Community Mobilization Research Articles

Organic online politics: Farmers, Facebook, and Myanmar's military coup

Despite perennial hope in the democratic possibilities of the internet, the rise of digital authoritarianism threatens online and offline freedom across much of the world. Yet while critical data studies has expanded its geographic focus, limited work to date has examined digital mobilization in the agrarian communities that comprise much of the Global South. This article advances the concept of “organic online politics,” to demonstrate how digital mobilization grows from specific rural conditions, material concerns, and repertoires of resistance, within the constraints of authoritarian violence and internet control. To do so, we examine social media interaction in the wake of the 2021 military coup in Myanmar, an agrarian nation with recent, rapid digital connection that corresponded with a decade-long democratic turn. Analyzing an original archive of over 2000 Facebook posts collected from popular farming pages and groups, we find a massive drop-off in online activity after the military coup and analyze the shifting temporalities of digital mobilization. Crucially, we highlight the embeddedness of online interaction within the material concerns of farming communities, examining how social media become a key forum for negotiating political crisis in Myanmar's countryside. These findings call attention to rural digital subcultures as fertile sites of investigation and point toward the need for future scholarship on data practices that attends to rooted agrarian struggles.

Women as Change Agent for Sustainable Development in the 21st Century in Nigeria

This study investigated women as change agent for sustainable development in the 21st century Nigeria. Two research questions guided the study; why are women the change agent in the 21st century in Nigeria for sustainable development? What are the hindrances that negate their active participation in sustainable development in Nigeria? descriptive survey research design was adopted for the study. The population consists of 5.6 million women in South-East Nigeria. The sample size was 400 women. The sampling technique adopted was multi stage sampling and simple random sampling. Data collected were analyzed using mean. The findings of the study showed that women in 21st century Nigeria are change agents for sustainable development because they posses characteristics such as community advocacy roles, promotion and grassroots mobilizations to achieve different change that could rob off on the socio-economic life of the people , contribution to the economy through business both at retail, wholesale and production level, care for the family, nurture and play a significant role in community building, mobilization skills, teaching skills , disciplinarian skills, disburser and manager of funds in the home, caregivers, educators, teacher, organizer, and home making. It was concluded among others that the role of women as agents of sustainable development seems to be more potent, effective and holds the possibilities of fostering a positive change that span the different areas for sustainable development . From the foregoing evidences, it is safe to deduce that through the use of women as agents for sustainable development, it is easier and gives a better result in the 21st century Nigeria that is battling with a lot of cultural, religious and political inclinations against women.

Prevalence and Factors Associated With Compliance With COVID-19 Presidential Lockdown Measures: A Cross-Sectional Study.

The coronavirus disease 2019 (COVID-19) is one of the most severe global health uncertainties to date. Although significant global effort has been put into implementing COVID-19 pandemic control measures such as lockdowns, travel restrictions, and hygiene precautions, the transmission is expected to resurface once these efforts are discontinued. We aimed to determine the prevalence and factors associated with compliance with presidential 53-day lockdown measures in June-July 2021 in northern Uganda. In this cross-sectional study, 587 adult participants (≥18 years old) from northern Uganda were selected using a systematic sampling method. Data collection involved interviewer-administered questionnaires with an internal validity of Cronbach's α = .72. Socio-demographic characteristics of participants were described, and multivariable modified Poisson regressions were performed to assess prevalence ratios between dependent and selected independent variables, with respective P values at 95% confidence intervals. All analyses were conducted using Stata 17.0. Participants' compliance with the presidential lockdown directives was high at 88%(95% CI: 85%-90%). Compliance with the presidential directives was more likely among participants who agreed to the lockdown measures [adjusted Prevalence Ratio, aPR = 1.28 (95% CI: 1.10-1.49; P = .001)] compared to those who did not, and more likely among those who were afraid of death from COVID-19 [aPR = 1.08 (95% CI: 1.01-1.15; P = .023)] than those who did not. However, compliance was less likely among males [aPR = 0.91 (95% CI: 0.86-0.97; P = .002)] compared to females, those aged 35 to 44 years [aPR = 0.87 (95% CI: 0.79-0.97; P = .013)] compared to those less 25 years; and unmarried [aPR = 0.89 (95% CI: 0.82-0.97; P = .011)] compared to the married. Compliance with the COVID-19 presidential lockdown measures in northern Uganda was high. The factors associated with compliance were the fear of death and agreement with presidential lockdown measures. However, compliance was less likely among males, unmarried persons, and persons aged 35 to 44. The authors recommend more community engagements, participation, sensitization, mobilization, and simultaneous application of multiple public health approaches to improve compliance and control of COVID-19.

A realist review of interventions targeting maternal health in low- and middle-income countries.

Maternal mortality is disproportionately higher in low- and middle-income countries compared to other parts of the world. International research efforts are reflective of the urgency to improve global maternal outcomes. The existing literature of maternal health interventions in low- and middle-income countries targets a variety of populations and intervention types. However, there is a notable lack of systemic reviews that examine the wider contextual and mechanistic factors that have contributed to the outcomes produced by interventions. This article aims to use realist synthesis design to identify and examine the relationships between the contexts, mechanisms and outcomes of maternal health interventions conducted in low- and middle-income countries. This will inform evidence-based practice for future maternal health interventions. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in low- and middle-income countries published in the last 5 years. We used open and axial coding of contexts, mechanisms and outcomes to develop an explanatory framework for intervention effectiveness. After eligibility screening and full-text analysis, 44 papers were included. The majority of effective interventions reported good healthcare system contexts, especially the importance of infrastructural capacity to implement and sustain the intervention. Most intervention designs used increasing knowledge and awareness at an individual and healthcare-provider level to produce intended outcomes. The majority of outcomes reported related to uptake of healthcare services by women. All mechanism themes had a relationship with this outcome. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilization and involvement to enable tailored interventions with optimal contextual fit.

‘Our courage has grown’: a grounded theory study of enablers and barriers to community action to address violence against women in urban India

Transforming communities into supportive environments for women facing risks of violence requires community members to play an active role in addressing violence against women (VAW). We did a grounded theory...

Evaluation of a community-based One Health intervention to reduce the risk of Lyme disease in a high-incidence municipality

Abstract Integrated interventions coherent with the One Health approach are required to maximize the effectiveness of tick-borne disease prevention. The objective of this study was to evaluate the feasibility of a community-based One Health preventive intervention in a municipality reporting a high incidence of Lyme disease (LD) in the province of Quebec, Canada. The intervention integrated several activities to promote the adoption of preventive behaviours in the community (community component), with the reduction of infected ticks in the environment (environmental component). To evaluate short-term effects of the community component, quantitative data on knowledge, attitudes, and practices (KAP) of citizens were collected using online questionnaires at the beginning of the intervention and 1 year later. To evaluate the implementation of the intervention, a qualitative approach was principally used, and individual interviews (n=37) were conducted with key informants. Results showed that having a high level of participation in the community activities included in the intervention was associated with a higher adoption of preventive measures at the end of the intervention, although participation was not significantly associated with changes in KAP over the intervention period. Interviews revealed that the community mobilization approach was perceived as an effective and sustainable way to empower citizens and researchers with regard to LD prevention. This study suggests that community-based interventions of this type offer a promising approach to the prevention of tick-borne diseases.

Development of a complex intervention package for dengue prevention

Introduction: Complex interventions are widely used in public health practices with noteworthy health impacts. Communication for Behavioural Impact (COMBI) plan is an effective method directed at enacting behaviour change to benefit health and social development which encourage precise behavioural outcomes and is effective in planning a behavioural change for dengue control. The aim of this study was to develop an intervention package to change the behaviour to prevent dengue in one of the highest dengue-endemic areas of Sri Lanka.Methods: The development of the intervention package was formulated according to the two phases, the ‘Theoretical phase’ and ‘Modelling phase’ of the framework for ‘Developing and Evaluating Complex Interventions’. World Health Organization’s 10 key steps in planning COMBI strategies were followed in order to develop the present intervention package. A situational market analysis was conducted in the highest dengue-endemic area in Kurunegala district to identify the Specific Behavioural Objectives (SBOO) for the COMBI plan. The development of the COMBI plan was conducted using the mixed methodological approach including quantitative and qualitative designs.Results: The overall goal of the COMBI plan was to decrease the morbidity and mortality due to dengue illness by improving the dengue prevention behaviours among householders. The SBOO for the plan were to improve the proper waste management practices according to the ‘3R concept’ (Reduce, Reuse and Re-cycling) and to improve the dengue prevention practices by 30 minutes of weekly cleaning. The strategies of intervention package were to conduct a community empowerment program to improve household waste management and weekly practices on dengue prevention by conducting administrative mobilization and public relationship, public advocacy, community mobilization, personal selling, advertising, and point of service promotion during follow-up.Conclusion: Developing a COMBI plan for an area after the identification of SBOO would be feasible to implement in order to empower the community to prevent dengue and improve community health services.

Impact of health education-based intervention on community’s awareness on dengue and its prevention in Chidambaram during COVID-19 pandemic

Background: Dengue fever is a global public health issue. It is acknowledged that vast, repeated, intense, and persistent health education programs for community mobilization are essential to achieving the aforementioned goals. The main objective of the study was to increase the dengue-related awareness and behavioral change through health education-based intervention among the selected urban communities in Chidambaram.Methods: A quasi experimental, community-based interventional study conducted among 150 residents of urban area of Annamalai Nagar, Chidambaram district consisting of both males and females of age groups between 18-75 years who were selected using stratified random sampling technique. Data was collected using semi structured questionnaire before and after intervention using flipchart, entered in Microsoft Excel and analysed using SPSS software. Descriptive and analytical statistics were applied.Results: Most of the study participants (32.7%) were in the age group of 30-39 years. More women (68.7%) participated in the survey among which 50.7% were educated up to secondary and higher secondary class. On comparing the results of mean values of knowledge, attitude and practice between pre-test and post-test, reflected significant improvement upon after health education by flipchart intervention. It was found very highly significant (p<0.001) between mean knowledge scores and significant (p<0.05) between mean practice scores.Conclusions: Health education could contribute to changes in perceptions, social capital, and a healthy house condition. It is very important to increase the awareness and participation of the community in controlling dengue prevalence.

Expanding Roles of Accredited Social Health Activists (ASHAs) in the 2019 Hepatitis E Outbreak in a Peri-urban Slum, Nagpur, India.

Due to constraints in the dedicated health work force, outbreaks in peri-urban slums are often reported late. This study explores the feasibility of deploying Accredited Social Health Activists (ASHAs) in outbreak investigation and understand the extent to which this activity gives a balanced platform to fulfil their roles during public health emergencies to reduce its impact and improve mitigation measures. Activities of ASHAs involved in the hepatitis E outbreak were reviewed from various registers maintained at the subcenter. Also, various challenges perceived by ASHAs were explored through focus group discussion (FGD). During March to May 2019, 13 ASHAs involved in the hepatitis outbreak investigation and control efforts in a peri-urban slum of Nagpur with population of around 9000. In total, 192 suspected hepatitis E cases reported. During the outbreak, ASHAs performed multiple roles comprising house-to-house search of suspected cases, escorting suspects to confirm diagnosis and referral, community mobilization for out-reach investigation camps, risk communication to vulnerable, etc. During the activity, ASHAs faced challenges such as constraints in the logistics, compromise in other health-related activities, and challenges in sustaining behavior of the community. It is feasible to implement the investigation of outbreaks through ASHAs. Despite challenges, they are willing to participate in these activities as it gave them an opportunity to fulfil the role as an activist, link worker, as well as a community interface.

Dietary analysis of traditional food cultures in India: An overview of 2600 BCE to the 21st century

Around 415 BC, Hippocrates proclaimed, “let food be thy medicine, and let medicine be thy food.” A report published in Elsevier’s Journal of Archaeological Science: Reports in 2021 by Archeological Survey of India (ASI), New Delhi, that ‘seven similar big-size brown ‘laddoos’ high protein, multigrain ‘laddoos’ (food balls)’ was found at the Harrapan site in Rajasthan India. Excavation results were surprisingly shocking to the world as many civilizations, sects & religions were not born then. Although India has capacity, if one Jute Sack of food grains is staked over another, they will reach moon and can come back and can still cover more than 1/3rd journey of the moon (2.347 times moon distance capacity). But even in 21st century scientific community are still talking about global hunger. Unfortunately, in the 2021 Global Hunger Index, India ranked 101st out of the 116 countries in 2021 GHI scores and fell under the serious group with a score of 27.5. Poshan Abhiyaan’s convergence mission to address malnutrition must be implemented through ensured community mobilization and participation. Multigrain Ladoos were used in ancient times need to be in the mainstream again to alleviate the hidden hunger. The research concludes that India in the past may have more food security than present India. Hence, ayurvedic foods are recommended for different health disorders as diet plays the most critical role in maintaining health parameters.

Understanding Factors Influencing Polio Vaccine Uptake in Ghana-Developing Meaningful Community Mobilization and Engagement Strategies in Collaboration with Religious Leaders.

This qualitative study explores how religious leaders in Ghana view polio and polio vaccine-related knowledge and perceptions of the community members. It also examines the personal characteristics of those who are most likely to accept or reject the vaccine. On the basis of the findings, this study provides a set of evidence-based recommendations to support religious leaders' efforts to create polio vaccine demand in their communities. The study is based on focus group discussions conducted with religious leaders from various geographic locations across Ghana. The discussions were transcribed verbatim and analyzed thematically. Twenty religious leaders, including Christian, Muslim, and leaders of traditional African religions, participated in the study. The findings show that both religious leaders and community members lack knowledge and have multiple culturally and religiously influenced explanations for polio. In addition, the findings reveal that vaccine safety and efficacy are linked to emotional narratives, and receiving the polio vaccine is not a social norm in all communities. Educated mothers in urban settings were identified as those most receptive to the polio vaccine. To create polio vaccine demand, religious leaders need to combat misinformation and the negative perceptions about the vaccine. Recommendations include conveying high-quality information to community members, developing tactics to address culturally and religiously sensitive matters, using emotionally inspired personal accounts to enhance positive attitudes toward polio vaccines and act as catalysts for positive social norms towards the polio vaccine. Educated mothers from urban areas can be engaged as champions in vaccine demand creation.

Intermediate hyperglycaemia, diabetes and blood pressure in rural Bangladesh: five-year post-randomisation follow-up of the DMagic cluster-randomised controlled trial

The DMagic trial showed that participatory learning and action (PLA) community mobilisation delivered through facilitated community groups, and mHealth voice messaging interventions improved diabetes knowledge in Bangladesh and the PLA intervention reduced diabetes occurrence. We assess intervention effects three years after intervention activities stopped. Five years post-randomisation, we conducted a cross-sectional survey among a random sample of adults aged ≥30-years living in the 96 DMagic villages, and a cohort of individuals identified with intermediate hyperglycaemia at the start of the DMagic trial in 2016. Primary outcomes were: 1) the combined prevalence of intermediate hyperglycaemia and diabetes; 2) five-year cumulative incidence of diabetes among the 2016 cohort of individuals with intermediate hyperglycaemia. Secondary outcomes were: weight, BMI, waist and hip circumferences, blood pressure, knowledge and behaviours. Primary analysis compared outcomes at the cluster level between intervention arms relative to control. Data were gathered from 1623 (82%) of the randomly selected adults and 1817 (87%) of the intermediate hyperglycaemia cohort. 2018 improvements in diabetes knowledge in mHealth clusters were no longer observable in 2021. Knowledge remains significantly higher in PLA clusters relative to control but no difference in primary outcomes of intermediate hyperglycaemia and diabetes prevalence (OR (95%CI) 1.23 (0.89, 1.70)) or five-year incidence of diabetes were observed (1.04 (0.78, 1.40)). Hypertension (0.73 (0.54, 0.97)) and hypertension control (2.77 (1.34, 5.75)) were improved in PLA clusters relative to control. PLA intervention effect on intermediate hyperglycaemia and diabetes was not sustained at 3 years after intervention end, but benefits in terms of blood pressure reduction were observed. Medical Research Council UK: MR/M016501/1 (DMagic trial); MR/T023562/1 (DClare study), under the Global Alliance for Chronic Diseases (GACD) Diabetes and Scale-up Programmes, respectively.

Health Care Financing and Financial Hardship among Rural and Urban Households in Ekiti State, Nigeria

Background: Individuals and families suffer financial hardship in seeking health care. The study aimed to assess health care financing and experience of financial hardship in seeking health care among urban and rural households in Ekiti State, Nigeria.
 Methods: This was a comparative, cross-sectional study. A multi-stage sampling technique was used to select 420 households each in the rural and urban areas. Data was collected using pre-tested, structured interviewer-administered questionnaire, and analysed using SPSS v20. Level of statistically significance was set at p-value of <0.05.
 Results: One hundred and seventy-nine respondents (42.6%) in the rural area, and 156 (37.1%) in the urban area had experienced difficulty in paying for health bills (p=0.105). Respondents who have had to borrow recently for seeking healthcare were 129 (30.7%) in the rural area, and 131 (31.2%) in the urban area (p=0.881), while 47 (11.2%) in the rural area, and 43 (10.2%) in the urban area have had to sell household assets (p=0.655). Out-of-Pocket was the main method of healthcare financing for the majority, 410 (97.6%) in the rural areas, and 400 (95.2%) in the urban areas. Only 10 (2.4%) of the ruralrespondents and 20 (4.8%) of the urban respondents were on health insurance.
 Conclusion: A high proportion of the study population experienced financial hardship and there is high dependence on out-of-pocket financing. This calls for increased community mobilization and acceleration of the progression of health insurance towards universal coverage in Ekiti State.

Realizing common prosperity: The action logic of social entrepreneurship community mobilization in rural tourism

The effective participation of rural residents in tourism social entrepreneurship can improve their quality of life and promote community transformation. Hence, it is important to understand the strategies and process of community mobilization by social entrepreneurs. This study focuses on the strategy of village cadre, who play the dual roles of an entrepreneur and a policy implementer to mobilize community residents to participate in collective tourism entrepreneurship and the mechanism for changing residents’ attitudes in a rural China context, by using the longitudinal research method of nonparticipatory observation and 50 interviews conducted in Yuanjia Village, Shaanxi Province. The results show that the community mobilization of social entrepreneurs has not been accomplished overnight but has undergone a 3-stage dynamic process of change. These results indicate that social enterprises should incorporate indigenous people into their value network in the early stage of tourism development and continue to explore the mechanism of affiliating residents with benefits, so as to further increase residents’ in-depth participation. Residents play the dual roles of producer and collaborator in tourism social entrepreneurship and work with social entrepreneurs to promote the sustainable development of rural tourism and achieve common prosperity.

Religious Tourist Attractions and Ecological Concerns in the Italian Dolomites: The Case of the Trekking of the Thinking Christ

The article examines the mobilisation of a local community after the creation of a religious attraction and a popular mountain trail in a protected and fragile context. Despite much research on the topic, the boundaries between spiritual or religious tourism and pilgrimage are still quite complicated. The research questions focused on the social reasons behind the growing invention and reinvention of religious places outside of liturgical celebrations and religious practices. Through a case study, the question of whether/how a religious attraction can give new meaning to a mountain tourist spot on the border of a UNESCO World Natural Heritage List Site is addressed, while also raising ecological issues.

Feasibility and preliminary effectiveness of integrating HIV prevention into an adolescent empowerment and livelihood intervention at youth clubs in rural Uganda

ABSTRACT The uptake of HIV prevention services is lower among youth than adults in sub-Saharan Africa. Existing youth livelihood trainings offer a potential entry point to HIV prevention services. We determined feasibility and preliminary effectiveness of integrating HIV prevention into youth clubs implementing an empowerment and livelihood for adolescents (ELA) intervention in rural Uganda. Staff conducted community mobilization for youth (15–24 years) over one month. Clubs met (3×/week) over six months, with local peer mentors trained to teach life-skills and sexual/reproductive health education. We integrated mentor-led education on HIV prevention, including pre- and post-exposure prophylaxis (PrEP/PEP). Clubs offered on-site HIV testing, a field trip to a local clinic and PrEP referrals after one month and six months. Surveys were conducted at baseline and six months. Forty-two participants (24 adolescent girls/young women (AGYW) and 18 adolescent boys/young men (ABYM)) joined the clubs. At baseline, no participants accepted referral for PrEP, whereas 5/18 (28%) sexually active, HIV-negative AGYW requested PrEP referral at follow-up. One ABYM requested PEP referral. Integration of HIV prevention services into an established ELA curriculum at mentor-led youth clubs in rural Uganda was feasible. PrEP uptake increased among sexually active AGYW. Evaluation of this approach for HIV prevention among youth merits further study.

A qualitative study on community perceptions on quality of healthcare services they received in the Malaria Elimination Demonstration Project in district Mandla, India

BackgroundThe utilization and impact of the healthcare services depend on the perceived quality, appropriateness, ease of availability, and cost of the services. This study aimed to understand the community's perception of the quality of healthcare services delivered as part of the Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India.MethodsThe study used qualitative techniques to analyze the community perceptions that emerged from the participants’ narratives during the Focus Group Discussions (FGDs) and in-depth Interviews with Key Informants (IKIs) on the promptness and quality of healthcare service delivery, the behaviour of MEDP staff, Information, Education and Communication, and Behavioural Change Communication activities, coordination with community members and other health personnel, and capacity building of healthcare workers and the community.Results36 FGDs and 63 IKIs with 419 respondents were conducted in nine blocks of district Mandla. Overall, 97% to 100% of beneficiaries associated MEDP with regularity and prompt service delivery, availability of diagnostics and drugs, friendly behaviour, good coordination, and community mobilization to enhance treatment-seeking behaviour.ConclusionsThe study's findings highlighted the importance of building and maintaining the community's participation and promoting the demand for optimal utilization of healthcare services inside the village to promptly achieve the malaria elimination goal.

Mobile Health and Nutrition Team Service Implementation in Somali and Afar Regions of Ethiopia: A Qualitative Implementation Science Study.

Ethiopia has been implementing Mobile Health and Nutrition Teams (MHNTs) to improve the accessibility of essential healthcare services for unreached populations with poor infrastructure to ensure health for all target by Universal health coverage (UHC). However, the current implementation status of this MNHT is not assessed. This study aimed to capture the current implementation status of the MHNT from the program managers, supporting partners and decision makers at each level of the health system structure in Afar and Somali regions. We conducted qualitative study with phenomenological study design. The data was collected from RHB MHNT coordinator, woreda health office MHNT coordinator, MHNT leader and representatives from implementing partners. The interview guides were developed using the CFIR framework. Out of the 17 respondents, 13 responded all the standard service packages a MHNT is expected to deliver (76.5%). Overall, the KIIs mentioned that the MHNTs are effective in ensuring access and quality of health services. MHNT strategy has high demand and acceptability by the community and the service providers. The main barrier to program implementation is the gap in service integration within and across sectors. Inadequate staffing of the MHNT, gaps in ensuring proper professional mix, frequent turnover of contract health workers, and skill gaps hamper effective and sustainable implementation of the program. MHNT establishment, effectiveness, acceptability and sustainably in the implementing woredas of Afar and Somali Regions is very promising. The culture of MHNT documentation and reporting needs some improvement. Besides, community engagement and government ownership are good drivers for sustainability of MHNT. Standardizing and adding additional professionals with capacity building is crucial to ensuring service quality. Furthermore, community mobilization and woreda leadership commitment boosting will be needed for granting sustainability. Finally, national scale up of this alternative strategy is recommended through standardized implementation modality.

Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria - A qualitative study.

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization.

A qualitative synthesis of the impact of infertility on the mental health of African women.

Infertility is a reproductive problem that affects all gender, race, or social class. In many African countries, the burden of infertility is usually associated with economic, psychological, and socio-cultural factors. This review aimed to explore the factors that impact the mental health of African women with primary infertility. A qualitative evidence synthesis was used to summarise and analyse primary qualitative studies focused on the impact of primary infertility on African women. Seventeen studies met the eligibility criteria and were included in the review. The review found that social pressure, stigma from family and community members, and financial constraints led to psychological distress. In addition, social stigma also led to marital problems which led to significant psychological distress and low self-worth, especially on the wife. Recommendations to reduce stigma among African infertile women were as follows: advocacy and community mobilisation, education by health professionals, and holistic person-centred care. An intersectional approach to inform public health and social policy was also suggested.