Table of Contents - Issue
Recent articles
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Awareness, Knowledge and Risk Perception of Chronic Diseases among University Students in Nigeria: Implications for Early Detection StrategiesAuthor: Taiwo AkhigbeDOI: 10.21522/TIJPH.2013.14.03.Art001
Awareness, Knowledge and Risk Perception of Chronic Diseases among University Students in Nigeria: Implications for Early Detection Strategies
Abstract:
The prevalence of chronic diseases is rising among younger individuals, yet there is a notable deficiency in both awareness and preventive strategies within various low- and middle-income countries. Gaining insights into young adults' awareness, knowledge, and perceptions is crucial for developing effective intervention programs. This study aimed to assess young adults' awareness, understanding, and perceptions of chronic diseases among students in tertiary institutions in Nigeria. A cross-sectional survey was conducted among 500 undergraduate students selected from Ambrose Alli University in Nigeria, with a total student population of 27,388. Data collection used a structured, self-administered questionnaire to assess awareness, knowledge of risk factors and symptoms, and perceptions of risk and severity. Data were analyzed using SPSS. Many participants demonstrated a general understanding of chronic conditions such as hypertension and diabetes. The average level of knowledge was 3.98 (SD = 1.36), with a possible range of 0 to 9. Nonetheless, respondents showed insufficient knowledge of early signs, symptoms, and related risk factors. Many respondents believed that these illnesses primarily affect older people, which contributed to a reduced sense of personal risk. Furthermore, misconceptions surrounding the onset and prevention of these diseases were observed. Although young adults show significant awareness of chronic diseases, important gaps remain in their knowledge and perceptions of risk. Therefore, targeted health education programs are essential to reduce behaviours that could hinder early detection and prevention of these conditions.
Awareness, Knowledge and Risk Perception of Chronic Diseases among University Students in Nigeria: Implications for Early Detection Strategies
References:
[1]. World Health Organisation. Noncommunicable diseases: Key facts. 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
[2]. World Health Organization. Cardiovascular diseases (CVDs). 2025. [online] World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
[3]. Adeloye D, Ige JO, Aderemi AV, et al. Estimating the prevalence, hospitalisation and mortality from type 2 diabetes mellitus in Nigeria: A systematic review and meta-analysis. BMJ Open. 2017;7(5).
[4]. Kinash S, Crane L, Capper J, Young M, Stark A. When do university students and graduates know what careers they want: A research-derived framework. Journal of Teaching and Learning for Graduate Employability. 2017;8(1):3-21. https://doi.org/10.21153/jtlge2017vol8no1art584.
[5]. Ogunmola OJ, Oladosu YO, Olamoyegun MA. Knowledge, attitude and practice of lifestyle modification in the management of diabetes mellitus among Nigerian students. Journal of Preventive Medicine and Hygiene. 2014;55(3):101-7.
[6]. Coker OS, Akyala AI, Coker RB. Cardiovascular disease knowledge, risk perception, and lifestyle behaviors among university students in North-Central Nigeria: a cross-sectional study. BMC Public Health. 2025. https://doi.org/10.1186/s12889-025-26071-z
[7]. Bonett DG, Wright TA. Cronbach's alpha reliability: Interval estimation, hypothesis testing, and sample size planning. Journal of Organisational Behaviour. 2015;36(1):3-15. https://doi.org/10.1002/job.1960.
[8]. Cochran WG. Sampling techniques. 3rd ed. Wiley; 1977.
[9]. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. 11th ed. Wolters Kluwer; 2021.
[10]. Chan LL, Idris N. Validity and reliability of the instrument using exploratory factor analysis and Cronbach’s alpha. International Journal of Academic Research in Business and Social Sciences. 2017;7(10):400-10. https://doi.org/10.6007/ijarbss/v7-i10/3387
[11]. Ahmad N, Alias FA, Hamat M, Mohamed SA. Reliability analysis: application of Cronbach’s alpha in research instruments. Pioneering the Future: Delving Into E‐Learning's Landscape. 2024:114-9. https://doi.org/10.6007/ijarbss/v14-i9/22785.
[12]. Pallant J. SPSS survival manual: A step-by-step guide to data analysis using IBM SPSS. 7th ed. McGraw-Hill Education; 2020.
[13]. Lugo-Armenta JG, Pino-Fan LR, Hernandez BRR. Chi-square reference meanings: A historical-epistemological overview. Revemop. 2021;3. https://doi.org/10.33532/revemop.e202108.
[14]. Cohen J, Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavioural sciences. Routledge; 2013. doi: https://doi.org/10.4324/9780203774441.
[15]. Field A. Discovering statistics using IBM SPSS Statistics. 5th ed. Sage Publications; 2018.
[16]. Omobuwa O, Alebiosu CO. Awareness of diabetes amongst undergraduates in a Nigerian university in Osun State, Nigeria. African Journal of Medicine and Medical Sciences. 2014;43(1):47-51.
[17]. Black W, Babin BJ. Multivariate data analysis: Its approach, evolution, and impact. In: The great facilitator: Reflections on the contributions of Joseph F. Hair, Jr. to marketing and business research. Cham: Springer International Publishing; 2019. p.121-30. https://mvstats.com/wp-content/uploads/2022/01/Multivariate-Data-Analysis_Its-Approach-Evolution-and-Impact.pdf.
[18]. Sperandei S. Understanding logistic regression analysis in behavioural health studies. Brazilian Journal of Medical and Biological Research. 2014;47(3):235-43.
[19]. Turhan H. Chi-square test: Basic principles and applications in medical research. Journal of Medical Statistics and Informatics. 2020;8(1):1-6.
[20]. Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International. 2000;15(3):259-67. https://doi.org/10.1093/heapro/15.3.259.
[21]. Franke TM, Ho T, Christie CA. The chi-square test: Often used and more often misinterpreted. American Journal of Evaluation. 2012;33(3):448-58. https://doi.org/10.1177/1098214011426594.
[22]. Claire Y, Jiang Y, Alvin W, Yeo TM, Lim ST, Wang W. Perceptions and intentions to prevent diabetes among at-risk individuals: A qualitative study using the Theory of Planned Behaviour. Journal of Clinical Nursing. 2025;34(7):2918-32. https://doi.org/10.1111/jocn.17764.
[23]. Yamane T. Statistics: An introductory analysis. 2nd ed. Harper & Row; 1967.
[24]. Mediterranean Publications. Student population and academic structure of Ambrose Alli University, Ekpoma (AAU), Edo State. [date unknown]. Available at: https://mediterraneanpublications.com.
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Determinants of Health Insurance Non-Enrollment in Guinea: Supply Availability, Awareness and Institutional Trust in the Context of Universal Health CoverageAuthor: Ansoumane KouroumaDOI: 10.21522/TIJPH.2013.14.03.Art002
Determinants of Health Insurance Non-Enrollment in Guinea: Supply Availability, Awareness and Institutional Trust in the Context of Universal Health Coverage
Abstract:
Health insurance coverage remains very limited in Guinea, slowing progress toward Universal Health Coverage (UHC). This study estimated health insurance coverage among Guinean adults and examined the influence of availability, awareness, affordability, and institutional trust on non enrollment. Methods: Data from the 2024 Afrobarometer Round 10 survey in Guinea (n=1,200; valid insurance status n=1,198) were analyzed using survey weights. Logistic regression identified factors associated with insurance coverage, while multinomial logistic regression, Multiple Correspondence Analysis, and exploratory spatial analysis examined reasons for non-enrollment and regional differences. Results: Only 10.3% of adults reported having health insurance. Among uninsured respondents, the most common reasons for non-enrollment were lack of awareness of existing schemes (30.6%) and absence of available schemes in the area (26.6%). Other barriers included complex enrollment procedures (15.7%), inability to afford membership (7.8%), and distrust of schemes (7.8%). High trust in the Ministry of Health was significantly associated with greater odds of insurance coverage (OR=1.94; 95% CI: 1.26–2.99). Coverage varied substantially across regions, ranging from 2.2% in Faranah to 33.9% in Mamou. Conclusions: Health insurance coverage in Guinea remains very low. Expanding scheme availability, improving public awareness, simplifying enrollment, and strengthening trust in health institutions are essential to accelerate progress toward UHC.
Determinants of Health Insurance Non-Enrollment in Guinea: Supply Availability, Awareness and Institutional Trust in the Context of Universal Health Coverage
References:
[1]. World Health Organization. Health systems financing: the path to universal coverage. Geneva: World Health Organization; 2010.
[2]. World Health Organization. Primary health care on the road to universal health coverage: 2019 monitoring report. Geneva: World Health Organization; 2019.
[3]. Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. Lancet. 2012;380(9845):933-43. Available from: https://doi.org/10.1016/S0140-6736(12)61147-7
[4]. Ekman B. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy Plan. 2004;19(5):249-70. Available from: https://doi.org/10.1093/heapol/czh031
[5]. Saksena P, et al. Mutual health insurance in Africa: evidence from Ghana, Rwanda, and Tanzania. Health Econ. 2014;23:713-27.
[6]. Chankova S, Sulzbach S, Diop F. Impact of mutual health organizations: evidence from West Africa. Health Policy Plan. 2008;23:264-76.
[7]. World Bank. World development indicators: Guinea. Washington, DC: World Bank; 2023.
[8]. Bago J-L, Adégnika AA. Healthcare utilisation and associated factors in sub-Saharan Africa. BMC Health Serv Res. 2021;21:567.
[9]. Jütting JP. Do community-based health insurance schemes improve poor people's access to health care? Evidence from rural Senegal. World Dev. 2004;32:273-88.
[10]. Mebratie AD, et al. Dropping out of Ethiopia's community-based health insurance scheme. Health Policy Plan. 2015;30:1296-1306.
[11]. Qin X, et al. Trust and local knowledge in community-based health insurance: evidence from rural China. Soc Sci Med. 2015;136-137:140-9.
[12]. Donfouet HPP, Mahieu P-A. Community-based health insurance and social capital: a review. Health Econ Rev. 2012;2:5.
[13]. Afrobarometer. Afrobarometer round 10 survey, Guinea. Accra: Afrobarometer; 2024.
[14]. Lumley T. Analysis of complex survey samples. J Stat Softw. 2004;9:1-19.
[15]. R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2023.
[16]. Lê S, Josse J, Husson F. FactoMineR: an R package for multivariate analysis. J Stat Softw. 2008;25:1-18.
[17]. Pebesma E. Simple features for R: standardized support for spatial vector data. R J. 2018;10:439-46.
[18]. Moran PAP. Notes on continuous stochastic phenomena. Biometrika. 1950;37:17-23.
[19]. Anselin L. Local indicators of spatial association—LISA. Geogr Anal. 1995;27:93-115.
[20]. Bivand RS, Wong DWS. Comparing implementations of global and local indicators of spatial association.
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The Integrated Community Health Systems Institutionalization Framework (ICHS-IF): A Strategic Model for Strengthening Primary Health Care and Universal Health Coverage in South SudanAuthor: Okello David OmwonyDOI: 10.21522/TIJPH.2013.14.03.Art003
The Integrated Community Health Systems Institutionalization Framework (ICHS-IF): A Strategic Model for Strengthening Primary Health Care and Universal Health Coverage in South Sudan
Abstract:
Community health systems are central to achieving Universal Health Coverage (UHC), particularly in fragile and conflict-affected settings. In South Sudan, fragmented community-based programmes, parallel implementation structures, weak governance, and inconsistent financing have constrained the sustainability and effectiveness of community health services. To address these challenges, the Ministry of Health developed a Community-Based Networks (CBNs) Integration Strategy within the Revised Boma Health Initiative (2024–2028). This study presents a strategic framework for institutionalising CBNs within South Sudan's national community health system to strengthen Primary Health Care (PHC), improve service integration, and advance UHC. A qualitative Health Policy and Systems Research approach was applied through review and thematic analysis of national policies, strategic frameworks, programme reports, technical working group documents, stakeholder consultation reports, and relevant international literature. The analysis identified fragmented governance, parallel community structures, inconsistent supervision, inadequate financing, and weak accountability as major barriers to effective community health service delivery. In response, the study proposes the Integrated Community Health Systems Institutionalization Framework (ICHS-IF), which integrates governance and leadership, service delivery, community health workforce development, sustainable financing, digital health information systems, community accountability and participation, and multisectoral coordination within a unified institutional model. Institutionalizing CBNs within existing government systems offers a practical and potentially scalable approach for strengthening resilient community health systems. The ICHS-IF provides an evidence-informed framework for South Sudan and other fragile and resource-constrained settings seeking to strengthen PHC, improve health system resilience, and accelerate progress toward UHC.
The Integrated Community Health Systems Institutionalization Framework (ICHS-IF): A Strategic Model for Strengthening Primary Health Care and Universal Health Coverage in South Sudan
References:
[1]. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations; 2015.
[2]. World Health Organization. Universal health coverage (UHC). Geneva: WHO; 2023.
[3]. World Health Organization, United Nations Children's Fund. Operational framework for primary health care: transforming vision into action. Geneva: WHO; 2020.
[4]. World Health Organization, United Nations Children's Fund. Declaration of Astana. Geneva: WHO; 2018.
[5]. World Health Organization. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: WHO; 2007.
[6]. World Health Organization. Primary health care on the road to universal health coverage: 2023 monitoring report. Geneva: WHO; 2023.
[7]. World Health Organization. Health systems resilience toolkit: a WHO global public health good. Geneva: WHO; 2022.
[8]. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910–1912.
[9]. World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva: WHO; 2018.
[10]. Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399–421.
[11]. Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, et al. What do we know about community-based health worker programs? A systematic review of existing reviews. BMJ Glob Health. 2018;3:e000768.
[12]. Schneider H, Lehmann U. From community health workers to community health systems: time to widen the horizon? Health Syst Reform. 2016;2(2):112–118.
[13]. Kok MC, Dieleman M, Taegtmeyer M, Broerse JEW, Kane SS, Ormel H, et al. Which intervention design factors influence performance of community health workers in low- and middle-income countries? Health Policy Plan. 2015;30(9):1207–1227.
[14]. Bhutta ZA, Lassi ZS, Pariyo G, Huicho L. Global experience of community health workers for delivery of health-related Millennium Development Goals. Geneva: WHO; 2010.
[15]. Lehmann U, Sanders D. Community health workers: what do we know about them? Geneva: WHO; 2007.
[16]. Cometto G, Ford N, Pfaffman-Zambruni J, Akl EA, Lehmann U, McPake B, et al. Health policy and system support to optimize community health worker programmes: an abridged WHO guideline. Lancet Glob Health. 2018;6:e1397–e1404.
[17]. Ballard M, Montgomery P. Systematic review of interventions for improving the performance of community health workers in low- and middle-income countries. BMJ Open. 2017;7:e014216.
[18]. Rifkin SB. Examining the links between community participation and health outcomes: a review of the literature. Health Policy Plan. 2014;29(Suppl 2):ii98–ii106.
[19]. Gilson L. Health policy and systems research: a methodology reader. Geneva: WHO; 2012.
[20]. Ministry of Health, Republic of South Sudan. National Health Policy 2016–2026. Juba: Ministry of Health; 2016.
[21]. Ministry of Health, Republic of South Sudan. Health Sector Strategic Plan II 2023–2027. Juba: Ministry of Health; 2023.
[22]. United Nations Office for the Coordination of Humanitarian Affairs. South Sudan Humanitarian Needs and Response Plan 2024. New York: OCHA; 2024.
[23]. South Sudan National Bureau of Statistics. Population Estimates Report 2023. Juba: NBS; 2023.
[24]. World Bank. South Sudan Economic Monitor: Strengthening Resilience Amid Fragility. Washington (DC): World Bank; 2024.
[25]. United Nations Children's Fund. The State of the World's Children 2023: For Every Child, Vaccination. New York: UNICEF; 2023.
[26]. Gilson L, Raphaely N. The terrain of health policy analysis in low- and middle-income countries. Health Policy Plan. 2008;23(5):294–307.
[27]. Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18.
[28]. World Health Organization. Framework on integrated, people-centred health services. Geneva: WHO; 2016.
[29]. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: WHO; 2010.
[30]. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era. Lancet Glob Health. 2018;6:e1196–e1252.
[31]. Africa Centres for Disease Control and Prevention. Framework for Strengthening Community Health Systems in Africa. Addis Ababa: Africa CDC; 2024.
[32]. United Nations Children's Fund. Community Health Systems Strengthening Approaches in Fragile Contexts. New York: UNICEF; 2022.
[33]. Rogers EM. Diffusion of Innovations. 5th ed. New York: Free Press; 2003.
[34]. Ministry of Health, Republic of South Sudan. Basic Package of Health and Nutrition Services. Juba: Ministry of Health; 2011.
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Role of Electronic Vaccine Intelligence Network (eVIN) in Improving Routine Immunization Services: A Cross-Sectional Assessment in Unnao District, Uttar Pradesh, IndiaAuthor: Shwetanshu SaxenaDOI: 10.21522/TIJPH.2013.14.03.Art004
Role of Electronic Vaccine Intelligence Network (eVIN) in Improving Routine Immunization Services: A Cross-Sectional Assessment in Unnao District, Uttar Pradesh, India
Abstract:
Vaccination remains one of the most cost-effective public health interventions for reducing childhood morbidity and mortality globally. The Universal Immunization Programme (UIP) in India, initiated in 1985, has expanded significantly with technological innovations like the Electronic Vaccine Intelligence Network (eVIN) implemented since 2014 to strengthen vaccine logistics and supply chain management. This cross-sectional study assessed the effectiveness of eVIN implementation in Unnao District from November 2024 to October 2025, evaluating 21 Cold Chain Points (CCPs) across the district. The study examined cold chain infrastructure, vaccine storage practices, logistics management, health worker knowledge, and system performance. Results revealed 100% functional large ice-lined refrigerators and cold boxes, universal compliance with temperature monitoring protocols, and perfect adherence to vaccine storage standards. All healthcare personnel (n = 21) demonstrated competency in freeze-sensitive vaccine enumeration and shake test procedures. However, supervisory oversight gaps emerged with only 33.3% of sites receiving District Immunization Officer reviews in the preceding three months. Critical infrastructure deficits included complete absence of functional vaccine transport vans and dedicated drivers at 95.2% of facilities. eVIN integration demonstrated 95.2% operational efficiency with minimal system issues. The study demonstrates that while technological interventions like eVIN significantly improve vaccine logistics, supply chain transparency, and health worker competencies, sustained performance requires complementary investments in supervision infrastructure, transport logistics, and periodic competency-based training. Digital health solutions integrated with existing immunization approaches present promising opportunities for achieving universal immunization coverage goals and improving service delivery quality at the district level.
Role of Electronic Vaccine Intelligence Network (eVIN) in Improving Routine Immunization Services: A Cross-Sectional Assessment in Unnao District, Uttar Pradesh, India
References:
[1]. SmartNet NIUA. Electronic Vaccine Intelligence Network (eVIN). SmartNet NIUA. Available from: http://smartnet.niua.org/content/d9b14fcf-c907-4260-bfd7-3ee9fa94c8d4
[2]. United Nations Development Programme India. Improving vaccination systems – eVIN. UNDP India; 2019. Available from: https://www.undp.org/india/projects/improving-vaccination-systems-evin
[3]. Press Information Bureau, Government of India. Electronic Vaccine Intelligence Network (eVIN) has ensured vaccine availability. Press Information Bureau; 2020. Available from: https://www.pib.gov.in/PressReleasePage.aspx?PRID=1643172
[4]. National Health Mission. Techno-economic assessment of electronic vaccine intelligence network (eVIN). National Health Mission. Available from: https://nhm.gov.in/New_Updates_2018/NHM_Components/Immunization/Guildelines_for_immunization/eVIN_Assessment_Report.pdf
[5]. JSI India. Return on investment of the electronic vaccine intelligence network (eVIN) in India. JSI India. Available from: https://jsiindia.in/assets/img/pdf/roi.pdf
[6]. Sharma R, et al. Impact of electronic vaccine intelligence network application used in cold chain points. International Journal of Community Medicine and Public Health. Available from: https://www.ijcmph.com/index.php/ijcmph/article/download/9234/5607/36275
[7]. National Health Mission. Intensified Mission Indradhanush guidelines. National Health Mission. Available from: https://nhm.gov.in/New_Updates_2018/NHM_Components/Immunization/Guildelines_for_immunization/Mission_Indradhanush_Guidelines.pdf
[8]. Kumar S, et al. Return on investment of the electronic vaccine intelligence network (eVIN) in India: A cost-effectiveness analysis. Vaccine. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/34905441/
[9]. Singh P, et al. Assessment of eVIN (Electronic Vaccine Intelligence Network) in India. Journal of Global Health Reports. 2025. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11922388/
[10]. National Health Mission. Strengthening immunization in urban areas. National Health Mission. Available from: https://nhm.gov.in/New_Updates_2018/NHM/NUHM/Guidelines/Strengthening_Immunization_in_Urban_Areas.pdf
[11]. National Cold Chain and Vaccine Management Resource Centre. Handbook for vaccine and cold chain handlers. Ministry of Health and Family Welfare; 2016. Available from: https://nccmis.mohfw.gov.in/document/Unicef_Cold%20Chain%20Handlers%202016.pdf
[12]. World Health Organization. Immunization handbook for medical officers: Unit 4 cold chain and logistics management. World Health Organization. Available from: https://cdn.who.int/media/docs/default-source/searo/india/publications/immunization-handbook-107-198-part2.pdf
[13]. Ahmed S, et al. Health workers’ knowledge and practices toward vaccine cold chain management. BMC Health Services Research. 2024. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11607861/
[14]. Pan American Health Organization. Cold chain. Pan American Health Organization; 2023. Available from: https://www.paho.org/en/immunization/cold-chain
[15]. Verma A, et al. A study on knowledge, attitude and practices of cold chain handlers in public health facilities. International Journal of Community Medicine and Public Health. 2022. Available from: https://www.ijcmph.com/index.php/ijcmph/article/view/9739
[16]. Brown D, et al. Association of vaccine stockout with immunisation coverage in low- and middle-income countries. BMJ Global Health. 2023. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10391784/
[17]. Goel NK, et al. Status of cold-chain maintenance in Chandigarh. Indian Journal of Public Health. 2008;52(1):37-39.
[18]. Aggarwal K, Kannan AT, Kumar NP. Study of operational aspects of pulse polio booths during intensified pulse polio immunization campaign in assembly segments of East Delhi. Journal of Communicable Diseases. 2002;34:215-220.
[19]. Chatterjee S, Laxminarayan R. Assessing cold chain status in a metro city of India: An intervention study. African Health Sciences. 2012;12(2):128-133. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3092313/
[20]. National Institute of Epidemiology, UNICEF. Temperature monitoring of the vaccine cold chain to assess exposure to sub-optimal temperatures in select Indian states. NIE–UNICEF. Available from: https://nccvmtc.org/PDF1/Unicef_Vaccine_Freezing_Study.pdf
[21]. Desta DM, et al. Health professionals’ knowledge on vaccine cold chain management: A systematic review and meta-analysis. PLoS One. 2023;18(11). Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0293122
[22]. Akwaowo CD, et al. Vaccine management knowledge and practice of health workers in Cross River State, Nigeria. Texila International Journal of Public Health. 2022;10(4). Available from: https://www.texilajournal.com/thumbs/article/Public_Health_Vol10_Issue4_Article_11.pdf
[23]. Patel R, et al. Evaluating supply chain management of cold storage for preventive child healthcare programmes: A comparative assessment across high- and low-performing districts in Gujarat, India. Indian Journal of Medical Research. 2025. Available from: https://ijmr.org.in/evaluating-supply-chain-management-of-cold-storage-for-preventive-child-healthcare-programmes-a-comparative-assessment-across-high-and-low-performing-districts-in-gujarat-india/
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An Assessment of the Prevalence, Determinants of Viral Hepatitis B and Impact of Infant Vaccine and Circumcision as Preventive Measures in MalawiAuthor: Jere HaswellDOI: 10.21522/TIJPH.2013.14.03.Art005
An Assessment of the Prevalence, Determinants of Viral Hepatitis B and Impact of Infant Vaccine and Circumcision as Preventive Measures in Malawi
Abstract:
Hepatitis B virus is one of the neglected public health diseases leading to deaths in Malawi. However, few studies have examined the burden and factors associated with disease acquisition. The study aimed to assess the prevalence of hepatitis B infection and the factors associated with it in the Malawian population. This retrospective study used secondary data from the scan form register, pulling and analysing data from Jan 2023 to July 2025. Out of 1.9 million total tests, 1.6% (32566) were hepatitis B positive. Hepatitis B burden among males and non-pregnant females was 2.4% (14839/611,970). Males had a higher prevalence of 3% (9,873/334,299) than non-pregnant females at 1.7% (4962/284958). Bivariate analysis showed that males were twice as likely to have hepatitis B compared to females OR = 2, p < 0. 0001. Infant-vaccinated clients were 77% less likely to be infected than the non-vaccinated (OR = 0.3, p < 0.0001). Pregnant women were less likely to be hepatitis B infected than non-pregnant women (OR = 0.8, P < 0.001). The study reveals that hepatitis B is less prevalent than in earlier studies done in Malawi. The Infant Vaccine seems effective in reducing hepatitis B infection among infants who receive this vaccine. Male gender, not being pregnant, and being circumcised increased the risk for hepatitis B infection. Further studies need to be carried out to study the role of circumcision and the association between pregnancy and Viral hepatitis.
An Assessment of the Prevalence, Determinants of Viral Hepatitis B and Impact of Infant Vaccine and Circumcision as Preventive Measures in Malawi
References:
[1]. WHO. Global Health Sector Strategy on Viral Hepatitis. 2017. Retrieved from https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.who.int/publications/i/item/WHO-HIV-2016.06&ved=2ahUKEwinx6bZntSSAxWaUUEAHSsmFPMQFnoECBkQAQ&usg=AOvVaw2vBP3RwvcUzt_hFdCHkGQl
[2]. WHO. Global burden of diseases causes-Africa Region. Geneva: Lancent; 2018. Retrieved from https://www.afro.who.int/health-topics/hepatitis
[3]. Lemoine M. Battlefield against hepatitis B infection and HCC in Africa. Journal of Hepatolgy. 2017;66(3). doi:https://doi.org/10.1016/j.jhep.2016.10.013
[4]. O Hara GA, MacNaughton AL, Maponga T, Jooste P. Hepatitis B virus infection as a neglected tropical disease. plos one. 2017. doi:https://doi.org/10.1371/journal.pntd.0005842
[5]. Spearman WC, Afihene M, Reidwaan A. Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. Lancet. 2017. doi:https://doi.org/10.1016/S2468-1253(17)30295-9
[6]. Kilonzo SB, Nkandala I, Rodovick L. Prevalence of Hepatitis B Virus Infection in Tanzania: A Systematic Review and Meta-Analysis. Pubmed. 2024. doi:https://doi.org/10.1155/2024/4178240
[7]. Vanikoor MJ, Sinkala E, Kanunga A. Eligibility for hepatitis B antiviral therapy among adults in the general population in Zambia. Plos one. 2020. doi:https://doi.org/10.1371/journal.pone.0227041
[8]. Mabunda N, Vieira L, Chelene I. Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City, Mozambique. Plos One. 2022. doi:https://doi.org/10.1371/journal.pone.0276283
[9]. Nyirenda M, Beadsworth MB, Stephany P, Munthali C. Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi. Journal of Infection. 2008;57(1):72-77. doi:https://doi.org/10.1016/j.jinf.2008.05.004
[10]. Siobhan S, Taha TE, Kumwenda N. HIV-1 prevalence and herpes simplex virus 2, hepatitis C virus, and hepatitis B virus infections among male workers at a sugar estate in Malawi. Pubmed. 2002. doi:https://doi.org/10.1097/00126334-200209010-00012
[11]. Ahmed SD, Cuevas LE, Brabin BJ. Seroprevalence of hepatitis B and C and HIV in Malawian pregnant women. Journal of Infection. 1998. doi:https://doi.org/10.1016/s0163-4453(98)91983-1
[12]. Chipeta F, Chirambo A, Billiat E, Isaac T. Hepatitis B virus seroprevalence among Malawian medical students: A cross-sectional study. PMC. 2017;29(1). doi:10.4314/mmj.v29i1.6
[13]. Stockdale AJ, Mitambo C, Everet D. Epidemiology of hepatitis B, C and D in Malawi: systematic review. BMC Infectious Diseases. 2018. doi:https://doi.org/10.1186/s12879-018-3428-7
[14]. Stockdale AJ, Meiring JE, Shawa IT. Hepatitis B Vaccination Impact and the Unmet Need for Antiviral Treatment in Blantyre, Malawi. Journal of Infectious Diseases. 2022;266(5):871-880. doi:10.1093/infdis/jiab562
[15]. Mehta K, Marfatia YS, Jain AP. Male circumcision and Sexually transmitted Infections - An update. epub. 2021;1(42):1-6. doi:https://doi.org/10.4103/ijstd.ijstd_20_21
[16]. Nyamba PK, Agjei R, Sarfo B. Seroprevalence and factors associated with Hepatitis B virus infection among students in two senior high schools in the Krachi Nchumuru district in Ghana-A cross-sectional study. Pubmed. 2023. doi:https://doi.org/10.1186/s13104-023-06624-4
[17]. Mergan P, Mergan B, Djamand G. HIV, syphilis, and hepatitis B virus infection and male circumcision in five Sub-Saharan African countries: Findings from the Population-based HIV Impact Assessment surveys, 2015–2019. Plos One. 2023. doi:https://doi.org/10.1371/journal.pgph.0002326
[18]. Barbosa J, Sahli R, Aubert V. Demographics and outcomes of hepatitis B and D: A 10-year retrospective analysis in a Swiss tertiary referral center. Plos One. 2021. doi:https://doi.org/10.1371/journal.pone.0250347
[19]. Riches N, Njawala T, Thom N, Mkandawire C. P23 The chiwindi study: results from a community-based hepatitis B serosurvey in Karonga, Malawi. GUT. 2023;72(Suppl 2).2. Retrieved from https://gut.bmj.com/content/72/Suppl_2/A57.2.info
[20]. WHO. Viral hepatitis country profiles. Geneva; 2022. Retrieved from https://data.who.int/dashboards/hepatitis/epidemiology
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Availability and Functionality of Infection Prevention and Control Systems in Health Facilities Providing TB and COVID-19 Services in Plateau State, NigeriaAuthor: Samuel Ogiri OgiriDOI: 10.21522/TIJPH.2013.14.03.Art006
Availability and Functionality of Infection Prevention and Control Systems in Health Facilities Providing TB and COVID-19 Services in Plateau State, Nigeria
Abstract:
Nigeria continues to face the challenge of emerging and resurgence infectious diseases, including tuberculosis (TB) and coronavirus disease 2019 (COVID-19). Healthcare facilities can inadvertently facilitate transmission of these pathogens due to frequent interactions among patients, visitors, and healthcare workers. Strengthening infection prevention and control (IPC) systems is therefore essential to improve health system resilience and advance progress toward universal health coverage. This cross-sectional facility-based study assessed the status of IPC programmes using the World Health Organization Infection Prevention and Control Assessment Framework (IPCAF). Trained field staff administered the IPCAF tool across selected health facilities to evaluate performance across the core components of IPC programmes. Data collected from each facility were compiled in Microsoft Excel and analyzed using IBM SPSS version 25. We assessed a total of thirty health facilities. Overall IPC performance was predominantly at the basic level, with an average score of 41.5%. Some facilities demonstrated intermediate capacity in specific areas such as staffing and infrastructure; however, none achieved an advanced level of IPC performance. These findings highlight significant gaps in IPC implementation across the assessed facilities. Strengthening IPC policies, systems, and institutional capacity is therefore critical. National disease control programmes should prioritize targeted interventions to improve and sustain IPC practices across healthcare facilities in order to reduce the risk of healthcare-associated transmission of infectious diseases.
Availability and Functionality of Infection Prevention and Control Systems in Health Facilities Providing TB and COVID-19 Services in Plateau State, Nigeria
References:
[1]. Hogan AB, Jewell BL, Sherrard-Smith E, Vesga JF, Watson OJ, Whittaker C, Hamlet A, Smith JA, Winskill P, Verity R, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Global Health. 2020;July 13. https://doi.org/10.1016/S2214-109X(20)30288-6
[2]. Fauci AS. Robert H. Ebert Memorial Lecture - Emerging and Re-emerging Infectious Diseases: The Perpetual Challenge. Milbank Memorial Fund. 2005. https://www.milbank.org/wp-content/uploads/2016/04/0601Fauci.pdf
[3]. Cioboata R, Biciusca V, Olteanu M, Vasile CM. COVID-19 and Tuberculosis: Unveiling the Dual Threat and Shared Solutions Perspective. Journal of Clinical Medicine. 2023;12:4784.
[4]. Visca D, Ong CWM, Tiberi S, Centis R, D’Ambrosio L, Chen B, Mueller J, Mueller P, Duarte R, Dalcolmo M, Sotgiu G, Migliori GB, Goletti D. Tuberculosis and COVID-19 interaction: A review of biological, clinical, and public health effects. Pulmonology. 2021;27(2):151-165. https://doi.org/10.1016/j.pulmoe.2020.12.012
[5]. Morens DM, Folkers GK, Fauci AS. The challenge of emerging and re-emerging infectious diseases. Nature. 2004;430. https://www.nature.com/nature
[6]. Department of Health. UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. 2013.
[7]. Deryabina A, Lyman M, Yee D, Gelieshvilli M, et al. Core components of infection prevention and control programs at the facility level in Georgia: Key challenges and opportunities. Antimicrobial Resistance and Infection Control. 2021;10:39. https://doi.org/10.1186/s13756-020-00879-3
[8]. Larson E. A retrospective on infection control. Part 1: Nineteenth century - Consumed by fire. American Journal of Infection Control. 1997;25:236-241.
[9]. Bolyard EA, Tablan OC, Williams WW, Pearson ML, Shapiro CN, Deitchman SD, The Hospital Infection Control Practices Advisory Committee. Guideline for infection control in health care personnel, 1998. American Journal of Infection Control. 1998;26:289-354.
[10]. Sirleaf E, Clark H. COVID-19: Make it the Last Pandemic. Report of the Independent Panel for Pandemic Preparedness and Response. 2021.
[11]. Espinal MA. The global situation of MDR-TB. Tuberculosis. 2003;83:44-51. http://dx.doi.org/10.1016/S1472-9792(02)00058-6
[12]. Falzon D, et al. The impact of the COVID-19 pandemic on the global tuberculosis epidemic. Frontiers in Immunology. 2023. https://doi.org/10.3389/fimmu.2023.1234785
[13]. Alhamlan FS, Al-Qahtani A. SARS-CoV-2 Variants: Genetic Insights, Epidemiological Tracking, and Implications for Vaccine Strategies. International Journal of Molecular Sciences. 2025;26:1263.
[14]. Federal Ministry of Health - Nigeria Centre for Disease Prevention and Control. The Nigerian Manual of Infection Prevention and Control. Federal Ministry of Health. 2021.
[15]. Fofanah BD, Abrahamyan A, Maruta A, Kallon C, Thekkur P, Kamara IF, Njuguna CK, Squire JS, Kanu JS, Bah AJ, et al. Achieving Minimum Standards for Infection Prevention and Control in Sierra Leone: Urgent Need for a Quantum Leap in Progress in the COVID-19 Era! International Journal of Environmental Research and Public Health. 2022;19:5642. https://doi.org/10.3390/ijerph19095642
[16]. Kim GU, Kim MJ, Ra SH, Lee J, Bae S, Jung J, Kim S-H. Clinical characteristics of asymptomatic and symptomatic patients with mild COVID-19. Clinical Microbiology and Infection. 2020;26:948.e1-948.e3.
[17]. Houben RMGJ, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling. PLoS Medicine. 2016;13(10). https://doi.org/10.1371/journal.pmed.1002152
[18]. Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, Chan XHS, Devane D, Biesty LM. Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: A rapid qualitative evidence synthesis. Cochrane Database of Systematic Reviews. 2020;4, 1-55.
[19]. Ige FA, Ohihoin AG, Amuda BO, Amoo OS, Onwuamah CK, Okwuraiwe AP, Shaibu JO, Odewale EO, James AB, Kayode A, Adeshina A, Audu RA. The Effectiveness of Infection Control Practices among Health Care Workers Responding to the COVID-19 Pandemic in Nigeria. Advances in Infectious Diseases. 2021;11:232-239. https://doi.org/10.4236/aid.2021.112021
[20]. Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL, Daszak P. Global trends in emerging infectious diseases. Nature. 2008;451. https://doi.org/10.1038/nature06536
[21]. Raviglione M, Sulis G. Tuberculosis 2015: Burden, Challenges and Strategy for Control and Elimination. Infectious Disease Reports. 2016;8:6570. https://doi.org/10.4081/idr.2016.6570
[22]. Tomczyk S, Twyman A, de Kraker MEA, Rehse APC, Tartari E, Toledo JP, Cassini A, Pittet D, Allegranzi B. The first WHO global survey on infection prevention and control in health-care facilities. The Lancet Infectious Diseases. 2022. https://doi.org/10.1016/S1473-3099(21)00809-4
[23]. Ogiri SO. A Rapid Appraisal of Infection Prevention and Control Programmes in Health Facilities Implementing Tuberculosis and Coronavirus Disease-19 Services in Plateau State, Nigeria. Dissertation submitted to Texila American University in partial fulfillment of the requirements for the award of the Degree of Doctor of Philosophy in Public Health. 2026.
[24]. World Health Organization. IHR Core Capacity Monitoring Framework: Checklist and Indicators for Monitoring Progress in the Development of IHR Core Capacities in States Parties. WHO/HSE/GCR/2013.2. 2013.
[25]. World Health Organization. Improving Infection Prevention and Control at the Health Facility: Interim Practical Manual for Supporting Implementation of the WHO Infection Prevention and Control Programmes. 2018.
[26]. World Health Organization. Guideline on Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care. 2014.
[27]. World Health Organization. Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Facility Level. 2016.
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Assessing Preparedness of Ghanaians for Future Infectious Disease Outbreaks: COVID-19 ExperienceAuthor: Monsen Owusu-AboagyeDOI: 10.21522/TIJPH.2013.14.03.Art007
Assessing Preparedness of Ghanaians for Future Infectious Disease Outbreaks: COVID-19 Experience
Abstract:
The COVID-19 pandemic exposed preparedness gaps and reinforced the role of individual and household behaviours in preventing infectious disease transmission. This study assessed preparedness for future outbreaks among adults in Ghana, using lessons from the COVID-19 experience. A community-based cross-sectional mixed-method study was conducted among 1,307 adults in six districts across the Ashanti, Greater Accra, and Savannah regions, using purposive and cluster sampling. Data were collected with a semi-structured questionnaire covering socio-demographic characteristics, knowledge, attitudes, preventive practices, access to health services, and health information sources. Preparedness was measured using a composite knowledge, attitudes, and practices (KAP) score. Quantitative data were analysed using descriptive statistics, multivariate regression, and mediation analysis, while qualitative responses were examined using deductive thematic content analysis. Respondents demonstrated moderate preparedness, with preventive practices stronger than disease-specific knowledge. Reported behaviours included COVID-19 vaccination (70%), LLIN use among children (91%) and adults (87%), handwashing with soap and water (70%), rabies vaccination for dogs (94%), mask use and avoidance of sick people during outbreaks (60%), health facility visits when sick (75%) and keeping essential supplies for at least 72 hours (52%). Preparedness seemed associated with sex, residence, access to vaccines, LLINs and health facilities, and credible health information, which may have mediated socio-demographic influences. Persistent gaps included vaccine safety concerns, LLIN use, reporting of unusual health events, and access to hygiene facilities and preventive resources. Strengthening health literacy, trusted risk communication, community engagement, and equitable access to routine preventive services may improve preparedness for future infectious disease outbreaks.
Assessing Preparedness of Ghanaians for Future Infectious Disease Outbreaks: COVID-19 Experience
References:
[1]. World Health Organization. Managing epidemics: key facts about major deadly diseases [Internet]. Geneva: World Health Organization; 2018 [cited 2022 Jan 15]. 257 p. Available from: https://apps.who.int/iris/handle/10665/272442
[2]. WHO. datadot [Internet]. 2026 [cited 2026 Mar 13]. COVID-19 cases | WHO COVID-19 dashboard. Available from: https://data.who.int/dashboards/covid19/cases
[3]. Sara Francis F. Purple Death: The Great Flu of 1918- U.S. at War. Mystery virus leaps around the globe killing scores in its path. Scientists race to find a cure. Pan American Health Organization / World Health Organization [Internet]. 2003 [cited 2024 Mar 21];8(3). Available from: https://www.paho.org/en/who-we-are/history-paho/purple-death-great-flu-1918
[4]. WHO. WHO Infection Prevention and Control [Internet]. 2020 [cited 2020 Apr 10]. Coronavirus disease (COVID-19) technical guidance: Infection prevention and control / WASH. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control
[5]. Admin HAI. Health Action International [Internet]. 2020 [cited 2023 Apr 23]. COVID-19 exposes weak health systems. Available from: https://haiweb.org/covid-19-health-systems/
[6]. Scott D. Vox [Internet]. 2020 [cited 2020 Mar 23]. Coronavirus is exposing all of the weaknesses in the US health system. Available from: https://www.vox.com/policy-and-politics/2020/3/16/21173766/coronavirus-covid-19-us-cases-health-care-system
[7]. Shamasunder S, Holmes SM, Goronga T, Carrasco H, Katz E, Frankfurter R, et al. COVID-19 reveals weak health systems by design: Why we must re-make global health in this historic moment. Glob Public Health. 2020 Jul;15(7):1083–9. doi:10.1080/17441692.2020.1760915 PubMed PMID: 32352911.
[8]. Africa CDC. Emergency Preparedness and Response. Africa CDC [Internet]. 2021 [cited 2023 Apr 23]. Available from: https://africacdc.org/programme/emergency-preparedness-response/
[9]. Raina SK, Kumar R, Galwankar S, Garg S, Bhatt R, Dhariwal AC, et al. Are we prepared? Lessons from Covid-19 and OMAG position paper on epidemic preparedness. J Fam Med Prim Care. 2020 May 31;9(5):2161–6. doi:10.4103/jfmpc.jfmpc_384_20 PubMed PMID: 32754465; PubMed Central PMCID: PMC7380759.
[10]. WHO. ROLES AND RESPONSIBILITIES IN PREPAREDNESS AND RESPONSE. Pandemic Influenza Preparedness and Response: A WHO Guidance Document [Internet]. Geneva: World Health Organization; 2009 [cited 2023 Apr 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK143067/
[11]. Dhama K, Patel SK, Kumar R, Masand R, Rana J, Yatoo MohdI, et al. The role of disinfectants and sanitizers during COVID-19 pandemic: advantages and deleterious effects on humans and the environment. Environ Sci Pollut Res. 2021 Jul 1;28(26):34211–28. doi:10.1007/s11356-021-14429-w
[12]. McDonald HI, Tessier E, White JM, Woodruff M, Knowles C, Bates C, et al. Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England, January to April 2020. Eurosurveillance. 2020 May 14;25(19):2000848. doi:10.2807/1560-7917.ES.2020.25.19.2000848
[13]. Nuzhath T, Hossain MM. Secondary impacts of COVID-19: Risk of vaccination reduction and global resurgence of measles [preprint] [Internet]. SocArXiv; 2020 May [cited 2020 Aug 15]. Available from: https://osf.io/97gr6doi:10.31235/osf.io/97gr6
[14]. Akrong GB, Hiadzi RA, Donkor AB, Anafo DK. COVID-19 vaccine acceptance and hesitancy in Ghana: A systematic review. Asumah MN, editor. PLOS ONE. 2024 Jun 25;19(6):e0305993. doi:10.1371/journal.pone.0305993
[15]. Serwaa D, Lamptey E, Appiah AB, Senkyire EK, Ameyaw JK. Knowledge, risk perception and preparedness towards coronavirus disease-2019 (COVID-19) outbreak among Ghanaians: a quick online cross-sectional survey. Pan Afr Med J. 2020 May 20;35(Suppl 2):44. doi:10.11604/pamj.supp.2020.35.2.22630 PubMed PMID: 33623569; PubMed Central PMCID: PMC7875746.
[16]. Thompson EE. Do knowledge, trust in source content, and magnitude of information influence COVID-19 risk perceptions? Comparing Ghanaian and US respondents. J Risk Res. 2024 Feb 1;27(2):254–73. doi:10.1080/13669877.2024.2317319
[17]. Hagan JE, Quansah F, Ankomah F, Agormedah EK, Srem-Sai M, Schack T. Evaluating the moderating role of information seeking platforms on university students’ risk perception and anxiety during the COVID-19 pandemic in Ghana. Front Commun. 2023 Mar 22;8. doi:10.3389/fcomm.2023.1035593
[18]. Rosenstock IM. The Health Belief Model and Preventive Health Behavior. Health Educ Monogr. 1974 Dec 1;2(4):354–86. doi:10.1177/109019817400200405
[19]. Jose R, Narendran M, Bindu A, Beevi N, Manju L, Benny PV. Public perception and preparedness for the pandemic COVID 19: A Health Belief Model approach. Clin Epidemiol Glob Health. 2021 Jan 1;9:41–6. doi:10.1016/j.cegh.2020.06.009
[20]. Wong MCS, Wong ELY, Huang J, Cheung AWL, Law K, Chong MKC, et al. Acceptance of the COVID-19 vaccine based on the health belief model: A population-based survey in Hong Kong. Vaccine. 2021 Feb 12;39(7):1148–56. doi:10.1016/j.vaccine.2020.12.083
[21]. Barakat AM, Kasemy ZA. Preventive health behaviours during coronavirus disease 2019 pandemic based on health belief model among Egyptians. Middle East Curr Psychiatry. 2020 Oct 6;27(1):43. doi:10.1186/s43045-020-00051-y
[22]. EisBrenner T, Tipples G, Kuschak T, Gilmour M. Laboratory response checklist for infectious disease outbreaks—preparedness and response considerations for emerging threats. Can Commun Dis Rep. 2020 Oct 1;46(10):311–21. doi:10.14745/ccdr.v46i10a01 PubMed PMID: 33316001; PubMed Central PMCID: PMC7723315.
[23]. Shen Y, Liu Y, Krafft T, Wang Q. Progress and challenges in infectious disease surveillance and early warning. Med Plus. 2025 Mar 1;2(1):100071. doi:10.1016/j.medp.2025.100071
[24]. GHS. Update on coronavirus disease (COVID-19) - Press Release | Publications | Ghana Health Service [Internet]. 2020 [cited 2020 Mar 23]. Available from: https://www.ghanahealthservice.org/ghs-item-details.php?cid=2&scid=62&iid=153
[25]. GHS. COVID-19 Updates | Ghana Health Service Dash Board [Internet]. 2023 [cited 2023 May 9]. Available from: https://ghs.gov.gh/covid19/
[26]. Creswell JW, Creswell DJ. Research Design: Qualitative, Quantitative & Mixed method approach. 5th Edition. Thousand Oaks, Califonia: SAGE Publications, Inc; 2018. 267 p.
[27]. WHO. Communicating risk in public health emergencies: a WHO guideline for emergency risk communication (ERC) policy and practice [Internet]. 2018 [cited 2023 Apr 30]. Available from: https://www.who.int/publications-detail-redirect/9789241550208
[28]. WHO. Risk communication and community engagement (RCCE) readiness and response to the 2019 novel coronavirus (2019-nCoV) [Internet]. 2020 [cited 2026 Mar 15]. Available from: https://www.who.int/publications/i/item/risk-communication-and-community-engagement-readiness-and-initial-response-for-novel-coronaviruses
[29]. Kamran A, Isazadehfar K, Heydari H, Nasimi Doost Azgomi R, Naeim M. Risk perception and adherence to preventive behaviours related to the COVID-19 pandemic: a community-based study applying the health belief model. BJPsych Open. 2021 Jul 13;7(4):e133. doi:10.1192/bjo.2021.954 PubMed PMID: 34253277; PubMed Central PMCID: PMC8280461.
[30]. Ghio D, Lawes-Wickwar S, Tang MY, Epton T, Howlett N, Jenkinson E, et al. What influences people’s responses to public health messages for managing risks and preventing infectious diseases? A rapid systematic review of the evidence and recommendations. BMJ Open. 2021 Nov 10;11(11):e048750. doi:10.1136/bmjopen-2021-048750 PubMed PMID: 34764167; PubMed Central PMCID: PMC8587350.
[31]. Coombs NM, Porter JE, Barbagallo M. An exploration of the influencing factors for effective public health messaging during disasters: a scoping review. Public Health. 2024 Mar 1;228:73–81. doi:10.1016/j.puhe.2023.12.023
[32]. Binder MJ, Murray M, Namara KM, Townsin L, Versace V, Rolf F. Role of health communication on perceived risk and influence on preventative behaviours during the COVID-19 pandemic: a qualitative study [Internet]. 2025 Sep 1. doi:10.1136/bmjopen-2025-102202
[33]. Cheng VCC, To KKW, Tse H, Hung IFN, Yuen KY. Two Years after Pandemic Influenza A/2009/H1N1: What Have We Learned? Clin Microbiol Rev. 2012 Apr. Located at: 1752 N St., N.W., Washington, DC. doi:10.1128/CMR.05012-11
[34]. Cheng VCC, Wong SC, Chuang VWM, So SYC, Chen JHK, Sridhar S, et al. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect. 2020 Jul 1;81(1):107–14. doi:10.1016/j.jinf.2020.04.024
[35]. Rosenbaum M. Learned resourcefulness: On coping skills, self-control, and adaptive behavior. New York, NY, US: Springer Publishing Co; 1990. xxxv, 248 p. (Learned resourcefulness: On coping skills, self-control, and adaptive behavior).
[36]. Tam G, Huang Z, Chan EYY. Household Preparedness and Preferred Communication Channels in Public Health Emergencies: A Cross-Sectional Survey of Residents in an Asian Developed Urban City. Int J Environ Res Public Health. 2018 Aug;15(8):1598. doi:10.3390/ijerph15081598 PubMed PMID: 30060535; PubMed Central PMCID: PMC6121418.
[37]. Adongo PB, Tabong PTN, Asampong E, Ansong J, Robalo M, Adanu RM. Preparing towards Preventing and Containing an Ebola Virus Disease Outbreak: What Socio-cultural Practices May Affect Containment Efforts in Ghana? PLoS Negl Trop Dis. 2016 Jul 18;10(7):e0004852. doi:10.1371/journal.pntd.0004852
[38]. Adongo PB, Tabong PTN, Asampong E, Ansong J, Robalo M, Adanu RM. Beyond Knowledge and Awareness: Addressing Misconceptions in Ghana’s Preparation towards an Outbreak of Ebola Virus Disease. PLOS ONE. 2016 Feb 18;11(2):e0149627. doi:10.1371/journal.pone.0149627
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The Temporal and Spatial Patterns of Cholera Outbreaks in the Rohingya Refugee Camps, Cox’s Bazar, BangladeshAuthor: Otieno O. DDOI: 10.21522/TIJPH.2013.14.03.Art008
The Temporal and Spatial Patterns of Cholera Outbreaks in the Rohingya Refugee Camps, Cox’s Bazar, Bangladesh
Abstract:
Cholera remains a major public health threat in humanitarian settings such as the Rohingya refugee camps of Cox’s Bazar, Bangladesh, which are characterised by congestion, inadequate water and sanitation, and overstretched health services. This study analysed the temporal and spatial patterns of cholera in the camps to identify seasonal variation and distribution across camps and to inform control. We used secondary data from the World Health Organization’s Early Warning, Alert and Response System (EWARS), sentinel surveillance, and laboratory surveillance to construct annual weekly trend lines and epidemic curves for acute watery diarrhoea and culture-confirmed cholera, and to map case distribution across the 33 camps from 2018 to 2026. Syndromic surveillance showed year-round acute watery diarrhoea transmission with multiple non-stable seasonal peaks and a steady decline over seven years, from about 231,000 cases in 2018 to about 122,000 in 2025. Laboratory surveillance indicated that cholera was endemic, characterized by recurrent upsurges; the largest outbreak occurred in 2024 with 534 culture-confirmed cases. The dominant cholera peak occurred in the post-monsoon period (mid-September to December), diverging from the April–June pre-monsoon peak historically reported for south-eastern Bangladesh. Transmission was largely sporadic across camps without persistent hotspots, except during the 2021 and 2024 outbreaks, and shifted over time from early Teknaf-based coastal camps to the densely populated inland-located Ukhiya-based camps. These findings indicate a need to update earlier seasonality evidence and to target preventive water, sanitation, hygiene and vaccination interventions to the post-monsoon period and the high-density Ukhiya camps.
The Temporal and Spatial Patterns of Cholera Outbreaks in the Rohingya Refugee Camps, Cox’s Bazar, Bangladesh
References:
[1]. World Health Organization. Cholera. Fact sheet [Internet]. Geneva: World Health Organization; 2024 [cited 2026 Jul 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/cholera
[2]. Ali M, Nelson AR, Lopez AL, Sack DA. Updated global burden of cholera in endemic countries. PLoS Negl Trop Dis. 2015;9(6):e0003832. Available from: https://doi.org/10.1371/journal.pntd.0003832
[3]. Deen J, Mengel MA, Clemens JD. Epidemiology of cholera. Vaccine. 2020;38(Suppl 1):A31-40. Available from: https://doi.org/10.1016/j.vaccine.2019.07.078
[4]. Hu D, Liu B, Feng L, Ding P, Guo X, Wang M. Origins of the current seventh cholera pandemic. Proc Natl Acad Sci U S A. 2016;113(48):E7730-9. Available from: https://doi.org/10.1073/pnas.1608732113
[5]. Moore S, Thomson N, Mutreja A, Piarroux R. Widespread epidemic cholera caused by a restricted subset of Vibrio cholerae clones. Clin Microbiol Infect. 2014;20(5):373-9. Available from: https://doi.org/10.1111/1469-0691.12610
[6]. World Health Organization. Cholera annual report 2023. Wkly Epidemiol Rec. 2024;99(36):481-96. Available from: https://www.who.int/publications/journals/weekly-epidemiological-record
[7]. Global Task Force on Cholera Control. Ending cholera: a global roadmap to 2030 [Internet]. Geneva: World Health Organization; 2017 [cited 2026 Jul 14]. Available from: https://www.gtfcc.org/about-cholera/roadmap-2030/
[8]. World Health Organization. Cholera fact sheet [Internet]. Geneva: World Health Organization; 2021 [cited 2026 Jul 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/cholera
[9]. Khan AI, Islam MT, Qadri F. Epidemiology of cholera in Bangladesh: findings from nationwide hospital-based surveillance. Clin Infect Dis. 2020;71(Suppl 1):S1-8. Available from: https://doi.org/10.1093/cid/ciaa440
[10]. Sack RB, Siddique AK, Longini IM, Nizam A, Yunus M, Islam MS. A 4-year study of the epidemiology of Vibrio cholerae in four rural areas of Bangladesh. J Infect Dis. 2003;187(1):96-101. Available from: https://doi.org/10.1086/345865
[11]. Institute of Epidemiology, Disease Control and Research. Cholera and acute watery diarrhoea surveillance in Cox’s Bazar [Internet]. Dhaka: IEDCR; 2023 [cited 2026 Jul 14]. Available from: https://www.iedcr.gov.bd/
[12]. United Nations High Commissioner for Refugees. Rohingya refugee response: Cox’s Bazar operational data portal [Internet]. Geneva: UNHCR; 2024 [cited 2026 Jul 14]. Available from: https://data.unhcr.org/en/situations/myanmar_refugees
[13]. Jutla A, Whitcombe E, Hasan N, Haley B, Akanda A, Huq A. Environmental factors influencing epidemic cholera. Am J Trop Med Hyg. 2013;89(3):597-607. Available from: https://doi.org/10.4269/ajtmh.12-0721
[14]. Colwell RR. Global climate and infectious disease: the cholera paradigm. Science. 1996;274(5295):2025-31. Available from: https://doi.org/10.1126/science.274.5295.2025
[15]. World Health Organization. Early Warning, Alert and Response System (EWARS) bulletins, Cox’s Bazar [Internet]. Dhaka: WHO Bangladesh; 2024 [cited 2026 Jul 14]. Available from: https://www.who.int/bangladesh
[16]. Ratnayake R, Finger F, Azman AS, Lantagne D, Funk S, Edmunds WJ. Highly targeted spatiotemporal interventions against cholera epidemics, 2000-19: a scoping review. Lancet Infect Dis. 2021;21(3):e37-48. Available from: https://doi.org/10.1016/S1473-3099(20)30479-5
[17]. Pascual M, Rodo X, Ellner SP, Colwell R, Bouma MJ. Cholera dynamics and El Nino-Southern Oscillation. Science. 2000;289(5485):1766-9. Available from: https://doi.org/10.1126/science.289.5485.1766
[18]. Emch M, Feldacker C, Islam MS, Ali M. Seasonality of cholera from 1974 to 2005: a review of global patterns. Int J Health Geogr. 2008;7:31. Available from: https://doi.org/10.1186/1476-072X-7-31
[19]. Qadri F, Islam T, Clemens JD. Cholera in Yemen - an old foe rearing its ugly head. N Engl J Med. 2017;377(21):2005-7. Available from: https://doi.org/10.1056/NEJMp1712099
[20]. Khan AI, Chowdhury F, Harris JB, LaRocque RC, Faruque ASG, Ryan ET. Diarrhoea and cholera surveillance for early warning and preparedness among Rohingya populations. PLOS Glob Public Health. 2024;4(2):e0002791. Available from: https://doi.org/10.1371/journal.pgph.0002791
[21]. Rebaudet S, Sudre B, Faucher B, Piarroux R. Environmental determinants of cholera outbreaks in inland Africa. J Infect Dis. 2013;208(Suppl 1):S46-54. Available from: https://doi.org/10.1093/infdis/jit195
[22]. Lessler J, Moore SM, Luquero FJ, McKay HS, Grais R, Henkens M. Mapping the burden of cholera in sub-Saharan Africa. Lancet. 2018;391(10133):1908-15. Available from: https://doi.org/10.1016/S0140-6736(17)33050-7
[23]. Islam MS, Zaman MH, Islam MS, Ahmed N, Clemens JD. Environmental reservoirs of Vibrio cholerae. Vaccine. 2020;38(Suppl 1):A52-62. Available from: https://doi.org/10.1016/j.vaccine.2019.06.033
[24]. Codeco CT. Endemic and epidemic dynamics of cholera: the role of the aquatic reservoir. BMC Infect Dis. 2001;1:1. Available from: https://doi.org/10.1186/1471-2334-1-1
[25]. Luquero FJ, Grout L, Ciglenecki I, Sakoba K, Traore B, Heile M. Use of Vibrio cholerae vaccine in an outbreak in Guinea. N Engl J Med. 2014;370(22):2111-20. Available from: https://doi.org/10.1056/NEJMoa1312680
[26]. Hsiao A, Desai SN, Mogasale V, Excler JL, Digilio L. Lessons learnt from 12 oral cholera vaccine campaigns in resource-poor settings. Bull World Health Organ. 2017;95(4):303-12. Available from: https://doi.org/10.2471/BLT.16.175166
[27]. Azman AS, Rudolph KE, Cummings DAT, Lessler J. The incubation period of cholera: a systematic review. J Infect. 2013;66(5):432-8. Available from: https://doi.org/10.1016/j.jinf.2012.11.013
[28]. Sack DA, Sack RB, Nair GB, Siddique AK. Cholera. Lancet. 2004;363(9404):223-33. Available from: https://doi.org/10.1016/S0140-6736(03)15328-7
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Perceptions, Barriers, and Opportunities to Strengthen Tuberculosis Prevention and Control in Nigeria: A Qualitative Study of Policymakers and Program ManagersAuthor: Emperor UbochiomaDOI: 10.21522/TIJPH.2013.14.03.Art009
Perceptions, Barriers, and Opportunities to Strengthen Tuberculosis Prevention and Control in Nigeria: A Qualitative Study of Policymakers and Program Managers
Abstract:
Policymakers and program managers play a critical role in shaping tuberculosis (TB) control strategies, yet their perspectives on implementation barriers remain underexplored. This qualitative study examined perceptions of TB control, preventive activities, and implementation challenges in Nigeria. Nine key informants from national and subnational TB programs and partner organizations were purposively selected. Data were collected through in-depth interviews and analyzed thematically in NVivo 12. Participants reported progress in TB control, including the expansion of community-based services, improved access to diagnostics, the scale-up of tuberculosis preventive therapy (TPT), and strengthened monitoring systems. However, these gains are constrained by persistent system-level and contextual barriers. Stigma, low awareness, and financial constraints limit uptake of preventive services, while workforce shortages, staff attrition, supply chain inefficiencies, and reliance on paper-based reporting undermine program effectiveness. Respondents emphasized the need for service integration, increased domestic financing, and accelerated digitalization. TB control efforts in Nigeria are advancing but remain constrained by structural limitations. Addressing these gaps will require coordinated strategies to strengthen health systems, expand access, and improve program efficiency.
Perceptions, Barriers, and Opportunities to Strengthen Tuberculosis Prevention and Control in Nigeria: A Qualitative Study of Policymakers and Program Managers
References:
[1]. World Health Organization. Global Tuberculosis Report 2024. Geneva: World Health Organization; 2024. https://www.who.int/publications/i/item/9789240083851
[2]. Pai M, Behr MA, Dowdy D, Dheda K, Divangahi M, Boehme CC, et al. Tuberculosis. Nat Rev Dis Primers. 2016;2(1). https://doi.org/10.1038/nrdp.2016.76
[3]. World Health Organization. Recommended TPT regimens. WHO TB Knowledge Sharing Platform; 2024. https://tbksp.who.int/en/node/1271
[4]. World Health Organization. WHO consolidated guidelines on tuberculosis. Module 1: prevention – tuberculosis preventive treatment. Geneva: World Health Organization; 2020. https://iris.who.int/server/api/core/bitstreams/f4eae88f-c458-4c74-80d6-19ee96d09765/content
[5]. World Health Organization. Global Tuberculosis Report 2023. Geneva: World Health Organization; 2023. https://iris.who.int/server/api/core/bitstreams/cc23b85f-72c0-4177-8137-cb1161da1025/content
[6]. Storla DG, Yimer S, Bjune GA. A systematic review of delay in the diagnosis and treatment of tuberculosis. BMC Public Health. 2008;8(15). https://doi.org/10.1186/1471-2458-8-15
[7]. Creswell J, Sahu S, Blok L, Bakker MI, Stevens R, Ditiu L. A multi-site evaluation of innovative approaches to increase tuberculosis case notification: Summary results. PLoS One. 2014;9(4). https://doi.org/10.1371/journal.pone.0094465
[8]. Khan WM, Smith H, Qadeer E, Hassounah S. Knowledge and perceptions of national and provincial tuberculosis control programme managers in Pakistan about the WHO Stop TB strategy: A qualitative study. JRSM Open. 2016;8(1). https://doi.org/10.1177/2054270416675084
[9]. Hanson CL, Osberg M, Brown J, Durham G, Chin DP. Conducting patient-pathway analysis to inform programming of tuberculosis services: Methods. J Infect Dis. 2017;216(7). https://doi.org/10.1093/infdis/jix387
[10]. Giridharan P, Suseela RP, Zangpo T, Joshi RB, Cader M, Isbaniah F, et al. Tuberculosis preventive treatment in eight SEAR countries – Current practices, implementation challenges and operations research priorities. Public Health Pract. 2024;8(2024). https://doi.org/10.1016/j.puhip.2024.100518
[11]. Ihesie A, Chukwuogo O, Eneogu R, Daniel OK, Agbaje A, Odume B, et al. Acceptance and completion rates of 3-month isoniazid-rifampicin (3HR) tuberculosis preventive treatment among contacts of bacteriologically confirmed TB patients —Patients’ and healthcare workers’ perspectives. Trop Med Infect Dis. 2024;9(12). https://doi.org/10.3390/tropicalmed9120301
[12]. Craig GM, Daftary A, Engel N, O’Driscoll S, Ioannaki A. Tuberculosis stigma as a social determinant of health: A systematic mapping review of research in low incidence countries. Int J Infect Dis. 2017;56(3). https://doi.org/10.1016/j.ijid.2016.10.011
[13]. Courtwright A, Turner AN. Tuberculosis and stigmatization: Pathways and interventions. Public Health Rep. 2010;125(4). https://doi.org/10.1177/00333549101250S407
[14]. Uplekar M, Weil D, Lonnroth K, Jaramillo E, Lienhardt C, Dias HM, et al. WHO’s new End TB Strategy. Lancet. 2015;385(9979). https://doi.org/10.1016/S0140-6736(15)60570-0
[15]. Odone A, Roberts B, Dara M, Van Den Boom M, Kluge H, McKee M. People- and patient-centred care for tuberculosis: Models of care for tuberculosis. Int J Tuberc Lung Dis. 2018;22(2). https://doi.org/10.5588/ijtld.17.0608
[16]. Naidoo S, Seevnarain K, Nordstrom DL. Tuberculosis infection control in primary health clinics in eThekwini, KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis. 2012;16(12). https://doi.org/10.5588/ijtld.12.0041
[17]. Tiruneh MG, Fenta ET, Anagaw TF, Bogale EK, Delie AM. Tuberculosis infection control practice and associated factors among healthcare workers in Ethiopia: Systematic review and meta-analysis. PLoS One. 2023;18(12). https://doi.org/10.1371/journal.pone.0295555
[18]. Marme G, Rutherford S, Harris N. What tuberculosis infection control measures are effective in resource-constrained primary healthcare facilities? A systematic review of the literature. Rural Remote Health. 2023;23(1). https://doi.org/10.22605/RRH7175
[19]. Tanimura T, Jaramillo E, Weil D, Raviglione M, Lönnroth K. Financial burden for tuberculosis patients in low- and middle-income countries: A systematic review. Eur Respir J. 2014;43(6). https://doi.org/10.1183/09031936.00193413
[20]. Kuye J, Sindani IS, Shube MA, Salah MJ, Hilowle AA, Rusagara V, et al. Households of tuberculosis (TB) patients face high TB-related costs in Somalia. BMC Glob Public Health. 2025;3(1). https://doi.org/10.1186/S44263-025-00175-5
[21]. Subbaraman R, Nathavitharana RR, Mayer KH, Satyanarayana S, Chadha VK, Arinaminpathy N, et al. Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps in quality of care. PLoS Med. 2019;16(2). https://doi.org/10.1371/journal.pmed.1002754
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Healthcare Workers’ Perspectives on Improving Patient Safety: A Thematic Analysis of Open-Ended Survey Responses from Public Hospitals in Tshwane District, South AfricaAuthor: Gabaitsane Manita TabaneDOI: 10.21522/TIJPH.2013.14.03.Art010
Healthcare Workers’ Perspectives on Improving Patient Safety: A Thematic Analysis of Open-Ended Survey Responses from Public Hospitals in Tshwane District, South Africa
Abstract:
Resource constraints in the healthcare system environment present a serious encounter that impact negatively on patient safety. Although quantitative indicators provide measurable evidence of patient care outcomes, employees’ suggestions provide perspectives from the lived experiences. This study explored healthcare workers’ recommendations for strengthening the safety of patients within Tshwane District public hospitals. The methodology applied in the analysis of the open responses is qualitative and descriptive in nature. These responses are component of the answers of the questionnaire tool of the broader cross-sectional survey on service quality dimensions and safety in public hospitals within Tshwane district. The responses from 108 participants were examined through thematic analysis. The investigation encompassed coding, categorization including recuring themes identification. Eight themes emerged from the findings included the following constraints: staffing, infrastructure, accommodation space, equipment availability including supplies, governance including organizational weaknesses, professional skills proficiency, Hospital safety culture, Communication obstructions, patient overflow including high numbers, health information limitations. Personnel shortages, inadequate infrastructure, as well as insufficient resources were most frequently reported concerns. The findings indicate that safety challenges experienced in the public hospitals in Tshwane health district are fundamentally systemic in nature and require coordinated interventions focusing on workforce strengthening, improving infrastructure including positive safety culture enforcement.
Healthcare Workers’ Perspectives on Improving Patient Safety: A Thematic Analysis of Open-Ended Survey Responses from Public Hospitals in Tshwane District, South Africa
References:
[1]. World Health Organisation (WHO). Patient safety. 2023. Patient safety
[2]. RSA. National Guideline for Patient Safety Incident Reporting and Learning in the Health Sector of South Africa. Version 2. 2022. https://knowledgehub.health.gov.za/system/files/elibdownloads/2022-03/National%20Guideline%20for%20Patient%20Safety%20Incident%20Reporting%20and%20Learning%20in%20South%20Africa%20Version%202_2022.pdf
[3]. Government Gazette 38486, R. G. Norms and Standards. Regulations in terms of Section 90 (1)(b) and (c) of the National Health Act, 2003 (Act no. 61 of 2003), applicable to certain categories of health establishments. Pretoria, RSA; 2015. www.gpwonline.co.za
[4]. Manzanera R, Moya D, Guilabert M, Plana M, Gálvez G, Ortner J, et al. Quality Assurance and Patient Safety Measures: A Comparative Longitudinal Analysis. Int J Environ Res Public Health. 2018;15(8):1568. https://doi.org/10.3390/ijerph15081568
[5]. Sharma B, Gadenne D. An investigation of the perceived importance and effectiveness of quality management approaches. TQM Mag. 2001;13(6):411–20.
[6]. George AZ. Research frameworks: Critical components for reporting qualitative health care research. J Patient Cent Res Rev. 2024;11(1):4–7.
[7]. World Health Organisation (WHO). Global Patient Safety Action Plan 2021-2030. WHO Press. Www.who.int. 2021. https://www.who.int/publications/i/item/9789240032705
[8]. Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches. 5th ed. Sage; 2018.
[9]. Braun V, Clarke V. What Can “Thematic Analysis” Offer Health and Wellbeing researchers. Int J Qual Stud Health Well-being. 2014;9(1). https://doi.org/10.3402/qhw.v9.26152
[10]. Saunders CH, Sierpe A, Plessen CV, Kennedy AM, Leviton LC, Bernstein SL, Goldwag J, King JR, Marx CM, Pogue JA, Saunders RK, Citters AV, Yen RW, Elwyn G, Leyenaar JK. Practical thematic analysis: A guide for multidisciplinary health services research teams engaging in qualitative analysis. BMJ. 2023;381(381):1–10. https://doi.org/10.1136/bmj-2022-074256
[11]. Roberts K, Dowell A, Nie J. Attempting Rigour and Replicability in Thematic Analysis of Qualitative Research Data; a Case Study of Codebook Development. Nih.gov. 2026. pmc.ncbi.nlm.nih.gov/articles/PMC6437927/pdf/12874_2019_Article_707.pdf. Accessed 1 May 2026.
[12]. World Health Organization (WHO). Patient safety: Global action on patient safety. 2019.
[13]. Aiken LH, Sloane DM, Ball J, Bruyneel L, Rafferty AM, Griffiths P. Patient satisfaction with hospital care and nurses in England: An observational study. BMJ Open. 2018;8(1). https://doi.org/10.1136/bmjopen-2017-019189
[14]. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, Pate M. High-quality health systems in the Sustainable Development Goals era. Lancet Glob Health. 2018;6(11)–e1252.
[15]. Mayosi BM, Benatar SR. Health and health care in South Africa-20 years after Mandela. N Engl J Med. 2014;371(14):1344–1353.
[16]. Tolobisa P, Naranjee N, Moonsamy S. Factors affecting reporting of patient safety incidents in the Eastern Cape primary health care. Afr J Prim Health Care Fam Med. 2026;18(1). https://doi.org/10.4102/phcfm.v18i1.4993
[17]. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Zurayk H. Health professionals for a new century: Transforming education to strengthen health systems. Lancet. 2010;376(9756):1923–1958.
[18]. Agency for Healthcare Research and Quality. Hospital survey on patient safety culture user database report. AHRQ. 2019.
[19]. Sun BC, Hsia RY, Weiss RE, Zingmond D, Liang LJ, Han W, Asch SM. Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med. 2013;61(6):605–611.
[20]. Bates DW, Singh H. Two decades since To Err Is Human: An assessment of progress and emerging priorities in patient safety. Health Aff. 2018;37(11):1736–1743. https://doi.org/10.1377/hlthaff.2018.0738
[21]. Armstrong M, Taylor S. Armstrong’s handbook of human resource management practice. 16th ed. Kogan Page Publishing; 2023. Kogan Page Publishing
[22]. Buchan J, Catton H, Shaffer F. Sustain and retain in 2022 and beyond: The global nursing workforce and the COVID-19 pandemic. International Council of Nurses; 2022.
[23]. Institute of Medicine. Assessing progress on the Institute of Medicine report: The future of nursing. National Academies Press; 2016. National Academies Press
[24]. Agency for Healthcare Research and Quality (AHRQ). Patient safety culture surveys. AHRQ; 2023. AHRQ Official Website
[25]. Boamah SA, Laschinger H, Wong C, Clarke S. Effect of transformational leadership on job satisfaction and patient safety outcomes. Nurs Outlook. 2018;66(2):180–189.
[26]. Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS One. 2016;11(7).
[27]. Brook J, Aitken L, Webb R, MacLaren J, Salmon D. Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review. Int J Nurs Stud. 2019;91:47–59.
[28]. Sammer CE, Lykens K, Singh KP, Mains DA, Lackan NA. What is Patient Safety Culture? A Review of the Literature. J Nurs Scholarsh. 2010;42(2):156–165. https://doi.org/10.1111/j.1547-5069.2009.01330.x
[29]. Wu AW. Medical error: the second victim. BMJ. 2000;320(7237):726–727. https://doi.org/10.1136/bmj.320.7237.726
[30]. World Health Organization & UNICEF. Global progress report on WASH in health care facilities. 2021. WHO and UNICEF Report
[31]. Kruse CS, Kristof C, Jones B, Mitchell E, Martinez A. Barriers to electronic health record adoption: A systematic literature review. J Med Syst. 2017;40(12):252.
[32]. Shields MA, Ward M. Improving nurse retention in the National Health Service in England: The impact of job satisfaction on intentions to quit. J Health Econ. 2001;20(5):677–701.
[33]. Leonard M, Graham S, Bonacum D. The human factor: The critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care. 2004;13(suppl 1)–i90.
[34]. Allegranzi B, Donaldson L, Kilpatrick C, Storr J, Kelly E, Park BJ. Global infection prevention and control priorities 2022–2030. Lancet Glob Health. 2022;10(6)–e804.
[35]. Yadav P. Health product supply chains in developing countries: Diagnosis of the root causes of underperformance and an agenda for reform. Health Syst Reform. 2015;1(2):142–154.
[36]. Kohler JC, Bowra A, Smalley K. Strengthening pharmaceutical systems to improve patient safety and access to medicines. Glob Health. 2020;16(1):1–9.
[37]. Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digit Med. 2020;3(17):1–10.
[38]. Healthcare Information and Management Systems Society (HIMSS). Interoperability in Healthcare. 2020.
[39]. Lincoln YS, Guba EG. Trustworthiness. Research theory, design, and methods. Walden University; 2016. https://studyhall.waldenu.edu/dpsy2017/wp-content/uploads/sites/5/2017/04/Trustworthiness.pdf
[40]. Ul Z, Kakar H, Rasheed R, Rashid A, College Y, Akhter S. Criteria for Assessing and Ensuring the Trustworthiness in Criteria for Assessing and Ensuring the Trustworthiness in Qualitative Research Qualitative Research criteria for assessing and ensuring the trustworthiness in qualitative research. Int J Bus Reflections. 2023;4(2). https://doi.org/10.56249/ijbr.00.00.00
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Institutionalising Social and Behaviour Change Systems for Universal Health Coverage in Fragile and Humanitarian Settings: Evidence from the South Sudan Social and Behaviour Change Strategic Framework (2026–2030)Author: Okello David OmwonyDOI: 10.21522/TIJPH.2013.14.03.Art011
Institutionalising Social and Behaviour Change Systems for Universal Health Coverage in Fragile and Humanitarian Settings: Evidence from the South Sudan Social and Behaviour Change Strategic Framework (2026–2030)
Abstract:
Social and Behaviour Change (SBC) is increasingly recognised as an important health systems function for strengthening Primary Health Care (PHC), health security, community resilience, and progress toward Universal Health Coverage (UHC), particularly in fragile and humanitarian settings. However, SBC implementation in many settings remains fragmented across disease-specific programmes, limiting coordination, institutional learning, sustainability, and national ownership. This study examines the South Sudan Social and Behaviour Change Strategic Framework (2026–2030) as a national health systems reform for institutionalising SBC. This study used a qualitative Health Policy and Systems Research approach, drawing on a documentary review and thematic analysis of national policies, strategic frameworks, programme documents, stakeholder consultation reports, international guidance, and peer-reviewed literature. The analysis identified governance and leadership; behavioural and social insights; community engagement and service experience; strategic communication and digital innovation; monitoring, evaluation, and adaptive learning; and sustainable financing and multisectoral coordination as interrelated institutional functions. Building on these findings, the study proposes the Integrated Social and Behaviour Change Systems Institutionalisation Framework (ISBCS-IF), illustrating how institutionalised SBC can strengthen health system performance, service utilisation, community trust, emergency preparedness, and progress toward UHC. South Sudan’s experience provides an adaptable systems model for governments and development partners seeking to institutionalise SBC within routine health systems in fragile and resource-constrained settings.
Institutionalising Social and Behaviour Change Systems for Universal Health Coverage in Fragile and Humanitarian Settings: Evidence from the South Sudan Social and Behaviour Change Strategic Framework (2026–2030)
References:
[1]. World Health Organization, United Nations Children's Fund. Declaration of Astana. Global Conference on Primary Health Care. Geneva: WHO; 2018.
[2]. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations; 2015.
[3]. World Health Organization, United Nations Children's Fund. Operational framework for primary health care: transforming vision into action. Geneva: WHO; 2020.
[4]. World Health Organization. World health statistics 2024. Geneva: WHO; 2024.
[5]. United Nations. Sustainable development goals report 2024. New York: United Nations; 2024.
[6]. World Health Organization. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: WHO; 2007.
[7]. World Health Organization. Behavioural and social sciences for better health: WHO technical guidance. Geneva: WHO; 2023.
[8]. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: WHO; 2010.
[9]. World Health Organization, United Nations Children's Fund. Primary health care measurement framework and indicators. Geneva: WHO; 2022.
[10]. United Nations Children's Fund. Social and Behaviour Change Strategy 2022–2030. New York: UNICEF; 2022.
[11]. World Health Organization. Behavioural insights for better health. Geneva: WHO; 2022.
[12]. United States Agency for International Development. Social and behavior change evidence review. Washington (DC): USAID; 2022.
[13]. Michie S, van Stralen MM, West R. The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42.
[14]. Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to designing interventions. London: Silverback Publishing; 2014.
[15]. Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.
[16]. Bronfenbrenner U. The ecology of human development. Cambridge (MA): Harvard University Press; 1979.
[17]. World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva: WHO; 2018.
[18]. World Health Organization. Risk communication and community engagement (RCCE) readiness and response to health emergencies. Geneva: WHO; 2021.
[19]. Africa Centres for Disease Control and Prevention. Risk Communication and Community Engagement Framework for Public Health Emergencies. Addis Ababa: Africa CDC; 2022.
[20]. Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries. Annu Rev Public Health. 2014;35:399–421.
[21]. Kok MC, Dieleman M, Taegtmeyer M, et al. Which intervention design factors influence performance of community health workers? Health Policy Plan. 2015;30(9):1207–1227.
[22]. Scott K, Beckham SW, Gross M, et al. What do we know about community-based health worker programmes? BMJ Glob Health. 2018;3:e000768.
[23]. World Health Organization. Communicating risk in public health emergencies. Geneva: WHO; 2018.
[24]. Gavi, the Vaccine Alliance. Demand Generation and Social and Behaviour Change for Immunisation. Geneva: Gavi; 2023.
[25]. United Nations Children’s Fund. The State of the World’s Children 2023: For Every Child, Vaccination. New York: UNICEF; 2023.
[26]. United Nations Children’s Fund. Programme Guidance for Social and Behaviour Change in Humanitarian Action. New York: UNICEF; 2023.
[27]. Ministry of Health, Republic of South Sudan. National Health Policy 2016–2026. Juba: Ministry of Health; 2016.
[28]. Ministry of Health, Republic of South Sudan. Health Sector Strategic Plan II 2023–2027. Juba: Ministry of Health; 2023.
[29]. Ministry of Health, Republic of South Sudan. Revised Community Health Strategy: Boma Health Initiative 2024–2028. Juba: Ministry of Health; 2024.
[30]. United Nations Office for the Coordination of Humanitarian Affairs. South Sudan Humanitarian Needs and Response Plan 2025. New York: United Nations; 2025.
[31]. World Bank. South Sudan Economic Monitor: Building Resilience in Fragile Settings. Washington (DC): World Bank; 2024.
[32]. Ministry of Health, Republic of South Sudan. National Health Promotion Strategy. Juba: Ministry of Health; 2022.
[33]. Ministry of Health, Republic of South Sudan. National Risk Communication and Community Engagement Strategy. Juba: Ministry of Health; 2023.
[34]. Ministry of Health, Republic of South Sudan. Community-Based Networks Integration Strategy under the Revised Boma Health Initiative 2024–2028. Juba: Ministry of Health; 2025.
[35]. Ministry of Health, Republic of South Sudan. South Sudan Social and Behaviour Change Strategic Framework 2026–2030. Juba: Ministry of Health; 2026.
[36]. Ministry of Health, Republic of South Sudan, United Nations Children's Fund. South Sudan Social and Behaviour Change Operational Framework 2026–2030. Juba: Ministry of Health and UNICEF; 2026.
[37]. World Health Organization. Global strategy on people-centred and integrated health services. Geneva: WHO; 2016.
[38]. Sheikh K, Gilson L, Agyepong IA, et al. Building the field of Health Policy and Systems Research. Health Res Policy Syst. 2011;9:19.
[39]. Gilson L. Health Policy and Systems Research: A Methodology Reader. Geneva: WHO; 2012.
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From Training to Competency: An Operations Research Evaluation of Family Planning and Post-Abortion Care Capacity Building in Sierra LeoneAuthor: Felix Ikenna ONUNKWORDOI: 10.21522/TIJPH.2013.14.03.Art012
From Training to Competency: An Operations Research Evaluation of Family Planning and Post-Abortion Care Capacity Building in Sierra Leone
Abstract:
Sierra Leone faces persistent reproductive health challenges, including unmet need for family planning, unsafe abortion-related morbidity, and limited public-sector capacity to provide quality family planning and post-abortion care services. This retrospective mixed-methods operations research evaluation assessed whether a competency-based training, mentorship, and supportive supervision model implemented under the Saving Lives Phase 2 project was associated with improvements in provider knowledge, clinical competency, quality-of-care indicators, and post-abortion care service delivery in selected public-sector facilities in Sierra Leone. Kirkpatrick’s four-level model and a programme theory linking training inputs to learning, workplace competency, service readiness, and service outputs guided the evaluation. The evaluation reviewed routine programme data from 2019 to 2020, including trainee reaction forms, pre- and post-test scores, competency assessment records, supervision and mentorship records, quality-of-care assessments, service statistics, programme reports, and exploratory financial and modelled impact estimates. Descriptive analysis summarised changes over time. Trainee reaction was highly positive. Mean knowledge scores increased from 28% at pre-test to 81% at post-test. The share of providers attaining Level 1 competency increased from 59% in Q3 2019 to 97% in Q4 2020. Model-site quality-of-care status increased from 3% in 2019 to 33% in 2020, while model-area status increased from 8% to 22%. Post-abortion care service volume increased from 442 in 2019 to 1,950 in 2020. The findings suggest programme-associated improvements across the training-to-practice pathway, but causal inference is limited by the retrospective descriptive design and absence of a comparison group.
From Training to Competency: An Operations Research Evaluation of Family Planning and Post-Abortion Care Capacity Building in Sierra Leone
References:
[1]. Statistics Sierra Leone, ICF. Sierra Leone Demographic and Health Survey 2019. Freetown, Sierra Leone, and Rockville, Maryland, USA: Statistics Sierra Leone and ICF; 2020. https://dhsprogram.com/publications/publication-FR365-DHS-Final-Reports.cfm
[2]. Sserwanja Q, Nuwabaine L, Kamara K, Musaba MW. Determinants of quality contraceptive counselling information among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey. BMC Womens Health. 2023;23:266. https://doi.org/10.1186/s12905-023-02419-8
[3]. Paul M, Gebreselassie H, Samai M, Benson J, Kargbo SAS, Lazzarino MM. Unsafe abortion in Sierra Leone: an examination of costs and burden of treatment on healthcare resources. J Womens Health Care. 2015;4:228. https://doi.org/10.4172/2167-0420.1000228
[4]. World Health Organization. Abortion care guideline. Geneva: World Health Organization; 2022. https://www.who.int/publications/i/item/9789240039483
[5]. Onunkwor FI. Training evaluation of Saving Lives Phase 2 Project in Sierra Leone. Freetown: Marie Stopes Sierra Leone; 2021. Unpublished internal programme evaluation report.
[6]. Kirkpatrick Partners. The Kirkpatrick Model. Kirkpatrick Partners; n.d. Accessed April 29, 2026. https://www.kirkpatrickpartners.com/the-kirkpatrick-model/
[7]. Bates R. A critical analysis of evaluation practice: the Kirkpatrick model and the principle of beneficence. Eval Program Plann. 2004;27(3):341–47. https://doi.org/10.1016/j.evalprogplan.2004.04.011
[8]. Weinberger M, Berdellima A, Stephens R, Hayes G, Munroe E. Impact 2 v5: an innovative tool for estimating the impact of reproductive health programmes: methodology paper. London: Marie Stopes International; 2018.
[9]. World Health Organization, Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs. Family planning: a global handbook for providers. 4th ed. Geneva and Baltimore: World Health Organization and Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs; 2022. https://www.who.int/publications/m/item/family-planning--a-global-handbook-for-providers--4th-ed
[10]. Sultan MA, Miller E, Tikkanen RS, Singh S, Kullu A, Cometto G, et al. Competency-based education and training for Community Health Workers: a scoping review. BMC Health Serv Res. 2025;25:263. https://doi.org/10.1186/s12913-025-12217-7
[11]. O’Donovan J, O’Donovan C, Kuhn I, Sachs SE, Winters N. Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Open. 2018;8(4):e021467. https://doi.org/10.1136/bmjopen-2017-021467
[12]. Vasan A, Mabey DC, Chaudhri S, Brown Epstein HA, Lawn SD. Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods. Health Policy Plan. 2017;32(3):437–52. https://doi.org/10.1093/heapol/czw144
[13]. Bruce J. Fundamental elements of the quality of care: a simple framework. Stud Fam Plann. 1990;21(2):61–91. https://doi.org/10.2307/1966669
[14]. Jain AK, Hardee K. Revising the FP quality of care framework in the context of rights-based family planning. Stud Fam Plann. 2018;49(2):171–79. https://doi.org/10.1111/sifp.12052
[15]. Holt K, Dehlendorf C, Langer A. Defining quality in contraceptive counseling to improve measurement of individuals’ experiences and enable service delivery improvement. Contraception. 2017;96(3):133–7. https://doi.org/10.1016/j.contraception.2017.06.005
[16]. Ali M, Tran NT. Defining counselling in contraceptive information and services: outcomes from an expert think tank. BMJ Sex Reprod Health. 2022;48(2):79–81. https://doi.org/10.1136/bmjsrh-2021-201132
[17]. Tunçalp Ö, Were WM, MacLennan C, Oladapo OT, Gülmezoglu AM, Bahl R, et al. Quality of care for pregnant women and newborns—the WHO vision. BJOG. 2015;122(8):1045–9. https://doi.org/10.1111/1471-0528.13451
[18]. World Health Organization. Respectful care. Geneva: World Health Organization; n.d. Accessed April 29, 2026. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/quality-of-care/respectful-care
[19]. World Health Organization. Post-abortion contraception: recommendations 41–47. In: Abortion care guideline. Geneva: World Health Organization; 2022. https://srhr.org/abortioncare/chapter-3/post-abortion-3-5/post-abortion-contraception-recommendations-41-47-3-5-4/
[20]. Avortri GS, Nabukalu JB, Nabyonga-Orem J. Supportive supervision to improve service delivery in low-income countries: is there a conceptual problem or a strategy problem? BMJ Glob Health. 2019;4(Suppl 9):e001151. https://doi.org/10.1136/bmjgh-2018-001151
[21]. Deussom R, Mwarey D, Bayu M, Abdullah SS, Marcus R. Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries. Hum Resour Health. 2022;20:2. https://doi.org/10.1186/s12960-021-00692-y
[22]. Kim CR, Lavelanet A, Ganatra B. Enabling access to quality abortion care: WHO’s Abortion Care guideline. Lancet Glob Health. 2022;10(4):e467–e468. https://doi.org/10.1016/S2214-109X(21)00552-0
[23]. World Health Organization. Global competency and outcomes framework for universal health coverage. Geneva: World Health Organization; 2022. https://www.who.int/publications/i/item/9789240034662
[24]. Robinson SJ, Ritchie AMA, Pacilli M, Nestel D, McLeod E, Nataraja RM. Simulation-based education of health workers in low- and middle-income countries: a systematic review. Glob Health Sci Pract. 2024;12(6):e2400187. https://doi.org/10.9745/GHSP-D-24-00187
[25]. Hellwig F, Moreira LR, Silveira MF, Vieira CS, Rios-Quituizaca PB, Masabanda M, et al. Policies for expanding family planning coverage: lessons from five successful countries. Front Public Health. 2024;12:1339725. https://doi.org/10.3389/fpubh.2024.1339725
[26]. World Health Organization. Working for Health 2022–2030 Action Plan. Geneva: World Health Organization; 2022. https://www.who.int/publications/i/item/9789240063389
[27]. World Health Organization. Patient safety incident reporting and learning systems: technical report and guidance. Geneva: World Health Organization; 2020. https://www.who.int/publications/i/item/9789240010338
[28]. World Health Organization. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. Geneva: World Health Organization; 2021. https://www.who.int/teams/integrated-health-services/patient-safety/policy/global-patient-safety-action-plan
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Evaluating Active Versus Passive Surveillance under IDSR 3rd Edition in Central Africa: A Comparative Implementation Analysis of Outbreak Detection, Reporting Completeness, and Cost effectiveness (2018 to 2024)Author: Daniel YotaDOI: 10.21522/TIJPH.2013.14.03.Art013
Evaluating Active Versus Passive Surveillance under IDSR 3rd Edition in Central Africa: A Comparative Implementation Analysis of Outbreak Detection, Reporting Completeness, and Cost effectiveness (2018 to 2024)
Abstract:
Central Africa faces recurrent outbreaks of cholera, measles, yellow fever, Mpox, and viral haemorrhagic fevers, compounded by fragile health systems, insecurity, and limited laboratory capacity. The 3rd Edition of the Integrated Disease Surveillance and Response (IDSR) framework provides updated guidance for strengthening early warning and response, yet implementation remains uneven across the region. This mixed methods implementation analysis combines a narrative review of policy documents, surveillance performance data (2018–2024), peer reviewed literature, and grey literature from Central African countries. Data were synthesized using thematic analysis and a comparative assessment guided by IDSR core functions, IHR (2005) capacities, and health system resilience dimensions (absorption, adaptation, transformation). Active surveillance approaches, including community based surveillance (CBS), active case finding, event based surveillance (EBS), and proactive rapid response teams, substantially outperformed passive facility based models. Active strategies reduced outbreak detection delays by a median of 8 days, increased weekly reporting completeness by 39 percentage points, and lowered cost per true alert detected by 65%. Countries such as Cameroon, DRC, Gabon, and CAR demonstrated scalable innovations: integrated digital IDSR platforms, motorcycle courier laboratory networks, remote SMS hotlines in conflict zones, and the region's first functional cross-border mechanism in the Lake Chad Basin. However, six systemic challenges persist, namely workforce deficits, laboratory fragmentation, fragmented information systems, insecurity, financing gaps, and weak cross-border coordination. Low-cost, adaptive interventions—community surveillance supervisors, integrated digital platforms, sample transport networks, and cross-border coordination calls—can transform surveillance performance across Central Africa within 24 months. Intentional or structured governance, domestic financing, and active implementation are essential to achieving regional health security aligned with IDSR 3rd Edition and IHR (2005).
Evaluating Active Versus Passive Surveillance under IDSR 3rd Edition in Central Africa: A Comparative Implementation Analysis of Outbreak Detection, Reporting Completeness, and Cost effectiveness (2018 to 2024)
References:
[1]. WHO Regional Office for Africa. Technical guidelines for integrated disease surveillance and response in the African region. 3rd ed. Brazzaville: WHO AFRO; 2019. Available from: https://www.afro.who.int/publications/technical-guidelines-integrated-disease-surveillance-and-response-african-region-3rd
[2]. WHO Regional Office for Africa. Epidemic-prone diseases in the African Region: annual outbreak report 2021. Brazzaville: WHO AFRO; 2022. Available from: https://www.afro.who.int/publications/annual-outbreak-report-2021
[3]. Fall IS, Rajatonirina S. Strengthening surveillance systems in Africa: progress, gaps, and the path forward under IDSR 3.0. BMJ Glob Health. 2023;8(Suppl 6). Available from: https://doi.org/10.1136/bmjgh-2023-012345
[4]. Africa Centres for Disease Control and Prevention. Surveillance system performance assessment: Central Africa regional report 2023. Addis Ababa: Africa CDC; 2024. Available from: https://africacdc.org/download/surveillance-performance-central-africa-2023
[5]. Ministry of Public Health, Cameroon. National IDSR implementation review: digital transformation and community-based surveillance achievements 2020--2024. Yaoundé: MINSANTE; 2024. Available from: https://www.minsante.cm/downloads/idsr-review-2024
[6]. Ministry of Health, Democratic Republic of the Congo. Community-based surveillance in conflict zones: lessons from the DRC pilot (2022--2023). Kinshasa: MOH DRC; 2023. Available from: https://www.sante.gouv.cd/rapports/cbs-conflict-zones-2023
[7]. Ministry of Health, Gabon. Laboratory integration and digital dashboards: Gabon's experience with IDSR 3.0. Libreville: MOH Gabon; 2024. Available from: https://www.sante.gouv.ga/idsr-laboratory-dashboard-2024
[8]. WHO Regional Office for Africa. Cross-border surveillance initiatives in the Lake Chad Basin: evaluation report. Brazzaville: WHO AFRO; 2024. Available from: https://www.afro.who.int/publications/cross-border-surveillance-lake-chad-basin-2024
[9]. Ministry of Health, Central African Republic. Remote surveillance innovations in inaccessible areas: SMS hotlines and community informants. Bangui: MOH CAR; 2023. Available from: https://www.sante.cf/rapports/remote-surveillance-car-2023
[10]. Ministry of Health, Chad. Humanitarian surveillance windows: piloting intensified data collection during ceasefires. N'Djamena: MOH Chad; 2024. Available from: https://www.sante.td/rapports/humanitarian-surveillance-windows-2024
[11]. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910-1912. Available from: https://doi.org/10.1016/S0140-6736(15)60755-3
[12]. Moon S, Sridhar D, Pate MA, Jha AK, Clinton C, Delaunay S, et al. Will Ebola change the game? Ten essential reforms before the next pandemic. Lancet. 2015;386(10009):2204-2221. Available from: https://doi.org/10.1016/S0140-6736(15)00946-0
[13]. Heymann DL, Chen L, Takemi K, Fidler DP, Tappero JW, Thomas MJ, et al. Global health security: the wider lessons from the West African Ebola virus disease epidemic. Lancet. 2015;385(9980):1884-1901. Available from: https://doi.org/10.1016/S0140-6736(15)60858-3
[14]. Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag. 2017;6(8):431-435. Available from: https://doi.org/10.15171/ijhpm.2017.36
[15]. WHO Regional Office for Africa. IDSR 3rd Edition implementation status report: Central Africa. Brazzaville: WHO AFRO; 2022. Available from: https://www.afro.who.int/publications/idsr-3rd-edition-status-report-central-africa-2022
[16]. World Bank. Health financing and surveillance capacity in fragile states: Central Africa regional diagnostic. Washington, DC: World Bank Group; 2024. Available from: https://openknowledge.worldbank.org/handle/10986/41234
[17]. The Pandemic Fund. Investment priorities for pandemic prevention, preparedness, and response: first call for proposals. Washington, DC: The Pandemic Fund; 2023. Available from: https://www.pandemicfund.org/sites/default/files/2023-05/Investment-Priorities-First-Call.pdf
[18]. World Health Organization. The impact of COVID-19 on health systems in the African Region: a synthesis report. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240028416
[19]. WHO Regional Office for Africa. Integrated disease surveillance and response: a regional strategy for communicable diseases. Harare: WHO AFRO; 1998. Available from: https://www.afro.who.int/publications/integrated-disease-surveillance-and-response-regional-strategy
[20]. Mboussou F, Ndumbi P, Ngom R, Mukendi D, Belizaire MR, Dalhatu I, et al. Trends in surveillance performance indicators for epidemic-prone diseases in the WHO African Region, 2015--2020. BMJ Glob Health. 2022;7(5). Available from: https://doi.org/10.1136/bmjgh-2022-008514
[21]. Nsubuga P, Nwanyanwu O, Nkengasong JN, Mukanga D, Trostle M. Strengthening public health surveillance and response in Africa: the role of integrated disease surveillance and response. Afr Health Monit. 2020;27:10-15. Available from: https://www.afro.who.int/publications/african-health-monitor-27-strengthening-public-health-surveillance
[22]. WHO Regional Office for Africa. Weekly regional reports on epidemic-prone diseases in Central Africa (2018--2024). Outbreaks and Emergencies Bulletin. Brazzaville: WHO AFRO; 2024. Available from: https://www.afro.who.int/outbreaks-emergencies-bulletin-central-africa
[23]. Biedron C, Lyman M, Struminger B, Yassin M, Kabamba L, Mwila C, et al. Evaluation of community-based surveillance in the Democratic Republic of the Congo: a mixed-methods study. BMJ Open. 2021;11(12). Available from: https://doi.org/10.1136/bmjopen-2021-051103
[24]. Gueye AS, Ndiaye A, Ndiaga M, Diop S, Ka D, Diallo I, et al. Cross-border surveillance in the Lake Chad Basin: impact on outbreak detection and response. Pan Afr Med J. 2023;44:89. Available from: https://doi.org/10.11604/pamj.2023.44.89.38912
[25]. Omondi I, Akello H, Wanyoike S, Nguidjol F, Nguemkam T, Mballa E, et al. One Health surveillance for anthrax in Cameroon: early warning through livestock mortality monitoring. Front Public Health. 2024;12:1357892. Available from: https://doi.org/10.3389/fpubh.2024.1357892
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Perceived Difficulty Accessing Healthcare in Guinea: A Population-Based Analysis of Financial, Organizational and Geographic BarriersAuthor: Ansoumane KouroumaDOI: 10.21522/TIJPH.2013.14.03.Art014
Perceived Difficulty Accessing Healthcare in Guinea: A Population-Based Analysis of Financial, Organizational and Geographic Barriers
Abstract:
Background: In Guinea, access to healthcare remains constrained despite facility availability. Objective: to estimate the prevalence and determinants of perceived difficulty obtaining care. Methods: We analyzed 2024 Afrobarometer Round 10 survey data from Guinea (n=1,200; n=948 with facility contact) using survey-weighted statistics and multivariable logistic regression. Results: 59.2% of respondents reported difficulty obtaining care. The most frequent barriers were high costs and informal payment requests (36.1% each), followed by long waiting times (22%) and drug shortages (16.2%). After adjustment, perceived difficulty was associated with informal payment demands (OR=2.11; 95% CI:1.54–2.87), high costs (OR=1.89; 1.35–2.63), long waiting times (OR=1.56; 1.03–2.35), and urban residence (OR=1.49; 1.10–2.03). Conclusion: Financial and organizational barriers are the main drivers of perceived access difficulty in Guinea; addressing fees, informal payments, and waiting times is essential to improve access.
Perceived Difficulty Accessing Healthcare in Guinea: A Population-Based Analysis of Financial, Organizational and Geographic Barriers
References:
[1]. World Health Organization. Primary health care on the road to universal health coverage: 2019 monitoring report. Geneva: World Health Organization; 2019.
[2]. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet. 2018;392:2203–12. https://doi.org/10.1016/S0140-6736(18)31668-4
[3]. World Bank. World development indicators: Guinea. Washington (DC): World Bank; 2023.
[4]. Arsenault C, Jordan K, Lee D, Dinsa G, Manzi F, Marchal B, et al. Equity in antenatal care quality: an analysis of 91 national household surveys. Lancet Glob Health. 2018;6:e1186–95. https://doi.org/10.1016/S2214-109X(18)30389-9
[5]. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51:95–124. https://doi.org/10.2307/3349613
[6]. Bago JL, Adégnika AA. Healthcare utilisation and associated factors in sub-Saharan Africa. BMC Health Serv Res. 2021;21:567. https://doi.org/10.1186/s12913-021-06578-8
[7]. Saksena P, Antunes AF, Xu K, Musango L, Carrin G. Mutual health insurance in Africa: evidence from Ghana, Rwanda, and Tanzania. Health Econ. 2014;23:713–27. https://doi.org/10.1002/hec.2945
[8]. Afrobarometer. Afrobarometer Round 10 survey, Guinea. Accra: Afrobarometer; 2024.
[9]. Bratton M, Mattes R, Gyimah-Boadi E. Public opinion, democracy, and market reform in Africa. Cambridge: Cambridge University Press; 2005.
[10]. Lumley T. Complex surveys: a guide to analysis using R. Hoboken (NJ): John Wiley & Sons; 2010.
[11]. R Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2023. Available from: https://www.R-project.org/
[12]. Pebesma E. Simple features for R: standardized support for spatial vector data. R J. 2018;10:439–46. https://doi.org/10.32614/RJ-2018-009
[13]. Moran PAP. Notes on continuous stochastic phenomena. Biometrika. 1950;37:17–23. https://doi.org/10.1093/biomet/37.1-2.17
[14]. Anselin L. Local indicators of spatial association—LISA. Geogr Anal. 1995;27:93–115. https://doi.org/10.1111/j.1538-4632.1995.tb00338.x
[15]. Bivand RS, Wong DWS. Comparing implementations of global and local indicators of spatial association. TEST. 2018;27:716–48. https://doi.org/10.1007/s11749-018-0599-x
[16]. Lewis M. Governance and corruption in public health care systems. Washington (DC): Center for Global Development; 2006. Working Paper.
[17]. World Health Organization. World health statistics 2024: monitoring health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization; 2024.
[18]. World Health Organization. Primary health care measurement framework and indicators: monitoring health systems through a primary health care lens. Geneva: World Health Organization; 2022.
[19]. United Nations. The Sustainable Development Goals report 2024. New York: United Nations; 2024.
[20]. GBD 2021 Universal Health Coverage Collaborators. Measuring universal health coverage based on an index of effective service coverage in 204 countries and territories, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2305–40.
[21]. World Bank. World development indicators 2024. Washington (DC): World Bank; 2024.
[22]. Hsiao A, Vogt V, Quentin W. Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa. PLoS One. 2019;14(9):e0223223. Doi:10.1371/journal.pone.0223223.
[23]. Kabia E, Molyneux S, Barasa E, Muraya K, et al. The hidden financial burden of healthcare: a systematic literature review of informal payments in sub-Saharan Africa. Wellcome Open Res. 2022;7:160. Doi:10.12688/wellcomeopenres.17228.1.
[24]. Rajan S, Santoso C, Aji MA, et al. Gender differences in informal payments for healthcare: evidence from 34 African countries. Health Policy Plan. 2022;37(1):14–24. Doi:10.1093/heapol/czab123.
[25]. Lagarde M, Palmer N. The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence? Bull World Health Organ. 2008;86(11):839–48. Doi:10.2471/BLT.07.049197.
[26]. Leive A, Xu K. Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bull World Health Organ. 2008;86(11):849–56. Doi:10.2471/BLT.07.049403.
[27]. Artignan J, Bellanger M. Does community-based health insurance improve access to care in sub-Saharan Africa? A rapid review. Health Policy Plan. 2021;36(4):572–84. Doi:10.1093/heapol/czaa174.
[28]. Ahinkorah BO, Ameyaw EK, Seidu AA, Odusina EK, Keetile M, Yaya S. Examining barriers to healthcare access and utilization of antenatal care services: evidence from demographic health surveys in sub-Saharan Africa. BMC Health Serv Res. 2021;21:125. Doi:10.1186/s12913-021-06129-5.
[29]. Adugna MB, Nabbouh F, Shehata S, Ghahari S. Barriers and facilitators to healthcare access for children with disabilities in low and middle income sub-Saharan African countries: a scoping review. BMC Health Serv Res. 2020;20:15. Doi:10.1186/s12913-019-4822-6.
[30]. Barasa E, Kazungu J, Nguhiu P, Ravishankar N. Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries. BMJ Glob Health. 2021;6(4):e004712. Doi:10.1136/bmjgh-2020-004712.
[31]. Frimpong AO, Amporfu E, Arthur E. Effects of public and external health spending on out-of-pocket payments for healthcare in sub-Saharan Africa. Health Policy Plan. 2022;37(9):1129–37. Doi:10.1093/heapol/czac068.
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WASH Infrastructure and Cholera Incidence in SomaliaAuthor: Yusuf Elmi MohamudDOI: 10.21522/TIJPH.2013.14.03.Art015
WASH Infrastructure and Cholera Incidence in Somalia
Abstract:
Access to safe water and sanitation (WASH) represents the primary defense against cholera. Despite the persistent prevalence of cholera in Somalia, there is a dearth of evidence on the impact of WASH in Somalia. This study employed a mixed-methods approach, including a survey of 134 households across ten cholera-affected districts, regression analysis of WASH influence over a 24-month period, a census of WASH services in health facilities, and interviews with 17 key informants. The regression analysis satisfied all required assumptions. To reduce variable overlap, we combined access to water and sanitation into a single WASH variable. This composite WASH variable demonstrated a strong association with cholera severity (B = −0.730, SE = 0.087, β = −0.418, t (130) = −8.35, p = .001). Individuals with access to WASH were significantly less likely to contract cholera or acute watery diarrhea (OR = 0.13, 95% CI [0.05, 0.36], p = .001). The model accounted for 67.8% of the variance in severity across Somalia (R² = 0.678, F (3,130) = 91.16, p = .001). Only 36.2% of health facilities had running water, and 41.4% had adequate sanitation. The primary causes of inadequate WASH services included malfunctioning water points, open defecation in densely populated areas, and water contamination during rainfall. Improving WASH should be a top priority, along with ongoing efforts in vaccination and health care. More investment is also needed in WASH systems that can withstand flooding in the Juba and Shabelle river basins to help reduce cholera cases by 2030.
WASH Infrastructure and Cholera Incidence in Somalia
References:
[1]. World Health Organization. Cholera: global situation. Geneva: WHO; 2024.
[2]. WHO Regional Office for Africa. Cholera in the African Region: 2025 epidemiological update. Brazzaville: ITS AFRO; 2025.
[3]. Global Task Force on Cholera Control. Somalia cholera: district-level case distribution, 2020-2024 (PAMI line list). Geneva: GTFCC; 2025.
[4]. United Nations Office for the Coordination of Humanitarian Affairs. Somalia humanitarian needs overview 2024. New York: OCHA; 2024.
[5]. United Nations Children's Fund. Somalia WASH situation report. New York: UNICEF; 2025.
[6]. Yusuf H, et al. Recurrent cholera outbreaks in Somalia: a situational analysis. Int J Epidemiol. 2025; 54(1):210-24.
[7]. Hussein A, et al. Cholera in Somalia: burden, determinants, and health system response. East Afr Med J. 2025; 102(1):45-58.
[8]. Wolfe MK, et al. addressing the global burden of cholera: developing WASH-related interventions. PLoS Negl Trop Dis. 2018; 12(1):e0005833.
[9]. Sultan AH, et al. Risk factors for cholera in Southwest State, Somalia: a case-control study. J Infect Dev Ctries. 2025; 19(1):12-24.
[10]. Navarro V. Medicine under capitalism. New York: Prodist; 1976.
[11]. Doyal L, Pennell I. The political economy of health. London: Pluto Press; 1979.
[12]. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988; 15(4):351-77. Doi: 10.1177/109019818801500401.
[13]. Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot? 1996; 10(4):282-98. Doi:10.4278/0890-1171-10.4.282.
[14]. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. 3rd ed. Thousand Oaks: SAGE Publications; 2017.
[15]. Greene JC, Caracelli VJ, Graham WF. Toward a conceptual framework for mixed-method evaluation designs. Educ Eval Policy Anal. 1989; 11(3):255-74. Doi: 10.3102/01623737011003255.
[16]. Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006; 18(1):59-82. Doi: 10.1177/1525822X05279903.
[17]. Field A. Discovering statistics using IBM SPSS statistics. 6th ed. Thousand Oaks: SAGE Publications; 2024.
[18]. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013; 13:117. Doi: 10.1186/1471-2288-13-117.
[19]. Lincoln YS, Guba EG. Naturalistic inquiry. Thousand Oaks: SAGE Publications; 1985.
[20]. O'Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014; 89(9):1245-51. Doi:10.1097/ACM.0000000000000388.
[21]. O'Cathain A, Murphy E, Nicholl J. The quality of mixed methods studies in health services research. J Health Serv Res Policy. 2008; 13(2):92-8. Doi:10.1258/jhsrp.2007.007074.
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Sexual and Reproductive Health Rights among People with Disabilities in Juba County, South SudanAuthor: Sebit Mustafa SebitDOI: 10.21522/TIJPH.2013.14.03.Art016
Sexual and Reproductive Health Rights among People with Disabilities in Juba County, South Sudan
Abstract:
The United Nations emphasizes inclusivity and leaving no one behind, advocating for universal health care, including sexual and reproductive health (SRH). However, the patterns of SRH rights among persons with disabilities remain poorly understood, with this group facing numerous barriers to accessing SRH services. We aimed to examine patterns of Sexual and Reproductive Health Rights (SRHR) among people with disabilities in South Sudan, focusing on Juba County. The study utilized qualitative methods for data collection, supplemented by in-depth quantitative secondary data. The researchers gathered qualitative data using key informant guides and observation. The study analyzed data using a master sheet. The findings revealed significant challenges in accessing SRH services, particularly in rural areas, where comprehensive services are scarcer than in urban centers. Men often mistrust family planning initiatives, viewing them as threats to their authority. Older individuals often exclude themselves from SRH relevance. Barriers such as stigma, discrimination, financial and physical constraints, limited perceived need, and gendered blame further hinder access. Gender-based violence, misconceptions, and negative associations exacerbate these challenges. Notably, comprehensive sex education in schools emerged as a critical intervention to foster liberal attitudes and self-control. In conclusion, the study underscores the exclusion of persons with disabilities from SRHR and highlights the urgent need for inclusive programs to address their specific needs. Limited access to services in rural areas, societal stigma, and misconceptions impede progress. Efforts should focus on promoting inclusive policies, enhancing awareness of SRHR for women with disabilities, and implementing comprehensive sex education. Addressing societal perceptions and fostering inclusivity are vital for advancing SRHR for persons with disabilities in South Sudan.
Sexual and Reproductive Health Rights among People with Disabilities in Juba County, South Sudan
References:
[1]. United Nations Committee on Economic, Social and Cultural Rights. General Comment No. 22 (2016) on the right to sexual and reproductive health (Article 12 of the International Covenant on Economic, Social and Cultural Rights). Geneva: United Nations; 2016. E/C.12/GC/22.
[2]. Mac-Seing M, Zarowsky C, D’Ambruoso L. Disability and sexual and reproductive health service utilisation in Uganda: an intersectional analysis of demographic and health surveys between 2006 and 2016. BMC Int Health Hum Rights. 2022;22:7.
[3]. United Nations. Report of the International Conference on Population and Development: Cairo, 5–13 September 1994. New York: United Nations; 1995.
[4]. World Health Organization, Office of the United Nations High Commissioner for Human Rights, UN Women, UNAIDS, UNDP, UNFPA, UNICEF. Eliminating forced, coercive and otherwise involuntary sterilization: an interagency statement. Geneva: WHO; 2014.
[5]. World Health Organization. HIV/AIDS [Internet]. Geneva: WHO; [cited 2019 May 28]. Available from: https://www.who.int/features/qa/71/en/
[6]. World Health Organization. Call to action to the global community: attaining universal health coverage through sexual and reproductive health and rights and HIV linkages. Geneva: WHO; 2018.
[7]. National Bureau of Statistics. Population Estimation Survey (PES) 2021. Juba: Republic of South Sudan; 2021.
[8]. International Organization for Migration. Disability Access and Inclusion Survey: Aweil South County, South Sudan. IOM DTM; 2023.
[9]. Pérez-Curiel P, Vicente E, Morán ML, Gómez LE. The right to sexuality, reproductive health, and found a family for people with intellectual disability: a systematic review. Int J Environ Res Public Health. 2023;20(2):1587. https://doi.org/10.3390/ijerph20021587
[10]. Ahmed WAM, Shokai SB, Abduelkhair IH, Boshra AY. Factors affecting utilization of family planning services in a post-conflict setting, South Sudan: a qualitative study. AIMS Public Health. 2015;2(4):655-66. doi:10.3934/publichealth.2015.4.655
[11]. Lawry LL, Gabor R, Katele J, et al. Mixed-methods reproductive health knowledge, attitudes and practices survey of IDPs, returnees and host communities in Jonglei State, South Sudan. BMJ Open. 2025;15(1):e083905. doi:10.1136/bmjopen-2024-083905.
[12]. Hartmann-Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2022 Nov 17;11(11):CD010216.
[13]. Ganle JK, Baatiema L, Quansah R, Danso-Appiah A. Barriers facing persons with disability in accessing sexual and reproductive health services in sub-Saharan Africa: a systematic review. PLoS One. 2020;15(10):e0238585. https://doi.org/10.1371/journal.pone.0238585
[14]. Akasreku BD, Habib H, Ankomah A. Pregnancy in disability: community perceptions and personal experiences in a rural setting in Ghana. J Pregnancy. 2018;2018:8096839. https://doi.org/10.1155/2018/8096839
[15]. Scott J, Averbach S, Modest AM, Hacker MR, Cornish S, Spencer D, et al. An assessment of attitudes toward gender inequitable sexual and reproductive health norms in South Sudan: a community-based participatory research approach. Conflict Health. 2013;7:24. doi:10.1186/1752-1505-7-24.
[16]. Using vignettes to gain insights into social norms related to voluntary family planning and gender-based violence in South Sudan. Glob Health Sci Pract. 2024.
[17]. They will say you want to make their home die: a mixed methods study to assess modern family planning use in partnered South Sudanese refugee and host populations in Northern Uganda. BMC Womens Health. 2022.
[18]. Kane S, Kok M, Rial M, Matere A, Dieleman M, Broerse JEW. Social norms and family planning decisions in South Sudan. BMC Public Health. 2016;16:1193. doi:10.1186/s12889-016-3839-6.
[19]. World Health Organization, United Nations Population Fund. Promoting sexual and reproductive health for persons with disabilities: WHO/UNFPA guidance note. Geneva: WHO; 2009. ISBN 9789241598682.
[20]. UNICEF South Sudan. The situation of children and women in South Sudan 2018–2020: situation analysis. Juba: UNICEF; 2021.
[21]. Ministry of Gender, Child and Social Welfare, Republic of South Sudan. National Disability Action Plan 2021–2030. Juba: Government of South Sudan; 2021.
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An Explorative Assessment of Factors Associated with Vaccine Hesitancy in Rural and Urban Communities in Akwa Ibom State, NigeriaAuthor: Idongesit Nta WilsonDOI: 10.21522/TIJPH.2013.14.03.Art017
An Explorative Assessment of Factors Associated with Vaccine Hesitancy in Rural and Urban Communities in Akwa Ibom State, Nigeria
Abstract:
Vaccine hesitancy remains a critical bottleneck to optimising immunisation coverage and herd immunity globally. In sub-Saharan Africa, particularly within Nigeria's socio-cultural landscape, vaccine deployment faces varied structural, cognitive, and contextual impediments. This study explored the multiple factors influencing vaccine hesitancy across rural and urban communities in Akwa Ibom State, Nigeria. Utilising an exploratory, cross-sectional qualitative design, 12 In-Depth Interviews (IDI) were conducted across three Urban (Uyo, Abak, Oron) and three Rural (Itu, Oruk Anam, Nsit Ibom) Local Government Areas. Participants were selected through stratified purposive sampling to reduce bias. Narratives from IDIs were transcribed, coded and interpreted using thematic analysis, incorporating both inductive and deductive approaches. Rural participants exhibited high foundational demand and positive vaccine optimism, driven primarily by perceived disease severity, and this was aided by peer-to-peer diffusion of positive vaccination experiences. However, their vulnerability stemmed from information deficits. Conversely, urban cohorts exhibited fragmented risk perceptions, deep-seated institutional mistrust, and acute sensitivity to systemic and physiological risks. Urban settings were uniquely vulnerable to digital misinformation accelerated by dense, unmediated information within their environments. Local authority structures varied fundamentally: rural areas relied heavily on centralised, culturally legitimised figures (village heads, town criers), whereas urban networks required decentralised communication modes (churches, broadcast media, digital networks). Vaccine hesitancy is highly context-specific and ecologically distinct in Akwa Ibom State. Public health interventions must discard homogeneous, top-down communication paradigms in favour of tailored, double-loop community participation strategies that embed peer-champion mechanisms and localised risk communication within existing rural and urban communities.
An Explorative Assessment of Factors Associated with Vaccine Hesitancy in Rural and Urban Communities in Akwa Ibom State, Nigeria
References:
[1]. World Health Organization. Immunization coverage. Geneva: WHO; 2024 [cited 2026 Jul 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
[2]. Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86(2):140-6. doi:10.2471/BLT.07.
[3]. Thomson A, Robinson K, Vallée-Tourangeau G. The 5As: A practical taxonomy for the determinants of vaccine uptake. Vaccine. 2016;34(8):1018-24. doi:10.1016/j.vaccine.2015.11.065.
[4]. World Health Organization. Ten threats to global health in 2019. Geneva: WHO; 2019 [cited 2026 Jul 8]. Available from: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
[5]. Wagner AL, Masters NB, Domek GJ, Mathew JL, Sun X, Asturias EJ, et al. Comparisons of vaccine hesitancy across five low- and middle-income countries. Vaccines. 2019;7(4):155. doi:10.3390/vaccines7040155.
[6]. Larson HJ, Jarrett C, Eckersberger E, Smith DMD, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007-2012. Vaccine. 2014;32(19):2150-9. doi:10.1016/j.vaccine.2014.01.081.
[7]. Babalola S. Maternal reasons for non-immunisation and partial immunisation in northern Nigeria. J Paediatr Child Health. 2011;47(5):276-81. doi:10.1111/j.1440-1754.2010.01909.x.
[8]. Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: An overview. Hum Vaccin Immunother. 2013;9(8):1763-73. doi:10.4161/hv.24657.
[9]. Hansen PR, Schmidtblaicher M, Bloom N. The value of vaccination. In: Bloom DE, editor. The value of vaccination. New York: Springer; 2011. p. 1-8. doi:10.1007/978-1-4419-7185-2_1.
[10]. Bish A, Yardley L, Nicoll A, Michie S. Factors associated with uptake of vaccination against pandemic influenza: A systematic review. Vaccine. 2011;29(38):6472-84. doi:10.1016/j.vaccine.2011.06.107.
[11]. Bertoncello C, Ferro A, Fonzo M, Zanovello S, Napoletano G, Russo F, et al. Socioeconomic determinants in vaccine hesitancy and vaccine refusal in Italy. Vaccines. 2020;8(2):276. doi:10.3390/vaccines8020276.
[12]. Zhang J, Xiao Y, Yao X, Zu J. Dynamic analysis of an SIR epidemic model with pulse vaccination and saturation incidence. Int J Biomathematics. 2011;4(1):11-26.
[13]. Oladokun RE, Adedokun BO, Lawoyin TO. Children who are not fully immunised and factors responsible for this in Ibadan, South-Western Nigeria. J Trop Pediatr. 2009;56(5):322-8. doi:10.1093/tropej/fmq004.
[14]. Antai D. Inequitable childhood immunization uptake in Nigeria: A multilevel analysis of individual and contextual determinants. BMC Infect Dis. 2009;9:181. doi:10.1186/1471-2334-9-181.
[15]. Wei F, Mullooly JP, Goodman M, McCarty MC, Hanson AM, Crane B, et al. Identification and characteristics of vaccine refusers. BMC Pediatr. 2009;9:18. doi:10.1186/1471-2431-9-18.
[16]. Wu AC, Wisler-Scher DJ, Griswold K, Colson E, Shapiro ED, Holmboe ES, et al. Postpartum mothers' attitudes, knowledge, and trust regarding vaccination. Matern Child Health J. 2008;12(6):766-73. doi:10.1007/s10995-007-0302-4.
[17]. Patra S, Patra B, Bhatt GS. A mathematical model for the control of an infectious disease using vaccination. Int J Math Anal. 2012;6(25):1215-24.
[18]. Chen RT, Rastogi SC, Mullen JR, Hayes SW, Cochi SL, Donlon JA, et al. The Vaccine Adverse Event Reporting System (VAERS) and media reporting of adverse events following immunization. JAMA. [Details missing from original text].
[19]. Wise J. Covid-19: New data on Oxford AstraZeneca vaccine backs continued use in over 30s, say regulators. BMJ. 2021;373:n1095. doi:10.1136/bmj.n1095.
[20]. National Resource Center for Refugees, Immigrants, and Migrants (NRC RIM). Conducting rapid qualitative community assessments: Discussion guide for vaccine confidence and hesitancy in RIM communities. University of Minnesota; Centers for Disease Control and Prevention; 2021 [cited 2026 Jul 8]. Available from: https://nrcrim.org
[21]. MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4. doi:10.1016/j.vaccine.2015.04.036.
[22]. Iwuagwu AO, Rayner D, Ngwu CN, Kalu ME. 'Why I have not taken the COVID-19 vaccine': A descriptive qualitative study of older adults' perceived views of COVID-19 vaccine uptake in Nigeria. J Popul Ageing. 2024;17(2):239-59. doi:10.1007/s12062-023-09410-z.
[23]. Zimmerman T, Shiroma K, Fleischmann KR, Jeng W, Forelle M, Lee Y. Misinformation and COVID-19 vaccine hesitancy. Vaccine. 2023;41(1):136-44. doi:10.1016/j.vaccine.2022.11.014.
[24]. Unfried K, Priebe J. Vaccine hesitancy and trust in sub-Saharan Africa. Sci Rep. 2024;14:10860. doi:10.1038/s41598-024-61205-0.
[25]. Falade B. The colonial effect: Language, trust and attitudes to science as predictors of vaccine hesitancy across Africa. Glob Health Sci Pract. 2024;20(1). doi:10.1177/20966083241257338.
[26]. Gao L, Zhang Y, Li W, Chen S. How urban versus rural population relates to COVID-19 booster vaccine hesitancy: A propensity score matching design study. Hum Vaccin Immunother. 2024;20(1):2297490. doi:10.1080/21645515.2023.2297490.
[27]. Frontiers in Tropical Diseases. Addressing malaria vaccine hesitancy in Nigeria: Lessons from the Pfizer-Kano incident and COVID-19 vaccination. Frontiers; 2025. doi:10.3389/fitd.2025.1691239.
[28]. Adeyemi RA, Ayandele O, Popoola O. Exploring COVID-19 pandemic perceptions and vaccine uptake among community members and primary healthcare workers in Nigeria: A mixed methods study. medRxiv [Preprint]. 2024. doi:10.1101/2024.09.02.24312966.
[29]. Rangi J, Mfinanga E, Sungura R, Tarimo E, Mahande MJ, Kidenya BR, et al. Contribution of community champions to accelerate the uptake of COVID-19 vaccination in Rukwa region, Tanzania. Pan Afr Med J. 2023;45(Suppl 1):5. doi:10.11604/pamj.supp.2023.45.1.39705.
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High HIV Prevalence among Female Refugee Sex Workers in Kampala, Uganda, Linked to Behavioural and Structural RisksAuthor: Gerald PandeDOI: 10.21522/TIJPH.2013.14.03.Art018
High HIV Prevalence among Female Refugee Sex Workers in Kampala, Uganda, Linked to Behavioural and Structural Risks
Abstract:
Female sex workers bear a disproportionate burden of HIV globally, yet little is known about HIV epidemiology among refugee sex workers in urban African settings. This study estimated HIV prevalence and examined behavioral and structural factors associated with HIV among female refugee sex workers in Kampala, Uganda. We conducted a cross-sectional study of 686 female refugee sex workers recruited through hotspot-based outreach and peer-referral networks in February and March 2026. Participants completed structured questionnaires and underwent HIV testing in accordance with national guidelines. Overall HIV prevalence was 21.0% (144/686; 95% CI: 18.1–24.3). HIV prevalence increased with age (χ² = 11.52, p = 0.003) and duration in sex work (χ² = 7.86, p = 0.02). In multivariable models, inconsistent condom use (APR = 1.87, 95% CI: 1.42–2.46), higher client volume (APR = 1.52, 95% CI: 1.12–2.05), alcohol use before sex (APR = 1.32, 95% CI: 1.04–1.67), exposure to work-related violence (APR = 1.39, 95% CI: 1.08–1.80), and police harassment (APR = 1.28, 95% CI: 1.00–1.63) were associated with HIV infection. These findings align with previous evidence that condomless sex, violence, alcohol use, stigma, and punitive work environments increase HIV vulnerability among female sex workers. Female refugee sex workers in Kampala face a substantial HIV burden driven by intersecting behavioral and structural vulnerabilities. Interventions addressing violence, substance use, and condom negotiation may reduce HIV risk in this population.
High HIV Prevalence among Female Refugee Sex Workers in Kampala, Uganda, Linked to Behavioural and Structural Risks
References:
[1]. Uganda Ministry of Health. Uganda Population-based HIV Impact Assessment 2020–2021: final report. Kampala: Ministry of Health; 2022. Available from: https://phia.icap.columbia.edu/uganda-final-report-2020-2021/
[2]. Uganda Ministry of Health. Crane survey report: HIV and STI bio-behavioural survey among key populations in Uganda. Kampala: Ministry of Health; 2022.
[3]. Shannon K, Strathdee SA, Goldenberg SM, Duff P, Mwangi P, Rusakova M, et al. Global epidemiology of HIV among female sex workers: influence of structural determinants. Lancet. 2015;385(9962):55-71. Available from: https://doi.org/10.1016/S0140-6736(14)60931-4
[4]. Baral S, Beyrer C, Muessig K, Poteat T, Wirtz AL, Decker MR, et al. Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(7):538-49. Available from: https://doi.org/10.1016/S1473-3099(12)70066-X
[5]. Joint United Nations Programme on HIV/AIDS. The urgency of now: AIDS at a crossroads. Geneva: UNAIDS; 2024. Available from: https://www.unaids.org/en/resources/documents/2024/global-aids-update-2024
[6]. World Health Organization. Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2022. Available from: https://www.who.int/publications/i/item/9789240052390
[7]. United Nations High Commissioner for Refugees. Global trends: forced displacement in 2023. Geneva: UNHCR; 2024. Available from: https://www.unhcr.org/global-trends
[8]. Logie CH, Okumu M, Mwima S, Hakiza R, Irungi KP, Kyambadde P, et al. The role of context in shaping HIV testing and prevention engagement among urban refugee and displaced youth in Kampala, Uganda. BMC Public Health. 2021;21:1241. Available from: https://doi.org/10.1186/s12889-021-11214-7
[9]. Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo YR. Socio-demographic characteristics and behavioral risk factors of female sex workers in sub-Saharan Africa: a systematic review. AIDS Behav. 2012;16(4):920-33. Available from: https://doi.org/10.1007/s10461-011-9985-z
[10]. Kerrigan DL, Kennedy CE, Morgan-Thomas R, Reza-Paul S, Mwangi P, Win KT, et al. Community empowerment among female sex workers is an effective HIV prevention intervention: a systematic review of the peer-reviewed evidence from low- and middle-income countries. AIDS Behav. 2013;17(6):1926-40. Available from: https://doi.org/10.1007/s10461-013-0458-4
[11]. Weller SC, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database Syst Rev. 2002;(1). Available from: https://doi.org/10.1002/14651858.CD003255
[12]. Decker MR, Crago AL, Chu SKH, Sherman SG, Seshu MS, Buthelezi K, et al. Human rights violations against sex workers: burden and effect on HIV. Lancet. 2015;385(9963):186-99. Available from: https://doi.org/10.1016/S0140-6736(14)60800-X
[13]. Deering KN, Amin A, Shoveller J, Nesbitt A, Garcia-Moreno C, Duff P, et al. A systematic review of the correlates of violence against sex workers. Am J Public Health. 2014;104(5). Available from: https://doi.org/10.2105/AJPH.2014.301909
[14]. Li Q, Li X, Stanton B. Alcohol use among female sex workers and male clients: an integrative review of global literature. Alcohol Alcohol. 2010;45(2):188-99. Available from: https://doi.org/10.1093/alcalc/agp095
[15]. Chersich MF, Bosire W, King’ola N, Temmerman M, Luchters S. Effects of hazardous and harmful alcohol use on HIV incidence and sexual behaviour: a cohort study of Kenyan female sex workers. Global Health. 2014;10:22. Available from: https://doi.org/10.1186/1744-8603-10-22
[16]. Strathdee SA, Stockman JK. Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions. Curr HIV/AIDS Rep. 2010;7(2):99-106. Available from: https://doi.org/10.1007/s11904-010-0043-7
[17]. Vandepitte J, Lyerla R, Dallabetta G, Crabbé F, Alary M, Buvé A. Estimates of the number of female sex workers in different regions of the world. Sex Transm Infect. 2006;82 Suppl 3. Available from: https://doi.org/10.1136/sti.2006.020081
[18]. Hargreaves JR, Boler T. Girl power: the impact of girls’ education on HIV and sexual behaviour. London: ActionAid International; 2006. Available from: https://healtheducationresources.unesco.org/library/documents/girl-power-impact-girls-education-hiv-and-sexual-behaviour
[19]. Witte SS, Batsukh A, Chang M. Sexual risk behaviors, alcohol abuse, and intimate partner violence among sex workers in Mongolia: implications for HIV prevention intervention development. J Prev Interv Community. 2010;38(2):89-103. Available from: https://doi.org/10.1080/10852351003640776
[20]. Platt L, Grenfell P, Meiksin R, Elmes J, Sherman SG, Sanders T, et al. Associations between sex work laws and sex workers’ health: a systematic review and meta-analysis of quantitative and qualitative studies. PLoS Med. 2018;15(12). Available from: https://doi.org/10.1371/journal.pmed.1002680
[21]. Lyons CE, Schwartz SR, Murray SM, Shannon K, Diouf D, Mothopeng T, et al. The role of sex work laws and stigmas in increasing HIV risks among sex workers. Nat Commun. 2020;11:773. Available from: https://doi.org/10.1038/s41467-020-14593-6
[22]. Joint United Nations Programme on HIV/AIDS. Global AIDS strategy 2021–2026: end inequalities, end AIDS. Geneva: UNAIDS; 2021. Available from: https://www.unaids.org/en/Global-AIDS-Strategy-2021-2026
[23]. World Health Organization. Pre-exposure prophylaxis. Geneva: World Health Organization; 2024. Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/prevention/pre-exposure-prophylaxis
[24]. Laga M, Alary M, Nzila N, Manoka AT, Tuliza M, Behets F, et al. Condom promotion, sexually transmitted diseases treatment, and declining incidence of HIV-1 infection in female Zairian sex workers. Lancet. 1994;344(8917):246-8. Available from: https://doi.org/10.1016/S0140-6736(94)93005-8
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Applying Fuzzy Logic to Assess Socio-Technical Transitions Shaping WASH Sustainability in Lower Omo Valley, EthiopiaAuthor: Getachew Asmare BelayDOI: 10.21522/TIJPH.2013.14.03.Art019
Applying Fuzzy Logic to Assess Socio-Technical Transitions Shaping WASH Sustainability in Lower Omo Valley, Ethiopia
Abstract:
This study applies a fuzzy logic modelling framework within a convergent mixed-methods design to assess the socio-technical determinants of water, sanitation, and hygiene (WASH) sustainability in Dassenech Woreda, South Omo Zone, Ethiopia. Sustainable WASH access remains a critical challenge across Sub-Saharan Africa due to environmental variability, weak governance systems, and socio-cultural complexity. To address these challenges, the study integrates quantitative data from 430 household surveys with qualitative insights derived from key informant interviews, focus group discussions, and ethnographic observation. A Mamdani-type fuzzy inference system was developed to model nonlinear interactions between technology appropriateness, community engagement, and institutional support. The results demonstrate that technology appropriateness is the most influential predictor of sustainability, although optimal outcomes occur only when all socio-technical variables interact synergistically. Defuzzification outputs reveal strong threshold effects, particularly when technology appropriateness exceeds 0.6. Qualitative findings further validate these results, emphasizing the critical role of indigenous governance systems in maintaining functionality and social legitimacy. This study contributes a novel methodological framework for analysing WASH sustainability under uncertainty and provides policy-relevant insights for climate-vulnerable pastoralist systems.
Applying Fuzzy Logic to Assess Socio-Technical Transitions Shaping WASH Sustainability in Lower Omo Valley, Ethiopia
References:
[1]. Gebresenbet F. Socio-technical approaches and WASH sustainability. Water Altern. 2022;15(2):345-62.
[2]. Foster T, et al. Strengthening sustainable WASH access and resilience in Sub-Saharan Africa. World Dev. 2025;171:106359. Available from: https://doi.org/10.1016/j.worlddev.2023.106359
[3]. Turton D. Pastoralist systems in Ethiopia. J East Afr Stud. 2017;11(3):421-39. Available from: https://doi.org/10.1080/17531055.2017.1337312
[4]. Zadeh LA. Fuzzy sets. Inf Control. 1965;8(3):338-53. Available from: https://doi.org/10.1016/S0019-9958(65)90241-X
[5]. Marks SJ, et al. Evaluating water system sustainability in Africa. Water Res. 2012;46(12):3600-12. Available from: https://doi.org/10.1016/j.watres.2012.04.018
[6]. Whittington D, et al. Improving water services in rural Kenya. Water Policy. 2009;11(1):1-18. Available from: https://doi.org/10.2166/wp.2009.087
[7]. Kebede S, et al. Behavioral determinants of hygiene in Ethiopia. BMC Public Health. 2024;24:1123. Available from: https://doi.org/10.1186/s12889-024-1123
[8]. White S. Social practice theory and WASH. Sociol Compass. 2021;15(6). Available from: https://doi.org/10.1111/soc4.12864
[9]. Avery S. Hydrological impacts on Lake Turkana. Hydrogeol J. 2018;26(3):815-29. Available from: https://doi.org/10.1007/s10040-018-1725-4
[10]. Dinka M, et al. WASH emergency interventions in Ethiopia. J Water Sanit Hyg Dev. 2023;13(2):245-58. Available from: https://doi.org/10.2166/washdev.2023.245
[11]. Harvey PA, Reed RA. Community-managed water supplies in Africa. J Water Supply Res Technol AQUA. 2007;56(6):365-78. Available from: https://doi.org/10.2166/aqua.2007.060
[12]. Jiménez A, Pérez-Foguet A. Water governance in Tanzania. Water Policy. 2011;13(5):626-41. Available from: https://doi.org/10.2166/wp.2011.037
[13]. Rural Water Supply Network. Sustainable rural water services in the Sahel. RWSN Report. 2019.
[14]. United States Agency for International Development. Sahel WASH resilience report. Washington (DC): USAID; 2020.
[15]. Admasu Y. Rural water supply sustainability in Ethiopia. Environ Health Insights. 2020;14:1-10. Available from: https://doi.org/10.1177/117863022091532
[16]. Schilling J, et al. Pastoral commons and climate risk. Glob Environ Change. 2019;57:101960. Available from: https://doi.org/10.1016/j.gloenvcha.2019.101960
[17]. Little P. Pastoral livelihoods and adaptation. Annu Rev Anthropol. 2024;53:211-29. Available from: https://doi.org/10.1146/annurev-anthro-2024
[18]. Kramer A. Socio-technical systems review. Technol Forecast Soc Change. 2022;176:121134. Available from: https://doi.org/10.1016/j.techfore.2021.121134
[19]. Hailu T, et al. Sanitation barriers in rural Ethiopia. BMC Environ Health. 2024;23:98. Available from: https://doi.org/10.1186/s12940-024-0098
[20]. Abate B, et al. Diarrheal disease prevalence in Ethiopia. PLOS Glob Public Health. 2024;4(1). Available from: https://doi.org/10.1371/journal.pgph.0001234
[21]. Tsegaye D, et al. Land cover change in the Omo Basin. Remote Sens Appl Soc Environ. 2025;31:100112. Available from: https://doi.org/10.1016/j.rsase.2024.100112
[22]. Alemu F, et al. Malaria clustering in Ethiopia. Int J Health Geogr. 2024;23:45. Available from: https://doi.org/10.1186/s12942-024-0045
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Systemic and Institutional Determinants of Cholera Transmission and Control in the Rohingya Refugee Camps, Cox’s Bazar, BangladeshAuthor: Otieno O. DDOI: 10.21522/TIJPH.2013.14.03.Art020
Systemic and Institutional Determinants of Cholera Transmission and Control in the Rohingya Refugee Camps, Cox’s Bazar, Bangladesh
Abstract:
Cholera has persisted and periodically surged in the Rohingya refugee camps of Cox’s Bazar, Bangladesh, despite sustained humanitarian investment, raising questions about the systemic factors that mitigate or enhance transmission. This study characterised the institutional and infrastructural determinants of cholera transmission and control through a synthesis of surveillance and programmatic data and a documentary review of the response architecture, 2018–2026. A multi-layered surveillance system combining community-based surveillance, indicator-based syndromic surveillance, sentinel rapid testing and laboratory confirmation underpinned outbreak detection. The syndromic burden of acute watery diarrhoea declined steadily, from approximately 231,000 cases in 2018 to approximately 122,000 in 2025, reflecting maturing water, sanitation and hygiene services. Culture-confirmed cholera nonetheless remained endemic with recurrent upsurges, the largest in 2024 (534 cases), demonstrating that infrastructural investment alone is insufficient. Rapid diagnostic test–positive counts exceeded but tracked culture-confirmed counts, indicating substantial laboratory confirmation capacity. Integrated reactive oral cholera vaccination, with coverage exceeding 90% in the 2025 campaign, was associated with rapid outbreak suppression. Persistent transmission was attributed to the fragility of water, sanitation, and hygiene gains against monsoon damage, residual point-of-use and foodborne pathways, a predominantly reactive posture, and funding volatility in a protracted crisis. The findings support a shift towards anticipatory, spatially and temporally targeted, integrated control, including environmental surveillance and preventive vaccination, sustained by predictable multi-year financing and strengthened health and water-sector coordination.
Systemic and Institutional Determinants of Cholera Transmission and Control in the Rohingya Refugee Camps, Cox’s Bazar, Bangladesh
References:
[1]. Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. Lancet. 2004;364(9449):1974-83. https://doi.org/10.1016/S0140-6736(04)17481-3
[2]. Spiegel PB, Le P, Ververs MT, Salama P. Occurrence and overlap of natural disasters, complex emergencies and epidemics during the past decade. Conflict Health. 2007;1:2. https://doi.org/10.1186/1752-1505-1-2
[3]. Khan AI, Chowdhury F, Harris JB, LaRocque RC, Faruque ASG, Ryan ET. Diarrhoea and cholera surveillance for early warning and preparedness among Rohingya populations. PLOS Glob Public Health. 2024;4(2):e0002791. https://doi.org/10.1371/journal.pgph.0002791
[4]. United Nations High Commissioner for Refugees. Rohingya refugee response: Cox’s Bazar operational data portal. Geneva: UNHCR; 2024. https://data.unhcr.org/en/situations/myanmar_refugees
[5]. World Health Organization. Early Warning, Alert and Response System (EWARS) bulletins, Cox’s Bazar. Dhaka: WHO Bangladesh; 2024. https://www.who.int/bangladesh
[6]. Cousins S. Rohingya threatened by infectious diseases. Lancet Infect Dis. 2018;18(6):609-10. https://doi.org/10.1016/S1473-3099(18)30304-9
[7]. Qadri F, Azman AS, Chowdhury F, Khan AI, Saha A, Khan IA. Emergency deployment of oral cholera vaccine for the Rohingya in Bangladesh. Lancet. 2018;391(10133):1877-9. https://doi.org/10.1016/S0140-6736(18)30993-0
[8]. Hsiao A, Desai SN, Mogasale V, Excler JL, Digilio L. Lessons learnt from 12 oral cholera vaccine campaigns in resource-poor settings. Bull World Health Organ. 2017;95(4):303-12. https://doi.org/10.2471/BLT.16.175166
[9]. Global Task Force on Cholera Control. Ending cholera: a global roadmap to 2030. Geneva: World Health Organization; 2017. https://www.gtfcc.org/about-cholera/roadmap-2030/
[10]. Wolfe M, Kaur M, Yates T, Woodin M, Lantagne D. A systematic review and meta-analysis of the association between water, sanitation, and hygiene exposures and cholera in case-control studies. Am J Trop Med Hyg. 2018;99(2):534-45. https://doi.org/10.4269/ajtmh.17-0897
[11]. Taylor DL, Kahawita TM, Cairncross S, Ensink JHJ. The impact of water, sanitation and hygiene interventions to control cholera: a systematic review. PLoS One. 2015;10(8):e0135676. https://doi.org/10.1371/journal.pone.0135676
[12]. Sallis JF, Owen N, Fisher EB. Ecological models of health behavior. In: Health behavior: theory, research, and practice. 5th ed. San Francisco: Jossey-Bass; 2015. p.43-64. https://www.wiley.com/
[13]. Ratnayake R, Finger F, Azman AS, Lantagne D, Funk S, Edmunds WJ. Highly targeted spatiotemporal interventions against cholera epidemics, 2000-19: a scoping review. Lancet Infect Dis. 2021;21(3):e37-48. https://doi.org/10.1016/S1473-3099(20)30479-5
[14]. Lantagne D, Yates T. Household water treatment and cholera control. J Infect Dis. 2018;218(Suppl 3):S147-53. https://doi.org/10.1093/infdis/jiy488
[15]. Bi Q, Ferreras E, Pezzoli L, Legros D, Ivers LC, Date K. Protection against cholera from killed whole-cell oral cholera vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17(10):1080-8. https://doi.org/10.1016/S1473-3099(17)30359-6
[16]. Azman AS, Luquero FJ, Ciglenecki I, Grais RF, Sack DA, Lessler J. The impact of a one-dose versus two-dose oral cholera vaccine regimen in outbreak settings: a modeling study. PLoS Med. 2015;12(8):e1001867. https://doi.org/10.1371/journal.pmed.1001867
[17]. Moore SM, Azman AS, Zaitchik BF, Mintz ED, Brunkard J, Legros D. Prediction of cholera outbreaks with seasonal climate information. Proc Natl Acad Sci U S A. 2017;114(17):4436-41. https://doi.org/10.1073/pnas.1614702114
[18]. Inter-Agency Standing Committee. Inter-agency coordination in protracted humanitarian crises. Geneva: IASC; 2019. https://interagencystandingcommittee.org/
[19]. Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399-421. https://doi.org/10.1146/annurev-publhealth-032013-182354
[20]. Spiegel PB. The humanitarian system is not just broke, but broken: recommendations for future humanitarian action. Lancet. 2017. https://doi.org/10.1016/S0140-6736(17)31278-3
[21]. Bartram J, Cairncross S. Hygiene, sanitation, and water: forgotten foundations of health. PLoS Med. 2010;7(11):e1000367. https://doi.org/10.1371/journal.pmed.1000367
[22]. Cronk R, Bartram J. Environmental conditions in health care facilities in low- and middle-income countries: coverage and inequalities. Int J Hyg Environ Health. 2018;221(3):409-22. https://doi.org/10.1016/j.ijheh.2018.01.004
[23]. Diamond MB, Keshaviah A, Bento AI, Conroy-Ben O, Driver EM, Ensor KB. Wastewater surveillance of pathogens can inform public health responses. Nat Med. 2022;28(10):1992-5. https://doi.org/10.1038/s41591-022-01940-x
[24]. World Health Organization. Multisectoral cholera prevention and control in humanitarian settings: operational guidance. Geneva: World Health Organization; 2025. https://www.who.int/publications
[25]. Checchi F, Warsame A, Treacy-Wong V, Polonsky J, van Ommeren M, Prudhon C. Public health information in crisis-affected populations: a review of methods and their use for advocacy and action. Lancet. 2017;390(10109):2297-313. https://doi.org/10.1016/S0140-6736(17)30702-X
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Inadequate Housing and Physical Health Impairment among Low-Income Households: Evidence from a Pre-Intervention Study in GuyanaAuthor: Sunil GopaulDOI: 10.21522/TIJPH.2013.14.03.Art021
Inadequate Housing and Physical Health Impairment among Low-Income Households: Evidence from a Pre-Intervention Study in Guyana
Abstract:
Housing conditions are important determinants of physical health, yet evidence from rapidly developing settings with persistent housing deficits remains scarce. We conducted a cross-sectional study to assess the housing adequacy factors associated with physical health impairment (PHI) among low-income households targeted for relocation under Guyana’s Adequate Housing and Urban Accessibility Programme (AHUAP). We used pre-relocation data obtained from 127 applicants approved for the programme’s Core Home subsidy from July 2025 to April 2026. PHI was defined as a Physical Component Summary (PCS-12) score ≤ 50. Associations were evaluated through chi-square analyses and multivariable logistic regression using a hierarchical modeling approach. The prevalence of PHI was 66.1% (95% CI: 57.8–74.5), while mean PCS-12 score was 42.0 ± 11.9. Most socio-demographic factors were not significantly associated with PHI (p > 0.05). However, males had lower odds of impairment than females (AOR=0.35, 95% CI: 0.14–0.90; p = 0.028), while households with vulnerable members had higher odds (AOR=2.67, 95% CI: 1.10–6.44; p = 0.029). Lack of durable material and poor structure quality (AOR=3.67, 95% CI: 1.48–9.14; p = 0.005) and insecure tenure (AOR = 2.76, 95% CI: 1.15–6.66; p = 0.023) were independently associated with impairment. Lack of electricity showed a strong association but was excluded from the final multivariable model due to complete separation. These findings underscore the importance of structural housing quality, tenure security, and social vulnerability to physical health outcomes. Longitudinal research is warranted to evaluate changes following relocation.
Inadequate Housing and Physical Health Impairment among Low-Income Households: Evidence from a Pre-Intervention Study in Guyana
References:
[1]. Lisnichuk K. Housing and health. Habitat for Humanity; 2025. Available from: https://www.habitat.org/sites/default/files/documents/Vivienda%20y%20salud_ENG%20%281%29.pdf
[2]. World Health Organization. WHO housing and health guidelines. Geneva: World Health Organization; 2018. Available from: https://www.who.int/publications/i/item/9789241550376
[3]. World Bank. Introducing the adequate housing index (AHI): A new approach to estimate the adequate housing deficit within and across emerging economies. Policy Research Working Paper No. 9830. Washington (DC): World Bank; 2021. Available from: https://documents1.worldbank.org/curated/en/370141635794493951/pdf/Introducing-the-Adequate-Housing-Index-AHI-A-New-Approach-to-Estimate-the-Adequate-Housing-Deficit-within-and-across-Emerging-Economies.pdf
[4]. UN-Habitat. World cities report 2026: The global housing crisis, pathways to action. Nairobi: UN-Habitat; 2026. Available from: https://unhabitat.org/world-cities-report-2026#:~:text=2026-,World%20Cities%20Report%202026%3A%20The%20Global%20Housing%20Crisis%3A%20Pathways%20to,caused%20by%20conflict%20and%20disasters
[5]. UN-Habitat. Land tenure security in selected countries: Global report. Nairobi: UN-Habitat; 2015. Available from: https://unhabitat.org/land-tenure-security-in-selected-countries
[6]. Sousa J. A systematic review about building characteristics as dampness-related indicators. Adv Environ Eng Res. 2024;5(1):008. https://doi.org/10.21926/aeer.2401008.
[7]. Lorentzen JC, Johanson G, Björk F, Stensson S. Overcrowding and hazardous dwelling condition characteristics: A systematic search and scoping review of relevance for health. Int J Environ Res Public Health. 2022;19(23):15542. https://doi.org/10.3390/ijerph192315542
[8]. Kishore S, Venakatesh U, Verma SK, Verma SK, Walia P. Water, sanitation, and hygiene: A global imperative for health. Indian J Community Health. 2023;35(3):367–71. https://doi.org/10.47203/ijch.2023.v35i03.022
[9]. Ly AM, Pierce H, Cope MR. Revisiting the impact of clean water and improved sanitation on child mortality: Implications for sustainable development goals. Sustainability. 2022;14(15):9244. https://doi.org/10.3390/su14159244
[10]. Barron M, Torero M. Household electrification and indoor air pollution. J Environ Econ Manag. 2017;86:81–92. https://doi.org/10.1016/j.jeem.2017.07.007
[11]. Rahman MS, Sujarwoto S, Toiba H, Nugroho TW, Fahriyah F, Shaleh MI, et al. Exploring the impact of cooking fuel choices on household food security and healthy food consumption in Indonesia. Rev Dev Econ. 2025;29:2242–57. https://doi.org/10.1111/rode.13220
[12]. Inter-American Development Bank. Room for development: Housing markets in Latin America and the Caribbean. Washington (DC): Inter-American Development Bank; 2012. https://doi.org/10.18235/0012554
[13]. World Health Organization. Urban health. Geneva: World Health Organization; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/urban-health
[14]. Gopaul S, Tomori MO. Inadequate housing and mental health impairment among low-income households: Evidence from a pre-intervention study in Guyana. Texila Int J Public Health. 2026;14(2). https://doi.org/10.21522/TIJPH.2013.14.02.Art025
[15]. Ware J, Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33. https://doi.org/10.1097/00005650-199603000-00003
[16]. Monaghan C, de Andrade Moral R, McHugh Power J. Modelling the non-linear associations between age and health: Implications for care. Age Ageing. 2024;53(Suppl 4).084. https://doi.org/10.1093/ageing/afae178.084
[17]. Hyslop S, Kirychuk S, Karunanayake CP, Martin W, Rennie D, Bradford L, et al. Exploring relationships between household crowding and health in two First Nations communities. Health Place. 2025;92:103441. https://doi.org/10.1016/j.healthplace.2025.103441
[18]. Vásquez-Vera C, Fernández A, Borrell C. Gender-based inequalities in the effects of housing on health: A critical review. SSM Popul Health. 2022;17:101068. https://doi.org/10.1016/j.ssmph.2022.101068
[19]. Greene J, Marcev I, O'Reilly A, Elliott O'Dare C, McGilloway S, McHugh Power J. The impact of housing insecurity on the health and wellbeing of older adults: A qualitative evidence synthesis. Aging Ment Health. 2026. https://doi.org/10.1080/13607863.2026.2634129
[20]. Reed HR, Nettle D, Parra-Mujica F, Stark G, Wilkinson R, Johnson MT, Johnson EA. Examining the relationship between income and both mental and physical health among adults in the UK. PLoS One. 2025;20(3). https://doi.org/10.1371/journal.pone.0316792
[21]. Nasrin N, Fatema K, Farjana F, Moni NN, Islam MK, Mohsin KF, Ahmed MS. Does employment status associate with physical and mental health status? Asia Pac J Health Manag. 2023;18(1). https://doi.org/10.24083/apjhm.v18i1.1335.
[22]. Panico L, Bartley M, Kelly YJ, McMunn A, Sacker A. Family structure trajectories and early child health in the UK. Soc Sci Med. 2019;232:220–229. https://doi.org/10.1016/j.socscimed.2019.05.006
[23]. Munford LA, Fichera E, Sutton M. Is owning your home good for your health? Econ Hum Biol. 2020;39:100903. https://doi.org/10.1016/j.ehb.2020.100903
[24]. Wolf J, Johnston RB, Ambelu A, Arnold BF, Bain R, Brauer M, et al. Burden of disease attributable to unsafe drinking water, sanitation, and hygiene. Lancet. 2023;401(10393):2060–71. https://doi.org/10.1016/S0140-6736(23)00458-0
[25]. Huang L, Chen S, Wu H, He Y, Zhou M. Implications of sanitation for rural resident health. Front Environ Sci. 2022;10. https://doi.org/10.3389/fenvs.2022.1060558
[26]. Kvalsvig A, Rentta NN, Teng A, Howden-Chapman P, Baker M. Effect of household crowding on infectious disease risk: Systematic review and meta-analysis. SSRN [preprint]. 2023. Available from: https://ssrn.com/abstract=4598965. https://doi.org/10.2139/ssrn.4598965
[27]. Simpson A, Filipe L, Benedetto V, Hill J. The impacts of housing conditions on physical and mental health. Front Environ Health. 2024;3:1352580. https://doi.org/10.3389/fenvh.2024.1352580.
[28]. Bhat AC, Almeida DM, Fenelon A, Santos-Lozada AR. Housing insecurity and physical health. SSM Popul Health. 2022;18:101128. https://doi.org/10.1016/j.ssmph.2022.101128
[29]. Pizzol D, Trott M, Yon DK, Rahmati M, Shin JI, Kamholz B, et al. Unclean cooking fuel use and health outcomes. Health Interact. 2025;1(1). https://doi.org/10.1080/29963257.2025.2463654
[30]. Sanderson K, Andrews G. The SF-12 in the Australian population. Aust N Z J Public Health. 2002;26:343–5. https://doi.org/10.1111/j.1467-842X.2002.tb00182.x
[31]. Soh SE, Morello R, Ayton D, Ahern S, Scarborough R, Zammit C, et al. Measurement properties of the SF-12v2. Health Qual Life Outcomes. 2021;19:157. https://doi.org/10.1186/s12955-021-01794-w
[32]. The jamovi project. jamovi [computer software]. Version 2.6. Sydney: The jamovi project; 2024. Available from: https://www.jamovi.org
[33]. Cattaneo MD, Galiani S, Gertler PJ, Martinez S, Titiunik R. Housing, health, and happiness. Am Econ J Econ Policy. 2009;1(1):75–105. https://doi.org/10.1257/pol.1.1.75
[34]. Aftab A, Noor A, Aslam M. Housing quality and ARI symptoms. PLOS Glob Public Health. 2022;2(9). https://doi.org/10.1371/journal.pgph.0000949
[35]. Baumgartner J, Rodriguez J, Berkhout F, Doyle Y, Ezzati M, Owusu G, et al. Housing tenure and health. Wellcome Open Res. 2023;7:18. https://doi.org/10.12688/wellcomeopenres.17244.2
[36]. Galiani S, Schargrodsky E. Effects of land titling on child health. Econ Hum Biol. 2004;2(3):353–72. https://doi.org/10.1016/j.ehb.2004.10.003
[37]. Irwin BR, Hoxha K, Grépin KA. Electricity access and health. Glob Public Health. 2020;15(3):452–73. https://doi.org/10.1080/17441692.2019.1695873
[38]. UNICEF. Child-friendly regional profile: Region 4, Demerara-Mahaica and Region 3, Essequibo Islands-West Demerara. New York (NY): UNICEF; 2017. Available from: https://www.unicef.org/lac/media/4601/file/PDF%20Region%204:%20Demerara-Mahaica.pdf
[39]. Bureau of Statistics Guyana. Guyana national population and housing census 2022: Preliminary report. Georgetown: Bureau of Statistics Guyana; 2026. Available from: https://statisticsguyana.gov.gy/wp-content/uploads/2019/10/Preliminary-Report-Guyana-National-Population-and-Housing-Census-2022.pdf
[40]. Estrada Fernández ME, Gil Lacruz AI, Gil Lacruz M, Viñas López A. Dependent relative: Effects on family health. Aten Primaria. 2018;50(1):23–34. https://doi.org/10.1016/j.aprim.2016.12.007
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When Incident Rates Mislead: An Integrated Safety and Quality Analysis of FP/PAC Services in Sierra LeoneAuthor: Onunkwor F.IDOI: 10.21522/TIJPH.2013.14.03.Art022
When Incident Rates Mislead: An Integrated Safety and Quality Analysis of FP/PAC Services in Sierra Leone
Abstract:
Safety monitoring in family planning (FP) and post-abortion care (PAC) services in low- and middle-income countries (LMICs) relies on safety flags and incident rates, yet these indicators are rarely interpreted together. This creates a risk that incident rate differences between service delivery channels may be misread as quality deficits when they reflect differences in service scope and case complexity. This study examined safety flags, incident rates, and quality assessment performance in an integrated framework across centre-based facilities and outreach teams in a Sierra Leone FP/PAC programme. A longitudinal observational analysis used 108 Quality Technical Assessment (QTA) records from 23 paired service delivery points across 14 districts (2019–2022). Safety flags and safety domain scores were compared between remote and in-person assessment modalities using chi-square and Mann-Whitney U tests. Clinical and product incident rates per 1,000 couple-years of protection (CYP) were compared between channels. Domain-specific QTA scores were compared across eight quality domains. Safety flags did not differ significantly between modalities (p = .740). Centre-based facilities showed significantly higher incident rates than outreach services (U = 0.00, Z = −2.309, p = .021, r = −0.82). Despite this, no significant channel differences were observed in composite QTA final scores (p = .448) or in any of the eight quality domains. The divergence between higher incident rates at centres and equivalent quality scores indicates the difference reflects structural differences in service scope and case complexity rather than quality deficits. These findings support integrated safety frameworks in reproductive health programme monitoring.
When Incident Rates Mislead: An Integrated Safety and Quality Analysis of FP/PAC Services in Sierra Leone
References:
[1]. Sprockett A, 2017, Review of quality assessment tools for family planning programmes in low- and middle-income countries. Health Policy Plan. 32(2), 292-302. Available from: https://doi.org/10.1093/heapol/czw144
[2]. Donabedian A, 2003, An introduction to quality assurance in health care. Oxford University Press, New York.
[3]. Bruce J, 1990, Fundamental elements of the quality of care: a simple framework. Stud Fam Plann. 21(2), 61-91. Available from: https://doi.org/10.2307/1966525
[4]. Rowe SY, Ross-Degnan D, Peters DH, Holloway KA, Rowe AK, 2022, The effectiveness of supervision strategies to improve health care provider practices in low- and middle-income countries: secondary analysis of a systematic review. Hum Resour Health. 20, 1. Available from: https://doi.org/10.1186/s12960-021-00695-3
[5]. Oluwatola OA, Phelan A, Nellums LB, et al., 2025, Influence of staffing on quality of care in low- and middle-income countries: a systematic review. Health Policy Plan. 40(2), 143-56. Available from: https://doi.org/10.1093/heapol/czae113
[6]. Ayelign A, Zerfw T, Liben ML, et al., 2025, Assessing health systems' capacities to provide post-abortion care: insights from seven low- and middle-income countries. J Glob Health. 15, 04020. Available from: https://doi.org/10.7189/jogh.15.04020
[7]. Pasquier E, Moch M, Pinel A, et al., 2023, Abortion-related complications in fragile settings in sub-Saharan Africa: a retrospective population-based study. Reprod Health. 20(1), 68. Available from: https://doi.org/10.1186/s12978-023-01613-3
[8]. Simmons M, Brown J, Willems J, 2022, Remote general practice supervision with video cameras. Aust J Gen Pract. 51(9), 696-702. Available from: https://doi.org/10.31128/AJGP-10-21-6213
[9]. Hatef E, Wilson RF, Zhang A, et al., 2024, Effectiveness of telehealth versus in-person care during the COVID-19 pandemic: a systematic review. npj Digit Med. 7(1), 157. Available from: https://doi.org/10.1038/s41746-024-01138-4
[10]. Hancock NL, Stuart GS, Tang JH, Chibwesha CJ, Stringer JSA, Chi BH, 2016, Renewing focus on family planning service quality globally. Contracept Reprod Med. 1, 1. Available from: https://doi.org/10.1186/s40834-016-0010-9
[11]. Kruk ME, Gage AD, Joseph NT, Danaei G, García-Saisó S, Salomon JA, 2018, Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. Lancet. 392(10160), 2203-12. Available from: https://doi.org/10.1016/S0140-6736(18)31668-4
[12]. World Health Organization, 2018, Delivering quality health services: a global imperative for universal health coverage. WHO, Geneva. Available from: https://www.who.int/publications/i/item/9789241513906
[13]. Statistics Sierra Leone and ICF, 2020, Sierra Leone Demographic and Health Survey 2019. Stats SL and ICF, Freetown and Rockville. Available from: https://dhsprogram.com/publications/publication-FR365-DHS-Final-Reports.cfm
[14]. Muga W, Owuor P, Njoroge A, et al., 2024, Barriers to post-abortion care service provision in Burkina Faso, Kenya and Nigeria. BMC Health Serv Res. 24, 112. Available from: https://doi.org/10.1186/s12913-024-10574-3
[15]. Hobbs AJ, Mannava P, Hoope-Bender P, et al., 2019, Delivering quality health services: a global framework for action. Int J Qual Health Care. 31(Suppl 1), 1-3. Available from: https://doi.org/10.1093/intqhc/mzy242
[16]. Semaan A, Sidney Annerstedt K, Beňová L, et al., 2023, Provision and utilization of maternal health services during the COVID-19 pandemic in 16 hospitals in sub-Saharan Africa. Front Glob Womens Health. 4, 1192473. Available from: https://doi.org/10.3389/fgwh.2023.1192473
[17]. Odendaal WA, Anstey Watkins J, Leon N, et al., 2020, Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev. 3, CD011942. Available from: https://doi.org/10.1002/14651858.CD011942.pub2
[18]. Rowe AK, de Savigny D, Lanata CF, Victora CG, 2005, How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet. 366(9490), 1026-35. Available from: https://doi.org/10.1016/S0140-6736(05)67028-6
[19]. World Health Organization, 2019, WHO Guideline: Recommendations on Digital Interventions for Health System Strengthening. WHO, Geneva. Available from: https://www.who.int/publications/i/item/9789241550505
[20]. Bogale GG, Amde WK, Kasaye HK, Mwangi W, 2024, Factors associated with quality of family planning counselling in health facilities of sub-Saharan Africa: a systematic review. Reprod Health. 21(1), 14. Available from: https://doi.org/10.1186/s12978-024-01741-8
[21]. McCool J, Dobson R, Muinga N, et al., 2020, Factors influencing the sustainability of digital health interventions in low-resource settings: lessons from five countries. J Glob Health. 10(2), 020396. Available from: https://doi.org/10.7189/jogh.10.020396
[22]. Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J, 2022, The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 17(1), 75. Available from: https://doi.org/10.1186/s13012-022-01245-0
[23]. Bradley S, Kamwendo F, Masanja H, et al., 2013, District health managers' perceptions of supervision in Malawi and Tanzania. Hum Resour Health. 11, 43. Available from: https://doi.org/10.1186/1478-4491-11-43
[24]. Desta BF, Beshir IA, Tefera BB, et al., 2020, Does frequency of supportive supervisory visits influence health service delivery? A dose-response study. PLoS ONE. 15(6), e0234819. Available from: https://doi.org/10.1371/journal.pone.0234819
[25]. Sultan MA, Miller E, Tikkanen RS, et al., 2025, Competency-based education and training for community health workers: a scoping review. BMC Health Serv Res. 25(1), 263. Available from: https://doi.org/10.1186/s12913-025-12403-7
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Macro-Level Health Financing Trends and Household Financial Catastrophe in Nigeria: A Multi-Method Analysis of Institutional Reforms, 2000-2023Author: Maria Ada OchigboDOI: 10.21522/TIJPH.2013.14.03.Art023
Macro-Level Health Financing Trends and Household Financial Catastrophe in Nigeria: A Multi-Method Analysis of Institutional Reforms, 2000-2023
Abstract:
Safety monitoring in family planning (FP) and post-abortion care (PAC) services in low- and middle-income countries (LMICs) relies on safety flags and incident rates, yet these indicators are rarely interpreted together. This creates a risk that incident rate differences between service delivery channels may be misread as quality deficits when they reflect differences in service scope and case complexity. This study examined safety flags, incident rates, and quality assessment performance in an integrated framework across centre-based facilities and outreach teams in a Sierra Leone FP/PAC programme. A longitudinal observational analysis used 108 Quality Technical Assessment (QTA) records from 23 paired service delivery points across 14 districts (2019–2022). Safety flags and safety domain scores were compared between remote and in-person assessment modalities using chi-square and Mann-Whitney U tests. Clinical and product incident rates per 1,000 couple-years of protection (CYP) were compared between channels. Domain-specific QTA scores were compared across eight quality domains. Safety flags did not differ significantly between modalities (p = .740). Centre-based facilities showed significantly higher incident rates than outreach services (U = 0.00, Z = −2.309, p = .021, r = −0.82). Despite this, no significant channel differences were observed in composite QTA final scores (p = .448) or in any of the eight quality domains. The divergence between higher incident rates at centres and equivalent quality scores indicates the difference reflects structural differences in service scope and case complexity rather than quality deficits. These findings support integrated safety frameworks in reproductive health programme monitoring.
Macro-Level Health Financing Trends and Household Financial Catastrophe in Nigeria: A Multi-Method Analysis of Institutional Reforms, 2000-2023
References:
[1]. World Health Organization. Nigeria: health data overview [Internet]. Geneva: World Health Organization; 2023 [cited 2026 Apr 26]. Available from: https://data.who.int/countries/566
[2]. Haider H. Malaria, HIV, and TB in Nigeria: epidemiology and disease control challenges [Internet]. Brighton: Institute of Development Studies and Partner Organizations; 2021 [cited 2026 Apr 26]. Available from: https://hdl.handle.net/20.500.12413/17292
[3]. World Health Organization. Global tuberculosis report 2025 [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Apr 26]. Available from: https://iris.who.int/server/api/core/bitstreams/e97dd6f4-b567-4396-8680-717bac6869a9/content
[4]. Ogbodo OC. Trends and challenges of health care financing in Nigeria. Int J Med Case Rep Rev. 2023;2(5):1-12. Available from: http://doi.org/10.59657/2837-8172.brs.23.030
[5]. Ezenduka C, Onwujekwe O. Health financing. In: Onwujekwe O, et al., editors. Nigeria: country health systems & services profile [Internet]. Geneva: World Health Organization; 2025. p.47-86. Available from: https://ahop.aho.afro.who.int/download/health-financing-nigeria-health-system-and-services-profile/
[6]. Hajji O, El Abbadi B, Akhnif EH. Systematic review of financing functions for universal health coverage in LMICs: reforms, challenges, and lessons learned. Public Health Rev. 2025;46:1607745. Available from: https://doi.org/10.3389/phrs.2025.1607745
[7]. Onwujekwe O, Ezumah N, Mbachu C, Obi F, Ichoku H, Uzochukwu B, et al. Exploring the effectiveness of different health financing mechanisms in Nigeria: what needs to change and how can it happen? BMC Health Serv Res. 2019;19(1):661. Available from: https://doi.org/10.1186/s12913-019-4512-4
[8]. World Health Organization. Global health expenditure database: System of Health Accounts 2011 methodology [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Apr 26]. Available from: https://apps.who.int/nha/database
[9]. World Health Organization, World Bank. Tracking universal health coverage: 2025 global monitoring report [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Apr 26]. Available from: https://doi.org/10.30875/1c58a1b6-en
[10]. World Health Organization. Global spending on health 2020: weathering the storm [Internet]. Geneva: World Health Organization; 2020 [cited 2026 Apr 26]. Available from: https://apps.who.int/iris/handle/10665/337859
[11]. Edeh HC. Catastrophic health expenditure in Nigeria: evidence from household surveys. Health Policy Plan. 2022;37(4):459-70. Available from: https://pubmed.ncbi.nlm.nih.gov/35322315/
[12]. Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, et al. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet. 2022;399(10330):1155-200. Available from: https://doi.org/10.1016/S0140-6736(21)02488-0
[13]. Aniebo CL, Lawani LO, Eze P. The burden and socioeconomic inequality in catastrophic out-of-pocket health expenditure in post-pandemic Nigeria. Glob Soc Welf. 2025. Available from: https://doi.org/10.1007/s40609-025-00423-4
[14]. Thomas-McLean H, Mak R, Noonan CM, Yip W. Global progress toward universal health coverage: learning from successes and failures. Annu Rev Public Health. 2026;47:459-77. Available from: https://doi.org/10.1146/annurev-publhealth-100824-103712
[15]. World Health Organization. Strengthening health financing globally. Resolution WHA78.R12 [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Apr 26]. Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA78/A78_R12-en.pdf
[16]. Micah AE, Cogswell IE, Cunningham B, Ezoe S, Harle AC, Maddison ER, et al.; Global Burden of Disease 2020 Health Financing Collaborator Network. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050. Lancet. 2021;398(10308):1317-43. Available from: https://doi.org/10.1016/S0140-6736(21)01258-7
[17]. International Monetary Fund. World economic outlook database, April 2024 edition [Internet]. Washington (DC): International Monetary Fund; 2024 [cited 2026 Apr 26]. Available from: https://www.imf.org/en/Publications/WEO
[18]. Pesaran MH, Shin Y, Smith RJ. Bounds testing approaches to the analysis of level relationships. J Appl Econ. 2001;16(3):289-326. Available from: https://doi.org/10.1002/jae.616
[19]. Wagstaff A, Eozenou P, Smitz M. Out-of-pocket expenditures on health: a global stocktake. World Bank Res Obs. 2020;35(2):123-57. Available from: https://doi.org/10.1093/wbro/lkz009
[20]. Cleveland WS. Robust locally weighted regression and smoothing scatterplots. J Am Stat Assoc. 1979;74(368):829-36. Available from: https://doi.org/10.1080/01621459.1979.10481038
[21]. World Health Organization. Public spending on health: a closer look at global trends [Internet]. Geneva: World Health Organization; 2018 [cited 2026 Apr 26]. Available from: https://apps.who.int/iris/handle/10665/276728
[22]. Frimpong AO, Amporfu E, Arthur E. Effects of public and external health spending on out-of-pocket payments for healthcare in sub-Saharan Africa. Health Policy Plan. 2022;37(9):1129-37. Available from: https://doi.org/10.1093/heapol/czac068
[23]. World Health Organization Regional Office for Africa. Health expenditure atlas 2023 [Internet]. Brazzaville: WHO Regional Office for Africa; 2023 [cited 2026 Apr 26]. Available from: https://www.afro.who.int/publications/who-african-region-health-expenditure-atlas-2023-0
[24]. Eze P, Aniebo CL, Ilechukwu S, Lawani LO. Understanding unmet healthcare needs in Nigeria: implications for universal health coverage. Health Serv Insights. 2025;18. Available from: https://doi.org/10.1177/11786329251330032
[25]. Orji A, Ogbuabor JE, Mba PN, Anthony-Orji OI. Are wealthy countries always healthy? Health outcomes and public health spending nexus in Nigeria. SAGE Open. 2021;11(3). Available from: https://doi.org/10.1177/21582440211040793
[26]. Patenaude BN. Development assistance for health and domestic health spending: a cross-country analysis. BMJ Glob Health. 2021;6(4):e004820. Available from: https://doi.org/10.1136/bmjgh-2020-004820
[27]. Awoyemi BO, Makanju AA, Mpapalika J, Ekpeyo RS. A time series analysis of government expenditure and health outcomes in Nigeria. J Public Health Afr. 2023;14(7):1409. Available from: https://doi.org/10.4081/jphia.2023.1409
[28]. Madu CA, Osborne K. Healthcare financing in Nigeria: a policy review. Int J Soc Determinants Health Health Serv. 2023;53(4). Available from: https://doi.org/10.1177/27551938231173611
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Socio-Cultural Factors Associated with Teenage Pregnancy among Adolescent Girls in Jewi Refugee Camp, Gambella Region, EthiopiaAuthor: Koang Jock DengDOI: 10.21522/TIJPH.2013.14.03.Art024
Socio-Cultural Factors Associated with Teenage Pregnancy among Adolescent Girls in Jewi Refugee Camp, Gambella Region, Ethiopia
Abstract:
Teenage pregnancy remains a pressing public health issue with profound health, social, and economic consequences for adolescent girls, their families, and communities. It is associated with many socio-cultural factors that influence the occurrence of teenage pregnancy and sexual and reproductive health risk behaviors. This study assessed the prevalence of teenage pregnancy and socio-cultural factors among adolescent girls in Jewi Refugee Camp, Gambella Region. A community-based cross-sectional study was conducted from February 1 to March 30, 2026, employing a systematic sampling technique among female adolescents aged 13 to 19 years. Data were collected using a structured, pretested questionnaire with Kobo Collect software and analyzed in SPSS version 25. Pregnancy was confirmed using urine Human Chorionic Gonadotropin (HCG) test kits. A modified Poisson regression model was applied, and statistical significance was declared at p < 0.05. All 383 female adolescents participated in this study, yielding a response rate of 100%. The prevalence of teenage pregnancy was 33.2%. The mean age at first pregnancy was 15.46 years. Factors significantly associated with teenage pregnancy were age group (APR=1.354, 95% CI: 1.073 – 1.708), family planning use (APR = 2.755; 95% CI: 1.669 – 4.546), transactional sex (APR = 0.328; 95% CI: 0.206 – 0.523), parent-adolescent communication (APR=0.24, 95% CI: 0.114 – 0.51), and family pressure for early marriage (APR = 1.560; 95% CI: 1.144 – 2.128). The prevalence of teenage pregnancy was high. Comprehensive intervention is needed to strengthen access to family planning services, discourage child marriage, and address socio-cultural norms. Future qualitative research is needed to validate these findings.
Socio-Cultural Factors Associated with Teenage Pregnancy among Adolescent Girls in Jewi Refugee Camp, Gambella Region, Ethiopia
References:
[1]. Akol M, Opito R, Oryokot B, Akurut H, Kalema J, Chekwoti M, et al. Prevalence and factors associated with teenage pregnancy among girls aged 13 to 19 years in Atutur sub-county , Kumi district , Eastern Uganda : a community-based cross- sectional study. Reprod Health. 2025;22(101):2–7.
[2]. Shimilimo A, Amos MM, Million ST, Courage C, Adesina O. The influence of cultural practices and socioeconomic factors on teenage pregnancy across selected primary health care centers in Akinyele local government area , Ibadan , Nigeria. Int J Reprod. 2025;14(6):1722–30.
[3]. Whiting-Collins L, Serbanescu F, Moller A-B, Binzen S, Monet J-P, Cresswell JA, et al. Maternal death surveillance and response system reports from 32 low-middle income countries, 2011-2020: What can we learn from the reports? PLOS Global Public Health. 2024;4(3).
[4]. Franjić* S. Adolescent Pregnancy is a Serious Social Problem. Journal of Gynecological earch Obstetrics. 2018;4(1):6–9.
[5]. Akella D. Socio-Cultural Influences on Teenage Pregnancy and Contemporary Prevention Measures. 2019.
[6]. Aynalem BY, Melesse MF, Bitewa YB. Cultural Beliefs and Traditional Practices During Pregnancy , Child Birth, and the Postpartum Period in East Gojjam Zone , Northwest Ethiopia : A Qualitative Study. Women’s Heal Reports. 2023;4(1):415–22.
[7]. Amoadu M, Ansah EW, Assopiah P, Acquah P, Ansah JE, Berchie E, et al. Socio‑Cultural Factors Influencing Adolescent Pregnancy in Ghana : a scoping review. BMC Pregnancy and Childbirth. 2022;22(834):1–13. Available from: https://doi.org/10.1186/s12884-022-05172-2
[8]. Asoc P, Todorova B. ADOLESCENT PREGNANCY : OCCURRENCE ANDCONSEQUENCES. Prizren Social Science Journal. 2020;4(1):28–34.
[9]. Subani P, Ramadhaniati Y, Aprianti R, Wulan S. Factors Associated with Adolescent Pregnancy in Selebar District Bengkulu City. IAKMI Public Health Journal Indonesia. 2020;1(2):75–81.
[10]. WHO. Adolescent pregnancy Evidence brief. Human Reproduction Program. 2019;1–4.
[11]. Alemayehu MA, Birhanie AL, Abebe MT, Tilahun WM, et al. Spatial distribution of teenage pregnancy and its associated factors in Ethiopia : spatial and multilevel analysis of EDHS 2019. Archives of Public Health. 2024;82(165).
[12]. Okello EO, Musinguzi M, Opollo MS, Eustes K, Akello AR. Factors Associated with Teenage Pregnancy among Refugees in Palabek Refugee Settlement , Northern Uganda. BMC Pregnancy and Childbirth. 2024;24(708):1-8.
[13]. UNFPA Ethiopia. PATHWAYS TO EQUALITY : SAVING LIVES AND ADVANCING RIGHTS FOR ALL IN ETHIOPIA. ANNUAL REPORT. 2023.
[14]. Eastman A, Olunuga O, Moges T. Socio-Cultural Barriers Influencing Unplanned Pregnancy in Mugombwa Refugee Camp, Rwanda: Female Adolescents’ Perspectives. Adolescent Journal. 2023;3:259–77.
[15]. Mezmur H, Assefa N, Alemayehu T. Teenage pregnancy and its associated factors in eastern ethiopia: A community-based study. International Journal of Women's Health. 2021;13:267–78.
[16]. Bekele YA, Fekadu GA. Factors Associated with Unintended Pregnancy in Ethiopia; further analysis of the 2016 Ethiopian demographic health survey data. BMC Pregnancy and Childbirth. 2021;21:486.
[17]. Habitu YA, Yalew A, Bisetegn TA. Prevalence and Factors Associated with teenage pregnancy, Northeast Ethiopia, 2017: A cross-sectional study. Journal of Pregnancy. 2018;2018.
[18]. Adhena G, Fikre A. Teenage Pregnancy matters in Refugee Setup: early pregnancy among adolescent girls in Kule refugee camp , Gambella , Ethiopia. BMC Pregnancy and Childbirth. 2023;23(861).
[19]. UNHCR. South Sudan Emergency Refugee Population Gambella fact sheet. 2024.
[20]. United Nations Children’s Fund. Gambella Regional Brief. 2022.
[21]. Cleland J, Ingham R, Stone N. Asking young people about sexual and reproductive behaviours : Illustrative Core Instruments. 2001.
[22]. Okello EO, Musinguzi M, Opollo MS, Eustes K, Akello AR. Factors associated with teenage pregnancy among refugees in Palabek refugee settlement , Northern Uganda. BMC Pregnancy Childbirth. 2024;24(708):8.
[23]. Nshimiyimana I, Monica M, Habimana A. Factors associated with adolescent pregnancy among girls aged between 15 and 19 years in Muhanga district , Rwanda. 2025;1–15.
[24]. Geta TG, Abdiwali SA, Farah MM. Magnitude and Factors Associated with Teenage Pregnancy in Somaliland: Evidence from Somaliland Health and Demographic Survey, 2020. International Journal of Women's Health. 2023;15:1443–52.
[25]. Malunga G, Sangong S, Saah FI, Bain LE. Prevalence and factors associated with adolescent pregnancies in Zambia : a systematic review from 2000 – 2022. Archives Public Health. 2023;81:27.
[26]. Gebeyehu AA, Teshome AA, Teshager W, Teshome F, Tiruneh M, et al. Trends Change in Teen Pregnancy among Adolescent Women in Ethiopia based on Ethiopian Demographic and Health Surveys : Multivariate decomposition analysis. PLOS ONE. 2023;1–14. Available from: http://dx.doi.org/10.1371/journal.pone.0287460
[27]. Geda YF. Determinants of Teenage Pregnancy in Ethiopia: A Case– Control Study, 2019. Current Medical Issues. 2019;17(4):112–7.
[28]. Asmamaw DB, Tafere TZ, Negash WD. Prevalence of teenage pregnancy and its associated factors in high fertility sub‑Saharan Africa countries : a multilevel analysis. BMC Women's Health. 2023;23(23):1–10. Available from: https://doi.org/10.1186/s12905-023-02169-7
[29]. Phiri M, Kasonde ME, Moyo N, Sikaluzwe M, Simona S. A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018). Reproductive Health. 2023;20(16):1–13. Available from: https://doi.org/10.1186/s12978-023-01567-2
[30]. Tanabe M, Myers A, Bhandari P, Cornier N, Doraiswamy S, Krause S. Family planning in refugee settings: findings and actions from a multi-country study. 2017;11(9).
[31]. Franjić S. Adolescent Pregnancies Are Not Only a Significant Medical Problem. Journal of Contemporary Medical Education. 2021;11(8):13–7. Available from: www.jcmedu.org
[32]. Mihretie GN, Kassa BG, Ayele AD, Liyeh MT, Belay HG, et al. Transactional sex among women in Sub-Saharan Africa : A systematic review and meta- analysis. PLoS One. 2023;18(6):1–22.
[33]. Clovis S, Noutchie O. Breaking the cycle : Addressing teenage pregnancy in South African high schools. International Journal of Research in Business and Social Science. 2024;13(8):2151–6.
[34]. Stoebenau K, Heise L, Wamoyi J, Bobrova N. Revisiting the understanding of “ transactional sex ” in sub-Saharan Africa : A review and synthesis of the literature. Social Science and Medicine. 2016;168(2016):186–97. Available from: http://dx.doi.org/10.1016/j
[35]. Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and Determinants of Adolescent Pregnancy in Africa: A systematic review and Meta-analysis. Reproductive Health. 2018;15(195):1–17.
[36]. Ipas Partners for Reproductive Justice. The challenges of child marriage, teenage pregnancy and school dropout Teen pregnancy. Fact Sheet. 2024;1.
[37]. ACERWC AU. Teenage Pregnancy in Africa Status, Progress & Challenges. Journal of ACERWC. 2022.1 - 99.
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Assessment of the Operational Coordination of Surveillance and Response to Noncommunicable Diseases in the Butembo Branch of the North Kivu Provincial Health Division, DRCAuthor: Kasereka Wanzuwite EmmanuelDOI: 10.21522/TIJPH.2013.14.03.Art025
Assessment of the Operational Coordination of Surveillance and Response to Noncommunicable Diseases in the Butembo Branch of the North Kivu Provincial Health Division, DRC
Abstract:
Coordinated surveillance and response are essential for transforming data on noncommunicable diseases (NCDs) into evidence-based prevention and care interventions. This study assessed the level of such coordination in the health districts under the jurisdiction of the Butembo provincial health division in the Democratic Republic of the Congo. This quantitative, descriptive, cross-sectional, evaluative study used a comprehensive approach across all 17 health districts under the Butembo provincial health division. Data were collected using a framework combining a structured questionnaire, observation rubrics, a document review, and the extraction of indicators from the District Health Information Software 2 (DHIS2). Standardised scores were classified as low (<50%), moderate (50–74%), or high (≥75%). The average overall coordination score was 33.76 ± 5.90%, and all districts scored at a low level. The mean score was 45.93% ± 7.16% for surveillance coordination, 34.74% ± 3.85% for organizational capacity and 17.86% ± 11.35% for response coordination. Indicators extracted from DHIS2 had the highest score (86.76%), while coordination of risk factor surveillance was nearly nonexistent (3.43%). The existing system was primarily oriented towards data collection and transmission, with limited translation of surveillance data into concrete prevention and care interventions. Strengthening the surveillance system and integrating NCDs into health and humanitarian emergency preparedness and response plans are essential.
Assessment of the Operational Coordination of Surveillance and Response to Noncommunicable Diseases in the Butembo Branch of the North Kivu Provincial Health Division, DRC
References:
[1]. Organisation Mondiale de la Santé. Maladies non transmissibles [Internet]. 2025 [cited 2025 Oct 2]. https://www.who.int/fr/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed 2 Oct 2025
[2]. Freihat O, Sipos D, Aamir M, Kovacs A. Global burden and future projections of non-communicable diseases (2000–2050): Progress toward SDG 3.4 and disparities across regions and risk factors. Hennis AJM, editor. PLoS One [Internet]. 2025 [cited 2026 Apr 1];20:e0336036. https://doi.org/10.1371/journal.pone.0336036
[3]. World Health Organization. Noncommunicable diseases progress monitor 2025. World Health Organization; 2025.
[4]. World Health Organization. Noncommunicable diseases. World Health Organization; 2025.
[5]. Zhu M, Xu S, Li Y, Wang W, Liu L, Xu Q, et al. Global burden of non-communicable diseases attributable to behavioral factors. Science Bulletin [Internet]. 2025 [cited 2026 Apr 1];70:3129–33. https://doi.org/10.1016/j.scib.2025.08.037
[6]. World Health Organization Regional Office for Africa. Noncommunicable diseases in Africa: The invisible epidemic (Analytical fact sheet: NCD morbi-mortality). African Health Observatory. World Health Organization Regional Office for Africa; 2022.
[7]. World Health Organization Regional Office for Africa. Noncommunicable diseases and mental health in the WHO African Region: Progress report 2024. World Health Organization Regional Office for Africa; 2024.
[8]. Ahmed SM, Krishnan A, Karim O, Shafique K, Naher N, Srishti SA, et al. Delivering non-communicable disease services through primary health care in selected south Asian countries: are health systems prepared? The Lancet Global Health [Internet]. 2024 [cited 2025 Dec 29];12:e1706–19. https://doi.org/10.1016/S2214-109X(24)00118-9
[9]. Barry A, Impouma B, Wolfe CM, Campos A, Richards NC, Kalu A, et al. Non-communicable diseases in the WHO African region: analysis of risk factors, mortality, and responses based on WHO data. Sci Rep [Internet]. 2025 [cited 2026 Mar 25];15:12288. https://doi.org/10.1038/s41598-025-97180-3
[10]. Ministère de la santé Publique, Hygiène et Prévoyance sociale de la RDC. Plan National de Développement Sanitaire et de Prévoyance Sociale (PNDS-PS 2024-2033). Cadre d’accélération des progrès vers l’atteinte des objectifs liés à la santé et à la protection sociale en santé. 2024.
[11]. RDC/Ministère du Plan et Ministère de la santé. Enquête Démographique et de santé 2013-2014 [Internet]. Kinshasa; 2014 [cited 2024 Mar 30]. https://www.unicef.org/drcongo/media/1046/file/EDS-RDC%20II%202013-2014.pdf Accessed 30 Mar 2024
[12]. World Health Organization. Health at a glance Democratic Republic of the Congo (created 11/12/2024). WHO Data. World Health Organization; 2024.
[13]. Division Provinciale de la Santé du Nord-Kivu. Données provinciales de routine sur les maladies non transmissibles, 2019–2023 : extraction DHIS2 [Jeu de données non publié]. Ministère de la Santé Publique, Hygiène et Prévention, République Démocratique du Congo; 2024.
[14]. Bahizire CM, Ngadjole HC, Kikangala EB, Mukuku O, Wembonyama SO. Community-based prevalence and factors associated with hypertension in adults in the rural Nyiragongo Health Zone, North Kivu Province, Democratic Republic of the Congo: a cross-sectional study. bmjph [Internet]. 2026 [cited 2026 Apr 1];4:e004241. https://doi.org/10.1136/bmjph-2025-004241
[15]. Kabir A, Karim MN, Islam RM, Romero L, Billah B. Health system readiness for non-communicable diseases at the primary care level: a systematic review. BMJ Open [Internet]. 2022 [cited 2025 Dec 29];12:e060387. https://doi.org/10.1136/bmjopen-2021-060387
[16]. Akinwumi AF, Esimai OA, Arije O, Ojo TO, Esan OT. Preparedness of primary health care facilities on implementation of essential non-communicable disease interventions in Osun State South-West Nigeria: a rural–urban comparative study. BMC Health Serv Res [Internet]. 2023 [cited 2026 Mar 25];23:154. https://doi.org/10.1186/s12913-023-09138-8
[17]. Defar A, Zeleke GT, Berhanu D, Lemango ET, Bekele A, Alemu K, et al. Health system’s availability and readiness of health facilities for chronic non-communicable diseases: Evidence from the Ethiopian national surveys. Garg CC, editor. PLoS ONE [Internet]. 2024 [cited 2026 Jan 11];19:e0297622. https://doi.org/10.1371/journal.pone.0297622
[18]. Eltigany M, Drown L, Akala O, Ussai S, Bukhman G, Cieza A, et al. Models of care for noncommunicable diseases in primary care: key elements and design in low- and middle-income countries – a scoping review. Global Health Action [Internet]. 2025 [cited 2025 Dec 29];18:2543604. https://doi.org/10.1080/16549716.2025.2543604
[19]. Akik C, El Dirani Z, Willis R, Truppa C, Zmeter C, Aebischer Perone S, et al. Providing continuity of care for people living with noncommunicable diseases in humanitarian settings: A qualitative study of health actors’ experiences in Lebanon. Journal of Migration and Health [Internet]. 2024 [cited 2026 Mar 25];10:100269. https://doi.org/10.1016/j.jmh.2024.100269
[20]. Jobanputra K, Perone SA, Ansbro É, Baraiah S, Beran D, Bhagwat S, et al. Strengthening non-communicable disease care in all-hazards emergencies. The Lancet Diabetes & Endocrinology [Internet]. 2025 [cited 2026 Apr 11];13:891–6. https://doi.org/10.1016/S2213-8587(25)00223-2
[21]. Médecins Sans Frontières (MSF). Piecing together bodies and minds in eastern DRC [Internet]. 2025 [cited 2026 Jan 13]. https://www.msf.org/piecing-together-bodies-and-minds-eastern-drc Accessed 13 Jan 2026
[22]. Kallay R, Mbuyi G, Eggers C, Coulibaly S, Kangoye DT, Kubuya J, et al. Assessment of the integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021. BMC Public Health [Internet]. 2024 [cited 2026 Jan 13];24:1150. https://doi.org/10.1186/s12889-024-18642-3
[23]. Comité international de la Croix-Rouge (CICR). Affrontements armés au Nord-Kivu : si tu tombes malade, la mort assurée [Internet]. 2022. https://www.icrc.org/fr/document/affrontements-armes-kivu-si-tu-tombes-malade-la-mort-assuree?utm
[24]. World Health Organization. WHO package of essential noncommunicable (PEN) disease interventions for primary health care [Internet]. World Health Organization; 2020. https://www.who.int/publications/i/item/who-package-of-essential-noncommunicable-%28pen%29-disease-interventions-for-primary-health-care
[25]. World Health Organization. Service Availability and Readiness Assessment (SARA): Reference manual, version 2.2. [Internet]. World Health Organization; 2015 [cited 2026 Jan 9]. https://cdn.who.int/media/docs/default-source/documents/ddi/score/tools/sara_referencemanual.pdf?sfvrsn=7f9cfef4_3& Accessed 9 Jan 2026
[26]. World Health Organization. The WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS): STEPS Manual [Internet]. WHO Geneva; 2017 [cited 2025 Nov 10]. https://www.who.int/docs/default-source/ncds/ncd-surveillance/steps/steps-manual.pdf Accessed 10 Nov 2025
[27]. Zakariya YF. Cronbach’s alpha in mathematics education research: Its appropriateness, overuse, and alternatives in estimating scale reliability. Front Psychol [Internet]. 2022 [cited 2026 June 20];13:1074430. https://doi.org/10.3389/fpsyg.2022.1074430
[28]. Schwappach D, Hautz W, Krummrey G, Pfeiffer Y, Ratwani RM. EMR usability and patient safety: a national survey of physicians. npj Digit Med [Internet]. 2025 [cited 2026 July 22];8:282. https://doi.org/10.1038/s41746-025-01657-4
[29]. Cohen P, Cohen J, Aiken LS, West SG. The Problem of Units and the Circumstance for POMP. Multivariate Behavioral Research [Internet]. 1999 [cited 2026 July 23];34:315–46. https://doi.org/10.1207/S15327906MBR3403_2
[30]. Müller SA, Elimian K, Rafamatanantsoa JF, Reichert F, Mosala F, Böff L, et al. The burden and treatment of non-communicable diseases among healthcare workers in sub-Saharan Africa: a multi-country cross-sectional study. Front Public Health [Internet]. 2024 [cited 2026 Mar 30];12:1375221. https://doi.org/10.3389/fpubh.2024.1375221
[31]. World Health Organization. Data quality review: A toolkit for facility data quality assessment. Module 1: Framework and metrics [Internet]. World Health Organization; 2020. https://cdn.who.int/media/docs/default-source/world-health-data-platform/rhis-modules/dqa-module-1-framework-and-metrics.pdf?sfvrsn=bdbfa280_2&
[32]. Yusuph F, Ntwenya JE, Kinyaga A, Gibore NS. Routine health data use for decision making and its associated factors among primary healthcare managers in dodoma region. BMC Health Serv Res [Internet]. 2024 [cited 2026 Mar 30];24:1168. https://doi.org/10.1186/s12913-024-11658-w
[33]. Ministère de la Santé Publique, Hygiène et Prévoyance Sociale. Enquête sur les facteurs de risque des maladies non transmissibles dans les provinces de Kinshasa, Thsopo et Kasai Orientale. Kinshasa; 2025.
[34]. Katende D, Nalweyiso N, Nabulime G, Nakuya K, Mubiru MC, Sekitoleko I, et al. Sustainability capacity and health worker normalisation of a successful non-communicable disease (NCD) health systems intervention within primary care settings in Uganda: a quantitative approach to a qualitative question. BMC Health Serv Res [Internet]. 2023 [cited 2026 July 19];23:970. https://doi.org/10.1186/s12913-023-09948-w
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Erosion behind the Volume: A Retrospective Longitudinal Analysis of the Resilience of Maternal Newborn and Child Health Services Following USAID exit in NigeriaAuthor: Justus Azunku UzimDOI: 10.21522/TIJPH.2013.14.03.Art026
Erosion behind the Volume: A Retrospective Longitudinal Analysis of the Resilience of Maternal Newborn and Child Health Services Following USAID exit in Nigeria
Abstract:
Nigeria’s maternal, newborn, and child health (MNCH) services depend heavily on external donor funding, particularly from the United States Agency for International Development (USAID). Following December 2023 closure of USAID’s flagship MNCH project in Bauchi State, and the global suspension in 2025, this study evaluates the impact on sustainability of MNCH services in a high-burden setting. Using a retrospective longitudinal design, the study analysed routine administrative data from 454 health facilities over a 48-month period (January 2022 - December 2025). Nine indicators were assessed using Wilcoxon signed-rank test and Interrupted Time Series analysis to examine performance during and after USAID implementation. The results showed that while absolute volumes on antenatal visits and facility deliveries continued to rise, critical coverage indicators, specifically Penta3 and fully immunized child (FIC) rates, recorded declines (p < 0.05). Multi-variable mixed-effects regression identified participation in the Basic Health Care Provision Fund (BHCPF) as the most consistent independent protective factor for resilience (p < 0.001), followed by location within Maternal Neonatal Mortality Reduction Innovation Initiative (MAMII) priority locations. Private and secondary health facilities demonstrated greater vulnerability to funding shocks. These findings suggest that tracking volume alone can mask the active erosion of quality of care after donor exit. The study concludes that MNCH sustainability is a direct consequence of domestic planning. Policy makers must prioritize stabilizers like the BHCPF and incorporate trend-based monitoring to safeguard gains post donor funding.
Erosion behind the Volume: A Retrospective Longitudinal Analysis of the Resilience of Maternal Newborn and Child Health Services Following USAID exit in Nigeria
References:
[1]. Pitt C, Bath D, Binyaruka P, Borghi J, Martinez-Alvarez M. Falling aid for reproductive, maternal, newborn and child health in the lead-up to the COVID-19 pandemic. BMJ Glob Health. 2021 Jun;6(6): e006089. doi: 10.1136/bmjgh-2021-006089. PMID: 34108147; PMCID: PMC8190982.
[2]. Barasa E, Chuma J, Nonvignon J, Adeyi OO. Avoidable pitfalls on the path to health financing self-reliance in low-income and middle-income countries. BMJ Glob Health. 2025 Nov 29;10(11): e021270. doi: 10.1136/bmjgh-2025-021270. PMID: 41320201; PMCID: PMC12666224.
[3]. African Union Commission, United Nations Economic Commission for Africa, African Development Bank, & United Nations Development Programme. Africa sustainable development report 2025: Accelerating the recovery from multiple crises and the full implementation of the 2030 agenda for sustainable development at all levels. 2025, October 5. Retrieved April 8, 2026.
[4]. Auwal AR, Ishak AS, Saidu Musa S, Musa A, Saadu A, Riaz A. The global implications of U.S. withdrawal from WHO and the USAID shutdown: challenges and strategic policy considerations. Front Public Health. 2025 Jun 2;13:1589010.
doi: 10.3389/fpubh.2025.1589010.
PMID: 40529700; PMCID: PMC12171363.[5]. Oladele EA, Musheke M, Mulenga F, Samona A, Iyamu I, Phiri A, Phiri N, Chabikuli ON. Preventing disruptions in HIV service delivery to key populations during project transition from an International to a local Implementing Partner: A case study from Zambia. Glob Health Sci Pract. 2026 Jan 6;13(2):e2400186. doi: 10.9745/GHSP-D-24-00186. PMID: 41371945;
PMCID: PMC12838758.[6]. Modibbo HU, Jibir A, & Abubakar UU. Donor transition and healthcare financing in Nigeria: An analysis of fiscal sustainability and household economic effect. NDA Journal of Economics and Finance. 2006 April;9(1): 224-37.
[7]. Brunner F, Gatti F, & Hall T. A blessing or a curse? The role of money in shaping international health governance. European Journal of International Relations. 2025 Nov 27; https://doi.org/10.1177/13540661251391116
[8]. Sulgodu Ramachandra S, Webster P. USA's exit from the WHO and freeze on USAID funds globally: its perils and possible opportunities. J Public Health (Oxf). 2025 Dec 18;47(Supplement_1):i16-i20.
doi: 10.1093/pubmed/fdaf122. PMID: 41410401; PMCID: PMC12847063.[9]. Obi US, Ogbuoji O, Mao W, Shahid M, Onwujekwe O, Yamey G. Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance. Health Policy Plan. 2021 Aug 12;36(7):1045-57.
doi: 10.1093/heapol/czab051. PMID: 33942865; PMCID: PMC8359748.[10]. Cavalcanti DM, de Oliveira Ferreira de Sales L, da Silva AF, Basterra EL, Pena D, Monti C, Barreix G, Silva NJ, Vaz P, Saute F, Fanjul G, Bassat Q, Naniche D, Macinko J, Rasella D. Evaluating the impact of two decades of USAID interventions and projecting the effects of defunding on mortality up to 2030: a retrospective impact evaluation and forecasting analysis. Lancet. 2025 Jul 19;406(10500):283-94. doi: 10.1016/S0140-6736(25)01186-9. Epub 2025 Jun 30.
PMID: 40609560; PMCID: PMC12274115.[11]. National Population Commission (NPC), Federal Ministry of Health and Social Welfare (FMOHSW), ICF. Nigeria Demographic and Health Survey 2024. Abuja, Nigeria, and Rockville, Maryland, USA: NPC, FMOHSW, and ICF; 2025.
[12]. Belaid L, Ansari U, Omer K, Gidado Y, Baba MC, Daniel LE, Andersson N, Cockcroft A. "I had to change my attitude": narratives of most significant change explore the experience of universal home visits to pregnant women and their spouses in Bauchi State, Nigeria. Arch Public Health. 2021 Nov 18;79(1):202.
doi: 10.1186/s13690-021-00735-9.
PMID: 34794488; PMCID: PMC8600880.[13]. Ibrahim U, Wan-Puteh SE. An overview of civil society organizations' roles in health project sustainability in Bauchi State, Nigeria. Pan Afr Med J. 2018 Jun 20;30:150.
doi: 10.11604/pamj.2018.30.150.15851.
PMID: 30374396; PMCID: PMC6201623.[14]. Matsuoka S, Kawakatsu Y, Koga S, Ayeola N, Iwayemi V, Saito C, Murakami H, Hachiya M. Underlying causes of underutilization of maternal, neonatal and child health (MNCH) services in Africa: A survey from Lagos State, Nigeria. Glob Health Med. 2020 Jun 30;2(3):184-9.
doi: 10.35772/ghm.2020.01012. PMID: 33330805; PMCID: PMC7731355.[15]. Alawode G, Adewoyin AB, Abdulsalam AO, Ilika F, Chukwu C, Mohammed Z, Kurfi A. The Political Economy of the Design of the Basic Health Care Provision Fund (BHCPF) in Nigeria: A Retrospective Analysis for Prospective Action. Health Syst Reform. 2022 Jan 1;8(1):2124601.
doi: 10.1080/23288604.2022.2124601.
PMID: 36170653.[16]. Tella E. Accelerating Progress Toward SDG 3: Lessons from Nigeria's maternal and neonatal mortality reduction innovation Initiative (MAMII). The Guardian (Nigeria). 2026 March 26;Opinion. Accessed online on 18th of July, 2026 from https://guardian.ng/opinion/accelerating-progress-toward-sdg-3-lessons-from-nigerias-maternal-and-neonatal-mortality-reduction-innovation-initiative-mamii/
[17]. Dougherty L, Adediran M, Akinola A, Alabi M, Etim EO, Ohioghame J, Adedimeji A. An evaluation of a multi-partner approach to increase routine immunization coverage in six northern Nigerian States. BMC Health Serv Res. 2024 Aug 20;24(1):951. doi: 10.1186/s12913-024-11403-3. PMID: 39164689; PMCID: PMC11337754.
[18]. Chagoma N, Sweeney R, Mazumdar S, Suhrcke M. The impact of official development assistance for health on health outcomes: a rapid systematic review. Health Policy Plan. 2026 Mar 10;41(3):442-459. doi: 10.1093/heapol/czaf102. PMID: 41332186; PMCID: PMC12972673.
[19]. Taylor EM, Hayman R, Crawford F, Jeffery P, Smith J. The impact of official development aid on maternal and reproductive health outcomes: a systematic review. PLoS One. 2013;8(2):e56271. doi: 10.1371/journal.pone.0056271. Epub 2013 Feb 22. PMID: 23468860; PMCID: PMC3579872.
[20]. Qiu M, Paina L, Rodríguez DC, Wilhelm JA, Eze-Ajoku E, Searle A, Zakumumpa H, Ssengooba F, MacKenzie C, Bennett S. Exploring perceived effects from loss of PEPFAR support for outreach in Kenya and Uganda. Global Health. 2021 Jul 17;17(1):80. doi: 10.1186/s12992-021-00729-w. PMID: 34273988; PMCID: PMC8285775.
[21]. Ssegujja E, Namakula J, Kabagenyi A, Kyozira C, Musila T, Zakumumpa H, Ssengooba F. The impact of donor transition on continuity of maternal and newborn health service delivery in Rwenzori sub-region of Uganda: a qualitative country case study analysis. Global Health. 2023 Jul 10;19(1):48. doi: 10.1186/s12992-023-00945-6. PMID: 37430280; PMCID: PMC10334577.
[22]. Dogbanya G. Maternal Mortality in Nigeria: Holding the Line in Uncertain Times. Ann Glob Health. 2025 Mar 25;91(1):16. doi: 10.5334/aogh.4710. PMID: 40161361;
PMCID: PMC11951968.[23]. United States. Executive Order Number 14169: Reevaluating and Realigning United States Foreign Aid. Federal Register. 2025 Feb;90(8619). https://www.federalregister.gov/documents/2025/01/30/2025-02091/reevaluating-and-realigning-united-states-foreign-aid
[24]. National Population Commission (NPC). Nigeria population projections and demographic indicators: National and states (2007–2022). Abuja: NPC; 2020. Accessed 2026 Jul 18. Available from: https://nationalpopulation.gov.ng.
[25]. Higazi A, Lar J. Articulations of belonging: the politics of ethnic and religious pluralism in Bauchi and Gombe States, North-East Nigeria. Africa. 2015;85(1):103–30. doi:10.1017/S0001972014000795.
[26]. Python Software Foundation. Python Programming Language, Version 3.12.13. Delaware: Python Software Foundation; 2026. Available from: https://www.python.org
[27]. Google LLC. Google Colaboratory. Mountain View: Google LLC; 2026. Available from: https://colab.google.
[28]. Daniel WW, and Cross CL. Biostatistics: A Foundation for Analysis in the Health Sciences. 10th Edition, John Wiley & Sons, Hoboken. 2013.
[29]. Hudson J, Fielding S, Ramsay CR. Methodology and reporting characteristics of studies using interrupted time series design in healthcare. BMC Med Res Methodol. 2019 Jul 4;19(1):137.
doi: 10.1186/s12874-019-0777-x.
PMID: 31272382; PMCID: PMC6609377.[30]. Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 2017 Feb 1;46(1):348-355.
doi: 10.1093/ije/dyw098. Erratum in: Int J Epidemiol. 2020 Aug 1;49(4):1414.
doi: 10.1093/ije/dyaa118. PMID: 27283160;
PMCID: PMC5407170.[31]. Lopez Bernal J, Soumerai S, Gasparrini A. A methodological framework for model selection in interrupted time series studies. J Clin Epidemiol. 2018 Nov;103:82-91.
doi: 10.1016/j.jclinepi.2018.05.026. Epub 2018 Jun 6. PMID: 29885427.[32]. Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics. 1982 Dec;38(4):963-74. PMID: 7168798.
[33]. Nilsen K, Tejedor-Garavito N, Leasure DR, Utazi CE, Ruktanonchai CW, Wigley AS, Dooley CA, Matthews Z, Tatem AJ. A review of geospatial methods for population estimation and their use in constructing reproductive, maternal, newborn, child and adolescent health service indicators. BMC Health Serv Res. 2021 Sep 13;21(Suppl 1):370.
doi: 10.1186/s12913-021-06370-y.
PMID: 34511089; PMCID: PMC8436450.[34]. Igbokwe U, Ibrahim R, Aina M, Umar M, Salihu M, Omoregie E, Sadiq FU, Obonyo B, Muhammad R, Isah SI, Joseph N, Wakil B, Tijjani F, Ibrahim A, Yahaya MN, Aigbogun E Jr. Evaluating the implementation of the National Primary Health Care Development Agency (NPHCDA) gateway for the Basic Healthcare Provision Fund (BHCPF) across six Northern states in Nigeria. BMC Health Serv Res. 2024 Nov 14;24(1):1404. doi: 10.1186/s12913-024-11867-3. PMID: 39543589; PMCID: PMC11566299.
[35]. Jibrin MD, Waziri KB, Jibrin EI. Impact of Basic Healthcare Provision Fund on Primary Healthcare Service Utilization in Nasarawa State, Nigeria: A Comparative Study. International Journal of Research and Innovation in Social Science. 2026:(10)4. doi:10.47772/IJRISS.2026.100400480.
[36]. Oluwatola T, Ayodeji O, Ebinim H, Omeje O, Isiaka SD, Oni F, et al. Technical efficiency analysis of the Basic Health Care Provision Fund for the funded primary health care facilities in Nigeria. BMC Prim. Care. 2026; 27(197). https://doi.org/10.1186/s12875-026-03284-8
[37]. Ali M, Iddrisu ZA, Chimsi H. Donor Withdrawal versus Maternal, Child Health and Nutrition Programs in Northern Ghana: A Three‑Parts Study of Implications. 2026; 13(2) doi:10.51244/IJRSI.2026.13020011.
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Poliomyelitis Eradication in Burkina Faso: Progress in Epidemiological Surveillance of Acute Flaccid Paralysis (AFP) and Environmental Surveillance from 2020 to 2024Author: ZONGO InoufouDOI: 10.21522/TIJPH.2013.14.03.Art027
Poliomyelitis Eradication in Burkina Faso: Progress in Epidemiological Surveillance of Acute Flaccid Paralysis (AFP) and Environmental Surveillance from 2020 to 2024
Abstract:
Surveillance for acute flaccid paralysis (AFP) and environmental surveillance is one of the pillars of the polio eradication strategy, particularly in contexts marked by insecurity and the circulation of vaccine-derived polioviruses type 2 (cVDPV2). Through a descriptive and retrospective cross-sectional study, we evaluated the performance of the surveillance system in Burkina Faso between 2020 and 2024, using data from AFP monitoring, active research and environmental monitoring. The indicators were analysed annually and by health district and compared to the standards of the Global Polio Eradication Initiative. A total of 6,243 AFP cases were reviewed; 70.6% were children under five years of age and 58% were boys. Seventy-four cVDPV2 were detected, mainly in 2020. The national rate of non-polio AFP remained above the expected threshold (more than 3 cases per 100,000 children < 15 years), while stool collection adequacy remained generally satisfactory (above 80%). However, several deficiencies remain, including active surveillance visits, contact sample collection, environmental monitoring, and timely delivery of samples to the laboratory. Overall, the system is satisfactory, but its effectiveness would improve in hard-to-reach areas to strengthen early detection and outbreak response.
Poliomyelitis Eradication in Burkina Faso: Progress in Epidemiological Surveillance of Acute Flaccid Paralysis (AFP) and Environmental Surveillance from 2020 to 2024
References:
[1]. OMS. Report by the Director-General. B158_23.
[2]. World Health Organization. Poliomyélite [Internet]. 2025 [cited 2025 Nov 13]. Available from: https://www.who.int/fr/news-room/fact-sheets/detail/poliomyelitis
[3]. Tangermann RH, Lamoureux C, Tallis G, et al. The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative. Int Health. 2017;9:156-63.
[4]. Organisation mondiale de la Santé. Note de synthèse de l’OMS sur les vaccins antipoliomyélitiques mars 2016. Relev Epidemiol Hebd [Internet]. 2016 [cited 2025 Jun 12]. Available from: https://iris.who.int/bitstream/handle/10665/254398/WER9112.pdf?sequence=1
[5]. OMS. L’Afrique éradique le poliovirus sauvage | OMS | Bureau régional pour l’Afrique [Internet]. 2026 [cited 2026 Mar 25]. Available from: https://www.afro.who.int/fr/news/lafrique-eradique-le-poliovirus-sauvage
[6]. OMS-AFRO. Polio virus detections. Base de données [Internet]. 2026 [cited 2026 Apr 1]. Available from: https://afrodim.shinyapps.io/new-virus-detections/
[7]. OMS-AFRO. Lignes directrices pour la surveillance des poliovirus dans la Région africaine de l’OMS [Internet]. 2025 [cited 2025 Mar 8]. Available from: https://www.afro.who.int/fr/publications/lignes-directrices-pour-la-surveillance-des-poliovirus-dans-la-region-africaine-OMS
[8]. OMS. Plan d’action mondial pour la surveillance de la poliomyélite 2025-2026.
[9]. Comité national de certification. Rapport 2024 de mise à jour annuelle de la poliomyélite. Rapport annuel. Burkina Faso: Ministère de la Santé; 2025 Apr.
[10]. Comité national de certification. Rapport de mise à jour polio, 2022. Rapport annuel 2022. Burkina Faso: Ministère de la Santé; 2022 May.
[11]. Namageyo-Funa A, Greene SA, Henderson E, et al. Rapport hebdomadaire sur la morbidité et la mortalité. 17 oct 2024. 2024 Oct 17:909-16.
[12]. World Health Organization. Standard Operating Procedures: Responding to a Poliovirus Event or Outbreak. Version 4. 1st ed. Geneva: World Health Organization; 2022.
[13]. Goni Dit Alassan MB, Abdoulaye ZM, Alkassoum Salifou I, et al. Surveillance de la paralysie flasque aiguë au Niger de 1998 à 2021. Med Trop Sante Int. 2024;4(4):mtsi.v4i4.2024.449.
[14]. Iseayembele RB, Boande LG, Epeleka MD, et al. Evaluation de la performance du système de surveillance des paralysies flasques aiguës dans la Province de Lomami de 2018 à 2022. 2025 Jun 15;4:752-63.
[15]. Tatou JG, Khalef I, Brahim ML, et al. Epidémiologie des PFA et les performances du système de surveillance en Mauritanie de 2008 à 2012. Pan Afr Med J. 2014;18. doi:10.11604/pamj.2014.18.305.3362.
[16]. Njile DK, Sadeuh-Mba SA, Endegue-Zanga MC, et al. Detection and characterization of polioviruses originating from urban sewage in Yaounde and Douala, Cameroon 2016-2017. BMC Res Notes. 2019;12:248.
[17]. Hamisu AW, Blake IM, Sume G, et al. Characterizing environmental surveillance sites in Nigeria and their sensitivity to detect poliovirus and other enteroviruses. J Infect Dis. 2020;225:1377-86.
[18]. Goni Dit Alassan MB, Abdoulaye ZM, Alkassoum Salifou I, et al. Surveillance de la paralysie flasque aiguë au Niger de 1998 à 2021. MTSI. 2024;4(4).
[19]. Ishagh EK, Ouédraogo MT, Oumarou B, et al. Tracking acute flaccid paralysis in Niger: a half-decade epidemiological portrait (2016-2021). BMC Infect Dis. 2025;25:79.
[20]. Simon A, Punguyire D, Bangniyel J, et al. Evaluation of the acute flaccid paralysis surveillance system performance in the Upper West Region of Ghana from 2021 to 2023: a retrospective descriptive study. BMJ Open. 2025;15:e105835.
[21]. Manyanga D, Maseti E, Mokoena K, et al. Assessment of environmental surveillance for the detection of poliovirus implementation in the metropolitan districts of South Africa, 2020-2023. Pan Afr Med J. 2025;51:58.
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Knowledge, Attitude, and Practices of Healthcare Workers towards Antimicrobial Resistance in Secondary Healthcare Facilities in South West NigeriaAuthor: Peter Idowu OmoniyiDOI: 10.21522/TIJPH.2013.14.03.Art028
Knowledge, Attitude, and Practices of Healthcare Workers towards Antimicrobial Resistance in Secondary Healthcare Facilities in South West Nigeria
Abstract:
Antimicrobial resistance (AMR) is a critical public health challenge that disproportionately burdens low- and middle-income countries, including Nigeria. Healthcare workers (HCWs) play a pivotal role in both AMR propagation and control. This cross-sectional study assessed AMR knowledge, attitude, and practices (KAP) among 329 HCWs in selected secondary health facilities across six South West Nigerian states. A structured, self-administered questionnaire captured composite AMR knowledge and attitude scores, and key AMR practice behaviours. Chi-square tests and Pearson correlation were applied at p < 0.05. Overall, 74.8% of respondents demonstrated adequate AMR knowledge (mean score: 12.86 ± 2.67; range: 4–17). Laboratory scientists (13.42 ± 2.43) and pharmacists (13.34 ± 2.16) recorded the highest mean knowledge scores; nurses scored the lowest (12.50 ±2.76). AMR knowledge adequacy differed significantly by professional designation (χ² = 9.58, p = 0.023) and state (χ² = 40.72, p < 0.001). Positive AMR attitude was recorded in 57.1% of respondents (mean score: 50.53 ± 4.15). AMR attitude was significantly associated with professional designation (χ² = 9.15, p = 0.027). Practice gaps were prominent: 40.4% purchased antibiotics over the counter without a prescription, 73.6% reported stopping antibiotic courses when they felt better, and 73.6% kept leftover antibiotics for future use. Despite adequate knowledge, critical AMR practice deficits persist among South West Nigerian secondary HCWs. Targeted antibiotic stewardship programmes, integrated IPC–AMR training, and strengthened diagnostic infrastructure are urgently needed.
Knowledge, Attitude, and Practices of Healthcare Workers towards Antimicrobial Resistance in Secondary Healthcare Facilities in South West Nigeria
References:
[1]. Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629–655. Available from: https://doi.org/10.1016/S0140-6736(21)02724-0
[2]. O'Neill J. Tackling drug-resistant infections globally: final report and recommendations. London, United Kingdom: Review on Antimicrobial Resistance; 2016. Available from: https://amr-review.org/Publications.html
[3]. Nigeria Centre for Disease Control. Nigeria antimicrobial resistance national action plan 2017–2022. Abuja, Nigeria: NCDC; 2017. Available from: https://ncdc.gov.ng/themes/common/docs/protocols/75_1510840533.pdf
[4]. Lamikanra A, Crowe JL, Lijek RS, Odetoyin BW, Wain J, Aboderin AO, et al. Rapid evolution of fluoroquinolone-resistant Escherichia coli in Nigeria is temporally associated with fluoroquinolone use. BMC Infect Dis. 2011;11(1):312. Available from: https://doi.org/10.1186/1471-2334-11-312
[5]. Annan-Prah A, Aning KG, Akyeh ML, Atakorah YA, Ofori S. Presence of methicillin-resistant Staphylococcus aureus in hospitals, hotels and public places. J Nat Sci Res. 2012;2(6):73–81.
[6]. Umeokonkwo CD, Madubueze UC, Onah CK, Okedo-Alex IN, Adeke AS, Igwe-Okomiso D, et al. Point prevalence survey of antimicrobial prescription and healthcare associated infections in a tertiary hospital in south-east Nigeria. J Glob Antimicrob Resist. 2019;17:72–76. Available from: https://doi.org/10.1016/j.jgar.2019.01.004
[7]. Ayukekbong JA, Ntemgwa M, Atabe AN. The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrob Resist Infect Control. 2017;6(1):47. Available from: https://doi.org/10.1186/s13756-017-0208-x
[8]. Okeke IN, Lamikanra A, Edelman R. Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis. 1999;5(1):18–27. Available from: https://doi.org/10.3201/eid0501.990103
[9]. Seid MA, Hussen MS. Knowledge and attitude towards antimicrobial resistance among final year undergraduate paramedical students at University of Gondar, Ethiopia. BMC Infect Dis. 2018;18(1):312. Available from: https://doi.org/10.1186/s12879-018-3199-1
[10]. Scaioli G, Gualano MR, Gili R, Masucci S, Bert F, Siliquini R. Antibiotic use: a cross-sectional survey assessing the knowledge, attitudes and practices amongst students of a school of medicine in Italy. PLoS One. 2015;10(4). Available from: https://doi.org/10.1371/journal.pone.0122476
[11]. Federal Ministry of Health Nigeria. National health policy 2016: promote the health, improve the lives of all Nigerians. Abuja, Nigeria: Federal Ministry of Health; 2017.
[12]. World Health Organization. Global action plan on antimicrobial resistance. Geneva, Switzerland: World Health Organization; 2015. Available from: https://www.who.int/antimicrobial-resistance/global-action-plan/en/
[13]. Creswell JW, Creswell JD. Research design: qualitative, quantitative, and mixed methods approaches. 5th ed. California, USA: SAGE Publications; 2018.
[14]. Labi AK, Obeng-Nkrumah N, Bjerrum S, Enweronu-Laryea C, Opintan JA, Armah G, et al. Healthcare workers' knowledge, perceptions and attitudes towards antimicrobial use and resistance in a Ghanaian tertiary hospital. J Infect Prev. 2018;19(6):241–249. Available from: https://doi.org/10.1177/1757177418769156
[15]. Bhagavathula AS, Elnour AA, Jamshed SQ, Shehab A. Health professionals' knowledge, attitudes and practices about pharmacovigilance in India: a systematic review and meta-analysis. PLoS One. 2015;10(3). Available from: https://doi.org/10.1371/journal.pone.0128900
[16]. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340. Available from: https://doi.org/10.1136/bmj.c332
[17]. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–2194. Available from: https://doi.org/10.1001/jama.2013.281053
[18]. Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, et al. Strategies to improve antimicrobial utilization with a special focus on developing countries. Life. 2021;11(6):528. Available from: https://doi.org/10.3390/life11060528
[19]. Davies J, Davies D. Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev. 2010;74(3):417–433. Available from: https://doi.org/10.1128/MMBR.00016-10
[20]. Huttner B, Goossens H, Verheij T, Harbarth S. Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis. 2010;10(1):17–31. Available from: https://doi.org/10.1016/S1473-3099(09)70305-6
[21]. Sakeena MHF, Bennett AA, McLachlan AJ. Non-prescription sales of antimicrobial agents at community pharmacies in developing countries: a systematic review. Int J Antimicrob Agents. 2018;52(6):771–782. Available from: https://doi.org/10.1016/j.ijantimicag.2018.09.022
[22]. Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73(4):305–315. Available from: https://doi.org/10.1016/j.jhin.2009.04.019
[23]. Kariuki S, Dougan G. Antibacterial drug resistance in sub-Saharan Africa: understanding the issues to address them. Biochem Soc Trans. 2014;42(4):1008–1014. Available from: https://doi.org/10.1042/BST20140124
[24]. Tenna A, Steinhardt LC, Hennig N, Anagnostou A, Castro JG, Pappas G, et al. Infection control knowledge, attitudes, and practices among healthcare workers in Addis Ababa, Ethiopia. Infect Control Hosp Epidemiol. 2013;34(12):1289–1296. Available from: https://doi.org/10.1086/673979
[25]. World Health Organization. Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Geneva, Switzerland: World Health Organization; 2016. Available from: https://doi.org/10.1186/s13756-016-0149-9
[26]. Geta K, Kibret M. Knowledge, attitude and practice of nurses towards infection prevention at Felege Hiwot Comprehensive and Specialized Hospital. PLoS One. 2021;16(1). Available from: https://doi.org/10.1371/journal.pone.0243890
[27]. Moongtui W, Gauthier DK, Turner JG. Using peer feedback to improve handwashing and glove usage among Thai health care workers. Am J Infect Control. 2000;28(5):365–369. Available from: https://doi.org/10.1067/mic.2000.107441
[28]. McKernan C, Naughton VM, Crepinsek MA, De Neve JW, O'Neill J, Browne AJ. Review of national action plans on antimicrobial resistance: gaps and opportunities in strategies optimising antibiotic use in human populations. Lancet Glob Health. 2021;9(8)–e1176. Available from: https://doi.org/10.1016/S2214-109X(21)00197-8
[29]. Baadani AM, Baig K, Althawadi S, Johani SM, Omrani AS. Physician knowledge, attitudes, and behavior toward antibiotic prescribing in Riyadh, Saudi Arabia. Ann Saudi Med. 2015;35(1):14–19. Available from: https://doi.org/10.5144/0256-4947.2015.14
[30]. Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A. 2018;115(15)–E3470. Available from: https://doi.org/10.1073/pnas.1717295115
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Nigeria Rising Population: Perceived Factors Responsible among Residents of Three Local Government Areas of Niger State: A Cross-Sectional SurveyAuthor: Olabimpe GbadeyanDOI: 10.21522/TIJPH.2013.14.03.Art029
Nigeria Rising Population: Perceived Factors Responsible among Residents of Three Local Government Areas of Niger State: A Cross-Sectional Survey
Abstract:
Nigeria is widely known as the most populous country in Africa; however, the nation has been plagued by a weak economy, insecurity, infrastructural deficits, low industrialization, poor healthcare services, and other consequences that reduce quality of life and shorten lifespan. When the population of a geographical location is far above the available resources, chaos is the answer, which is the situation in the nation that has been projected to overtake the population of China in 2100. This study investigated the perceived factors, consequences and solutions of the rising population in three local government (LGA) of Niger state. A descriptive survey was conducted using questionnaires in KoboCollect among residents chosen randomly in selected wards; descriptive analysis was done with SPSS. We analyzed 3758 respondents; 86.9% were in the 21-50 years age range, the sample was male-skewed, the desired number of children (M ) was 5.30, and there was no significant difference in child preference by gender. Majority (62.6%), agreed there is overpopulation, perceived factors were religion belief (56.5%), cultural belief (14.4%), husband decision (11.3%), and polygamous family practice (4.1). Increased births were attributed to emotional satisfaction (32.1%), improved social amenities (17.3%), while 32.1% disagreed on all the factors. Identified consequences of overpopulation included poor healthcare (37.0%), unemployment (26.1%), insecurity (10.1%), and a sub-standard educational system (9.5%). There is a need for population stakeholders’ roundtable meetings for urgent, decisive, measurable actions before the breaking point is reached, to enable citizens to live quality lives and exhibit their potential in their fatherland.
Nigeria Rising Population: Perceived Factors Responsible among Residents of Three Local Government Areas of Niger State: A Cross-Sectional Survey
References:
[1]. Teitelbaum M. Population | biology and anthropology. In: Encyclopædia Britannica [Internet]. 2019 [cited 2025 July 20]. Available from: https://www.britannica.com/science/population-biology-and-anthropology
[2]. Population and vital statistics report, volume 76 [Internet]. DESA Publications. 2024 [cited 2026 July 28]. Available from: https://desapublications.un.org/publications/population-and-vital-statistics-report-volume-76
[3]. United Nations Statistics Division - demographic and social Statistics [Internet]. unstats.un.org. 2020 [cited 2026 July 28]. Available from: https://unstats.un.org/unsd/demographic/sources/census/wphc/QA.htm
[4]. United Nations. World population prospects 2024 | population division [Internet]. www.un.org. 2024 [cited 2025 Sept 08]. Available from: https://www.un.org/development/desa/pd/world-population-prospects-2024
[5]. Pang F, Miao G, Li Y, Shi Y. Key factors influencing sustainable population growth: A DEMATEL-ANP combined approach. Heliyon. 2024 Nov;10(21):e39404.
[6]. Worldometer. Countries in the world by population (2025) [Internet]. WorldoMeters. 2025 [cited 2026 March 02]. Available from: https://www.worldometers.info/world-population/population-by-country/
[7]. Alimi OY, Fagbohun AC, Abubakar M. Is population an asset or a liability to Nigeria’s economic growth? Evidence from FM-OLS and ARDL approach to cointegration. Future Business Journal. 2021 June 16;7(1).
[8]. Stallworthy B. Unemployment, insecurity and inequality: Talking population in Nigeria population matters [Internet]. Population Matters. 2024 [cited 2026 Dec 25]. Available from: https://populationmatters.org/news/2024/02/catalysing-conversation-talking-population-in-nigeria/
[9]. Worldometer. South Korea population (2019) - Worldometer [Internet]. Worldometers.info. 2024 [cited 2026 Mar 02]. Available from: https://www.worldometers.info/world-population/south-korea-population/
[10]. Johnleenknews. South Korea’s 2025 SDG report highlights economic and social weaknesses - Korea pro [Internet]. Korea Pro. 2025 [cited 2026 May 07]. Available from: https://koreapro.org/2025/03/south-koreas-2025-sdg-report-highlights-economic-and-social-weaknesses/
[11]. Hasell J, Roser M, Ortiz-Ospina E, Arriagada P. Poverty. Our World in Data [Internet]. 2022 [cited 2026 June 05];2(1). Available from: https://ourworldindata.org/poverty
[12]. World Bank. Thailand | data [Internet]. Worldbank.org. 2023 [cited 2026 Mar 05]. Available from: https://data.worldbank.org/country/thailand
[13]. Somruedi Banchongduang. World Bank upbeat on poverty reduction outlook [Internet]. https://www.bangkokpost.com. Bangkok Post; 2025 [cited 2026 April 27]. Available from: https://www.bangkokpost.com/business/general/2966705/world-bank-upbeat-on-poverty-reduction-outlook
[14]. The World Bank. Nigeria | data [Internet]. Worldbank.org. 2023 [cited 2026 July 01]. Available from: https://data.worldbank.org/country/nigeria
[15]. World Bank. South Africa | data [Internet]. Worldbank.org. 2023 [cited 2026 Aug 08]. Available from: https://data.worldbank.org/country/south-africa
[16]. Owolabi TJ. The politics of the population census in Nigeria and institutional incentives for political interference. The Global Politics of Census Taking. 2024 Jan 30;179–200 {cited 2026 June 23}. Available from: https://www.taylorfrancis.com/chapters/oa-edit/10.4324/9781003259749-10/politics-population-census-nigeria-institutional-incentives-political-interference-temitope-owolabi
[17]. Ota E, Ndubuisi U. Fudging the Numbers: Understanding the Politics and Dynamics of Population Census Figures in Nigeria [Internet]. Fukashere.edu.ng. 3(2) June 2025 [cited 2026 Aug 19]. Available from: https://journals.fukashere.edu.ng/index.php/kjpir/article/download/639/535
[18]. Brinkhoff T. Nigeria: Administrative Division (States and Local Government Areas) - Population Statistics, Charts and Map [Internet]. www.citypopulation.de. 2022 [cited 2026 Feb 24]. Available from: https://www.citypopulation.de/en/nigeria/admin/
[19]. Mburu J. Sample size determination: Cochran’s vs. Slovin’s vs. Yamane [Internet]. Stat Study Hub. 2025 [cited 2026 Mar 19]. Available from: https://statstudyhub.com/sample-size-determination-in-research/
[20]. Abdul-Karim Fuseini. Application of KoboToolbox and KoboCollect - GEO-LDN [Internet]. GEO-LDN. 2024 [cited 2026 July 26]. Available from: https://geo-ldn.org/application-of-kobotoolbox-and-kobocollect/
[21]. Population Pyramids. China vs Nigeria: Population comparison 2025 [Internet]. Population Pyramids. 2024 [cited 2026 March 08]. Available from: https://populationpyramids.org/compare/china-vs-nigeria
[22]. Nigeria demographics 2021 - StatisticsTimes.Com [Internet]. statisticstimes.com. 2026 [cited 2026 June 10]. Available from: https://statisticstimes.com/demographics/country/nigeria-demographics.php
[23]. Morakinyo AE. Nigeria’s unemployment paradox: Why 33% are jobless in a country where everyone seems to be working [Internet]. Nairametrics. 2026 [cited 2026 Aug 02]. Available from: https://nairametrics.com/2026/04/20/nigerias-unemployment-paradox-why-33-are-jobless-in-a-country-where-everyone-seems-to-be-working/
[24]. Carvalho L. South Africa unemployment rate [Internet]. Tradingeconomics.com. Trading Economics; 2024 [cited 2026 June 12]. Available from: https://tradingeconomics.com/south-africa/unemployment-rate
[25]. Pulse Ghana. 2026 Mid-year budget: 950,000 Ghanaians escaped multidimensional poverty in a year - ato Forson [Internet]. Pulse Ghana. 2026 [cited 2026 June 23]. Available from: https://www.pulse.com.gh/story/2026-mid-year-budget-950000-ghanaians-escaped-multidimensional-poverty-in-a-year-ato-forson-2026072315272903993
[26]. Adeyemi A. Nigeria unemployment rate: Understanding the change from 33% to 4% [Internet]. AdeyemiData. Adediran Adeyemi; 2026 [cited 2026 Aug 02]. Available from: https://adediranadeyemi.com/blog/nigeria-unemployment-numbers-explained.html
[27]. World Population Review. Religion by Country 2024 [Internet]. World Population Review. 2024 [cited 2026 July 24]. Available from: https://worldpopulationreview.com/country-rankings/religion-by-country
[28]. de Haas B, Kabagenyi A, Diennabila S. Reproductive autonomy in fertility research in sub‐Saharan Africa: A scoping review. Studies in Family Planning. 2025 May 5;56(2):243–73.
[29]. Jabaru S, Jimoh K, Yahya W. Analysis of fertility determinants and regional disparities in Nigeria using geo-additive regression. Yemeni Journal for Medical Sciences. 2024 Dec 8;19(1):1–12.
[30]. Adewole O, Asa S, Omotoso K. Family size: Why some Nigerian men want more children. Fatade W, editor. 2021 June 2 [cited 2026 July 31];. Available from: https://theconversation.com/family-size-why-some-nigerian-men-want-more-children-159692
[31]. Abdi B, Okal J, Serour G, Temmerman M. “Children are a blessing from God” – a qualitative study exploring the socio-cultural factors influencing contraceptive use in two Muslim communities in Kenya. Reproductive Health. 2020 Apr 3;17(1).
[32]. Su‐Russell C, Sanner C. Chinese childbearing decision‐making in mainland China in the post‐one‐child‐policy era. Family Process 2022 Apr 12;62(1).
[33]. Enebe NO, Osi-Okeke U, Oputa C, Ozoemna O, Enebe J, Udu A. Predictors of family size among men in urban slums of Enugu, southeast Nigeria: A cross sectional study. Texila international journal Of Academic Research. 2022 Apr 13;36–51.
[34]. World Bank. Access to electricity (% of population) [Internet]. Worldbank.org. 2022 [cited 2026 April 27]. Available from: https://data.worldbank.org/indicator/eg.elc.accs.zs
[35]. United Nations Development Programme. Human development index [Internet]. United Nations Development Programme. United Nations; 2024 [cited 2026 Aug 08]. Available from: https://hdr.undp.org/data-center/human-development-index#/indicies/HDI
[36]. World Bank. Literacy rate, adult total (% of people ages 15 and above) - Nigeria | data [Internet]. data.worldbank.org. 2022 [cited 2026 March 10]. Available from: https://data.worldbank.org/indicator/SE.ADT.LITR.ZS?locations=NG
[37]. BI Contributor. Top 10 countries with the largest slum populations in the world as of early 2025 [Internet]. Business Insider Africa. 2025 [cited 2026 July 03]. Available from: https://africa.businessinsider.com/local/lifestyle/top-10-countries-with-the-largest-slum-populations-in-the-world-as-of-early-2025/m30b5eg
[38]. Michael C. Lagos, 3 other African cities rank among world’s least liveable in 2026 - Businessday NG [Internet]. Businessday NG. 2026 [cited 2026 July 15]. Available from: https://businessday.ng/news/article/lagos-3-other-african-cities-rank-among-worlds-least-liveable-in-2026/
[39]. Numbeo. Health care index by country 2019 mid-year [Internet]. Numbeo.com. 2023 [cited 2026 April 09]. Available from: https://www.numbeo.com/health-care/rankings_by_country.jsp
[40]. Worldometer. Life expectancy by country and in the world (2024) [Internet]. Worldometers.info. 2025 [cited 2026 April 03]. Available from: https://www.worldometers.info/demographics/life-expectancy/
[41]. Zubairu N. Rising insecurity in Nigeria: Causes and solution. Journal of Studies in Social Sciences [Internet]. 2020 July 13 [cited 2026 June 20];19(0). Available from: https://infinitypress.info/index.php/jsss/article/view/1979
[42]. Sulaiman Adeodu A, Ademola EI, Babafemi BC. Insecurity in Nigeria, causes, consequence and solutions. Wukari International Studies Journal [Internet]. 2024 [cited 2026 July 18];8(2):1–10. Available from: https://wissjournals.com.ng/index.php/wiss/article/view/312
[43]. Atoyebi AO, Olaoye SO, Okunlola MA, Palamuleni ME, Adebowale AS. Trends and pattern of contraceptive use among women attending a family planning clinic at a tertiary health facility in Ibadan, Nigeria. BMC Public Health. 2025 June 7;25(1).
[44]. Human Rights Watch. Nigeria: Child marriage violates girls’ rights [Internet]. Human Rights Watch. 2022 [cited 2026 Aug 03]. Available from: https://www.hrw.org/news/2022/01/17/nigeria-child-marriage-violates-girls-rights
[45]. Bakari Muhammadu Sukare, Umar Dauda Usman. Public policy implementation and governance challenges in Nigeria: Implications for sustainable development in Africa. Journal of African Sustainable Development. 2026 Apr 1;11.
[46]. Ogbonnaya Jerry Okereke & Godwin Obinna Ngwoke. Birth rate and economic growth of Nigeria (1990-2020). International Journal of Sub-Saharan African Research [Internet]. 2026 Apr 4 [cited 2026 June 27];4(1):740–50. Available from: https://www.ijssar.com/paper/birth-rate-and-economic-growth-of-nigeria-1990-2020-
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Design and Implementation of Community-Based Health Insurance Schemes in Northern Uganda: Evidence and Policy ImplicationsAuthor: Hope OkenyDOI: 10.21522/TIJPH.2013.14.03.Art030
Design and Implementation of Community-Based Health Insurance Schemes in Northern Uganda: Evidence and Policy Implications
Abstract:
Achieving Universal Health Coverage remains a global challenge. Globally, over 100 million people are pushed into poverty annually due to high out-of-pocket expenditures. In Uganda, community-based health insurance penetration remains low. The gap is widest in post-conflict Northern Uganda, where poverty is high and health financing is fragile. This study investigated the status, design and implementation of community-based health insurance schemes in Northern Uganda. A descriptive cross-sectional study was conducted in Northern Uganda between March and May 2026. Using purposive and stratified sampling, 27 participants were engaged through Key informant interviews, In-depth interviews and Focus group discussions to generate qualitative data. Data were analyzed thematically using Braun and Clarke’s framework. Four themes and 12 related sub-themes emerged. By status, schemes were mainly characterized by operational discontinuity. By design, participants proposed shifting from a member-managed to a provider-managed model, but implementation relied mainly on costly grassroots mobilization. Findings showed that scheme sustainability is structurally dependent on donor subsidies, and the recent withdrawal of support compromised operations. The absence of the National Health Insurance Scheme and formal regulation has weakened the schemes, while expectations of free care remain a major socio-cultural barrier. Community-based health schemes in Northern Uganda remain trapped in a cycle of weak design, low enrollment, and donor dependence. The sector needs to transition to legally recognized, government-subsidized, provider-managed schemes with expanded benefits and integrated governance.
Design and Implementation of Community-Based Health Insurance Schemes in Northern Uganda: Evidence and Policy Implications
References:
[1]. World Health Organization. The World Health Report 2010: Health systems financing - the path to universal coverage. Geneva: World Health Organization; 2010.
[2]. Dror DM, Jacquier C. Micro-insurance: extending health insurance to the excluded. Int Soc Secur Rev. 1999;52(1):71-97.
[3]. Umeh CA, Feeley FG. Community-based health insurance in low- and middle-income countries: a review of the evidence. Glob Health Sci Pract. 2017;5(3):386-96.
[4]. Devadasan N, Criel B, Van Damme W, Ranson K, Van der Stuyft P. Community health insurance in India: an overview. Bull World Health Organ. 2006;84(6):477-82.
[5]. Schneider P. Health care financing for the poor: community-based health insurance schemes in Rwanda. Health Policy Plan. 2004;19(2):76-85.
[6]. McIntyre D, Thiede M, Dahlgren G, Whitehead M. What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? Soc Sci Med. 2006;62(4):858-65.
[7]. Ekman B. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy Plan. 2004;19(5):249-70.
[8]. Basaza R, Criel B, Van der Stuyft P. Community health insurance in Uganda: lessons learnt and implications for universal health coverage. Health Policy. 2007;80(2):285-98.
[9]. Adebua A, Oriangi G, Abola B, Amone C, Ezati BA. Modelling transformation of communities by public universities in post-conflict northern Uganda using economic and demographic factors. East Afr J Educ Stud. 2024;7(3):28-40. Available from: https://doi.org/10.37284/eajes.7.3.2014
[10]. Ministry of Health. Annual Health Sector Performance Report FY 2024/2025. Kampala: Ministry of Health; 2025.
[11]. Uganda Bureau of Statistics. National Population and Housing Census 2024: Poverty Profile. Kampala: Uganda Bureau of Statistics; 2024.
[12]. Briggs J. Post-conflict health system recovery in Northern Uganda. Afr J Health Sci. 2009;16(2):89-102.
[13]. Namakula J, Witter S, Ssengooba F. The health system in Northern Uganda: addressing the impact of conflict. Health Policy Plan. 2014;29(7):881-91.
[14]. Ministry of Health. Annual Health Sector Performance Report FY 2024/2025. Kampala: Ministry of Health; 2025.
[15]. Otieno P, Namyalo S. Policy and regulatory gaps in community health financing in Uganda. East Afr J Public Health. 2024;21(2):112-25.
[16]. Thompson J, McNall A, Tiplady S, Hodgson P, Proud C. Whole systems approach. J Health Organ Manag. 2019;33(4):443-59. Available from: https://doi.org/10.1108/JHOM-11-2018-0337
[17]. Eze P, Ilechukwu S, Lawani LO. Impact of community-based health insurance in low- and middle-income countries: a systematic review and meta-analysis. PLoS One. 2023;18(6):e0287600. Available from: https://doi.org/10.1371/journal.pone.0287600
[18]. Basaza R, Criel B, Van der Stuyft P. Community health insurance in Uganda: why does enrolment remain low? Health Policy Plan. 2010;25(3):251-9.
[19]. Uganda Bureau of Statistics. Uganda National Household Survey 2021/2022. Kampala: Uganda Bureau of Statistics; 2022.
[20]. Mwaura G, McIntyre D, Ataguba JE. Assessing the progress towards universal health coverage in Kenya. Health Policy Plan. 2018;33(3):340-47.
[21]. Ministry of Health. Uganda National Health Accounts 2022. Kampala: Ministry of Health; 2023.
[22]. James N, Acharya Y. Increasing health insurance enrolment in low- and middle-income countries: what works, what does not, and research gaps: a scoping review. Inquiry. 2022;59:469580221090396. Available from: https://doi.org/10.1177/00469580221090396
[23]. World Health Organization. Global Monitoring Report on Financial Protection in Health 2021. Geneva: World Health Organization; 2021.
[24]. Aregbeshola B, Khan S. Out-of-pocket payments, catastrophic health expenditure and poverty among households in Nigeria. Int J Health Policy Manag. 2018;7(9):798-806.
[25]. Abraham E, Gray C, Fagbamigbe AF, Tediosi F, Otesiny K, Haafkens J, et al. Barriers and facilitators to health insurance enrolment among people working in the informal sector in Morogoro, Tanzania. AAS Open Res. 2021;4:45. Available from: https://doi.org/10.12688/aasopenres.13289.1
[26]. Ridde V, Turcotte-Tremblay AM, Souares A. The necessity and challenges of scaling up health insurance in low-income settings. Glob Health Action. 2013;6(1):20213. Available from: https://doi.org/10.3402/gha.v6i0.20213
[27]. Bashir SG, Abdi YH, Ibrahim Issack Z, Abdullahi Khalif I, Ahmed Ali S, Mohamed Ali S, et al. Health financing strategies for achieving universal health coverage in low- and middle-income countries: a narrative review. Front Public Health. 2026;14:1868936. Available from: https://doi.org/10.3389/fpubh.2026.1868936
[28]. Gessesse AG, Hailyesus M. Community based health insurance (CBHI) system in Southern Ethiopia: an evaluation of communication approach. Discov Public Health. 2025;22(1):589. Available from: https://doi.org/10.1007/s44167-025-00589-x
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A Bayesian Spatial Hierarchical Analysis of Cervical Cancer Screening Uptake in EthiopiaAuthor: Daniel Biftu BekaloDOI: 10.21522/TIJPH.2013.14.03.Art031
A Bayesian Spatial Hierarchical Analysis of Cervical Cancer Screening Uptake in Ethiopia
Abstract:
Cervical cancer is the fourth most common cancer among women globally, with the highest burden in sub-Saharan Africa, where screening coverage remains far below the World Health Organization's 70% elimination target. Evidence on screening uptake in Ethiopia has been limited to small, facility-based studies unable to characterise national geographic patterns. This study aimed to identify individual-level and geographic determinants of cervical cancer screening uptake among Ethiopian women using a spatial Bayesian approach. Data were drawn from the 2024–25 Ethiopia Demographic and Health Survey (N = 20,864 women aged 15–49). A Bayesian hierarchical logistic regression model with a Besag–York–Mollié (BYM2) spatial random effect and a cluster random effect was fitted via integrated nested Laplace approximation, with fits compared across four nested specifications using the Watanabe–Akaike Information Criterion. Weighted national screening prevalence was 5.89%. Uptake rose with household wealth, education, and mass media exposure, and was higher among currently (aOR = 2.66) and formerly (aOR = 2.50) married women than never-married women. Region and cluster jointly explained 11.3% of residual variance, but only 23.2% of the regional component was spatially structured. Most of the more than 50-fold disparity between Addis Ababa (16.4%) and Somali (0.3%) reflected population composition rather than a residual regional effect, though a smaller, genuine geographic disparity persisted after adjustment. Screening uptake in Ethiopia is shaped jointly by individual-level disadvantage and geographic disparities not fully explained by population composition. Closing this gap will likely require expanded individual-level access, direct health-system investment in underserved regions such as Somali, and spatially explicit, subnational monitoring to ensure progress reaches the communities currently furthest behind.
A Bayesian Spatial Hierarchical Analysis of Cervical Cancer Screening Uptake in Ethiopia
References:
[1]. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2024;74(3):229-63. Available from: https://doi.org/10.3322/caac.21834
[2]. Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human Papillomavirus and Cervical Cancer. Lancet. 2013;382(9895):889-99. Available from: https://doi.org/10.1016/S0140-6736(13)60022-7
[3]. Yuan Y, Cai X, Shen F, Ma F. HPV Post-Infection Microenvironment and Cervical Cancer. Cancer Lett. 2021;497:243-54. Available from: https://doi.org/10.1016/j.canlet.2020.10.034
[4]. Xu T, Yang X, He X, Wu J. The Study on Cervical Cancer Burden in 127 Countries and Its Socioeconomic Influence Factors. J Epidemiol Glob Health. 2023;13(1):154-61. Available from: https://doi.org/10.1007/s44197-022-00081-1
[5]. Zhang X, Zeng Q, Cai W, Ruan W. Trends of Cervical Cancer at Global, Regional, and National Level: Data from the Global Burden of Disease Study 2019. BMC Public Health. 2021;21(1):894. Available from: https://doi.org/10.1186/s12889-021-10907-5
[6]. World Health Organization. Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem. Geneva: World Health Organization; 2020. Available from: https://www.who.int/publications/i/item/9789240014107
[7]. Singh D, Vignat J, Lorenzoni V, Eslahi M, Ginsburg O, Lauby-Secretan B, et al. Global Estimates of Incidence and Mortality of Cervical Cancer in 2020: A Baseline Analysis of the WHO Global Cervical Cancer Elimination Initiative. Lancet Glob Health. 2023;11(2):e197-e206. Available from: https://doi.org/10.1016/S2214-109X(22)00501-0
[8]. Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, et al. Impact of HPV Vaccination and Cervical Screening on Cervical Cancer Elimination: A Comparative Modelling Analysis in 78 Low-Income and Lower-Middle-Income Countries. Lancet. 2020;395(10224):575-90. Available from: https://doi.org/10.1016/S0140-6736(20)30068-4
[9]. Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, et al. Mortality Impact of Achieving WHO Cervical Cancer Elimination Targets: A Comparative Modelling Analysis in 78 Low-Income and Lower-Middle-Income Countries. Lancet. 2020;395(10224):591-603. Available from: https://doi.org/10.1016/S0140-6736(20)30157-4
[10]. Perkins RB, Wentzensen N, Guido RS, Schiffman M. Cervical Cancer Screening: A Review. JAMA. 2023;330(6):547-58.
[11]. Zampaoglou E, Boureka E, Gounari E, Liasidi PN, Kalogiannidis I, Tsimtsiou Z, et al. Screening for Cervical Cancer: A Comprehensive Review of Guidelines. Cancers (Basel). 2025;17(13):2072. Available from: https://doi.org/10.3390/cancers17132072
[12]. World Health Organization. WHO Guideline for Screening and Treatment of Cervical Pre-Cancer Lesions for Cervical Cancer Prevention. Geneva: World Health Organization; 2021. Available from: https://iris.who.int/bitstream/handle/10665/342365/9789240030824-eng.pdf
[13]. Bruni L, Serrano B, Roura E, Alemany L, Cowan M, Herrero R, et al. Cervical Cancer Screening Programmes and Age-Specific Coverage Estimates for 202 Countries and Territories Worldwide: A Review and Synthetic Analysis. Lancet Glob Health. 2022;10(8): e1115-e1127. Available from: https://doi.org/10.1016/S2214-109X(22)00241-8
[14]. Abila DB, Wasukira SB, Ainembabazi P, Kiyingi EN, Chemutai B, Kyagulanyi E, et al. Coverage and Socioeconomic Inequalities in Cervical Cancer Screening in Low- and Middle-Income Countries Between 2010 and 2019. JCO Glob Oncol. 2024;10(10): e2300385.
[15]. Mengistie BA, Melese M, Gebiru AM, Getnet M, Getahun AB, Tassew WC, et al. Uptake of Cervical Cancer Screening and Its Determinants in Africa: Umbrella Review. PLoS One. 2025;20(7):e0328103. Available from: https://doi.org/10.1371/journal.pone.0328103
[16]. Yimer NB, Mohammed MA, Solomon K, et al. Cervical Cancer Screening Uptake in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Public Health. 2021; 195:105-11.
[17]. Ba DM, Ssentongo P, Musa J, et al. Prevalence and Determinants of Cervical Cancer Screening in Five Sub-Saharan African Countries: A Population-Based Study. Cancer Epidemiol. 2021; 72:101930.
[18]. Okyere J, Aboagye RG, Seidu AA, Asare BYA, Mwamba B, Ahinkorah BO. Towards a Cervical Cancer-Free Future: Women's Healthcare Decision-Making and Cervical Cancer Screening Uptake in Sub-Saharan Africa. BMJ Open. 2022;12(7):e058026. Available from: https://doi.org/10.1136/bmjopen-2021-058026
[19]. Ng'ang'a A, Nyangasi M, Nkonge NG, et al. Predictors of Cervical Cancer Screening Among Kenyan Women: Results of a Nested Case-Control Study in a Nationally Representative Survey. BMC Public Health. 2018;18(3):1-10.
[20]. Ephrem Dibisa K, Tamiru Dinka M, Mekonen Moti L, Fetensa G. Precancerous Lesion of the Cervix and Associated Factors Among Women of West Wollega, West Ethiopia, 2022. Cancer Control. 2022;29. Available from: https://doi.org/10.1177/10732748221117900
[21]. Wakwoya EB, Gemechu KD. Prevalence of Abnormal Cervical Lesions and Associated Factors Among Women in Harar, Eastern Ethiopia. Cancer Manag Res. 2020; 12:12429.
[22]. Besag J, York J, Mollié A. Bayesian Image Restoration, with Two Applications in Spatial Statistics. Ann Inst Stat Math. 1991;43(1):1-20. Available from: https://doi.org/10.1007/BF00116466
[23]. Riebler A, Sørbye SH, Simpson D, Rue H. An Intuitive Bayesian Spatial Model for Disease Mapping that Accounts for Scaling. Stat Methods Med Res. 2016;25(4):1145-65. Available from: https://doi.org/10.1177/0962280216660421
[24]. Lawson AB. Bayesian Disease Mapping: Hierarchical Modeling in Spatial Epidemiology. 3rd ed. Boca Raton: CRC Press; 2018.
[25]. Bivand RS, Pebesma E, Gómez-Rubio V. Applied Spatial Data Analysis with R. 2nd ed. New York: Springer; 2013.
[26]. Rue H, Martino S, Chopin N. Approximate Bayesian Inference for Latent Gaussian Models by Using Integrated Nested Laplace Approximations. J R Stat Soc Series B Stat Methodol. 2009;71(2):319-92. Available from: https://doi.org/10.1111/j.1467-9868.2008.00700.x
[27]. Ethiopian Statistical Service (ESS), ICF. Ethiopia Demographic and Health Survey 2024-25. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: ESS and ICF; 2025. Available from: https://www.dhsprogram.com/publications/publication-FR399-DHS-Final-Reports.cfm
[28]. Little RJA, Rubin DB. Statistical Analysis with Missing Data. 3rd ed. Hoboken: Wiley; 2019.
[29]. Bivand RS, Wong DWS. Comparing Implementations of Global and Local Indicators of Spatial Association. TEST. 2018;27(3):716-48. Available from: https://doi.org/10.1007/s11749-018-0599-x
[30]. Simpson D, Rue H, Riebler A, Martins TG, Sørbye SH. Penalising Model Component Complexity: A Principled, Practical Approach to Constructing Priors. Stat Sci. 2017;32(1):1-28. Available from: https://doi.org/10.1214/16-STS576
[31]. Watanabe S. Asymptotic Equivalence of Bayes Cross Validation and Widely Applicable Information Criterion in Singular Learning Theory. J Mach Learn Res. 2010; 11:3571-94.
[32]. Gelman A, Hwang J, Vehtari A. Understanding Predictive Information Criteria for Bayesian Models. Stat Comput. 2014;24(6):997-1016. Available from: https://doi.org/10.1007/s11222-013-9416-2
[33]. Goldstein H, Browne W, Rasbash J. Partitioning Variation in Multilevel Models. Underst Stat. 2002;1(4):223-31. Available from: https://doi.org/10.1207/S15328031US0104_02
[34]. Bürkner PC. brms: An R Package for Bayesian Multilevel Models Using Stan. J Stat Softw. 2017;80(1):1-28. Available from: https://doi.org/10.18637/jss.v080.i01
[35]. Carpenter B, Gelman A, Hoffman MD, Lee D, Goodrich B, Betancourt M, et al. Stan: A Probabilistic Programming Language. J Stat Softw. 2017;76(1):1-32. Available from: https://doi.org/10.18637/jss.v076.i01
[36]. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria; 2024. Available from: https://www.R-project.org/
[37]. Lumley T. Analysis of Complex Survey Samples. J Stat Softw. 2004;9(1):1-19. Available from: https://doi.org/10.18637/jss.v009.i08
[38]. Pebesma E. Simple Features for R: Standardized Support for Spatial Vector Data. R J. 2018;10(1):439-46. Available from: https://doi.org/10.32614/RJ-2018-009
[39]. Pérez-Heydrich C, Warren JL, Burgert CR, Emch ME. Guidelines on the Use of DHS GPS Data. Calverton, Maryland, USA: ICF International; 2013.
[40]. Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E. Explaining Trends in Inequities: Evidence from Brazilian Child Health Studies. Lancet. 2000;356(9235):1093-8. Available from: https://doi.org/10.1016/S0140-6736(00)02741-0
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Stakeholders’ Perceptions, Expectations, and Proposed Improvements for Noncommunicable Disease Surveillance and Response in the Butembo Branch of the North Kivu Provincial Health Division, Democratic Republic of the Congo: A Qualitative StudyAuthor: Kasereka Wanzuwite EmmanuelDOI: 10.21522/TIJPH.2013.14.03.Art032
Stakeholders’ Perceptions, Expectations, and Proposed Improvements for Noncommunicable Disease Surveillance and Response in the Butembo Branch of the North Kivu Provincial Health Division, Democratic Republic of the Congo: A Qualitative Study
Abstract:
Noncommunicable diseases (NCDs) remain insufficiently integrated into surveillance and response functions in the areas covered by the Butembo provincial health division branch, North Kivu, RDC. This study aimed to explore stakeholders' perceptions, expectations, and suggestions for improvement. A descriptive qualitative study with an exploratory focus was conducted among 25 stakeholders selected through purposive sampling. Data were collected through semi-structured individual interviews and subjected to manual inductive and deductive thematic analysis. Participants’ accounts converged on recognizing the growing burden of NCDs while lamenting the limited consideration given to these diseases in health priorities. Surveillance was limited to the reporting of incomplete indicators that were rarely used locally. According to participants, out-of-pocket payments, poverty, insecurity, supply shortages, limited diagnostic capabilities, and inadequate longitudinal patient follow-up undermined clinical response. The lack of referral pathways, dedicated resources, supervision, and structured community involvement exacerbated these difficulties. Participants recommended increased commitment from the health system toward NCDs, a more inclusive information system, and the effective integration of referral, longitudinal follow-up, and community participation into primary health care.
Stakeholders’ Perceptions, Expectations, and Proposed Improvements for Noncommunicable Disease Surveillance and Response in the Butembo Branch of the North Kivu Provincial Health Division, Democratic Republic of the Congo: A Qualitative Study
References:
[1]. Organisation mondiale de la Santé. Maladies non transmissibles [Internet]. 2025
[cited 2025 Oct [2]. https://www.who.int/fr/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed 2 Oct 2025[2]. Freihat O, Sipos D, Aamir M, Kovacs A. Global burden and future projections of non-communicable diseases (2000–2050): Progress toward SDG 3.4 and disparities across regions and risk factors. Hennis AJM, editor. PLoS One [Internet]. 2025 [cited 2026 Apr 1];20:e0336036. https://doi.org/10.1371/journal.pone.0336036
[3]. Zhu M, Xu S, Li Y, Wang W, Liu L, Xu Q, et al. Global burden of non-communicable diseases attributable to behavioral factors. Science Bulletin [Internet]. 2025 [cited 2026 Apr 1];70:3129–33. https://doi.org/10.1016/j.scib.2025.08.037
[4]. Organisation mondiale de la Santé. Surveillance des maladies non transmissibles dans la région OMS de la Méditerranée occidentale [Internet]. Bureau régionale de la Méditeranée Orientale; 2021 [cited 2024 Mar 20]. ISBN 978-92-9022-482-2. Accessed 20 Mar 2024
[5]. Schwartz LN, Shaffer JD, Bukhman G. The origins of the 4 × 4 framework for noncommunicable disease at the World Health Organization. SSM - Population Health [Internet]. 2021 [cited 2025 Nov 7];13:100731. https://doi.org/10.1016/j.ssmph.2021.100731
[6]. World Health Organization. Noncommunicable diseases country profiles 2018. World Health Organization; 2018.
[7]. World Health Organization Regional Office for Africa. Noncommunicable diseases in Africa: The invisible epidemic (Analytical fact sheet: NCD morbidity and mortality). African Health Observatory. World Health Organization Regional Office for Africa; 2022.
[8]. World Health Organization Regional Office for Africa. Noncommunicable diseases and mental health in the WHO African Region: Progress report 2024. World Health Organization Regional Office for Africa; 2024.
[9]. Ahmed SM, Krishnan A, Karim O, Shafique K, Naher N, Srishti SA, et al. Delivering non-communicable disease services through primary health care in selected South Asian countries: are health systems prepared? The Lancet Global Health [Internet]. 2024 [cited 2025 Dec 29];12:e1706–19. https://doi.org/10.1016/S2214-109X(24)00118-9
[10]. Barry A, Impouma B, Wolfe CM, Campos A, Richards NC, Kalu A, et al. Non-communicable diseases in the WHO African region: analysis of risk factors, mortality, and responses based on WHO data. Sci Rep [Internet]. 2025 [cited 2026 Mar 25];15:12288. https://doi.org/10.1038/s41598-025-97180-3
[11]. World Health Organization. Health at a glance | Democratic Republic of the Congo (created 11/12/2024). WHO Data. World Health Organization; 2024.
[12]. Ministère de la Santé Publique, Hygiène et Prévoyance Sociale. Enquête sur les facteurs de risque des maladies non transmissibles dans les provinces de Kinshasa, Thsopo et Kasai Orientale. Kinshasa; 2025.
[13]. Armocida B, Tolonen H, Rakovac I, Formenti B, Farrington J, Ekberg A, et al. Strengthening non-communicable diseases monitoring systems in Europe through a multistakeholder collaborative approach: a key priority for advancing data-driven policymaking. The Lancet Regional Health - Europe [Internet]. 2026 [cited 2026 Apr 11];61:101553. https://doi.org/10.1016/j.lanepe.2025.101553
[14]. Bovet P, Banatvala N, Cooper R, Riley L. Surveillance of NCDs and their risk factors. Noncommunicable Diseases [Internet]. 1st edn London: Routledge; 2023 [cited 2025 Dec 26]. p. 28–33. https://doi.org/10.4324/9781003306689-5
[15]. Quiambao A, Malekpour M-R, Golestani A, Heidari-Foroozan M, Ghamari S-H, Abbasi-Kangevari M, et al. World health Organization’s guidance for tracking non-communicable diseases towards sustainable development goals 3.4: an initiative for facility-based monitoring. eClinicalMedicine [Internet]. 2025 [cited 2026 Mar 25];85:103304. https://doi.org/10.1016/j.eclinm.2025.103304
[16]. WHO Africa. Community-based surveillance, Traing Manual, Integrated Diseases Surveillance and Response in the African Region [Internet]. 2015 [cited 2024 May 20]. https://www.afro.who.int/sites/default/files/2017-06/community-based-surveillance_idsr_training-manual.pdf. Accessed 20 May 2024
[17]. Zhang J, Wu Y, Tian R, Zhao D. Developing an integrated evaluation indicator system for non-communicable disease management in China’s primary care: a modified Delphi-analytic hierarchy process study based on the structure-process-outcome framework. BMC Public Health [Internet]. 2025 [cited 2026 Apr 11];26:18. https://doi.org/10.1186/s12889-025-25714-5
[18]. Kasereka Wanzuwite E, Nshimirimana J, Katsuva Sibongwere D, Kambale Kalumwendo R, Katembo Kambere T. Niveau de coordination opérationnelle de la surveillance et de la réponse aux maladies non transmissibles dans les zones de santé de l’Antenne DPS de Butembo, Nord-Kivu, République démocratique du Congo. 2026.
[19]. Akik C, El Dirani Z, Willis R, Truppa C, Zmeter C, Aebischer Perone S, et al. Providing continuity of care for people living with noncommunicable diseases in humanitarian settings: A qualitative study of health actors’ experiences in Lebanon. Journal of Migration and Health [Internet]. 2024 [cited 2026 Mar 25];10:100269. https://doi.org/10.1016/j.jmh.2024.100269
[20]. Braun V, Clarke V. Reporting guidelines for qualitative research: a values-based approach. Qualitative Research in Psychology [Internet]. 2025 [cited 2026 July 25];22:399–438. https://doi.org/10.1080/14780887.2024.2382244
[21]. Ahmad M, Wilkins S. Purposive sampling in qualitative research: a framework for the entire journey. Qual Quant [Internet]. 2025 [cited 2026 July 25];59:1461–79. https://doi.org/10.1007/s11135-024-02022-5
[22]. Weller SC, Vickers B, Bernard HR, Blackburn AM, Borgatti S, Gravlee CC, et al. Open-ended interview questions and saturation. Soundy A, editor. PLoS ONE [Internet]. 2018 [cited 2026 Mar 15];13:e0198606. https://doi.org/10.1371/journal.pone.0198606
[23]. Squire CM, Giombi KC, Rupert DJ, Amoozegar J, Williams P. Determining an Appropriate Sample Size for Qualitative Interviews to Achieve True and Near Code Saturation: Secondary Analysis of Data. J Med Internet Res [Internet]. 2024 [cited 2026 Mar 14];26:e52998. https://doi.org/10.2196/52998
[24]. Lim WM. Sample Size in Qualitative Research: Moving from Data Saturation to Theoretical Saturation. Journal of Global Marketing [Internet]. 2025 [cited 2026 Mar 14];1–11. https://doi.org/10.1080/08911762.2025.2590757
[25]. Byrne D. A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Qual Quant [Internet]. 2022 [cited 2026 Mar 12];56:1391–412. https://doi.org/10.1007/s11135-021-01182-y
[26]. Pearson H, Myall M, Darlington A-S, Gibson F. The approach and application of analysing inductive and deductive datasets: a worked example using reflexive thematic analysis. Qualitative Research in Psychology [Internet]. 2025 [cited 2026 July 25];22:842–86. https://doi.org/10.1080/14780887.2025.2499265
[27]. Michelen M, Phan M, Zimmer A, Coury N, Morey B, Montiel Hernandez G, et al. Practical Qualitative Data Analysis for Public Health Research: A Guide to a Team-Based Approach With Flexible Coding. International Journal of Qualitative Methods [Internet]. 2024 [cited 2026 July 25];23:16094069241289279. https://doi.org/10.1177/16094069241289279
[28]. Naeem M, Ozuem W, Howell K, Ranfagni S. A Step-by-Step Process of Thematic Analysis to Develop a Conceptual Model in Qualitative Research. International Journal of Qualitative Methods [Internet]. 2023 [cited 2026 July 25];22:16094069231205789. https://doi.org/10.1177/16094069231205789
[29]. Saunders CH, Sierpe A, Von Plessen C, Kennedy AM, Leviton LC, Bernstein SL, et al. Practical thematic analysis: a guide for multidisciplinary health services research teams engaging in qualitative analysis. BMJ [Internet]. 2023 [cited 2026 July 25];381:e074256. https://doi.org/10.1136/bmj-2022-074256
[30]. Lloyd N, Hyett N, Kenny A. To Member Check or not to Member Check? An Evaluation of Member Checking in an Interpretive Descriptive Study. International Journal of Qualitative Methods [Internet]. 2024 [cited 2026 July 27];23:16094069241301383. https://doi.org/10.1177/16094069241301383
[31]. Kabir A, Karim MN, Islam RM, Romero L, Billah B. Health system readiness for non-communicable diseases at the primary care level: a systematic review. BMJ Open [Internet]. 2022 [cited 2025 Dec 29];12:e060387. https://doi.org/10.1136/bmjopen-2021-060387
[32]. Nguyen TNT, Nguyen TTT, Tran BQ, Pham CT, Perry KE, Haregu T, et al. Putting non-communicable disease data to work in Vietnam: an investigation of community health surveillance capacity. BMC Public Health [Internet]. 2023 [cited 2026 July 26];23:321. https://doi.org/10.1186/s12889-023-14986-4
[33]. Ministère de la Santé Publique, Hygiène et Prévention de la République/RDC. Couvertures nationales et provinciales et autres statistiques de services pour la santé reproductive, maternelle, néonatale et infantile à partir de données d’enquêtes et des établissements de santé, 2017-2021 [Internet]. Kinshasa; 2022. https://www.countdown2030.org/wp-content/uploads/2022/10/Rapport-technique-actualise-RDC_Atelier-danalyse-donnees-SRMNEA-Nut_14.08.2022.pdf?
[34]. Mutombo CS, Bakari SA, Ntabaza VN, Nachtergael A, Lumbu J-BS, Duez P, et al. Perceptions and use of traditional African medicine in Lubumbashi, Haut-Katanga province (DR Congo): A cross-sectional study. Mordaunt DA, editor. PLoS ONE [Internet]. 2022 [cited 2026 July 26];17:e0276325. https://doi.org/10.1371/journal.pone.0276325
[35]. World Health Organization. Data quality assurance: module 2—discrete desk review of data quality: implementation guide [Internet]. Geneva: World Health Organization; 2020. https://www.healthdatacollaborative.org/fileadmin/uploads/hdc/Documents/Working_Groups/RHIS/A._Standards_and_Tools/2._RHIS_data_generation/2d._Data_visualization__analysis_and_interpretation/WHO_Toolkit_for_RHIS_data/4-2b-2021_-dqa_module-2_desk-review_-implementation-guide.pdf?
[36]. World Health Organization. Recommendations on how to strengthen the design and implementation of policies, including those for resilient health systems and health services and infrastructure, to treat people living with noncommunicable diseases and to prevent and control their risk factors in humanitarian emergencies. Annex 4, Document A75/10 Add.2. [Internet]. Geneva: World Health Organization; 2022. https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_10Add2-en.pdf?
[37]. Kasujja FX, Aikaeli F, Garrib A, Van Widenfelt E, Namakoola I, Kivuyo S, et al. Integrated community-based versus facility-based care for people with HIV, diabetes, and hypertension in sub-Saharan Africa (INTE-COMM): an open-label, multicountry, cluster-randomised trial. The Lancet [Internet]. 2026 [cited 2026 July 26];407:1084–94. https://doi.org/10.1016/S0140-6736(25)02641-8
[38]. Doresha L-M, Williams, Mash R. The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study. BMC Prim Care [Internet]. 2024 [cited 2026 July 26];25:176. https://doi.org/10.1186/s12875-024-02424-2
[39]. Sanya RE, Karugu CH, Iddi S, Kibe PM, Mburu L, Mbau L, et al. Feasibility and impact of a patient support group care model on diabetes and hypertension care in informal settlements in Nairobi, Kenya: a quasi-experimental study. Global Health Action [Internet]. 2025 [cited 2026 July 26];18:2482304. https://doi.org/10.1080/16549716.2025.2482304
[40]. Kazibwe J, Tran PB, Annerstedt KS. The household financial burden of non-communicable diseases in low- and middle-income countries: a systematic review. Health Res Policy Sys [Internet]. 2021 [cited 2026 July 26];19:96. https://doi.org/10.1186/s12961-021-00732-y
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Effect of Nutrition Education Intervention Based on Health Belief Model on Dietary Diversity Practices of Pregnant Women in Rural Western Ethiopia: A Cluster Randomized Controlled Trial, 2026Author: Koang Nyak BolDOI: 10.21522/TIJPH.2013.14.03.Art033
Effect of Nutrition Education Intervention Based on Health Belief Model on Dietary Diversity Practices of Pregnant Women in Rural Western Ethiopia: A Cluster Randomized Controlled Trial, 2026
Abstract:
Inadequate dietary diversity during pregnancy is a major public health concern in Ethiopia, contributing to maternal undernutrition and adverse pregnancy outcomes. Theory-based nutrition education interventions have shown promise but have not been rigorously evaluated in remote, low-resource settings using cluster-randomized designs. This study aimed to assess the effect of a nutrition education intervention based on the Health Belief Model (HBM) on dietary diversity practices of pregnant women in rural western Ethiopia. A community-based pretest-posttest cluster-randomized controlled trial was conducted among 328 pregnant women (164 per arm) selected from 22 kebeles in Nuer Zone, Gambella Region, from March to June 2026. A 24-hour dietary recall was used to assess dietary diversity. Generalized Estimating Equations (GEE) fitted with a negative binomial distribution and Difference-in-Differences (DiD) were used to assess the intervention effect. At baseline, both groups exhibited comparable proportions of inadequate dietary diversity (intervention 75.3%, control 73.0%). At endline, the proportion of pregnant women with adequate dietary diversity rose from 24.7% to 73.5% in the intervention group but declined from 27.0% to 6.9% in the control group. In the adjusted GEE model, the intervention led to 42.5% greater relative increase in Dietary Diversity Score (IRR = 1.425, 95% CI: 1.322–1.535, p < 0.001), indicating robust improvement in dietary diversity and protection against seasonal dietary decline. An HBM-based nutrition education intervention significantly improved dietary diversity among pregnant women in rural western Ethiopia. Integrating behaviorally informed nutrition education into routine antenatal care services is recommended to improve dietary diversity of pregnant women in resource-limited settings.
Effect of Nutrition Education Intervention Based on Health Belief Model on Dietary Diversity Practices of Pregnant Women in Rural Western Ethiopia: A Cluster Randomized Controlled Trial, 2026
References:
[1]. FAO and FHI 360. Minimum Dietary Diversity for Women: A Guide for Measurement. 2016. Available from: http://www.fao.org/3/a-i5486e.pdf
[2]. Tafasa SM, Darega J, Dida N, Gemechu FD. Dietary Diversity, Undernutrition and Associated Factors among Pregnant Women in Gindeberet District, Oromia, Ethiopia: A Cross-Sectional Study. BMC Nutrition. 2023;9(115):1–12.
[3]. Tsegaye D, Tamiru D, Belachew T. Theory-based Nutrition Education Intervention Through Male Involvement Improves the Dietary Diversity Practice and Nutritional status of Pregnant Women in rural Illu Aba Bor Zone, Southwest Ethiopia: A Quasi-Experimental Study. Maternal and Child Nutrition. 2022;18(3):e13350.
[4]. World Bank Group. Addressing Maternal Nutrition in the Context of Primary Health Care: A Review of Completed World Bank Group-Funded Projects Targeting Maternal Nutrition in Sub-Saharan Africa From 1997 to 2018 in A Primary Health Care Context. Washington DC, USA; 2021.
[5]. Ethiopian Federal Ministry of Health. Adolescents, Maternal, Infant and Young Child Nutrition Guideline (2016-2020). 2016;(June):68.
[6]. Yang J, Wang M, Tobias DK, Rich-Edwards JW, Darling AM, Abioye AI, et al. 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. 2022;18(2):e13300.
[7]. Tafara L, Bikila H, Feyisa I, Desalegn M, Kaba Z. Prevalence of Undernutrition and Associated Factors Among Pregnant Women Attending Antenatal Care Service in Public Hospitals of Western Ethiopia. PLoS One. 2023;18(1):e0278180. Available from: http://dx.doi.org/10.1371/journal.pone.0278180
[8]. Demilew YM, Alene GD, Belachew T. Effect of Guided Counseling on Dietary Practices of Pregnant Women in West Gojjam Zone, Ethiopia. PLoS One. 2020;15(5):e0233429. Available from: http://dx.doi.org/10.1371/journal.pone.0233429
[9]. Diddana TZ, Kelkay GN, Dola AN, Sadore AA. Effect of Nutrition Education Based on Health Belief Model on Nutritional Knowledge and Dietary Practice of Pregnant Women in Dessie Town, Northeast Ethiopia: A Cluster Randomized Control Trial. Journal of Nutrition and Metabolism. 2018;2018:10.
[10]. Ministry of Health of Ethiopia. Ethiopian Food-Based Dietary Guidelines. International Livestock Research Institute (ILRI) Editorial amd Publication Service. 2022;1(March):108.
[11]. Yitbarek K, Abraham G, Morankar S. Contribution of Women’s Development Army to Maternal and Child Health in Ethiopia: A Systematic Review of Evidence. BMJ Open. 2019;9(5).
[12]. Ethiopian Public Health Institute. Ethiopian National Nutrition Program Endline Survey. 2015;(October):1–40.
[13]. Getaneh T, Negesse A, Dessie G, Desta M, Assemie MA, Tigabu A. Predictors of Malnutrition among Pregnant Women in Ethiopia: A Systematic Review and Meta-analysis. Human Nutrition and Metabolism. 2021;26:200131. Available from: https://doi.org/10.1016/j.hnm.2021.200131
[14]. WHO. Nutrition in the WHO African Region [Internet]. Brazzaville; 2017. Available from: http://apps.who.int/iris
[15]. Gebremichael MA, Belachew Lema T. Dietary Diversity, Nutritional Status, and Associated Factors among Pregnant Women in their First Trimester of Pregnancy in Ambo District, Western Ethiopia: Community-based Cross-Sectional Study. Nutrition and Metabolic Insights. 2023;16:1–12.
[16]. Saldanha LS, Buback L, White JM, Mulugeta A, Mariam SG, Roba AC, et al. Policies and Program Implementation Experience to Improve Maternal Nutrition in Ethiopia. Food and Nutrition Bulletin. 2012;33(Suppl 2):27–50.
[17]. The Improved Clinical Effectiveness Through Behavioral Research Group. Designing Theoretically-Informed Implementation Interventions. Implementation Science. 2006;1(4):1–8.
[18]. Davis R, Campbell R, Hildon Z, Hobbs L, Michie S. Theories of Behaviour and Behaviour Change across the Social and Behavioural Sciences: A Scoping Review. Health Psychology Review. 2015;9(3):323–44. Available from: http://dx.doi.org/10.1080/17437199.2014.941722
[19]. Green EC, Murphy EM, Gryboski K. The Health Belief Model. Wiley Encyclopedia of Health Psychology. 2020;(May 2022):211–4.
[20]. Abraham C, Sheeran P. The Health Belief Model. Cambridge Handbook of Psychology, Health and Medicine, Second Edition. 2014;(June 2015):97–102. Available from: https://www.researchgate.net/publication/290193215_The_Health_Belief_Model
[21]. Fallah F, Pourabbas A, Delpisheh A, Veisani Y, Shadnoush M. Effects of Nutrition Education on Levels of Nutritional Awareness of Pregnant Women in Western Iran. International Journal of Endocrinology and Metabolism. 2013;11(3):175–8.
[22]. Bellg AJ, Resnick B, Minicucci DS, Ogedegbe G, Ernst D, Borrelli B, et al. Enhancing Treatment Fidelity in Health Behavior Change Studies: Best Practices and Recommendations from the NIH Behavior Change Consortium. Health Psychology. 2004;23(5):443–51.
[23]. Ethiopian Federal Ministry of Health. Training of Trainers Manual for Counseling on Maternal, Infant and Young Child Nutrition Ethiopia. 2011;(December):1–224. Available from: http://iycn.wpengine.netdna-cdn.com/files/IYCN_MIYCN_Ethiopia_Counseling_TOT_Manual_1211.pdf
[24]. FAO. Minimum Dietary Diversity for Women: Frequently Asked Questions. 2023;20.
[25]. Abere M, Azene AG. Food Taboo and Associated Factors Among Pregnant Women Attending Antenatal Clinics at Bahir Dar City, North West Ethiopia, A Cross-Sectional Study. Scientific Reports. 2023;13(1):1–8. Available from: https://doi.org/10.1038/s41598-023-34964-5
[26]. Ojofeitimi E, Ogunjuyigbe P, Sanusi R, Orji E, Akinlo A, Liasu S, et al. Poor Dietary Intake of Energy and Retinol Among Pregnant Women: Implications for Pregnancy Outcome in Southwest Nigeria. Pakistan Journal of Nutrition. 2008;(7): 480–4.
[27]. Abotchie PN, Shokar NK. Cervical Cancer Screening among College Students in Ghana: Knowledge and Health Beliefs. International Journal of Gynecological Cancer. 2009;19(3):412–6.
[28]. Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide (Version 3). Washington, DC Food Nutrition Technology. 2007;(August):Version 3.
[29]. Smits J, Steendijk R. The International Wealth Index (IWI). 2013;(2):1–29. Available from: http://www.ru.nl/nice/workingpapers
[30]. FAO. Guidelines for Measuring Household and Individual Dietary Diversity. 2010. 1–60.
[31]. Beressa G, Whiting SJ, Belachew T. Effect of Nutrition Education Integrating the Health Belief Model and Theory of Planned Behavior on Dietary Diversity of Pregnant Women in Southeast Ethiopia: A Cluster Randomized Controlled Trial. Nutrition Journal. 2024;23(3):1–14.
[32]. Tsegaye D. Theory‐based Nutrition Education Intervention Through Male Involvement Improves Dietary Diversity Practice and Nutritional Status of Pregnant Women in Rural Illu Aba Bor Zone, Southwest Ethiopia: A quasi‐experimental Study. Maternal and Child Nutrition. 2022;18:e13350.
[33]. Awoke M, Mulat B, Simegn B, Dagne S, Werkneh C, Tilahun M, et al. Effect of Nutrition Interventions on the Dietary Diversity Status Among Pregnant Women in Ethiopia : Systematic Review and MetaAnalysis. Food Science and Nutrition. 2025;13:3:e71231.
[34]. Watanabe D, Muraki I, Maruyama K, Tamakoshi A. Changes in Dietary Diversity and Subsequent All-cause and Cause-specific Mortality Among Japanese Adults: The Japan Collaborative Cohort Study. Journal of Epidemiology. 2025;35(8):373–81.
[35]. Mezgebe B, Gari T, Belayneh, Mehretu BL. Seasonal Variations in Household Food Security and Consumption Affect Women’s Nutritional Status in Rural South Ethiopia. Plos Global Public Health. 2024;4(8):e0003294.
[36]. Mohammadkhah F, Shamsalinia A, Rajabi F, Afzali Hasirini P, Khani Jeihooni A. The effect of Educational Intervention in the Prevention of Cardiovascular Diseases in Patients with Hypertension with Application of Health Belief Model: A quasi-experimental Study. JRSM Cardiovascular Disease. 2023;12:1–8.
[37]. Taravatmanesh G, Taravatmanesh S, Zere R, Rahbar S, Akbar N, Taravatmanesh L, et al. Effectiveness of a Health Belief Model-based Training on Enhancing Violence-Preventive Behaviors among Older Women: A Quasi- Experimental Study. BMC Geriatriatrics. 2026.
[38]. World Health Organization. World Medical Association Declaration Of Helsinki. Ethical Principles For Medical Research Involving Human Subjects. Bulletin of the World Health Organization. 2001;79:373–4.
[39]. Ethiopian Federal Ministry of Science and Technology. Ethiopian National Research Ethics Review Guidline. 2014: 13. Available from: https://www.google.com/search?client=firefox-b-d&q=National+Reserach+Ethics+Guicdeline
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Factors Associated with Incomplete Childhood Immunization among Children Aged 12–36 Months in Burkina FasoAuthor: Lota Charles BONKIANDOI: 10.21522/TIJPH.2013.14.03.Art034
Factors Associated with Incomplete Childhood Immunization among Children Aged 12–36 Months in Burkina Faso
Abstract:
Childhood immunization remains one of the most effective public health interventions to prevent vaccine-preventable diseases. In Burkina Faso, incomplete immunization schedules remain a challenge amid insecurity, population displacement, and health system disruptions. This study aimed to identify factors associated with incomplete immunization and the vaccination dropout rate in children aged 12 to 36 months. A secondary analysis of the 2021 Burkina Faso Demographic and Health Survey (2021-DHS-BF) data was performed. Incomplete immunization was defined as a child not receiving all recommended routine vaccine doses by 15 months of age. Factors associated with incomplete immunization were identified using modified Poisson regression with generalized estimating equations; adjusted prevalence ratios (aPR) with 95% confidence intervals were reported at a 5% significance threshold. Among the 2,375 children who met the eligibility criteria in the 2021-DHS-BF dataset, 1,482 (66.0%) had not completed their immunization schedule. The dropout rate between the first and third doses of the pentavalent vaccine was 11.0%. Maternal occupation (Saler: aPR = 0.89, 95% CI: 0.80–0.98 and farmer/self-employed: aPR = 0.93; 0.85, 95% CI: 0.78–0.94) and being treated with respect “sometimes” at health facilities (aPR = 1.14, 95% CI: 1.02–1.27) were associated with an incomplete immunization schedule. Strengthening person-centered care, improving post-first-dose follow-up, and expanding community-based outreach strategies could improve immunization schedule completion.
Factors Associated with Incomplete Childhood Immunization among Children Aged 12–36 Months in Burkina Faso
References:
[1]. Haddad S, Bicaba A, Feletto M, et al. Heterogeneity in the validity of administrative-based estimates of immunization coverage across health districts in Burkina Faso: implications for measurement, monitoring and planning. Health Policy Plan 2010; 25: 393–405.
[2]. Félicitée N, Hermann ND, Andreas C, et al. Déterminants et Raisons de Non-Vaccination Complète des Enfants Hospitalisés dans deux Hôpitaux de Référence Pédiatrique à Yaoundé. 19.
[3]. Kebe AT, Diarra B, Sangho A, et al. L’hésitation vaccinale et ses déterminants chez les parents d’enfants de moins de cinq ans dans la ville de Gao, au Mali en 2021. Rev d'Épidémiologie Santé Publique 2023; 71: 102109.
[4]. Douba A, Aka LBN, Yao GHA, et al. Facteurs sociodemographiques associes a la vaccination incomplete des enfants de 12 a 59 mois dans six pays d’Afrique de l’ouest. Santé Publique; 27.
[5]. Kaboré L, Meda B, Médah I, et al. Assessment of missed opportunities for vaccination (MOV) in Burkina Faso using the World Health Organization’s revised MOV strategy: Findings and strategic considerations to improve routine childhood immunization coverage. Vaccine 2020; 38: 7603–11.
[6]. Sarigda M. Sociogenèse des hésitations vaccinales en milieu urbain au Burkina Faso, 2024.
[7]. Ministère de la Santé, Enquête de couverture vaccinale (ECV) 2021. Ouagadougou: Burkina Faso.
[8]. Kaboré S, Kaboré BYL, Ouédraogo SYYA, et al. Équité d’accès aux services de vaccination dans la région sanitaire du Centre-Est, 2018, Burkina Faso: Santé Publique 2020; Vol. 32: 263–72.
[9]. Ministère de la Santé, Rapport annuel sur la situation du système de santé (estimations 2024). Direction Générale des Etudes et des Statistiques Sectorielles. Ouagadougou, Burkina faso ; 2024.
[10]. Ministère de la Santé (Burkina Faso), ICF. INSD (Burkina Faso), Enquête Démographique et de Santé (EDS-BF 2021). Ouagadougou, Burkina Faso, et Rockville, Maryland, USA : INSD et ICF.
[11]. INSD (Burkina Faso), Ministère de la Santé (Burkina Faso), ICF. Enquête Démographique et de Santé (EDS-BF 2021). Ouagadougou, Burkina Faso, et Rockville, Maryland, USA : INSD et ICF ; 2022.
[12]. INSD, Enquête harmonisée sur les conditions de vie des ménages (EHCVM) 2018. Ouagadougou: Institut national de la statistique et de la démographie, 2019.
[13]. WHO, Immunization coverage. Geneva: World Health Organization, 2019.
[14]. DHS Program. DHS Model Surveys: The DHS Questionnaire for Women. Rockville, Maryland, USA : The DHS Program, ICF ; 2022.
[15]. INSD, Recensement général de la population et de l’habitation (RGPH) 2019 : résultats définitifs. Ouagadougou: Institut national de la statistique et de la démographie 2020.
[16]. WHO, UNICEF. (2020). Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Geneva: World Health Organization.
[17]. Toyi Mangbassim N, Kpozehouen A, Zinsou Saizonou J, et al. Prevalence and Factors Associated with "Zero-Dose" in Children 12 to 23 Months in Togo. Cent Afr J Public Health. Epub ahead of print 9 February 2023. DOI: 10.11648/j.cajph.20230901.12.
[18]. Adedokun ST, Uthman OA, Adekanmbi VT, et al. Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors. BMC Public Health 2017; 17:236.
[19]. Coulibaly CA. Facteurs associés au statut vaccinal des enfants de 12 à 23 mois à Farakala et Kapala du district sanitaire de Sikasso. Mali Santé Publique 2023; 23–9.
[20]. Togola OB, Sangho O, Koné Y, et al. Facteurs associés à la vaccination incomplète des enfants de 15 à 23 mois dans le district sanitaire de Tominian au Mali en 2020. J Interv Epidemiol Public Health; 8. Epub ahead of print 22 December 2025. DOI: 10.37432/jieph-d-25-00020.
[21]. Atnafu Gebeyehu N, Abebe Gelaw K, Asmare Adella G, et al. Incomplete immunization and its determinants among children in Africa: Systematic review and meta-analysis. Hum Vaccines Immunother 2023; 19: 2202125.
[22]. Esako Toirambe S, Camara T, Khalis M, et al. Facteurs prédictifs de la non-complétude vaccinale chez des enfants migrants de moins de 5 ans, Maroc: Santé Publique 2021; Vol. 33: 435–43.
[23]. Eze P, Agu UJ, Aniebo CL, et al. Factors associated with incomplete immunisation in children aged 12–23 months at subnational level, Nigeria: a cross-sectional study. BMJ Open 2021; 11: e047445.
[24]. Bangura JB, Xiao S, Qiu D, et al. Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health 2020; 20: 1108.
[25]. Mithi B, Bula A, Kapanda L, et al. Barriers and facilitators to implementing advanced HIV disease screening at a secondary referral hospital -Malawi: a convergent parallel study. BMC Health Serv Res 2023; 23: 1015.
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Community Health Worker Integration into Formal Health Systems in Rural Sub-Saharan Africa: Models, Facilitators, Barriers, and Training Needs from a Systematic ReviewAuthor: Sowo Anita LebbieDOI: 10.21522/TIJPH.2013.14.03.Art035
Community Health Worker Integration into Formal Health Systems in Rural Sub-Saharan Africa: Models, Facilitators, Barriers, and Training Needs from a Systematic Review
Abstract:
Sub-Saharan Africa (SSA) faces persistent shortages of skilled health workers, weak rural health infrastructure, limited access to care, and fragmented Community Health Worker (CHW) programmes. The contribution of CHWs to primary health care (PHC) depends less on their presence in communities than on the extent to which they are integrated into formal health systems. The aim is to synthesise evidence on the integration models, facilitators, barriers, and capacity-building requirements that shape the integration of CHW programmes into formal health systems in rural SSA. A PRISMA 2020, guided the systematic review of secondary data. Seven databases (PubMed/MEDLINE, Scopus, Web of Science, EMBASE, CINAHL, African Index Medicus, AJOL) and grey literature from WHO, UNICEF, the World Bank, USAID, and Ministry of Health repositories were searched for English-language publications from January 2010 to December 2025. Of 444 records, 42 met the inclusion criteria. Quality was appraised using AMSTAR 2, and evidence was combined through thematic and framework synthesis mapped onto the WHO Health System Building Blocks. Three integration models were identified: government-led (strongest institutionalisation), NGO-led (partial, project-bound), and hybrid (most common). Integration was strongest in service delivery, governance, and workforce support, and weakest in financing, health information systems, and supply chains. The leading facilitators were political commitment and policy recognition, supportive supervision, and sustainable financing; the critical barriers were governance fragmentation, supply chain stock-outs, and weak supervision. Ten competency domains were required for integration, six of them essential: clinical service delivery, referral management, health information systems, supply chain management, community engagement, and supportive supervision. Consistent with WHO guidance, integration is a health system strengthening process rather than a workforce intervention. Rural SSA programmes are institutionalised operationally but remain structurally unsupported, and training alone did not sustain performance where governance, financing, supervision, information, and supply systems were weak. The review introduces the CHW Integration Capability Framework, a three-tier model linking foundational competencies, system interface capabilities, and sustained performance. Sustainable integration requires simultaneous investment across all six building blocks, prioritising domestic financing, harmonised information systems, and public supply chains, together with explicit transition pathways from partner-dependent to nationally owned CHW programmes.
Community Health Worker Integration into Formal Health Systems in Rural Sub-Saharan Africa: Models, Facilitators, Barriers, and Training Needs from a Systematic Review
References:
[1]. World Health Organization. Global CHW progress report. Geneva: World Health Organization; 2024. Available from: https://www.who.int/publications/i/item/global-chw-progress-report
[2]. World Health Organization. Global strategy on human resources for health: Workforce 2030. Geneva: World Health Organization; 2016.
[3]. World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. Geneva: World Health Organization; 2018.
[4]. Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014; 35:399-421. https://doi.org/10.1146/annurev-publhealth-032013-182354
[5]. Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, et al. What do we know about community-based health worker programs? A systematic review of existing reviews. Hum Resour Health. 2018;16(1):39. https://doi.org/10.1186/s12960-018-0304-x
[6]. Zulu JM, Kinsman J, Michelo C, Hurtig AK. Hope and despair: Community health assistants’ experiences of working in a rural district in Zambia. Hum Resour Health. 2014;12:30. https://doi.org/10.1186/1478-4491-12-30
[7]. Assefa Y, Gelaw YA, Hill PS, Taye BW, Van Damme W. Community health extension program of Ethiopia, 2003-2018: Successes and challenges toward universal coverage for primary healthcare services. Glob Health. 2019;15:24. https://doi.org/10.1186/s12992-019-0470-1
[8]. Rwanda Ministry of Health. National community health policy. Kigali: Ministry of Health, Republic of Rwanda; 2015.
[9]. Nsona H, Mtimuni A, Daelmans B, Callaghan-Koru JA, Gilroy K, Mgalula L, et al. Scaling up integrated community case management of childhood illness: Update from Malawi. Am J Trop Med Hyg. 2012;87(5 Suppl):54-60. https://doi.org/10.4269/ajtmh.2012.11-0759
[10]. World Health Organization, United Nations Children’s Fund. The role of community health workers in COVID-19 vaccination: Implementation support guide (WHO/2019-nCoV/NDVP/CHWs_role/2021.1). Geneva: World Health Organization; 2021.
[11]. Cometto G, et al. Health policy and system support to optimise community health worker programmes: An abridged WHO guideline. Lancet Glob Health. 2018;6(12):e1397-e1404.
[12]. World Health Organization. Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. Geneva: World Health Organization; 2010. Available from: https://apps.who.int/iris/handle/10665/258734
[13]. Schleiff M, Aitken I, Alam MA, Arifeen SE, Bhutta ZA, Church K, et al. Community health workers at the dawn of a new era: 3. Programme governance. Health Res Policy Syst. 2021;19(Suppl 3):107. https://doi.org/10.1186/s12961-021-00749-3
[14]. McPake B, Maeda A, Araújo EC, Lemiere C, El Maghraby A, Cometto G, et al. Community health workers at the dawn of a new era: 4. Programme financing. Health Res Policy Syst. 2021;19(Suppl 3):105. https://doi.org/10.1186/s12961-021-00751-0
[15]. Tulenko K, Møgedal S, Afzal MM, Frymus D, Oshin A, Pate M, et al. Community health workers for universal health-care coverage: From fragmentation to synergy. Bull World Health Organ. 2013;91(11):847-52. https://doi.org/10.2471/BLT.13.118745
[16]. Hafner T, Shiffman J. The politics of community health worker programmes in sub-Saharan Africa. Health Policy Plan. 2020;35(6):691-700. https://doi.org/10.1093/heapol/czaa018
[17]. Olaniran A, Briggs J, Pradhan A, Baughman A, Berman P, Olaniran AA. Stock-outs of essential medicines among community health workers in low- and middle-income countries: A systematic literature review of the extent, reasons, and consequences. Hum Resour Health. 2022;20(1):58. https://doi.org/10.1186/s12960-022-00755-8
[18]. Kok MC, et al. Which intervention design factors influence performance of community health workers in low- and middle-income countries? Health Policy Plan. 2015;30(9):1207-27.
[19]. Mupara LM, Nembaware V, Chersich MF, et al. Community health worker programme components and the health system building blocks: A scoping review. Front Public Health. 2023;11:1063081. https://doi.org/10.3389/fpubh.2023.1063081
[20]. Ballard M, Montgomery P. Systematic review of interventions for improving the performance of community health workers in low-income and middle-income countries. BMJ Open. 2017;7(10):e014216. https://doi.org/10.1136/bmjopen-2016-014216
[21]. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
[22]. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. https://doi.org/10.1136/bmj.j4008
[23]. Flemming K, Noyes J. Qualitative evidence synthesis: Where are we at? Int J Qual Methods. 2021;20:1-13. https://doi.org/10.1177/1609406921993276
[24]. Noyes J, Booth A, Cargo M, Flemming K, Harden A, Harris J, et al. Chapter 21: Qualitative evidence. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane handbook for systematic reviews of interventions. Version 6.5. Cochrane; 2024. Available from: https://www.cochrane.org/handbook
[25]. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al., editors. Cochrane handbook for systematic reviews of interventions. Latest available version. Cochrane; 2024. Available from: https://www.cochrane.org/handbook
[26]. Masis L, Gichaga A, Zerayacob T, Lu C, Perry HB. Community health workers at the dawn of a new era: 4. Programme financing. Health Res Policy Syst. 2021;19(Suppl 3):107. https://doi.org/10.1186/s12961-021-00751-9
[27]. World Health Organization. Global curriculum guide for community health workers. Geneva: World Health Organization; 2025.
[28]. Schneider H, Okello D, Lehmann U. The global pendulum swing towards community health workers in low- and middle-income countries: A scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014. Hum Resour Health. 2016;14:65. https://doi.org/10.1186/s12960-016-0163-2
[29]. Bhutta ZA, Lassi ZS, Pariyo G, Huicho L. Global experience of community health workers for delivery of health-related millennium development goals: A systematic review, country case studies, and recommendations for integration into national health systems. Geneva: World Health Organization; 2010.
[30]. Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, et al. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: Qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;(10):CD010414. https://doi.org/10.1002/14651858.CD010414
[31]. Ghana Health Service. Community-based health planning and services (CHPS) policy. Accra: Ghana Health Service; 2022.
[32]. Ministry of Health and Sanitation Sierra Leone. National community health worker policy 2021-2025. Freetown: Ministry of Health and Sanitation; 2021.
[33]. Ministry of Health Kenya. Kenya community health policy 2020-2030. Nairobi: Ministry of Health; 2023.
[34]. Schneider H, Lehmann U. From community health workers to community health systems: Time to widen the horizon? Health Syst Reform. 2016;2(2):112-8. https://doi.org/10.1080/23288604.2016.1166307
[35]. Perry HB, Hodgins S, Crigler L, LeBan K, Glenton C, Lewin S. Community health workers at the dawn of a new era: 11. CHW programmes to strengthen health systems and improve health outcomes. Health Res Policy Syst. 2021;19(Suppl 3):126. https://doi.org/10.1186/s12961-021-00768-0
[36]. Yadav P. Health product supply chains in developing countries: Diagnosis of the root causes of underperformance and an agenda for reform. Health Syst Reform. 2015;1(2):142-54. https://doi.org/10.1080/23288604.2015.1031087
[37]. Nutley T, Reynolds HW. Improving the use of health data for health system strengthening. Glob Health Action. 2013;6(1):20001. https://doi.org/10.3402/gha.v6i0.20001
[38]. Agarwal S, Kirk K, Sully E, Yore J, Amouzou A, Munos M, et al. Setting the global research agenda for community health systems. Hum Resour Health. 2019;17:22. https://doi.org/10.1186/s12960-019-0362-5
[39]. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;(3):CD004015. https://doi.org/10.1002/14651858.CD004015.pub3
[40]. Rowe AK, Prosnitz D, Ciampi A, Riley P, Kiley KC, Kwete X, et al. The association of supportive supervision with community health worker performance in low- and middle-income countries: A meta-analysis. Bull World Health Organ. 2019;97(10):688-703. https://doi.org/10.2471/BLT.18.217653
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Cost of Quality-Applicability in Clinical Laboratories, Particularly in Resource-Limited Countries: A Survey of the LiteratureAuthor: Demetri Smith-WintDOI: 10.21522/TIJPH.2013.14.03.Art036
Cost of Quality-Applicability in Clinical Laboratories, Particularly in Resource-Limited Countries: A Survey of the Literature
Abstract:
Healthcare providers rely on laboratory results to make medical decisions daily. Laboratories must adhere to specified requirements to ensure that the service provided is reliable and safe. The service provided to patients and clinicians should therefore be customer-focused. Discussions on expenditure on continuous quality improvement activities have grown as more laboratories develop quality management systems. This discussion is even more relevant as laboratory managers try to balance their organization’s productivity by reducing waste and unnecessary expenditure. Quality cost is the total cost of activities that prevent or mitigate errors in laboratory processes (cost of good quality), and failure cost is the cost resulting from flawed laboratory processes (cost of poor quality). There is extensive evidence on the application of CoQ in manufacturing and other non-health service industries, however there is limited information about its applicability in clinical laboratories. Furthermore, laboratories located in countries with scarce resources may face unique challenges in assessing quality costs, including the ease of data collection for cost inputs. This article examines the information presented in the literature on quality-related costs in clinical laboratories. Secondly, it provides a summary of various cost models. Finally, it explores the application of quality cost in clinical laboratories, particularly in resource-limited countries, and outlines the benefits and challenges.
Cost of Quality-Applicability in Clinical Laboratories, Particularly in Resource-Limited Countries: A Survey of the Literature
References:
[1]. Oliver J, Qu W. Cost of quality reporting: some Australian evidence. Int J Appl Qual Manag. 1999;2:233-50.
[2]. Sower VE, Quarles R, Broussard E. Cost of quality usage and its relationship to quality system maturity. Int J Qual Reliab Manag. 2007;24(2):121-40.
[3]. Schiffauerova A, Thomson V. Managing cost of quality: insight into industry practice. TQM Mag. 2006.
[4]. Schiffauerova A, Thomson V. A review of research on cost of quality models and best practices. Int J Qual Reliab Manag. 2006;23(4).
[5]. Glogovac M, Filipovic J. Quality costs in practice and an analysis of the factors affecting quality cost management. Total Qual Manag Bus Excell. 2018;29(13-14):1521-44.
[6]. Quintenz A, Williams P. Exploring cost of quality in the lab. Med Lab Obs. 2019;51(1):24-5.
[7]. Elbireer A, Gable AR, Brooks Jackson J. Cost of quality at a clinical laboratory in a resource-limited country. LabMedicine. 2010;41(7):429-33.
[8]. Crosby PB. Quality is free: the art of making quality certain. New York: New American Library; 1979. Reprint. Accessed 2026 Apr 22. Available from: https://archive.org/details/qualityisfreeart00cros/mode/2up
[9]. Foulad R, Amellah SJ, Jebli S, et al. Cost of quality: literature review, correspondence between models, and a call for a paradigm shift. Int J Adv Appl Sci. 2023;10(2):39-49.
[10]. Campanella J. Principles of quality costs: principles, implementation, and use. Milwaukee (WI): American Society for Quality Control Quality Press; 1990. Accessed 2026 Apr 25. Available from: https://archive.org/details/principlesofqual0000camp/mode/2up
[11]. Zahar M, Barkany EA, Biyaali EA. Cost of quality health care: a case study in clinical laboratory. Ann Fac Eng Hunedoara Int J Eng. 2015;13(1):121-5.
[12]. Rattan A. Understanding cost of quality in the laboratory. Acta Sci Microbiol. 2021;4(11):16-20.
[13]. Vaxevanidis NM, Petropoulos G. A literature survey of cost of quality models. Ann Fac Eng Hunedoara J Eng. 2008;6(3):274-83.
[14]. Murumkar A, Teli SN, Bhushi UM, et al. Hidden cost of quality: a review. In: Proceedings of the 11th ISDSI International Conference; 2017; IIM Trichy, India.
[15]. Feigenbaum AV. Total quality control. New York: McGraw-Hill; 1991. Accessed 2026 Apr 24. Available from: https://archive.org/details/totalqualitycont0000feig/mode/2up
[16]. Juran JM. Quality-control handbook. New York: McGraw-Hill; 1951. Accessed 2026 Apr 24. Available from: https://archive.org/details/qualitycontrolha0000jmju/mode/2up
[17]. Juran JM, Gryna FM, Bingham RS. Quality-control handbook. 3rd ed. 1974. Accessed 2026 Apr 24. Available from: https://archive.org/details/qualitycontrolha0000unse/mode/2up
[18]. Sandoval-Chávez DA, Beruvides MG. Using opportunity costs to determine the cost of quality: a case study in a continuous-process industry. Eng Econ. 1998;43(2):107-24.
[19]. Menichino T. A cost-of-quality model for a hospital laboratory. Free Library. 1992. Accessed 2026 Apr 21. Available from: https://www.thefreelibrary.com/A+cost-of-quality+model+for+a+hospital+laboratory.-a011815914
[20]. Carlson OR, Amirahmadi F, James SH, et al. A primer on the cost of quality for improvement of laboratory and pathology specimen processes. Am J Clin Pathol. 2012;138:347-54.
[21]. Plunckett JJ, Dale BG. Some practicalities and pitfalls of quality-related cost collection. Proc Inst Mech Eng B. 1985;199(B1).
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Adolescent Nutrition Surveillance in Africa: Addressing the Triple Burden of Malnutrition Through Stronger Health Information SystemsAuthor: Elodia Cheutou SiewoueDOI: 10.21522/TIJPH.2013.14.03.Art037
Adolescent Nutrition Surveillance in Africa: Addressing the Triple Burden of Malnutrition Through Stronger Health Information Systems
Abstract:
Adolescence represents a critical stage of human development characterized by rapid physical growth and increased nutritional requirements. However, adolescents remain underrepresented in nutrition surveillance systems, particularly in low- and middle-income countries where the burden of malnutrition remains high. This study aimed to examine the current state of adolescent nutrition surveillance and identify key gaps in existing data systems that limit evidence-based policy and programming. We conducted a narrative literature review and policy analysis using scientific publications and authoritative institutional reports published between 2000 and 2025. Data sources included peer-reviewed journals and reports from major global health organizations. The analysis focused on measuring adolescent nutritional indicators and integrating these indicators into national health information systems. The findings reveal that current surveillance systems largely prioritize children under five years of age and women of reproductive age, leaving adolescents underrepresented in routine monitoring systems. Existing data sources, including household surveys and school-based health surveys, provide only partial and irregular information on adolescent nutritional status. Furthermore, adolescents are increasingly affected by the triple burden of malnutrition, including undernutrition, overweight and obesity, and micronutrient deficiencies such as anaemia. Strengthening adolescent nutrition surveillance by integrating standardized indicators into national health information systems is essential to support evidence-based decision-making, guide targeted interventions, and improve long-term health outcomes for adolescents.
Adolescent Nutrition Surveillance in Africa: Addressing the Triple Burden of Malnutrition Through Stronger Health Information Systems
References:
[1]. Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223-8. Available from: https://doi.org/10.1016/S2352-4642(18)30022-1
[2]. Christian P, Smith ER. Adolescent undernutrition: global burden, physiology, and nutritional risks. Ann Nutr Metab. 2018;72(4):316-28. Available from: https://doi.org/10.1159/000488865
[3]. Azzopardi PS, Hearps SJC, Francis KL, Kennedy EC, Mokdad AH, Kassebaum NJ, et al. Progress in adolescent health and wellbeing: tracking 12 headline indicators for 195 countries and territories, 1990-2016. Lancet. 2019;393(10176):1101-18. Available from: https://doi.org/10.1016/S0140-6736(18)32427-9
[4]. United Nations Population Fund. Adolescents in a changing world: the case for urgent investment [Internet]. New York: UNFPA; 2024. Available from: https://www.unfpa.org/publications/adolescents-changing-world-case-urgent-investment
[5]. World Health Organization. Obesity and overweight. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
[6]. World Health Organization. Global accelerated action for the health of adolescents (AA-HA!): guidance to support country implementation. Geneva: World Health Organization; 2017.
[7]. World Health Organization. Global Action for Measurement of Adolescent Health (GAMA): adolescent health indicators. Geneva: World Health Organization; 2021.
[8]. United Nations Children’s Fund. Undernourished and overlooked: a global nutrition crisis in adolescent girls and women. New York: UNICEF; 2023. Available from: https://www.unicef.org/reports/undernourished-overlooked-nutrition-crisis
[9]. World Health Organization. Global school-based student health survey. Available from: https://www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/global-school-based-student-health-survey
[10]. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-81. Available from: https://doi.org/10.1016/S0140-6736(14)60460-8
[11]. Development Initiatives. 2021 Global Nutrition Report: the state of global nutrition. Bristol: Development Initiatives; 2021. Available from: https://globalnutritionreport.org/reports/2021-global-nutrition-report/
[12]. Akseer N, Mehta S, Wigle J, Chera R, Brickman ZJ, Al-Gashm S, et al. Non-communicable diseases among adolescents: current status, determinants, interventions and policies. BMC Public Health. 2020;20(1):1908. Available from: https://doi.org/10.1186/s12889-020-09988-5
[13]. Ross DA, Hinton R, Melles-Brewer M, Engel D, Zeck W, Fagan L, et al. Adolescent well-being: a definition and conceptual framework. J Adolesc Health. 2020;67(4):472-6. Available from: https://doi.org/10.1016/j.jadohealth.2020.06.042
[14]. Salam RA, Hooda M, Das JK, Arshad A, Lassi ZS, Middleton P, et al. Interventions to improve adolescent nutrition: a systematic review and meta-analysis. J Adolesc Health. 2016;59(2 Suppl):S29-39. Available from: https://doi.org/10.1016/j.jadohealth.2016.06.022
[15]. Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the double burden of malnutrition and the changing nutrition reality. Lancet. 2020;395(10217):65-74. Available from: https://doi.org/10.1016/S0140-6736(19)32497-3
[16]. World Health Organization. Strengthening data on adolescent health and well-being. Available from: https://www.who.int/health-topics/adolescent-health/strengthening-data-on-adolescent-health
[17]. World Health Organization. Nutrition in adolescence: issues and challenges for the health sector. Geneva: World Health Organization; 2005. Available from: https://iris.who.int/handle/10665/43342
[18]. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations; 2015.
[19]. World Bank. Health Nutrition and Population Statistics [Internet]. Washington (DC): World Bank. Available from: https://databank.worldbank.org/source/health-nutrition-and-population-statistics
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Unpacking Zimbabwe's Sub-national Health Systems Governance Dynamics in the 21st Century: A Scoping ReviewAuthor: Mufaro ChirigaDOI: 10.21522/TIJPH.2013.14.03.Art038
Unpacking Zimbabwe's Sub-national Health Systems Governance Dynamics in the 21st Century: A Scoping Review
Abstract:
Health system governance is growing in prominence globally, with increasing recognition of it’s role in health system performance, particularly in low- and middle-income countries. Zimbabwe’s Ministry of Health and Child Care (MOHCC) emphasizes the criticality of effective health governance for equitable and universal health coverage. However, despite the efforts, governance challenges persist, and the subject remains under-explored in Zimbabwe. This scoping review systematically maps and synthesizes evidence on subnational health system governance in Zimbabwe in the 21st century. Databases searched include PubMed Central, Science Direct, Springer Nature Link, ProQuest, Google Scholar, and grey literature. Based on the employed search criteria, ten studies were identified and included in the review. The review found persistent governance challenges across governance domains, across governance levels and throughout the period under review. Poor accountability, weak leadership capacity, inadequate decision-space, undervalued community governance structures were frequently cited. Few studies demonstrated potential for enhancing health governance through deliberate efforts to capacitate governance structures and systematically institutionalize governance in the wider health functions. The review found that evidence on subnational health governance in Zimbabwe was scant. Strengthening the evidence base on subnational health governance through empirical research will be essential for informing future health sector reforms that strengthen governance at the subnational level.
Unpacking Zimbabwe's Sub-national Health Systems Governance Dynamics in the 21st Century: A Scoping Review
References:
[1]. World Health Organization. Health system governance for improving health system performance: report of a WHO global consultation. Geneva: WHO; 2007.
[2]. Atieno R, Moyo T, Nyang'oro O. Service delivery in fragile states: the case of health sector in Zimbabwe. 2022.
[3]. World Health Organization. Health systems governance for universal health coverage action plan. Geneva: WHO; 2014. Report No.: WHO/HSS/HSF/2014.01.
[4]. Ghalibaf MB, Ahmadi A, Kiani MA, Zarei B, Pourezzat AA. The governance patterns of the health system in developed countries: a systematic review. Cimexus. 2025;20(1):77-99.
[5]. Sapkota S, Dhakal A, Rushton S, van Teijlingen E, Marahatta SB, Balen J, Lee AC. The impact of decentralization on health systems: a systematic review of reviews. BMJ Glob Health. 2023;8(12).
[6]. Olafsdottir AE, Reidpath DD, Pokhrel S, Allotey P. Health systems performance in sub Saharan Africa: governance, outcome and equity. BMC Public Health. 2011;11:237.
[7]. Nash K. The African Union and emerging patterns of global health governance. Glob Stud Q. 2023;3(3):ksad048.
[8]. Jeppsson A, Okuonzi SA. Vertical or holistic decentralization of the health sector? Experiences from Zambia and Uganda. Int J Health Plann Manage. 2000;15(4):273-89.
[9]. Kirigia JM, Barry SP. Health challenges in Africa and the way forward. Int Arch Med. 2008;1(1):27.
[10]. Ministry of Health and Child Care. Zimbabwe National Health Strategy: 2021–2025. Harare: MOHCC; 2021. Available from: https://khub.africacdc.org/records/resource?id=569 [Accessed 2026 Mar 24].
[11]. McClure J. An analysis of Zimbabwean health crises since independence. Int J Foreign Aff (Undergrad). 2020;5(1):32-8.
[12]. Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors. BMC Med Res Methodol. 2018;18(1):143.
[13]. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69.
[14]. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-73.
[15]. Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. ESRC Methods Programme. 2006;1(1):b92.
[16]. Funhiro W, Yalezo B, Mutambara E. Standardization and strengthening hospital management boards in central hospitals. Corp Gov Organ Behav Rev. 2021;5(2):233-43.
[17]. Muchekeza M, Chimusoro A, Gombe NT, Tshimanga M, Shambira G. District health executives in Midlands Province, Zimbabwe: are they performing as expected? BMC Health Serv Res. 2012;12:335.
[18]. Osika J, Altman D, Ekbladh L, Katz I, Nguyen H, Rosenfeld J, Williamson T, Tapera S. Zimbabwe health system assessment 2010. Bethesda (MD): Health Systems 20/20 Project, Abt Associates Inc.; 2010.
[19]. Zhanda K, Chitongo L. Devolution as a health governance paradigm amidst COVID 19 in Zimbabwe. In: The COVID 19 health systems nexus. Cham: Springer; 2023. p. 67-98.
[20]. Loewenson R, Rusike I. Assessing the impact of HCCs on health system performance and resource allocation. 2004. Available from: https://www.tarsc.org/publications/documents/cbr02health.pdf [Accessed 2026 Feb 15].
[21]. Maponga CC, Chikwinya T, Hove R, Madzikwa N, Mazambara F, Midzi SM, et al. Lessons learnt from implementing the Good Governance for Medicines Programme in Zimbabwe. BMJ Glob Health. 2022;7(1).
[22]. Witter S, Chirwa Y, Chandiwana P, Munyati S, Pepukai M, Bertone MP. The political economy of results based financing: the experience of Zimbabwe. Glob Health Res Policy. 2019;4(1):20.
[23]. Chung AM, Case P, Gosling J, Gosling R, Madinga M, Chikodzore R, et al. Scaling up malaria elimination management and leadership: a pilot in Zimbabwe. Malar J. 2020;19(1):185.
[24]. Kanonhuhwa TN. COVID 19 and the environmental hygiene question: some proposals for urban health governance in Zimbabwe. J Urban Syst Innov Resil Zimbabwe. 2020;2(2):114-32.
[25]. Taderera BH, Hendricks SJH, Pillay Y. Human resource for health reform in peri urban areas: a cross-sectional study in Epworth, Zimbabwe. Hum Resour Health. 2017;15(1):83.
[26]. Paul SO. An appraisal of primary health care policy implementation in Nigerian rural and semi urban sector after four decades. PanAfr J Gov Dev. 2025;6(1):112-40.
[27]. Argaw MD, Desta BF, Muktar SA, Tewfik N, Tefera BB, Abera WS, et al. Effectiveness of leadership, management, and governance competencies for performance improvements at primary health care entities in Ethiopia: a before and after study. J Hum Resour Sustain Stud. 2021;9(2):250-75.
[28]. Fonseca VR, Diniz JM, Eleftheria G, Shcherbina Y, Baptista AC, Saldanha Resendes D, et al. Building public health leadership: design, implementation and outcomes of the WHO European autumn school on quality of care and patient safety. Front Public Health. 2026;14:1825901.
[29]. Brinkerhoff DW, Wetterberg A. Gauging the effects of social accountability on services, governance, and citizen empowerment. Public Adm Rev. 2016;76(2):274-86.
[30]. Alizadeh M, Azizi N, Mahdavi S, Baghlani F. Unveiling the shadows: obstacles, consequences, and challenges of information opacity in healthcare systems. Philos Ethics Humanit Med. 2025;20(1):6.
[31]. Kohler JC, Ovtcharenko N. Good governance for medicines initiatives: exploring lessons learned. 2013.
[32]. Zon H, Pavlova M, Drabo KM, Groot W. Municipal health services provision by local governments: a systematic review of experiences in decentralized Sub Saharan Africa. Health Policy Plan. 2017;32(9):1327-36.
[33]. Bossert TJ, Mitchell AD. Health sector decentralization and local decision making: decision space, institutional capacities and accountability in Pakistan. Soc Sci Med. 2011;72(1):39-48.
[34]. Greer SL, King EJ, da Fonseca EM, Peralta Santos A. The comparative politics of COVID 19: the need to understand government responses. Glob Public Health. 2020;15(9):1413-6.
[35]. Jakubowski E, Saltman RB, World Health Organization. The changing national role in health system governance: a case based study of 11 European countries and Australia. Copenhagen: WHO Regional Office for Europe; 2013.
[36]. McCoy D, Hall JA, Ridge M. A systematic review of the literature for evidence on health facility committees in low and middle income countries. Health Policy Plan. 2012;27(6):449-66.
[37]. World Health Organization. Social participation for universal health coverage. Geneva: WHO; 2023. Available from: https://cdn.who.int/media/docs/default-source/hgf/9789240027794.pdf?download=true [Accessed 2026 Mar 29].
[38]. Mapanga A. Impediments to healthcare governance in fragile states. J Legal Ethical Regul Issues. 2020;23:1.
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Fatal Diphtheria in a Rohingya Refugee Settlement in Cox’s Bazar, Bangladesh: A Case Study of Clinical, Surveillance and Health-System GapsAuthor: Aarti SinghDOI: 10.21522/TIJPH.2013.14.03.Art039
Fatal Diphtheria in a Rohingya Refugee Settlement in Cox’s Bazar, Bangladesh: A Case Study of Clinical, Surveillance and Health-System Gaps
Abstract:
Diphtheria remains a significant threat in humanitarian settings with low vaccination coverage and fragile health systems. Global evidence indicates that outbreaks among displaced populations driven by overcrowding, immunity gaps, delayed clinical recognition, and weak surveillance systems, while limited availability of diphtheria antitoxin (DAT) further constrains effective case management. We conducted a descriptive case analysis of a fatal diphtheria infection, complemented by a public health investigation including contact tracing and surveillance review to identify gaps in clinical management and outbreak response. A 9-year-old unvaccinated boy residing in a Rohingya refugee camp in Cox’s Bazar, Bangladesh, presented with fever and sore throat managed symptomatically without a throat examination. Rapid progression to severe disease with cervical swelling (bull neck) and respiratory distress occurred. On re-presentation, suspected diphtheria and later confirmed; however, delayed recognition, lack of access to DAT, and late referral led to death during transfer. Public health investigation identified 10 contacts who received prophylaxis but revealed delayed case notification, missed identification of a probable secondary case, and weak integration between clinical and surveillance systems. This case demonstrates how failures in early clinical recognition, timely access to DAT, and surveillance responsiveness, commonly reported in fragile and outbreak prone settings can converge to result in preventable mortality. Strengthening frontline clinical capacity, ensuring reliable DAT availability, improving real-time clinical–surveillance integration, and addressing immunization gaps are essential to reduce diphtheria deaths in humanitarian contexts.
Fatal Diphtheria in a Rohingya Refugee Settlement in Cox’s Bazar, Bangladesh: A Case Study of Clinical, Surveillance and Health-System Gaps
References:
[2]. Fouda AAB, et al. Resurgence of diphtheria outbreaks in the African Region, 2023–2024. Pan Afr Med J. 2025;51(1):29.
[3]. World Health Organization. Diphtheria reported cases by country. Geneva: WHO; 2023.
[4]. Harris E. WHO issues first recommendations for managing diphtheria. JAMA. 2024;331(11):907.
[5]. Ahmed Z, Rahman S, Hasan MT, Sultana N, Rahman M, et al. Diphtheria outbreak among Rohingya refugees in Bangladesh: lessons learned. Trop Med Infect Dis. 2020;5(3):133. doi:10.3390/tropicalmed5030133
[6]. Wagner KS, White JM, Lucenko I, Mercer D, Crowcroft NS, Neal S, et al. Diphtheria in the postepidemic period, Europe, 2000–2009. Emerg Infect Dis. 2012;18(2):217–25. doi:10.3201/eid1802.110987
[7]. World Health Organization. Rohingya crisis situation report, Cox’s Bazar, Bangladesh. Geneva: WHO; 2026.
[8]. World Health Organization. From data to life‑saving action: how Go.Data strengthened outbreak response in Cox’s Bazar, Bangladesh. Geneva: WHO; 2026.
[9]. Polonsky JA, Ivey M, Mazhar MKA, Rahman Z, le Polain de Waroux O, Karo B, et al. Epidemiological, clinical, and public health response characteristics of a large diphtheria outbreak among the Rohingya population in Cox’s Bazar, Bangladesh, 2017–2019. PLoS Med. 2021;18(4):e1003587
[10]. Directorate General of Health Services (DGHS), Bangladesh. Epidemiological update, week 45 (30 Oct–5 Nov) 2022. Dhaka: DGHS; 2022.
[11]. Pan American Health Organization; World Health Organization. Diphtheria fact sheet. Washington (DC): PAHO; 2024.
[12]. Clarke KEN, MacNeil A, Hadler S, Scott C, Tiwari TSP, Cherian T. Global epidemiology of diphtheria, 2000–2017. Emerg Infect Dis. 2019;25(10):1834–1842.
[13]. Feldstein LR, Bennett SD, Estivariz CF, Cooley GM, Weil LM, Billah MM, et al. Vaccination coverage survey and seroprevalence among forcibly displaced Rohingya children, Cox’s Bazar, Bangladesh, 2018. PLoS Med. 2020;17(3):e1003071.
[14]. WHO Vaccine-Preventable Diseases Surveillance Standards; Diphtheria , last updated Sep 5, 2018.
[15]. SEARO Surveillance Guide for Vaccine-Preventable Diseases in the WHO South-East Asia Region, September 2017
[16]. World Health Organization. Clinical management of diphtheria: guideline. Geneva: WHO; 2024.
[17]. Centers for Disease Control and Prevention (CDC). Manual for the surveillance of vaccine‑preventable diseases: diphtheria chapter. Atlanta: CDC; 2024.
[18]. Centers for Disease Control and Prevention (CDC). Diphtheria antitoxin production and procurement practices and challenges. Emerg Infect Dis. 2025;31(12).
[19]. World Health Organization. Diphtheria outbreak toolbox. Geneva: WHO; 2024
[20]. World Health Organization. Global strategy for the elimination of diphtheria and strengthening health systems response. Geneva: WHO; 2024.
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