Context-specific Strategies Research Articles

Instructional Leadership Development Practices in Ethiopia: Curriculum Development and Implementation Practices, and Career Development Frameworks

The purpose of this study is twofold: to examine the curriculum structure for instructional leaders’ training and development against the desired competences; and to evaluate the career development framework of instructional leaders. With these ends in view, the study examined the instructional leadership framework, the curriculum document, and the instructional leaders’ recruitment, selection and retention strategies. Unstructured interviews were made with purposely selected thirty-one (31) interviewees until information saturates. Hence, the perspectives of instructional leadership trainers, instructional leaders, zone education department heads, and national level education experts who were selected using a purposive sampling technique were explored through one-on-one interviews. The data analysis and presentation was made based on the major themes identified as purposes of the study. In the light of these, the qualitative data analysis discloses the absence of national instructional leadership framework from which instructional leadership curriculum should have emerged. It was also understood that the loosened curriculum development culture ultimately resulted in the curriculum’s lack of relevance to the desired competences for instructional leadership development. It was further learnt that there existed an absence of context specific recruitment, selection and retention strategies for instructional leaders. It is, therefore, concluded that the instructional leadership development practices of Ethiopia, seemed to have been deviating from expectations. Hence, it is recommended that there is a need to design a national instructional leadership development framework based on which the instructional leadership curriculum development and implementation practices could be managed. The recruitment, selection, and retention strategies should also involve incentive packages that could attract competent candidates to the profession. It is further recommended that there is a need to promote positive mindset exercises for instructional leaders to take their own professional development initiatives.

“A person who does not have money does not enter”: a qualitative study on refugee women’s experiences of respectful maternity care

BackgroundWomen’s childbirth experiences in health facilities is at the core of quality of care. Their perceptions of poor-quality care, including disrespectful care at health facilities during childbirth, is recognized as a significant barrier to seeking care for subsequent births. Research that explores women’s perspectives of the dimensions of disrespect and mistreatment during childbirth in Arab countries is scarce, and there is none pertaining to refugee groups who carry the burden of multiple vulnerabilities and who suffer from discontinued care, especially in fragile health systems. This paper aims at presenting Palestinian, Iraqi and Syrian refugee women’s experiences, understanding and interpretation of disrespect and mistreatment during childbirth in hospitals in Lebanon.MethodsThis study employed phenomenology, a qualitative research design to generate data through in-depth interviews. Women who were 3 to 6 months postpartum were recruited through the non-governmental organizations (NGOs) that are actively engaged in providing welfare and healthcare services to different populations of refugee women in Lebanon. In total, 24 women were interviewed. All interviews were audio recorded, transcribed verbatim and subjected to thematic analysis.ResultsOf the 24 women who participated in this study, 9 were Palestinian, 12 were Syrian and 3 were Iraqi. The participants spoke of restricted choices to hospitals, care providers and to types of birth, while revealing adverse experiences during childbirth in healthcare facilities, including verbal and physical abuse, disrespectful verbal and non-verbal communication by healthcare providers. They also reported sub-standard care, denial of birth companions and breaches to their privacy. Our findings exemplify how the coverage of the cost of facility-based births by UN agencies and NGOs increase refugee women’s vulnerability to disrespect and mistreatment during childbirth.ConclusionThis study shows how disrespect and mistreatment are intertwined in a complex system which is devised to ensure access to facility-based birth for displaced populations. Implications for programs and policies point to the need for strengthening capacity and for providing resources for the adaptation of global guidelines into context-specific strategies for the provision of quality maternity care during humanitarian crises and beyond.

Smart regional spaces: ready set go!

ABSTRACT Smart cities have come to dominate international academic, political and industry discourse. In contrast, limited attention has been given to the ‘smartisation’ of regional and rural areas. However, simply applying smart city thinking is not the way forward. Many of the social, economic, and environmental initiatives generated by the smart city movement respond to the challenges of dense urban living. These do not necessarily translate to the spatial scales, assets, budgets, and distinct, and often opposite challenges faced by regional and rural areas, including the substantial divide in digital inclusion compared to their urban counterparts. Digital connectivity is a prerequisite for a smart transition. Parallel to improved connectivity, regional and rural areas need context-specific place-based strategies, projects, programs, and tools, to successfully engage with the smart places movement and the opportunities and benefits it has to offer. The Smart Regional Spaces: Ready Set Go! project aims to pivot the smart places movement into regional and rural New South Wales (NSW). The project pilots new tools and techniques to upskill, and empower regional councils and their communities to directly engage with smart technologies and reduce the digital divide.

Seasonal influenza vaccine uptake among healthcare workers in tertiary care hospitals, Bangladesh: Study protocol for influenza vaccine supply and awareness intervention

BackgroundHealthcare workers (HCWs), such as doctors, nurses, and support staffs involved in direct or indirect patient care, are at increased risk of influenza virus infections due to occupational exposures. Vaccination is the most effective way to prevent influenza. Despite the World Health Organization (WHO) recommendations, Bangladesh lacks a seasonal influenza vaccination policy for HCWs, and thus vaccination rates remain low. The current project aims to investigate the effect of interventions on influenza vaccine awareness and availability of vaccine supply, explore HCWs’ knowledge and perceptions about influenza vaccination, understand the barriers and motivators for influenza vaccine uptake, and understand policymakers' views on the practicality of influenza vaccination among HCWs.MethodWe will conduct the study at four tertiary care teaching hospitals in Bangladesh, using a cluster randomized controlled trial approach, with the hospital as the unit of randomization and intervention. The study population will include all types of HCWs.The four different types of intervention will be randomly allocated and implemented in four study hospitals separately. The four interventions will be: i) ensuring the availability of influenza vaccine supply; ii) developing influenza vaccine awareness; iii) both ensuring influenza vaccine supply and developing influenza vaccine awareness and iv) control arm with no intervention. Both quantitative and qualitative approaches will be applied to assess the intervention effect. We will estimate the Difference in Differences (DID) with 95% CI of the proportion of vaccine uptake between each intervention and control (non-intervention) arm, adjusting for the clustering effect. The qualitative data will be summarised using a framework matrix method.DiscussionThe results of this study will inform the development and implementation of a context-specific strategy to enhance influenza vaccination rates among Bangladeshi HCWs.Trial registrationClinicaltrials.gov NCT05521763. Version 2.0 was registered in September 2022, and the first participant enrolled in March 2022. Retrospectively registered.

Depression management and antiretroviral treatment outcome among people living with HIV in Northwest and East regions of Cameroon

BackgroundSeveral interventions have shown benefits in improving mental health problems such as depression which is common in people living with HIV. However, there is a paucity of evidence on the effect of these interventions in improving HIV treatment outcomes. This study aimed at bridging this evidence gap and guiding the integration of depression and HIV management, particularly in rural health settings of Cameroon.Materials and methodsWe carried out a cluster-randomized intervention study targeting persons aged 13 years and above who had been on antiretroviral treatment for 6–9 months. Participants were followed up for 12 months during which those in the intervention group underwent routine screening and management of depression. Comparisons were done using the two-way ANOVA and Chi-squared test with significance set at 5%.ResultsOverall, 370 participants with a median age of 39 years (IQR: 30–49) were enrolled in this study. Of these, 42 (11.3%) were screened with moderate to severe depressive symptoms and 41 (11.1%) had poor treatment adherence. There was a significant drop in depression scores in the intervention group from 3.88 (± 3.76) to 2.29 (± 2.39) versus 4.35 (± 4.64) to 3.39 (± 3.0) in controls (p < 0.001) which was accompanied by a drop in the prevalence of moderate to severe depressive symptoms in the intervention group from 9% to 0.8% (p = 0.046). Decreased depression scores were correlated with better adherence scores with correlation coefficients of − 0.191, − 0.555, and − 0.513 at baseline, 6 months, and 12 months of follow-up respectively (p < 0.001) but there was no significant difference in adherence levels (p = 0.255) and viral suppression rates (p = 0.811) between groups.ConclusionThe results of this study suggest that considering routine screening and management of depression as an integral component of HIV care could positively impact HIV treatment outcomes. However, there is a need for more research to identify the best combinations of context-specific and cost-effective strategies that can impactfully be integrated with HIV management.Trial registration Trial registration Number: DRKS00027440. Name of Registry: German Clinical Trials Register. Date registration: December 10, 2021 (‘retrospectively registered’). Date of enrolment of the first participant: 05/08/2019

Radiography Managers' Perspectives on the Strategies to Mitigate Disruptive Behaviours: A Qualitative Exploratory Study.

Disruptive behaviours (DBs) are not normally in the scope of legal sanctions, notwithstanding their undesirable effects. Hence, many healthcare organizations still have difficulty in dealing with them in an effective manner. Several studies suggest that few organizations have tailor-made policies or procedures for evaluating, proving and mitigating these behaviours. However, evidence shows that mitigating DBs is critical to empowering healthcare workers to focus on providing superior, affordable and safe patient care. The aim of this study was to explore radiography managers’ perspectives on the strategies to mitigate DBs involving radiographers. An exploratory qualitative study employing one-on-one semi-structured in-depth interviews was carried out between March and April 2021. Eleven radiography managers at central hospitals in Harare Metropolitan Province were selected by criterion-purposive sampling. The interview data were analyzed using Tesch’s method of qualitative analysis. The data were first manually coded and then entered into Nvivo (QSR International Version 11) for further analysis. Three themes emerged from the interview data including awareness of DBs, willingness to address DBs, and conflict resolution. Context-specific strategies to mitigate DBs should be identified and implemented to guarantee a healthy work environment for radiographers so that they focus on providing excellent and safe patient care.

Evaluation of the Impact of the First Wave of COVID-19 and Associated Lockdown Restrictions on Persons with Disabilities in 14 States of India.

Background: There is a paucity of data to assess the impact of the COVID-19 pandemic on persons with disabilities (PwDs) in India. About 27.4 million cases were reported as of 27 May 2021. The continuing pandemic in the form of subsequent waves is expected to have negative repercussions for the disabled globally, particularly in India, where access to health, rehabilitation, and social care services is very limited. Therefore, this study aimed to assess the impact of the COVID-19 pandemic and lockdown restrictions on PwDs in India. Objective: To determine the level of disruption due to COVID-19 and the associated countrywide lockdown restrictions on PwD in India during the first wave. Methods: Using a cross-sectional, mixed-methods approach, data were collected from a representative sample of 403 persons with disabilities in 14 states in India during the COVID-19 first wave at two different points in time (Lockdown and post-lockdown phase). Factors associated with the negative impact were examined using the Chi-square test for associations. The paired comparisons between ‘lockdown’ with the ‘post-lockdown’ phase are presented using McNemar’s test and the marginal homogeneity test to compare the proportions. Additionally, a subsample of the participants in the survey was identified to participate in in-depth interviews and focus group discussions to gain in-depth insights on the study question and substantiate the quantitative findings. The framework approach was used to conduct a thematic analysis of the qualitative data. Results: About 60% of the PwDs found it difficult to access emergency medical services during the lockdown, and 4.6% post lockdown (p < 0.001). Likewise, 12% found it difficult to access rehabilitation services during the lockdown, and 5% post lockdown (p = 0.03). About 76% of respondents were apprehensive of the risk of infection during the lockdown, and this increased to 92% post lockdown (p < 0.001). Parents with children were significantly impacted due to lockdown in the areas of Medical (p = 0.007), Rehabilitation (p = 0.001), and Mental health services (p = 0.001). The results from the qualitative study supported these quantitative findings. PWDs felt that the lockdown restrictions had negatively impacted their productivity, social participation, and overall engagement in everyday activities. Access to medicines and rehabilitation services was felt to be extremely difficult and detrimental to the therapeutic benefits that were gained by them during the pre-pandemic time. None of the pandemic mitigation plans and services was specific or inclusive of PWDs. Conclusions: COVID-19 and the associated lockdown restrictions have negatively impacted persons with disabilities during the first wave in India. It is critical to mainstream disability within the agenda for health and development with pragmatic, context-specific strategies and programs in the country.

Caregiver perceptions of the broader societal benefits of vaccination: A path toward sustainable vaccine advocacy in India

Over the last decade growing public health evidence suggests that, in addition to health-related benefits, there are also social and economic benefits of vaccination. Research to understand how caregivers in low-and-middle-income countries perceive these social and economic benefits, or if these benefits factor into their vaccination decisions for their children, has been limited. Leveraging qualitative strategies to gain more nuanced insights into caregiver perceptions of vaccination benefits has also been significantly underexplored. We conducted in-depth interviews with 13 caregivers of children, at which point we reached saturation, in Mewat District, Haryana, an area in India with low vaccination coverage. Interview results suggest that caregivers of children associate positive health outcomes with vaccination programs, and some additional social and economic benefits beyond improved health outcomes. Caregivers also shared how local advocacy and gaps in vaccination programs can affect their perceptions of vaccination benefits. Qualitatively exploring the perceived benefits provides a unique understanding of the value that caregivers assign to vaccination and complements existing knowledge on factors that dissuade caregivers from vaccination. These insights will allow researchers to better identify and design context-specific advocacy strategies to strengthen vaccination programs in communities with low vaccine uptake and acceptance.

Perceived benefits and barriers to community participation in development projects – The case of Hazina ya Maendeleo ya Pwani on the Kenya coast

Benefits and barriers to participating in community development projects as perceived by participants were studied in coastal counties of Kenya through a World Bank-funded initiative known as Hazina ya Maendeleo ya Pwani (HMP). Primary data were collected from 326 randomly selected HMP beneficiaries using questionnaires. Data analysis using SPSS prioritized perceived benefits of participation as: acquisition of additional financial support (94 %); development of new skill (90.8 %); enhanced ability to meet own individual needs (90.8 %); development of valuable professional relationships (90.8 %); acquisition of useful knowledge (84.2 %); increased utilization of own expertise (77.9 %) heightened public profile (77.2 %); ability to contribute to community (71.9 %); ability to have greater impact (68.8 %); and enhanced ability to effect public policy (49.1 %). Perceived barriers were prioritized as: feeling unwelcome (89.4 %); lack of information or not knowing (87.9 %); feeling unable to make a difference (87.9 %); demanding work schedule at home or office (69.7 %); inadequate transportation (50.8 %); and concern for safety (43.2 %). The study concluded that while the perceived benefits still strengthen the argument for active involvement of communities, development practitioners need to incorporate “what’s in it for me?” as an incentive for participation in future. They should also develop context-specific strategies to overcome participation barriers.

It was the best of times, it was the worst of times: a tale of two cities-Beijing and Shanghai-why the divergent COVID-19 control outcomes?

COVID-19 both creates and complicates public health challenges. Yet the pandemic also provides a unique lens for dissecting complex issues in global health that could benefit society in the long run. In this paper, we discuss the underlying reasons that can help explain the divergent COVID-19 control outcomes between Beijing and Shanghai—two advanced metropolitans that are similar in their municipal capacity, administrative capability and pandemic strategy. We hope insights of this investigation contribute to the development of disease prevention systems, such as context-specific and data-driven public health strategies that could yield optimal pandemic control outcomes with minimal unintended consequences, both amid and beyond COVID-19.

Critical transition of multifunctional stability induced by nitrogen enrichment in grasslands differing in degradation severity

Nitrogen (N) enrichment poses a severe threat to ecosystem multifunctionality. Given increasing variability of ecosystem functioning and uncertainty under global change, a pressing question is how N enrichment affects temporal stability of multiple functions (i.e., ‘multifunctional stability’). Whether the responses of multifunctional stability to N enrichment change with external disturbance, such as grasslands with different degradation statuses, remains unclear. We conducted multi-level N enrichment experiments at four grassland sites with no, moderate, severe, and extreme degradation statuses in Inner Mongolia, China. We measured temporal stability of five functions, comprising aboveground net primary productivity, soil total carbon (C) and N storage, and soil microbial biomass C and N storage, to explore how multifunctional stability responded to N enrichment. The temporal stability of most individual functions and multifunctional stability decreased sharply when N input exceeded 20 g N m−2 y−1 in the non-, moderately, and severely degraded grasslands, whereas the threshold declined to 10 g N m−2 y−1 in the extremely degraded grassland. The relative importance of plant and soil microbes in regulating multifunctional stability varied along the degradation gradient. In particular, plant species asynchrony and species richness showed strong positive relationships with multifunctional stability in the non- and moderately degraded grasslands, whereas soil microbial diversity, especially bacterial diversity, was positively associated with multifunctional stability in the severely and extremely degraded grasslands. Overall, our findings identified a critical threshold for N-induced multifunctional stability and called for context-specific biodiversity conservation strategies to buffer the negative effect of N enrichment on grassland ecosystem stability.

What makes a woman? Understanding the reasons for and circumstances of female genital mutilation/cutting in Indonesia, Ethiopia and Kenya

This study presents the reasons for, and circumstances of, female genital mutilation/cutting (FGM/C) in Indonesia, Ethiopia and Kenya. Data were collected in 2016 and 2017 by means of a household survey conducted with young people (15–24 years) and through focus group discussions, in-depth interviews and key informant interviews with youth and community stakeholders. The study findings confirm previously documented reasons for FGM/C, noting that these reasons are interconnected, and are rooted in gender norms. These reasons drive the alterations of bodies to produce a ‘cultured’ body in the form of the ‘pure body’ among Sundanese and Sasak peoples in Indonesia, the ‘tame’ body among the Amhara people in Ethiopia and the ‘adult body’ among the Maasai people in Kenya. While health workers and parents are important decision-makers in each setting, young Maasai women are, at times, able to exercise their agency to decide whether to undergo FGM/C, owing to their older age at circumcision. Changing legal and social contexts in each setting have brought about changes in the practice of FGM/C such as increased medicalisation of the procedure in Indonesia. The clear links between the different drivers of FGM/C in each setting demonstrate the need for context-specific strategies and interventions to create long-lasting change.

Mental Health, Chronic Disease, and Substance Use: Findings From Rural Texas

There are vital links among mental health conditions, chronic diseases, and substance use disorders. Simultaneous examination of the relationship among these three conditions is essential for providing well-integrated care to rural residents who have limited resources and for representing medically underserved areas. We aimed to assess the burden of behavioral health conditions and chronic diseases from a rural Texas community to garner context-specific insights and inform effective health promotion strategies in similar communities. We conducted a cross-sectional study among 181 residents from various zip codes in a rural Texas county. A self-administered, 18-item health-needs questionnaire was used to collect data from the participants. Of the total participants, 30.0% reported mental health conditions, 16.0% reported substance use disorders, and 44.2% reported having at least one type of chronic disease. Overall, mental health conditions were associated with substance use disorders [OR: 1.58 (95% CI: 0.73–2.42)] and chronic disease [OR: 1.07 (95% CI: 0.39–1.75)], but no associations were observed between substance use and chronic disease [OR: 0.62 (95% CI: -0.20–1.43)]. The economic and accessibility barriers that rural residents commonly face call attention to the need for integrated care that combines primary care and behavioral health services.

Social Listening to Enhance Access to Appropriate Pandemic Information Among Culturally Diverse Populations: Case Study From Finland.

Social listening, the process of monitoring and analyzing conversations to inform communication activities, is an essential component of infodemic management. It helps inform context-specific communication strategies that are culturally acceptable and appropriate for various subpopulations. Social listening is based on the notion that target audiences themselves can best define their own information needs and messages. This study aimed to describe the development of systematic social listening training for crisis communication and community outreach during the COVID-19 pandemic through a series of web-based workshops and to report the experiences of the workshop participants implementing the projects. A multidisciplinary team of experts developed a series of web-based training sessions for individuals responsible for community outreach or communication among linguistically diverse populations. The participants had no previous training in systematic data collection or monitoring. This training aimed to provide participants with sufficient knowledge and skills to develop a social listening system based on their specific needs and available resources. The workshop design took into consideration the pandemic context and focused on qualitative data collection. Information on the experiences of the participants in the training was gathered based on participant feedback and their assignments and through in-depth interviews with each team. A series of 6 web-based workshops was conducted between May and September 2021. The workshops followed a systematic approach to social listening and included listening to web-based and offline sources; rapid qualitative analysis and synthesis; and developing communication recommendations, messages, and products. Follow-up meetings were organized between the workshops during which participants could share their achievements and challenges. Approximately 67% (4/6) of the participating teams established social listening systems by the end of the training. The teams tailored the knowledge provided during the training to their specific needs. As a result, the social systems developed by the teams had slightly different structures, target audiences, and aims. All resulting social listening systems followed the taught key principles of systematic social listening to collect and analyze data and used these new insights for further development of communication strategies. This paper describes an infodemic management system and workflow based on qualitative inquiry and adapted to local priorities and resources. The implementation of these projects resulted in content development for targeted risk communication, addressing linguistically diverse populations. These systems can be adapted for future epidemics and pandemics.

Implementation Science in Pediatric Critical Care - Sedation and Analgesia Practices as a Case Study.

Sedation and analgesia (SA) management is essential practice in the pediatric intensive care unit (PICU). Over the past decade, there has been significant interest in optimal SA management strategy, due to reports of the adverse effects of SA medications and their relationship to ICU delirium. We reviewed 13 studies examining SA practices in the PICU over the past decade for the purposes of reporting the study design, outcomes of interest, SA protocols used, strategies for implementation, and the patient-centered outcomes. We highlighted the paucity of evidence-base for these practices and also described the existing gaps in the intersection of implementation science (IS) and SA protocols in the PICU. Future studies would benefit from a focus on effective implementation strategies to introduce and sustain evidence-based SA protocols, as well as novel quasi-experimental study designs that will help determine their impact on relevant clinical outcomes, such as the occurrence of ICU delirium. Adoption of the available evidence-based practices into routine care in the PICU remains challenging. Using SA practice as an example, we illustrated the need for a structured approach to the implementation science in pediatric critical care. Key components of the successful adoption of evidence-based best practice include the assessment of the local context, both resources and barriers, followed by a context-specific strategy for implementation and a focus on sustainability and integration of the practice into the permanent workflow.

Optimizing antibiotic use in Indonesia: A systematic review and evidence synthesis to inform opportunities for intervention.

A major driver of antimicrobial resistance (AMR) and poor clinical outcomesis suboptimal antibiotic use, although data are lacking in low-resource settings. We reviewed studies on systemic antibiotic use (WHO ATC/DDD category J01) for human health in Indonesia, and synthesized available evidence to identify opportunities for intervention. We systematically searched five international and national databases for eligible peer-reviewed articles, in English and Indonesian, published between 1 January 2000 and 1 June 2021 including: (1) antibiotic consumption; (2) prescribing appropriateness; (3) antimicrobial stewardship (AMS); (4) consumers' and providers' perceptions. Two independent reviewers included studies and extracted data. Study-level data were summarized using random-effects model meta-analysis for consumption and prescribing appropriateness, effect direction analysis for antimicrobial stewardship (AMS) interventions, and qualitative synthesis for perception surveys. (PROSPERO: CRD42019134641). Of 9323 search hits, we included 100 reports on antibiotic consumption (20), prescribing appropriateness (49), AMS interventions (13), and/or perception (25) (8 categorized in >1 domain). The pooled estimate of overall antibiotic consumption was 134.8 DDD per 100 bed-days (95%CI 82.5-187.0) for inpatients and 121.1 DDD per 1000 inhabitants per day (10.4-231.8) for outpatients. Ceftriaxone, levofloxacin, and ampicillin were the most consumed antibiotics in inpatients, and amoxicillin, ciprofloxacin, and cefadroxil in outpatients. Pooled estimates for overall appropriate prescribing (according to Gyssens method) were 33.5% (18.1-53.4) in hospitals and 49.4% (23.7-75.4) in primary care. Pooled estimates for appropriate prescribing (according to reference guidelines) were, in hospitals, 99.7% (97.4-100) for indication, 84.9% (38.5-98.0) for drug choice, and 6.1% (0.2-63.2) for overall appropriateness, and, in primary care, 98.9% (60.9-100) for indication, 82.6% (50.5-95.7) for drug choice and 10.5% (0.8-62.6) for overall appropriateness. Studies to date evaluating bundled AMS interventions, although sparse and heterogeneous, suggested favourable effects on antibiotic consumption, prescribing appropriateness, guideline compliance, and patient outcomes. Key themes identified in perception surveys were lack of community antibiotic knowledge, and common non-prescription antibiotic self-medication. Context-specific intervention strategies are urgently needed to improve appropriate antibiotic use in Indonesian hospitals and communities, with critical evidence gaps concerning the private and informal healthcare sectors. Wellcome Africa Asia Programme Vietnam.

Attitudes, Roles, and Community Perspectives Regarding Male Involvement in Breastfeeding in Juba, South Sudan

There is growing awareness that fathers’ infant-feeding preferences may influence mothers’ intentions to breastfeed and help promote optimal breastfeeding. Despite this understanding, fathers are not part of most breastfeeding promotion strategies such as ‘mother-to-mother’ support groups. This study examined male partners’ breastfeeding attitudes, roles, and community views on male involvement through quantitative and qualitative methods. We interviewed 275 fathers of children aged &lt;2 years, 15 key informants, and five focus groups to learn from the community. The data were analyzed using SPSS version 28.0; and thematically to generate frequency tables, median, interquartile range, and repeating patterns. Above 70% of fathers agreed that breastfeeding did not harm marriage or reduce women’s attractiveness. Breastfeeding in public is also accepted, and responsibilities are shared. The study also found support for &gt;80% of the critical roles, including housework, baby care, and holding and watching the mother breastfeed. Education level was significantly associated with breastfeeding attitudes (r=-0.207 p =0.001&lt;0.05) and roles (r=0.308, p=0.001&lt;0.05). Employment status was also significantly associated with attitudes (r=0.184, p=0.003&lt;0.05) and roles in breastfeeding (r=-0.155, p=0.007&lt;0.05). However, there was no significant association between hours of work and the attitudes/roles of male partners in breastfeeding (r=-0.074, p=0.125&gt;0.05 and r=0.049, p=0.224&gt;0.05, respectively). The key barriers that emerge included challenging patriarchy, gender role segregation; Sexism; false beliefs; and work-related, social, economic, and personal factors. The major cultural hurdles that emerged signify the need to develop context-specific strategies to dispel myths about male breastfeeding involvement and promote supporting practices.

Co-production of knowledge and strategies to support climate resilient fisheries

AbstractKnowledge co-production offers a promising approach to design effective and equitable pathways to reach development goals. Fisheries Strategies for Changing Oceans and Resilient Ecosystems by 2030 (FishSCORE), a United Nations Ocean Decade programme, will co-produce knowledge that advances solutions for climate resilient fisheries through networks and partnerships that include scientists, stakeholders, practitioners, managers, and policy experts. FishSCORE will establish (1) a global network that will develop broadly relevant information and tools to assess and operationalize climate resilience in marine fisheries and (2) local and regional partnerships that will apply those tools to identify and forward context-specific resilience strategies. FishSCORE's activities will be guided by a set of core principles that include commitments to inclusivity, equity, co-leadership, co-ownership, and reciprocity. FishSCORE will focus on identifying solutions for climate resilient fisheries, and it will also advance goals associated with capacity, power, and agency that will support iterative, pluralistic approaches to decision-making in fisheries experiencing ongoing climate-driven changes. This process of co-producing knowledge and strategies requires considerable investments of time from all partners, which is well aligned with the Ocean Decade. However, secure funding must be prioritized to support and implement co-production activities over this long time horizon.

Identifying multilevel and multisectoral strategies to develop a Theory of Change for improving child and adolescent mental health services in a case-study district in South Africa

BackgroundThe lack of child and adolescent mental health (CAMH) policies and implementation plans constitute major barriers to CAMH services in low resource settings. Engaging with on-the-ground stakeholders to identify possible contextually appropriate strategies for developing a CAMH collaborative system and inform CAMH plans and policies is important to ensure that resultant policies and plans are feasible and appropriate. Together with key stakeholders across multiple sectors, this study aims to (i) co-identify causal factors and potential strategies to overcome bottlenecks in one district in SA as a case study; and (ii) Co-develop a Theory of Change (ToC) for increasing access to CAMH services within the resource constraints of a remote resource-scarce district as a case study.MethodsA participatory workshop was held with key stakeholders (n = 40) from the Departments of Health (DoH), Basic Education (DBE), and Social Development (DSD) and three community-based organisations offering CAMH services in the district. The stakeholders identified context-specific causal factors and possible strategies to address the bottlenecks in the workshop. All the factors identified in the workshop were compared and consolidated. A ToC map was developed based on the data obtained from the workshop. The ToC was further refined by conducting a follow-up virtual workshop with stakeholders (n = 15).ResultsMapping out the strategies identified in the workshop facilitated the development of a ToC model for the resource-scarce context. Key multilevel and multisectoral task-sharing strategies emerged in support of the development of a collaborative system of care that includes the development of (i) community awareness programs and user-friendly CAMH psychoeducation and screening tools to strengthen mental health literacy and facilitate early identification at the community level; (ii) an intersectoral working group to facilitate intersectoral collaboration (iii) a functional district CAMH referral system, (iv) youth-friendly CAMH care packages.ConclusionsIn scarce-resource contexts, it is feasible to work collaboratively with key stakeholders across multiple sectors to identify feasible multilevel and multisectoral strategies that can be used to develop a ToC for improved access to CAMH services within a task-sharing approach.

Drought risk assessment in Mediterranean agricultural watersheds: A case study in Central Italy

Mediterranean watersheds are expected to face increased and more severe drought events due to climate change. Urgent action is needed to shift from a reactive approach to a proactive one, for which drought risk assessment is fundamental. Nevertheless, the current methodology to calculate composite risk indicators is still debated, undermining the overall robustness and validity of drought risk assessments. Furthermore, the diversity of socio-ecological contexts, spatiotemporal scales, and data availability hamper the homogenization of assessment methods. We present a complete drought risk assessment methodology, applied to the agricultural systems of five Italian coastal watersheds, introducing a simple robustness evaluation method to validate the assessment tool and archetype analysis to link the outputs with adaptation strategies. Forty-two (42) indicators were included to represent hazard, exposure, and vulnerability. Past and future drought hazards were estimated considering multiple types of droughts with data from public observatories.The results show highest hazard for the southern part of the study region, highest exposure in the coastal and high-value wine producers’ municipalities, while vulnerability patterns are less clear. Major adaptation efforts should target specific watersheds of the Grosseto province, which has the highest projected drought risk. Archetype analysis was then used to suggest possible context-specific adaptation strategies. The proposed methodology, with the integration of a robustness evaluation and the archetype analysis, represents an advancement toward shared and homogeneous guidelines in state-of-the-art drought risk assessments.