Focal Persons Research Articles

Exploring the barriers to healthcare access among persons with disabilities: a qualitative study in rural Luuka district, Uganda.

The aim of the research was to explore the barriers to healthcare access for persons with various disabilities in rural Luuka district of Uganda. The findings will assist in appreciating the challenges persons with disabilities face in accessing Healthcare in a rural setting. These insights will contribute to the development of an intervention to improve healthcare access that is affordable, timely and acceptable. This qualitative study formed the exploratory formative phase of the 'Missing Billion' project. A total of 27 participants with disabilities-visual impairment (n=5), physical impairment (n=5), multiple impairments (n=6) and intellectual/ cognitive impairment (n=5) were purposively selected to participate in in-depth interviews conducted by two experienced researchers. Participants were identified through contact lists provided by the district disability focal person and local disability associations, with additional participants identified through snowball sampling. Interviews with persons with hearing impairment (n=6) were conducted by a researcher with hearing impairment. The interviews were audio/video recorded and transcribed to facilitate thematic data analysis. We used the disability-inclusive health 'Missing Billion' framework to map and inform the barriers. The study was conducted between September and November 2022 in rural communities in Luuka district, Eastern Uganda. On the demand side, challenges revolved around autonomy and awareness, limited access to health information, lack of financial capacity and dependence on caregivers for healthcare choices left persons with disabilities feeling disempowered. On the supply side, discrimination and negative attitudes from healthcare workers were reported as prevalent. Absence of healthcare workers and service delivery delays impacted on healthcare access, resulting in poor care. Inaccessible healthcare facilities compounded issues, as they had limited accessibility features. Complex and interconnected barriers underscore the pressing need for systemic changes to ensure equitable healthcare access for persons with disabilities in rural Uganda.

Compliance with weekly iron folic acid supplementation and associated factors among secondary school adolescent girls, in Jimma Arjo District, West Ethiopia, 2022: A mixed method cross-sectional Study

Background: Iron deficiency anemia is a prevalent and major public health problem in low- and middle-income countries among adolescent girls. The risk of Iron deficiency anemia and its consequences are prevented by taking and complying with a weekly iron-folic acid supplement. However, there was no information regarding compliance and its associated factors in Ethiopia. The study aimed to determine the magnitude of compliance with weekly Iron-folic acid supplementation and associated factors among Jimma Arjo secondary school adolescent girls. Methods: Institutional-based cross-sectional study was conducted on 417 adolescent girls in three secondary schools of Jimma Arjo, West Ethiopia from March 1st to 31st, 2022 using interviewer-administered structured and semi-structured questionnaires. Bivariable and multivariable logistic regression analyses were used to determine the association of variables. Results: Compliance with iron-folic acid supplementation was 29.3% with 95% CI (24.9, 33.3). Mother`s secondary level of education (AOR=4.94 (95% CI:2.45,9.94)), awareness of anemia (AOR=4.23 (95% CI:2.35,7.61)), good knowledge about iron-folic acid supplementation (AOR=3.96 (95% CI:2.17,7.22)), lack of iron-folic acid supplementation (AOR=0.42 (95% CI:0.23,0.75)), and iron-folic acid supplementation side effects (AOR=0.17 (95% CI:0.08,0.37)) were factors significantly associated with iron-folic acid supplementation compliance. Misconceptions about iron-folic acid supplementation, forgetfulness of tablet, lack of access to drinking water, and irregularity of school weekly iron-folic acid supplementation days were identified as the main barriers to adolescent girls' compliance with iron-folic acid supplementation in a qualitative study. Conclusions: Weekly iron-folic acid supplementation compliance was low at 29.3%. Scheduled health education, parental participation in the program, access to drinking water, refresher training for school focal persons, and fixed weekly iron-folic acid supplementation days can improve compliance with iron-folic acid supplementation and are recommended.

Exploring characteristics and severity of road traffic injuries in Lebanon using emergency department hospital-based data

In Lebanon, the lack of quality data on road traffic injuries (RTIs) led to the implementation of a hospital-based RTI surveillance system by the Ministry of Health in in private and public-run hospitals in the Bekaa governorate. This paper aims to describe the characteristics and severity of RTIs recorded over two years during the pilot phase. It also assesses the strengths and challenges of the surveillance system, highlighting areas for enhancement. The data collected from the Emergency department (ED) was used to conduct a retrospective analysis of population-based injuries hospitalized for road traffic crashes (RTC). Designated focal persons reported injuries weekly using a standardized form, which included demographic and crash-related variables, body lesions, and vital signs. Data were coded per the International Classification of Diseases (ICD-10), entered into Epidata, and analyzed using SPSS. The RTI surveillance system was assessed using Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis. Over two years, a total of 1576 cases of RTIs were reported. The male-to-female ratio was 2.16 and the majority of RTIs (44.4%) were recorded among those aged between 15 and 29 years old. From 2013 to 2015, a decrease of 0.7% in the revised trauma score (RTS < 4) was recorded. On the contrary, an increase of 3.9% in injury severity score (ISS) that ranged between 15 and 75 was reported. The probability of survival of an injured individual at one month was improved. The hospital-based surveillance system demonstrated strengths in structured data collection and ethical considerations but faced challenges like underreporting, limited coverage, and resource constraints. Recommendations for improvement include enhancing data quality and timely reporting, ultimately supporting evidence-based road safety interventions.

Transformational Leadership As A Catalyst For Enhancing Gender Equality And Women's Representation In Public Administration: Opportunities For Increased Access And Involvement In South Sudan

The Gender Equality in Public Administration Study was carried at the National Transformational Leadership Institute (NTLI) of the University of Juba in partnership with the Ministry of Gender Child and Social Welfare and UNDP South Sudan. The Study employed UNDP’s global GEPA initiative framework and UNDP-OECD Toolkit for Mainstreaming and Implementing Gender Equality in Public Life. which consists of four pillars, namely,1) Institutional and governance frameworks for gender equality and mainstreaming; 2) Gender-sensitive practices in parliaments; 3) Gender-sensitive public employment systems; 4) Gender-sensitive practices in the judiciary. Based on South Sudan context and the systems alreadyestablished,some key aspects of the UNDP-OECD tool with particular emphasis on Pillars (1) and (3) were adopted. Both qualitative and quantitative methods of data collection that include surveys, face-to-face interviews, consultation workshops and focus group discussions were used to reach out to gender focal persons from all government institutions (ministries, commissions and parastatal organizations), organized forces, Academia and Civic groups that include Faith Based Organizations, Civil Society Organizations and Disability Persons Organisations.The collated information was analysed using SPSS and interpretation provided. The studyfound the existence of considerable gender differentials in terms of genderrights, accessto humanrights and access to justice. Gender inequality and Sexual Gender-Based Violence are widespread and mostly intensified by cultural norms and insecurity caused by interstate and intracommunal conflicts. Gender equality and women’s access, involvement and representation in Public Administration are linked to multiple structural and functional constraints which differ across sectors in South Sudan. Analysis from this study, clearly underlines that participation and access to formal political power structures is impeded by inherent gender imbalance in institutionalstructures, unequal power sharing, socio-economic context, culture, ideological and psychologicalfactors, which remain sticky, normalized and increasingly accepted as part of life. From the foregoing, it is imperative that directed policy initiatives and legal framework be established to address the issues. The Government of the Republic of South Sudan should conduct a review of the legislative and policy framework to integrate the minimum of 35% quotas for womenin all public administration (National Gender Policy; National Strategic Plan Framework; LabourAct, Civil Service Act and Public Service Regulations);

Assessment of the State of Pharmacovigilance in Secondary Hospitals in the Federal Capital Territory of Nigeria, Using WHO Pharmacovigilance Indicators.

The importance of pharmacovigilance (PV) in ensuring drug safety, especially in the detection and prevention of adverse drug reactions (ADRs) is critical. However, PV activities in Nigeria still face many challenges, such as very low spontaneous reporting rates, and inadequate training and funding. This study assessed the state of pharmacovigilance in the federal capital territory of Nigeria (FCT), using WHO pharmacovigilance indicators. A cross-sectional questionnaire-based survey was carried out among secondary healthcare facilities in the FCT. The WHO Pharmacovigilance Indicators Questionnaire, which consists of the structural, process and outcome measures, was used to collect data from the focal person for pharmacovigilance at all the consenting facilities. Descriptive statistics were used to summarize all variables. Ethical approval was obtained from the Ethics Review Committee of the FCT development authority. Of the 14 secondary healthcare facilities in the FCT, 11 agreed to the study (response rate = 84.6%). Among the respondents, 4 (36.4%) were females, and 2 (18.2%) had 9 years of experience in pharmacovigilance. For the core structural indicators, 7 (63.6%) of the facilities had a pharmacovigilance center while only 4 (36.4%) had a copy of the Nigerian pharmacovigilance policy. Regarding financial provisions, 10 (90.9%) hospitals reported that there was no regular financial provision for the center while 10 (90.9%) centers had a standard adverse drug reaction reporting form. For the core process indicators, the mean ± SD of the nine core process indicators ranged from 0.9 ± 3.0 to 75.6 ± 38.6 and the total number of reports in the local database, therapeutic ineffectiveness, and medication error were limited. The assessment of pharmacovigilance activities in the Federal Capital Territory of Nigeria revealed significant gaps in infrastructure, financial support, and process implementation. Despite the presence of pharmacovigilance centers in the majority of facilities, the lack of consistent financial support and limited adherence to core process indicators highlight the need for enhanced training, resources, and policy enforcement to improve ADR reporting and overall drug safety monitoring. Strengthening these areas is crucial for advancing pharmacovigilance practices and ensuring patient safety in Nigeria.

Improving access to tuberculosis preventive treatment for children in Ethiopia: designing a home-based contact management intervention for the CHIP-TB trial through formative research

BackgroundTuberculosis (TB) preventive treatment (TPT) is a long-standing recommendation for children exposed to TB but remains poorly implemented. Home-based contact management may increase access and coverage of TPT among children exposed to TB in their households.MethodsSixty in-depth interviews were conducted with key informants including program managers, TB providers (known as TB focal persons), health extension workers and caregivers whose children had recently engaged with TB prevention services in Oromia, Ethiopia in 2021 to understand the barriers and facilitators to providing home-based TB prevention services for children aged < 15 years. Thematic content analysis was conducted including systematically coding each interview.ResultsHome-based services were considered a family-centered intervention, addressing the time and financial constraints of clients. Stakeholders proposed a task-shared intervention between health extension workers and facility-based TB focal persons. They recommended that TB services be integrated into other home-based services, including HIV, nutrition, and vaccination services to reduce workload on the already overstretched health extension workers. Community awareness was considered essential to improve acceptability of home-based services and TPT in general among community members.ConclusionsDecentralization of TPT should be supported by task-sharing initiation and follow up between health extension workers and facility-based TB focal persons and integration of home-based services. Active community engagement through several existing mechanisms can help improve acceptability for both home-based interventions and TPT promotion overall for children.Trial registrationThe results presented here were from formative research related to the CHIP-TB Trial (Identifier NCT04369326) registered on April 30, 2020. This qualitative study was separately registered at NCT04494516 on 27 July 2020.

Expanding Geographical Access to Cancer Care in Botswana: Current Status and Future Prospects.

The growing cancer burden in Botswana has been linked to aging, lifestyle factors, and high HIV infection prevalence. The government has designated four geographically distributed hospitals as public oncology centers (POCs). A needs assessment was undertaken to ascertain the characteristics of cancer care at these centers. A multisite cross-sectional survey study of cancer care was conducted with oncology staff at Princess Marina Hospital (PMH), Nyangabgwe Referral Hospital (NRH), Sekgoma Memorial Hospital (SMH), and Letsholathebe II Memorial Hospital (LMH) from February to April 2021. At each POC, a focal person (experienced nurse working in oncology) identified relevant oncology staff and confirmed service availability. Only PMH and NRH had a broad array of diagnostic, surgical, and treatment services. In addition, PMH was the only center with a a dedicated inpatient oncology service, a multidisciplinary committee to review patients, and a palliative care team. To support the only national cancer screening program, for cervical cancer, all POCs offered Pap tests. Mammography, available at PMH and NRH, was used solely for diagnosis. Patients from POCs requiring radiation therapy were referred to Gaborone Private Hospital at government expense. For perceived service availability, 51 staff, mainly oncologists, physicians, and nurses, were surveyed (66% based at PMH). Perceptions of services revealed a few concerns, for example, numerous staff considered hysterectomies for cervical cancer available when they were only performed at PMH. Despite Botswana's efforts to increase the proximity of cancer services to patients, there are marked gaps, particularly at the two district-level POCs, SMH and LMH. In the future, SMH and LMH could provide selected services for specific prevalent cancers on-site, as well as follow-up and palliative care.

Multiplicities and fluidity in the networked relationships of migrant academics in Britain

AbstractIncreasing internationalization and marketization of higher education, global research collaboration, and staff mobility place academics' networking practices at the centre of higher education systems. Migrant academics are conceptualized with different network types including personal, local and transnational family and friendship networks. However, this research aims to understand the boundaries between different types of participants' networked relationships. The data of this paper comes from a larger research project on transnational family relationships of migrant academics conducted between 2018 and 2022. Life story interviews with 45 migrant academics from 27 different national backgrounds working at British universities were conducted. Additionally, sociogram maps are used as embedded in qualitative interviews. Migration background (as European or non‐European countries); gender; age; the length of the stay in the UK; academic position/contract type; annual income level and marital/relationship status were considered while forming the sample. The findings reveal that network forms and structures do not determine the resources and benefits of relationships; rather, individuals' actions over a time period and the meanings they attribute shape the positions of an alter (other actors that the focal person have connection with) within the personal network structure. As such, actions and meanings regarding those actions can bring one forward or backward in the personal network hierarchy. The boundaries regarding the content of these networks are usually blurred in relation to time, relationality and human agency attributing specific sets of meanings to certain relationships. The findings of this research translate into specific contributions to the discussions in migration and social network research. That is, research findings emphasized that different types of networks shaping participants' lives and migratory experiences are far from being stable and fixed, rather, they are characterized by being transmissive and dynamic. It is revealed that none of the network categories are homogenous, stable and fixed in terms of the content of the relationships. This adds to Emirbayer and Goodwin's (1994) discussions around the ‘form’ and the ‘content’ of networks. This paper underscores the significance of the historical settings, dynamism and the content of each relationship in understanding individual networks.

An assessment of infection prevention and control implementation in Malawian hospitals using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool

Infection prevention and control (IPC) is important for the reduction of healthcare-associated infections (HAI). The World Health Organization (WHO) developed the IPC Assessment Framework (IPCAF) tool to assess the level of IPC implementation and to identify areas for improvement in healthcare facilities. A cross -sectional survey was conducted using the WHO IPCAF tool from May to June 2023. The aim was to provide a baseline assessment of the IPC programme and activities within health care facilities in Malawi. Forty healthcare facilities were invited to participate. IPC teams were requested to complete the IPCAF and return the scores. The IPCAF tool scores were assessed as recommended in the WHO IPCAF tool. The response rate was 82.5%. The median IPCAF score was 445 out of 800 corresponding to an intermediate IPC implementation level. The results revealed that 66.7% facilities were at intermediate level, 26.4% at basic level, and 6.9% at advanced level. Most facilities (76%) had an IPC program in place with clear objectives and an IPC focal person. Few had a dedicated budget for IPC. The IPCAF domain "monitoring/audit of IPC practices and feedback" had the lowest median score of 15/100, and in 90% of facilities, no monitoring, audit, and feedback was done. HAI surveillance median score was 40/100, workload, staffing and bed occupancy median score was 45/100. Whilst there has been some degree of implementation of WHO IPC guidelines in Malawi's healthcare system, there is significant room for improvement. The IPCAF tool revealed that monitoring/audit and feedback, HAI surveillance and workload, staffing and bed occupancy need to be strengthened. The IPCAF scoring system may need reconsidering given the centrality of these domains to IPC.

Enhancing HIV treatment and support: a qualitative inquiry into client and healthcare provider perspectives on differential service delivery models in Uganda

BackgroundHIV/AIDS continues to be a significant contributor to illness and death, particularly in sub-Saharan Africa. In this study, we conducted a qualitative assessment to understand Client and Healthcare Provider Perspectives on Differential Service Delivery Models in Uganda. The purpose was to establish strengths and weaknesses within the services delivery models, inform policy and decision-making, and to facilitate context specific solutions.MethodsBetween February and April 2023, a qualitative cross-sectional study was utilised to gather insights from a targeted selection of individuals, including People Living with HIV (PLHIV), healthcare workers, HIV focal persons, community retail pharmacists, and various stakeholders. The data collection process included eleven in-depth interviews, nine key informant interviews, and eight focus group discussions carried out across eight districts in Central Uganda. The collected data was analyzed through inductive thematic analysis with the aid of Excel.ResultsThe various Differentiated Service Delivery Models (DSDMs), notably Community-Client-Led Drug Distribution (CCLAD), Community Drug Distribution Point (CDDP), Community Retail Pharmacy Drug Distribution Point (CRPDDP), and the facility-based Facility Based Individual Model (FBIM), were reported to have several positive impacts. These included improved treatment adherence, efficient management of antiretroviral (ARV) supplies, reduced exposure to infectious diseases, enhanced healthcare worker hospitality, minimized travel time for ART refills, stigma reduction, and decreased waiting times. Concern was raised about the lack of improvement in HIV status disclosure, opportunistic infection treatment, adherence to seasonal appointments, and sustainability due to the overreliance of the DSDMs on donor funding, suggesting potential discontinuation without funding. Doubts about health workers’ commitment surfaced. Notably, the CCLAD model displayed self-sustainability, with clients financially supporting group members to collect medicines.ConclusionCommunity-based DSDMs, such as CCLAD and CDDP, improve ART refill convenience, social support, and client experiences. These models reduce travel and waiting times, lowering infection risks. Addressing challenges and enhancing facility-based models is vital. In order to maintain funding after donor funding ends, sustainability measures like cross-subsidization can be used. If well implemented, the DSDMs have the potential to produce better or comparable ART outcomes compared to the FBIM model.

Impact Assessment of the Isang Tasáng Lapis: An Extension Program of the Teacher Education Department of Batanes State College

The Batanes State College as one of the State Colleges in the country has been fulfilling its duty and mandate in delivering extension services to its community. The college through its Teacher Education Department has implemented an extension program on December 2022 to June 2023 dubbed as “Isang Tasàng Lapis: An Extension Project of the Teacher Education Department to the Academically Challenged Pupils of Basco Central School” which aimed to improve the literacy skills of pupils. This research evaluated the impact of the extension program and the challenges encountered in the implementation. The descriptive -comparative design was employed with 52 parents, 17 BCS teachers, and 8 TED faculty members as respondents to the study. The findings of this research indicated that the extension project is positively perceived by both parents and teachers. Specifically, the project has notably increased the motivation of the learners to attend classes which was validated by the teachers and acknowledged by the parents. This study also provided evidence that the academic performance of learners was improved after attending the project. The data revealed that the project significantly contributed to improving the learners’ academic performance. Thus, this study affirms the effectiveness of the project and suggests its potential value in enhancing the learners’ academic success. The study also identified challenges related to planning, implementation, and monitoring wherein both groups indicated minimal challenges in all phases indicating an excellent planning and execution of the project. However, minor challenges such as clarity on partner agency’s focal person, insufficient resources, and project sustainability were pointed out improvement. Based on the findings of the study, recommendations were made to improve the project. The recommendations include designing activities to foster creativity, curiosity, and empathy among pupils, prioritizing immediate needs in reading comprehension and numeracy, and enhancing planning and coordination between partners schools. It was also recommended to address resource constraints such as materials, equipment, manpower, and time to ensure smooth implementation of the project. Other recommendations include implementing strong monitoring frameworks and planning for project sustainability and improving learning environment to optimize interventions and enhance academic success.

The Effectiveness of Occupational Health and Safety Practices in Public Technical Training Institutes

The study aimed to evaluate the extent of occupation-related injuries and accidents, the use of Personal Protective Equipment (PPE), Occupational Health and Safety (OHS) training, and awareness and implementation of OHS policy among Technical Training Institutes (TTIs). The study used qualitative and quantitative methods to analyze data from 99 final-year trainees, including 47 auto mechanics, 24 electricians, 16 welders, and six OHS focal persons. Data was collected through self-administered questionnaires and in-depth interviews and analyzed using SPSS-16 and MAXQDA-2020. The study revealed a commendably low rate of hazards in training institutes (TTIs), with a mere 10.26% and a mean score of 2.1. This positive outcome, a testament to the high awareness of OHS and PPEs, should give reassurance about the current state of OHS practices in TTIs. The training system was a resounding success, with a mean rating of 4.09 for trainees' understanding and use of PPEs. However, the study also identified areas for improvement, particularly the urgent need for improved monitoring and management support. This need for immediate action is crucial for sustaining and enhancing these standards, and it should make the audience feel the urgency of the situation. [Abstract continued in PDF]

Understanding the barriers and facilitators of human papillomavirus vaccine uptake in Kwale and Mombasa counties in Kenya: A study protocol

Background Cervical cancer poses a significant public health problem globally. Human papillomavirus (HPV) vaccination protects against HPV types 16 and 18, responsible for approximately 70% of cervical cancer cases. The optimal vaccination age is in the early adolescent period before sexual debut with possible HPV infection. In 2019, through the Ministry of Health, the Kenya government introduced the HPV vaccine to 10-14-year-old girls. However, analysis of the vaccine coverage across the counties shows that uptake is suboptimal. Our study proposes to apply the World Health Organization (WHO) Measuring Behavioural and Social Drivers (BeSD) of the vaccination framework to understand the barriers and facilitators of HPV vaccine uptake in two counties of Kenya. Methods The study design will be cross-sectional, utilising a mixed methods approach for data collection. We will sample 668 girls aged 10–14 years, across the two counties of Kwale and Mombasa and collect data using using an interviewer-administered questionnaire. Qualitative data will be collected through focus group discussions with CHEWs, and community leaders, and key informant interviews with nurses, clinical officers, vaccine program managers and national vaccine focal persons. We will use the WHO BeSDvaccination framework as our conceptual framework. Significance Understanding the barriers and facilitators for HPV vaccination will help in developing strategies to be applied for improving HPV vaccine uptake.

On Schools’ Safe Spaces: A Review of Gender-Responsive Basic Education in the Schools Division Office of Imus City

This research investigates the implementation of the Safe Spaces Act (Republic Act No. 11313) in the public elementary and secondary schools of the Schools Division Office of Imus City. The study evaluates the extent of gender-responsive policy implementation in educational institutions, emphasizing the dissemination of policy information and the strategies employed to create a safe and inclusive environment for all students. Using a qualitative research design, the study employs thematic analysis to interpret the data collected from interviews with Gender and Development (GAD) focal persons. Key findings indicate that while integration into curricula, printed materials, and online platforms are common dissemination methods, there are significant challenges such as insufficient budget, lack of knowledge, and cultural resistance. The study highlights the necessity for cultural reform, adequate resources, and enhanced critical reasoning among stakeholders to ensure the effective implementation of the Safe Spaces Act. Recommendations include the extension of the study to other divisions, the incorporation of quantitative methods for broader validation, and policy improvements to foster a more inclusive educational environment. The ultimate goal is to safeguard learners’ rights and promote gender equality within the school system.

Water, Sanitation and Hygiene Services in Healthcare Facilities in Bayelsa State Nigeria: A Primordial Prevention Strategy for Infectious Disease Control

Lack or inadequate Water, Sanitation and Hygiene (WASH) in Healthcare Facilities (HCF) have been reported severally as having an impact on the transmission of infectious diseases or outbreak of infectious diseases in a healthcare setting. The study conducted in Bayelsa State, South-South of Nigeria was an institutional-based survey that utilized observational checklist and a key-informant interview for data collection. Eleven (11) HCFs comprising of 6(54.5%) primary healthcare facilities and 5(45.5%) secondary healthcare facilities was used for this study. While 8(72.7%) of the HCFs were owned by the Government 3(27.3%) were owned by private individuals and faith-based organizations. All HCF had tap water drawn from borehole as their main source of water supply but only 4(36.4%) have alternative source of water supply. All water supplies were within the HCFs and are less than 500 m from the point of care. Only 1(9.1%) out of 11 HCFs surveyed lacked water at the time of assessment. The type of toilet present in all the HCFs is the flush (water system) and they are all within the HCF premises. Over ninety percent (90.9%) of the HCFs had no toilet designed for those with limited mobility. Wash hand basins for hand hygiene were found to be available in all the HCFs except 1(9.1%). Four (4) (36.4%) of the HCFs had separate bins for the different categories of healthcare wastes while 7(63.6%) had not. There were posters of handwashing and disease prevention in 6(54.5%) of the HCFs. In all the HCFs, there was no WASH monitoring team. The study therefore advocates for WASH monitoring team and focal persons in all the HCFs to ensure adequate provision of WASH services. The study equally recommends further study involving more HCFs and assessing the constraints militating against the provision, use and maintenance of WASH infrastructures at HCFs in Bayelsa State.

Health care prioritization process for the elderly in rural Tanzania under decentralized system: Prospects and challenges.

Beginning the early 1990s, many countries globally adopted the third-generation health sector reforms with a focus of strengthening the primary health care system through community participation. On the contrary, three decades later, primary health care systems in many Low- and Middle-Income countries (LMICs) including Tanzania have remained weak. Specifically, priority setting for the vulnerable groups including the elderly have been weak. We aimed to analyse the prospects and challenges of the priority setting process for the elderly health care services following the 1990s health sector reforms in Tanzania. We conducted an exploratory case study on priority setting process for the elderly healthcare services in Igunga and Nzega Tanzania. We carried out 24 Key Informant Interviews (KIIs) with the positions of District medical officers, social welfare, Medical Officers in-charge (MOI), planning officers and health system information focal person. Additionally, we carried out two focus group discussions (FGDs), one from each district with six participants from each group. Participants for the FGDs were MOI, health secretary, representative members of Health Facility Governing Committee (HFGC) and Council Health Management Team (CHMT). Data were analyzed using the qualitative content analysis. Two categories emerged from the analysis of the transcripts. These were the prospects and challenges in priority setting for the elderly population under the decentralized health sector in rural Tanzania. The prospects included; the capacity of the LGAs on priority setting; existence of strategies used by LGAs; availability of teamwork spirit and the existence of guidelines for priority setting at LGAs. The challenges included difficulties of elderly identification, insufficient resources to implement the planned activities at the LGAs, unintegrated digitalized government health information tools or programs at the LGAs, interference of LGAs by the Central Government and low interest of stakeholders on elderly health care. This study highlights the prospects and challenges facing priority setting for elderly care at the centralized health system in rural Tanzania. From the results the process is well organized but faces some challenges which if not addressed jeopardized and has potential to continue affecting the priority setting. Addressing the challenges highlighted requires joint efforts from both the elderly population in the community, healthcare providers and decision makers across all levels of the health system. This study serves as an eye-opener and calls for a bigger study to get a comprehensive picture of priority setting of the elderly health care in Tanzania.

Equity in HIV/AIDS services requires optimization of mainstreaming sectors in Ethiopia

BackgroundMainstreaming HIV and AIDS across sectors is crucial to close the disparities in service provision and coverage. However, evidence has shown that certain social groups are left behind in receiving HIV/AIDS services. The objective of this study was twofold: to understand the reasons behind the existing inequities and to explore challenges of equity in HIV/AIDS services in the Amhara region of Ethiopia.MethodsTwenty-two adults (aged 26–57 years) from eighteen sectors that are mainstreaming HIV and AIDS were purposefully selected until the point of saturation and participated in a semi-structured in-depth interview conducted between January 20 and February 17, 2023. Interviewees were asked to describe their mainstreaming experiences in equitable HIV/AIDS services, reflect on the challenges and barriers that impede equitable service provision, or explain the reasons behind the existence of inequity in HIV/AIDS services. The interviews were audio recorded, transcribed, translated, and iteratively analysed, with early analysis informing subsequent interviews. An inductive-reflexive thematic analysis was conducted, whereby themes and subthemes were identified, and the relationships between subthemes and patterns were critically reviewed.ResultsThe challenges to equitable HIV/AIDS service provision were grouped into eight thematic areas: (1) changing contexts that shifts public and government attention to emerging diseases, war and political instability, and poverty; (2) leadership-related, such as the lack of supervision and monitoring, not politicising HIV/AIDS (not providing political attention to HIV/AIDS) and weak intersectoral collaboration; (3) financial constraints due to a random budgeting and contract interruption with non-governmental organisations (NGOs); (4) lack of resources due to scarcity and unfair distribution; (5) inadequate skilled personnel due to inadequate numbers and lack of continuous professional and career development; (6) lack of equity-related evidence-based tools and guidelines; (7) inadequate understanding of equity due to lack of training and misunderstanding, and lack of access to equity-oriented tools and guidelines; and (8) cultural norms, values, and perceptions.ConclusionsThis study identified critical challenges faced in the equitable HIV/AIDS services provision. To achieve equity in HIV/AIDS services, mainstreaming sectors need to invest in mechanisms to sustain services in emergency situations; identify effective leaders to maintain collaboration, monitoring, and evaluation; institutionalise responsive budgeting and establish alternative funds to maintain non-governmental organisations initiatives; provide continuous up-to-date training and create a common evidence-sharing platform; implement proper recruitment, education, and professional development of HIV/AIDS focal persons; and promote and practice culturally safe care. It is, therefore, essential to optimise sectors that are mainstreaming HIV/AIDS and incorporate equity considerations in their strategic plans and working guidelines.

Adverse Events Following Immunization with Novel Oral Polio Vaccine Type 2, and the Experience and Challenges of Reporting in Sierra Leone.

The manifestation and spread of neuroinvasive circulating vaccine-derived polioviruses (cVDPVs) across several countries, which led to the emergency use of the novel oral polio vaccine type 2 (nOPV2), raised concerns about adverse events following immunization (AEFI) surveillance. We assessed the attributes of AEFI with nOPV2 and examined stakeholder experiences and challenges in AEFI surveillance in Sierra Leone. Using a mixed method approach, we retrospectively reviewed passive data collected during a 2021 immunization campaign, and conducted semi-structured, interviews with vaccinators, district AEFI focal persons, and key stakeholders at the national Expanded Program on Immunization and the National Medicines Regulatory Authority. AEFI were categorized using the Medical Dictionary for Regulatory Activities (MedDRA) Preferred Terms (PTs) and System Organ Class (SOC). Outcomes were stratified as recovered or not, with preventability and causality assessed using the Schumock and Thornton and World Health Organization (WHO) algorithms, respectively. A total of 528 suspected AEFI were documented, predominantly affecting children aged 28 days to 23 months (63.3%). Most reported AEFI were administration site conditions and general disorders, with pyrexia being the predominant PT. Of 80 serious cases, 78 recovered, with 74 having an inconsistent causal relationship with the vaccine. Most serious cases (78) were deemed non-preventable, with only two being probably preventable. AEFI reporting was not routinely carried out across the group of people interviewed. AEFI reporting was not consistently performed, with discrepancies in defining reportable events and confusion over responsibility. Challenges with the open data kit (ODK) platform were noted, along with perceived inadequacies in training. While the nOPV2 is relatively new, the majority of AEFI were not serious, and most serious cases were not causally linked to the vaccine. Participants exhibited variations in experience and awareness of AEFI reporting.

Barriers and benefits of mHealth for community health workers in integrated community case management of childhood diseases in Banda Parish, Kampala, Uganda: a cross-sectional study

BackgroundLow-quality data presents a significant challenge for community health workers (CHWs) in low and middle-income countries (LMICs). Mobile health (mHealth) applications offer a solution by enabling CHWs to record and submit data electronically. However, the barriers and benefits of mHealth usage among CHWs in informal urban settlements remain poorly understood. This study sought to determine the barriers and benefits of mHealth among CHWs in Banda parish, Kampala.MethodsThis qualitative study involved 12 key informant interviews (KIIs) among focal persons from Kampala City Council Authority (KCCA) and NGOs involved in data collected by CHWs, and officials from the Ministry of Health (MOH) and two mixed-sex Focused Group Discussions (FGDs) of CHWs from Banda parish, Kampala district. Data analysis utilised Atlas Ti Version 7.5.7. Thematic analysis was conducted, and themes were aligned with the social-ecological model.ResultsThree themes of institutional and policy, community and interpersonal, and individual aligning to the Social ecological model highlighted the factors contributing to barriers and the benefits of mHealth among CHWs for iCCM. The key barriers to usability, acceptability and sustainability included high training costs, CHW demotivation, infrastructure limitations, data security concerns, community awareness deficits, and skill deficiencies. Conversely, mHealth offers benefits such as timely data submission, enhanced data quality, geo-mapping capabilities, improved CHW performance monitoring, community health surveillance, cost-effective reporting, and CHW empowering with technology.ConclusionDespite limited mHealth experience, CHWs expressed enthusiasm for its potential. Implementation was viewed as a solution to multiple challenges, facilitating access to health information, efficient data reporting, and administrative processes, particularly in resource-constrained settings. Successful mHealth implementation requires addressing CHWs’ demotivation, ensuring reliable power and network connectivity, and enhancing capacity for digital data ethics and management. By overcoming these barriers, mHealth can significantly enhance healthcare delivery at the community level, leveraging technology to optimize resource utilization and improve health outcomes. mHealth holds promise for transforming CHW practices, yet its effective integration necessitates targeted interventions to address systemic challenges and ensure sustainable implementation in LMIC contexts.

COVID 19 Vaccination implementation among preparatory school students in Akaki Kality Sub city, Addis Ababa, Ethiopia

Coronavirus (COVID-19) is a global pandemic that has affected 229 countries and territories. Vaccines are one of the best ways to prevent and slow down transmission of COVID 19. Since students in school setting share teaching rooms, sport facilities, and other facilities like toilet and cafeteria, and have a higher number of social contacts, this study aimed to assess implementation of Vaccination against COVID 19 among preparatory school selected secondary preparatory schools in Akaki Kality Sub city, Addis Ababa, Ethiopia. Descriptive cross sectional study design using multistage random sampling technique was conducted among secondary school students in Akaki Kality sub city, Addis Ababa, Ethiopia from March 01 – 25, 2023. A total of 349 students proportionally allocated to five schools in Akaki Kality sub city were interviewed and focus group discussion were conducted with five catchment health center immunization focal persons. In this study, preparatory students had 44.6% knowledge and 17.5% practice regarding COVID 19 vaccination. Religion, residence, and the educational level of students’ parent were found associated with students’ knowledge on vaccination against COVID 19. Previous COVID 19 illness and knowledge of students were found to be associated with students’ vaccination practice against COVID 19. In comparison to other studies, relatively limited knowledge and poor practice were observed. Knowledge was found to be associated with students’ practices indicating the need for strengthening behavioral, risk communication and community engagement activities using religious leaders and different communication platforms. Additionally, to address vaccine related shortages, partnerships should be strengthened at different levels to enable direct purchases, utilization of group financing and donation options.