Focus Group Discussions Participants Research Articles

Factors influencing adoption, innovation of new technology and decision-making by small-scale resource-constrained farmers: The perspective of farmers in lower Gweru, Zimbabwe

A study was conducted in Lower Gweru Communal area of Zimbabwe to determine factors affecting small-scale resource-constrained farmers’ technology adoption and innovation processes. Specific objectives included determining circumstances when farmers consider learning about and adopting new technologies; documenting challenges faced by farmers in technology adoption; and determining the kind of support farmers require in adopting technologies or innovating. Multistage stratified random sampling was used to select a study sample of 256 farmers who participated in focus group discussions (FGDs). Additionally, semi-structured interviews (SSIs) with 200 farmers, selected from within the 256 FGD participants, were conducted to corroborate data collected in FGDs and participant observation. The study found that farmers were ready to learn and adopt new technologies when proposed technologies were (i) cheaper to acquire and use than their current technologies, (ii) easier and simpler to use, (iii) reduced labor requirements, and (iv) increased crop yields and/or animal productivity. Specifically, the study found high adoption rates of new technologies with traits similar to the farmers’ traditional practices such as conservation agriculture (with a 90% adoption rate) and thermal composts (with a 78% adoption rate). In terms of challenges, farmers were hampered mainly by lack of capital to acquire new technologies and lack of access to information, credit facilities and markets. In terms of support, in addition to capital and issues of access, farmers preferred to be actively involved in defining problems and developing solutions, technologies and innovations. Rather than being mere beneficiaries of new technologies developed by others, they want to be included in processes such as field-based participatory learning extension and innovation projects. In keeping with their self-perception as businessmen and women, perhaps most significantly, this study has reaffirmed that small-scale farmers, despite their educational limitations, their age, their constrained circumstances, and their risk profiles – are conscious and deliberate decision-makers. They are rational in their approach to adoption of technology, but are dominated by factors of cost, impact on income, and, of greatest influence, risk. Key words: extension, innovation, indigenous technologies, learning, perception, small-scale farmers, technology adoption

Health Extension Postnatal Care Services Utilization and Associated Factors Among Mothers in Kindo Didaye District, Southern Ethiopia: a Community-Based Mixed-Method Study

Background: Postnatal care is care provisions being delivered during postnatal period. Lack of care in this period may result in death or disability as well as missed opportunities to promote healthy behaviors affecting women, newborns, and children. We need to understand the level and factors affecting health extension postnatal care services utilization. Objective: To determine the prevalence of health extension postnatal care services utilization and associated factors among mothers who gave birth in the last year in Kindo Didaye district, Southern Ethiopia, 2017. Methodology: A community-based cross-sectional mixed-method study was conducted from March 1-30, 2017 to get the final sample size of 645 mothers. Descriptive statistics were used to describe study participants. Binary logistic regression was used to identify associated factors among the explanatory variables at P < 0.05. Results: The prevalence of utilization of Post-natal care services is 32.8%. Having husbands attended secondary and above education, having at least one Antenatal care attendance, last delivery in the health institution, planning to utilize services, visitation, and notification of delivery by Health extension workers were factors to utilize services. The majority of Focus group discussion participants said that Health extension workers were not visiting at their homes and hence mothers might not be encouraged to attend health extension Post-natal care services. Conclusion: The prevalence of mothers who utilized health extension Post-natal care services in the district was very low. Thus, focusing on the identified factors could improve and sustain Post-natal care services from rural Health extension workers.

Feasibility of HPV vaccination program implementation: A qualitative study

The implementation of the Human Papillomavirus (HPV) vaccination program is still experiencing obstacles in several developing countries. This setback is related to the lack of knowledge and the high cost of the vaccine so that it affects people's behavior about the HPV vaccine. HPV vaccination in adolescents itself as primary prevention has not been widely conducted by adolescents in Indonesia. The results of previous studies showed that not many teenagers had vaccinated against HPV by using self-financing guarantees such as health savings. The obstacles faced in implementing HPV vaccination are that the vaccine is still expensive and there is lack of knowledge of parents and adolescents about the importance of HPV immunization. This formative research using qualitative methods was conducted to analyze the implementation plan of the HPV vaccination program. Data were collected through focus group discussions (FGD) and in-depth interviews. At the end of each FGD activity or interview, transcription and thematic analysis based on content were done. The FGD participants were ten teachers, while the in-depth interview participants were one school committee. This study found two main themes, namely the scheme of implementing the HPV vaccination program and obstacles to the implementation of HPV vaccination. Schools generally supported the program implementation. However, parents still question the importance of the HPV vaccination for their daughters and consider the vaccine costs expensive. Implementation of the HPV vaccination program must consider the existing program schemes in schools and possible obstacles. The results suggested that for the next HPV vaccination program, the facilitators should provide intense and relevant education to parents about the importance and side effects of HPV immunization, and are expected to build a willingness of parents to vaccinate their daughters and seek vaccination costs, one of which can be through a savings program.

Socio-cultural beliefs and practices during pregnancy, child birth, and postnatal period: A qualitative study in Southern Ghana

Despite investments in interventions to reduce maternal and neonatal morbidity and mortality, progress has been slow, especially in developing countries. Socio-cultural beliefs in communities often lead to the adoption of certain practices during pregnancy, childbirth, and postnatal period. Therefore, this study was conducted to identify these beliefs and practices and how they affect maternal and child health care services. Purposive sampling was used to select focus group discussion participants (13) among community members, pregnant women whose gestation was at least 6 months, and women with babies less than 6 months of age. In addition, 22 in-depth interviews were conducted among health workers at district, subdistrict, and community levels. All interviews were audio-recorded and transcribed verbatim. With the aid of NVivo 11, the data was analysed thematically. The study’s findings showed that socio-cultural beliefs and practices are widespread covering antenatal through childbirth to the postnatal period. Both harmful and harmless practices were identified. Protecting pregnancy from evil forces resulted in the practice of confinement and consequently late initiation of antenatal care. The use of herbal preparations to augment labour was reported and this practice favoured home delivery and use of Traditional Birth Attendant. The study concludes that socio-cultural beliefs are common and transcend the entire peripartum period. Some of these social practices tend to affect utilisation of some essential maternal and child health practices. However, accepting harmless social practices during labour will improve trust and cater for community’s worldview about childbirth and foster skilled delivery.

Assessment of the feasibility of Juntos: A support programme for families of children affected by Congenital Zika Syndrome

Background: The 2015-16 Zika epidemic resulted in thousands of children born with congenital Zika syndrome (CZS). In Brazil, gaps in the health system often caused parents to be left with insufficient information and support. Consequently, we developed and piloted Juntos - a participatory support programme which aims to improve knowledge, capacities and build support networks for caregivers of children with CZS. Methods: Six caregiver groups received the programme between August 2017 and June 2018: three in Rio de Janeiro and three in Bahia. We assessed the feasibility of Juntos against six of the eight areas of a feasibility framework described by Bowen et al. to consider whether Juntos ‘could work’. These areas were: acceptability, demand, implementation, practicality, adaptation and limited efficacy. We used mixed methods including: 1) baseline and end-line questionnaires completed by all group participants; 2) in-depth interviews with 18 participants, seven facilitators and three key stakeholders; 3) participant focus group discussions after each session; 4) researchers session observation; and 5) recording programme costs. Results: 37/48 (77%) enrolled families completed both questionnaires. Acceptability and demand were noted as high, based on participant responses to interview questions, focus group feedback and satisfaction scores. Potential for implementation and practicality were also demonstrated through interviews with facilitators and key stakeholders and analysis of project documents. Two groups included caregivers of children with non-Zika related developmental disabilities, showing potential for adaptability. Self-reported quality of life scores increased in caregivers between baseline and end-line, as did the dimensions of family relationships and daily activities in the Pediatric Quality of Life Inventory (PEDS QL) Family Impact Module, showing limited efficacy. Conclusions: The programme showed feasibility according to Bowen’s framework. However, further research of scale up, particularly in the areas of integration, expansion and limited efficacy are needed to ascertain if the programme is effective.

Factors associated with willingness to use oral pre-exposure prophylaxis (PrEP) in a fisher-folk community in peri-urban Kampala, Uganda

BackgroundThe World Health Organization (WHO) recommends the use of pre-exposure prophylaxis (PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with willingness to use PrEP among key populations at risk of HIV, such as members of communities with exceptionally high HIV prevalence.ObjectiveTo examine the perceptions and factors associated with willingness to use oral PrEP among members of fishing communities in Uganda, a key population at risk of HIV.MethodsWe conducted an explanatory sequential mixed-methods study at Ggaba fishing community from February to June 2019. Survey data were collected from a systematic random sample of 283 community members in which PrEP had not been rolled out yet by the time of we conducted the study. We carried out bivariate tests of association of willingness to use PrEP with demographic characteristics, HIV risk perception, HIV testing history. We estimated prevalence ratios for willingness to use PrEP. We used backward elimination to build a multivariable modified Poisson regression model to describe factors associated with willingness to use PrEP. We purposively selected 16 participants for focus group discussions to contextualize survey findings, analysing data inductively and identifying emergent themes related to perceptions of PrEP. Key resultsWe enrolled 283 participants with a mean age of 31 ± 8 years. Most (80.9%) were male. The majority of participants had tested for HIV in their lifetime, but 64% had not tested in the past 6 months. Self-reported HIV prevalence was 6.4%. Most (80.6, 95%CI 75.5–85.0) were willing in principle to use PrEP. Willingness to use PrEP was associated with perceiving oneself to be at high risk of HIV (aPR 1.99, 95%CI 1.31–3.02, P = 0.001), having tested for HIV in the past 6-months (aPR 1.13, 95%CI 1.03–1.24, P = 0.007), and completion of tertiary education (aPR 1.97, 95%CI 1.39–2.81, P < 0.001). In focus group discussions, participants described pill burden, side-effects and drug safety as potential barriers to PrEP use.Conclusions and recommendationsOral PrEP was widely acceptable among members of fishing communities in peri-urban Kampala. Programs for scaling-up PrEP for fisherfolk should merge HIV testing services with sensitization about PrEP and also increase means of awareness of PrEP as an HIV preventive strategy .

Assessment of the feasibility of Juntos: A support programme for families of children affected by Congenital Zika Syndrome.

Background: The 2015-16 Zika epidemic resulted in thousands of children born with congenital Zika syndrome (CZS). In Brazil, gaps in the health system often caused parents to be left with insufficient information and support. Consequently, we developed and piloted Juntos - a participatory support programme which aims to improve knowledge, capacities and build support networks for caregivers of children with CZS. Methods: Six caregiver groups received the programme between August 2017 and June 2018: three in Rio de Janeiro and three in Bahia. We assessed the feasibility of Juntos against six of the eight areas of a feasibility framework described by Bowen et al. to consider whether Juntos 'could work'. These areas were: acceptability, demand, implementation, practicality, adaptation and limited efficacy. We used mixed methods including: 1) baseline and end-line questionnaires completed by all group participants; 2) in-depth interviews with 18 participants, seven facilitators and three key stakeholders; 3) participant focus group discussions after each session; 4) researchers session observation; and 5) recording programme costs. Results: 37/48 (77%) enrolled families completed both questionnaires. Acceptability and demand were noted as high, based on participant responses to interview questions, focus group feedback and satisfaction scores. Potential for implementation and practicality were also demonstrated through interviews with facilitators and key stakeholders and analysis of project documents. Two groups included caregivers of children with non-Zika related developmental disabilities, showing potential for adaptability. Self-reported quality of life scores increased in caregivers between baseline and end-line, as did the dimensions of family relationships and daily activities in the Pediatric Quality of Life Inventory (PEDS QL) Family Impact Module, showing limited efficacy. Conclusions: The programme showed feasibility according to Bowen's framework. However, further research of scale up, particularly in the areas of integration, expansion and limited efficacy are needed to ascertain if the programme is effective.

Contextual and psychological factors influencing open defecation free status: an exploratory qualitative study in rural South Western Uganda

IntroductionAchieving the Open defecation free (ODF) status remains a major challenge in Uganda, yet it contributes significantly to child health improvement. Literature on social, cultural and behavioral aspects that influence the ODF status in rural Uganda is limited. The study therefore, explored perceived factors influencing the ODF status in rural South Western Uganda.MethodsAn exploratory study employing qualitative techniques and based on deductive analysis between month December 2020 and January 2021 was conducted. Seven Focus Group Discussions (FGDs and three Key Informant Interviews (KIs) were conducted in Kabale District, southwestern Uganda. Focus Group Discussion participants were mothers and fathers having children of 2 years and below while KIIs included local community leaders and health extension workers. Data was analyzed using a categorization matrix derived from the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) model which is comprised of contextual and psychological factors. Text was further categorized into high and low statements for attainment of ODF status.ResultsThe contextual factors influencing the Open Defecation Free status behavior included; farming activities far from home, financial constraints, rainy seasons, collapsible soft soils, and alcohol use. Psychological factors influencing ODF status included; perceived health risk for typhoid disease, low perceived severity for lack of ODF components, negative attitude of less value attached to ODF components, and a feeling of time wastage practicing ODF status behavior. The perception that the community has the ability to attain the ODF status was high. Although, the capability to maintain ODF was low when it comes to replacement of ODF component if stolen or destroyed.ConclusionOpen Defecation Free status is influenced by contextual and psychological factors. Therefore, it’s crucial for sanitation promotors to always identify such context specific factors in order to design sanitation and hygiene promotion interventions to address the ODF free status related challenges.

Land Administration: Securing Limited Resource with Skyrocketed Demand in Shashemene City of Oromia Regional State, Ethiopia

This study aims to assess urban land administration practices in the study area. The study has applied a multi-stage representative sampling technique to achieve this objective. The researcher has employed a descriptive research design, and both quantitative and qualitative methods were adopted. The study used 137 systematically selected sample households from four sampled kebeles. The primary data was collected from the municipal city officials and experts, focus group discussions participants as well as households by the researcher with the help of enumerators, and secondary data was collected from rules and regulations, documents concerning land and property registration system, different documents on good governance principles and official records. Five (5) key informants from sectorial offices concerning urban land administration were interviewed. The researcher has also organized two focus group discussions having six (6) purposively selected participants in each group comprising the residents of Shashemene city. The cumulative findings revealed an absence of transparency on land administration-related issues and a problem of responsiveness in the study area. Finally, the study recommended organizing meetings to take complaints as input, setting clear and uniform work procedures based on the study's findings.

Identification of University Resources in an Effort to Design a Disaster Resilience Training Module

The current disaster management paradigm emphasizes community empowerment, thus enabling the community to become a helping subject, not an object that needs help. Data shows that Indonesia is a country prone to all sources of natural disasters. The purpose of this research is to compile modules in creating a disaster resilient campus. After the modules are compiled, the next step is to socialize the modules, conduct training of trainers, training and evaluate the training that has been carried out based on the modules that have been prepared. Research methods. Quantitative research design, with a descriptive approach. Aims to identify the potential of higher education institutions in efforts to reduce disaster risk in an effort to develop training modules. The population and sample were FGD (Focus Group Discussion) participants and disaster management experts/experts, and 100 module trial participants.The research variables were obtained from the results of literature studies and FGDs. Furthermore, the identification results are used to develop modules that can be used as Field Rehearsal guides. Modules are obtained in 3 ways: identification, FGD and expert consultation. The variables of this study are the presence of disaster courses, the presence of disaster course lecturers, the competence of lecturer training, the existence of training modules for lecturers, the diversity of potential disaster sources. Result.The results of the analysis test on all variables which are learning activities, are valid and reliable. From the results of the analysis, it can be obtained that the item score with a total score is then compared with the r table value (5% significance with a 2-sided test and n = 110) in the amount of 0.195. The decision was that all the r values from the analysis were more than (&gt;) the r table values. Conclusion. The results showed that the modules that had been developed by conducting literature studies, FGDs and expert consuls had been tried out. The results of the analysis test show that the module can be used for disaster risk reduction (DRR) training for campuses. The importance of conducting training by paying attention to the 10 learning activities as disaster training competency standards.

Perceived Barriers to Weight Loss: A Qualitative Study of the Lived Experiences of Women with Obesity in Shiraz

Background: Obesity is a public health issue, leading to many medical and socially unacceptable complications. To combat obesity, going on a diet is a routine prescription by dieticians. Although men and women with obesity are equally advised to lose their body weight, almost in all societies women are more adhered to their prescribed diets. However, some of weight reducing diets seems neither effective nor long lasting. This study aimed to assess perceived barriers to weight-loss programs among women with obesity in Shiraz. Methods: This qualitative study was conducted in 2017 in Shiraz. To fulfill the objectives of the study, eight semi-structured focus group discussions (FGDs) and seven in-depth interviews with key informants were performed. The eligible participants for FGDs were women with obesity who were not satisfied with their diet and were selected through a public call in Shiraz. Results: A total of 1429 initial codes were obtained from FGDs, and after categorizing, four main barriers were resulted. Dietary, socio-cultural, supportive- psychological, and economic issues were identified as the main perceived barriers to weight-loss programs. Conclusion: The study findings provided comprehensive information about the probable causes of diet prescriptions failure, which can assist dietitians to improve the efficacy of their weight management advice in clinics.

English

This paper discusses how rosewood as a common-pool resource is managed and utilized at the local community level in the wake of aggravated exploitation of the resource for export to feed external markets. Non-probability sampling technique coupled with focus group discussion was used to collect primary data from two administrative districts in the transitional zone between the savannah and high forest in Ghana. In all, researchers interacted with 96 respondents in a survey and 77 participants in focus group discussions in 6 communities. The results indicate that the governance structure and management strategy for the sustainable use of rosewood and other forest commons are ineffective in the studied communities. Illegal rosewood harvesting thrived due to weak institutional structures, poor community knowledge of the value of rosewood logs in the international market and poor public knowledge about a ban on the harvesting and export of rosewood. Sustainable management and utilization of rosewood and other forest commons on village lands (lands outsider protected areas) could be improved if local communities are empowered and given technical support to manage forest resources on their lands. The conduct of natural capital accounting in forest resources and communicating the result to local communities could help residents appreciate the true value of forest resources and probably aspire for a greater quota of benefits. With a better understanding of the value of a forest, residents may be motivated to protect it from unsustainable use. &nbsp; Key words: Institutional structures, natural resource use, sustainable management, illegal logging.

Potential of Higher Education Institutions in Disaster Risk Reduction

Background. Indonesia is a country that has many potential disasters. Often referred to as the Supermarket Disaster state. Every individual, group and community needs to have preparedness in dealing with disasters. Preparedness can be done through training that is carried out in a planned, academic and periodic manner. So far, there is no habit of conducting disaster simulations or field rehearsals at the Health Polytechnic of the Ministry of Health in Surabaya. The identification of the potential of this higher education institution is the first step in preparing the field rehearsal module plan. The final goal is to develop a disaster preparedness module, design institutional policies and form a community disaster preparedness team. Research methods. In this study, a quantitative design was used, with a descriptive approach. Aims to identify the potential of Higher Education in disaster risk reduction efforts. The population and sample are FGD (Focus Group Discussion) participants and disaster mitigation experts/experts. The research variables were obtained from the results of literature studies and FGDs. Furthermore, the identification results are used to compile a module that can be used for Field Rehearsal guidelines. Modules are obtained in 3 ways: identification, FGD and expert consultation. The variables of this research are the existence of disaster courses, the presence of disaster course lecturers, the competence of lecturer training, the existence of training modules for lecturers, the diversity of potential sources of disaster. The results. The results of the study show as follows: 96% of campuses at the Health Polytechnic of the Ministry of Health in Surabaya have disaster courses. Lecturers of disaster courses are all from within the study program as much as 63%, a mixture of inside and outside the study program as much as 31%, and a mixture of lecturers from inside and from guest lecturers as much as 6%. Lecturers who have never attended disaster training 52%. Campuses that have never been on campus simulations are 43% and have held simulations but not regularly once a year = 31%. As many as 90% of lecturers stated that they strongly agreed to hold disaster simulation training. 34% of campuses that have the potential for 3 kinds of disasters. Conclusion: The identification results in this study indicate the importance of the existence of disaster courses, the presence of disaster course lecturers, the competence of lecturer training, the existence of training modules for lecturers, the diversity of potential sources of disaster. It is necessary to prepare a disaster preparedness training module in an effort to reduce disaster risk.

Development of Smart Postpartum Care Application Based on Community Health Centers, as a Method for Mentoring Postpartum Mothers: A Mixed Method Approach.

Background:Early detection of postpartum problems can help reduce maternal mortality in Indonesia. Early detection can be achieved by monitoring postpartum mothers using a guidance system. The purpose of this study was to describe the development of a guidance system, namely, Smart Postpartum Care (SMAP CARE) and present its functional and acceptance tests.Materials and Methods:This study was a development study conducted in 2019 using a mixed-method approach. Data were collected through Focus Group Discussions (FGDs) and a literature study. The FGD participants consisted of six doctors, six nurses, and midwives from six community health Public health center in Semarang City, Indonesia. The collected data were analyzed using the Colaizzi method. The content of the postpartum mentoring application was based on input from the experts in health education and health services. Before widely applied, a feasibility study on the application was carried out in community health centers involving postpartum mothers and health care teams.Results:Five themes were generated from FGDs: (1) postpartum monitoring facilities; (2) monitoring postpartum mothers through visits to health centers and home care; (3) problems with postpartum mothers (including problems with mothers, babies, and the environment); (4) management of high-risk postpartum mothers; and (5) the risk of postpartum mothers, which could cause death. The SMAP CARE provides some features to educate postpartum mothers, for example (a) changes in the physiological aspects of postpartum mothers, (b) breast milk, (c) newborn care, (d) signs of danger in newborns, (e) problems with babies, (f) problems with postpartum mothers, and (g) signs of danger in postpartum mothers.Conclusions:The application developed in this research, SMAP CARE, helps to facilitate mentoring for postpartum mothers and can be extended to community health centers in Indonesia.

An Appraisal of Environmental and Social Impact Assessment in Ethiopia: The Case of Meta Abo Brewery

This study investigates the implementation and follow-up of the environmental and social impact assessment (ESIA) in Meta Abo Brewery in Ethiopia. Specifically, it aims to assess the implementation mechanism and status of ESIA monitoring and evaluation, the adequacy of the legal and administrative framework for ESIA implementation and follow-up, and the perception of residents towards the ESIA implementation and follow-up by the proponent. A mixed research approach was employed to collect and analyze both qualitative and quantitative data. Thematic and descriptive data analysis was used to analyze data collected through key informant interviews (KII), focus group discussion (FGD), closed-ended questions, and document review. Data were obtained from 11 purposely selected interviewees and 6 FGD participants, as well as 175 randomly selected respondents. This study found the practical implementation mechanism of ESIA monitoring and evaluation as well as weak ESIA monitoring and evaluation status through the case study. The main causes of this weak ESIA system are weak implementation of ESIA monitoring and evaluation by the regulatory body and proponent, weak cooperation among regulatory body and proponent, weak institutional capacity, and weak managerial commitments. The study also indicated a lack of adequate legal and administrative frameworks and the absence of regular revision of relevant legislation. Additionally, the study identified that the proponent has some weaknesses in the ESIA implementation and follow-up. The findings regarding the legal and administrative framework can be developed to guide the formulation and amendment of the ESIA legal and administrative framework not only for Ethiopia, but other developing countries as well. Moreover, the findings of this study can be a groundwork for future studies to fill the gap by understanding the social-cultural barrier and finding appropriate strategies to enhance the ESIA system in developing countries.

Community knowledge, perceptions, and practices regarding malaria and its control in Jabi Tehnan district, Amhara Region, Northwest Ethiopia

BackgroundUse of long-lasting insecticidal nets (LLINs), indoor residual spraying (IRS), community-based malaria education, prompt diagnosis and treatment are key programme components of malaria prevention and control in Ethiopia. However, the effectiveness of these interventions is often undermined by various challenges, including insecticide and drug resistance, the plasticity of malaria vectors feeding and biting behaviour, and certain household factors that lead to misuse and poor utilization of LLINs. The primary objective of this study was to document households’ perceptions towards malaria and assess the prevalence of the disease and the constraints related to the ongoing interventions in Ethiopia (LLINs, IRS, community mobilization house screening).MethodsThe study was conducted in Jabi Tehnan district, Northwestern Ethiopia, from November 2019 to March 2020. A total of 3010 households from 38 villages were randomly selected for socio-economic and demographic survey. Focus group discussions (FGDs) were conducted in 11 different health clusters considering agro-ecological differences. A total of 1256 children under 10 years of age were screened for malaria parasites using microscopy to determine malaria prevalence. Furthermore, 5-year malaria trend analysis was undertaken based on data obtained from the district health office to understand the disease dynamics.ResultsMalaria knowledge in the area was high as all FGD participants correctly identified mosquito bites during the night as sources of malaria transmission. Delayed health-seeking behaviour remains a key behavioural challenge in malaria control as it took patients on average 4 days before reporting the case at the nearby health facility. On average, households lost 2.53 working days per person-per malaria episode and they spent US$ 18 per person per episode. Out of the 1256 randomly selected under 10 children tested for malaria parasites, 11 (0.89%) were found to be positive. Malaria disproportionately affected the adult segment of the population more, with 50% of the total cases reported from households being from among individuals who were 15 years or older. The second most affected group was the age group between 5 and 14 years followed by children aged under 5, with 31% and 14% burden, respectively.ConclusionDespite the achievement of universal coverage in terms of LLINs access, utilization of vector control interventions in the area remained low. Using bed nets for unintended purposes remained a major challenge. Therefore, continued community education and communication work should be prioritized in the study area to bring about the desired behavioural changes.

Recommendations for improving access to healthcare for street-connected children and youth in Kenya: A qualitative study

BackgroundStreet-connected children and youth (SCY) in Kenya have a high burden of disease and require access to healthcare that is responsive and sensitive to their needs and situation living and working on the streets. However, evidence suggests that SCY in Kenya are facing significant barriers to accessing healthcare, which may be impacting their health and well-being. Therefore, we sought to identify opportunities for ameliorating access to healthcare for SCY in Kenya from stakeholders including healthcare providers, SCY, policymakers, and community members. MethodsThis qualitative analysis focuses on a sub-set of data concerning the delivery of healthcare to SCY and recommendations to improve access to healthcare for this population. We interviewed 100 participants in focus group discussions and in-depth interviews across 5 counties in Kenya from May 2017 and September 2018. We conducted a thematic analysis situated in a conceptual framework for access to healthcare. Our results are presented in five major themes positioned in this conceptual framework’s five dimensions of accessibility of care and five corresponding abilities of persons: approachability and ability to perceive the need for healthcare; acceptability of health services and ability to seek healthcare; availability and accommodation of health services and ability to reach healthcare; affordability and ability to pay for healthcare services; appropriateness of care and ability to engage as an empowered patient with the health system. ResultsOur results found three fundamental components of ameliorating access to healthcare for SCY in Kenya including: 1) the need for universal health coverage for SCY to alleviate barriers with respect to affordability, ability to pay, availability, and ability to reach; 2) the need to ensure that healthcare providers are trained and sensitized to provide care to SCY to improve acceptability; and 3) that multidisciplinary, holistic, and community-based approaches to healthcare for SCY are essential in order to adequately meet their distinct needs. ConclusionSCY in Kenya urgently require access to quality healthcare given their substantial morbidities and mortality. Improving access to healthcare for SCY requires addressing a lack of affordability and an inability to pay. It also requires healthcare providers to feel supported and resourced to provide care to SCY to resolve issues of acceptability. Finally, given SCY’s multitude of unmet needs, multidisciplinary and community-based approaches to care may be integral to improving short- and long-term health and well-being for SCY.

Combating Lassa fever for sustainable development: Interplay of perceived behavioural control and current preventive practices in most endemic States in Nigeria.

Lassa fever has become a recurring incidence in Nigeria with high case fatality rates recorded in recent times. Given that total compliance with standard hygiene is recommended as a fundamental ingredient for the prevention of Lassa fever, this study investigated the influence of perceived behavioural control and current household and environmental hygiene practices for Lassa fever prevention among residents of selected Lassa fever endemic states in Nigeria. Data collected from primary sources through a mixed-methods approach, using self-administered structured questionnaire and Focus Group Discussions (FGDs) was used for analysis and drawing of inferences. The sample size consisted of 663 survey respondents and 72 FGD participants. The quantitative data was analysed with the aid of SPSS version 23 using descriptive and inferential statistics while thematic analysis was employed in analysing the qualitative data. The findings indicate that the residents perceived certain recommended hygiene practices as 'easy-to-perform' while some are perceived as 'difficult-to-perform'. Compliance with standard hygiene practices is still partial due to the significant influence of Perceived Behavioural Control on current practices towards Lassa fever prevention in all the selected states at (R2= .023, .040 and .111 for Ebonyi, Edo and Ondo states respectively, at p˂0.05). The study recommends the establishment of community-based mechanized food/crops drying facilities at subsidized rates to remove the risk of food contamination by rodents during sun-drying and extensive use of interpersonal communication channels for door-to-door campaign for the total compliance with the preferred hygiene practices for Lassa fever.

\u201cRight diet for the right person\u201d: a focus group study of nutritionist-dietitians\u2019 perspectives on nutritional genomics and gene-based nutrition advice

Advances in nutritional genomics are intended to revolutionize nutrition practice. A basic understanding of nutritional genomics among nutritionist-dietitians is critical for such advancements to occur. As a precedent to the development and integration of gene-based nutrition advice, this study aimed to assess hospital-based nutritionist-dietitians’ perceptions of nutritional genomics. A total of ten focus group discussions (FGDs) with sixty-one registered nutritionist-dietitians (RNDs) from hospitals in the National Capital Region (NCR), Philippines, were conducted from October to November 2019. Data were collected using a pretested semistructured discussion guide, and thematic analysis was subsequently performed. Diverging perceptions about nutritional genomics were noted among the FGD participants. Five themes emerged relating to the enablers and barriers of gene-based nutrition advice: training and capacity building, the extent of information to be disclosed, cost, ethical considerations, and government support. Themes related to the desired features of the gene-based nutrition advice included being consent-driven, cost-effective, technology-oriented, and guided by standards. The results of this study suggest that training and continued learning will equip RNDs to provide nutrition advice based on genetic information. However, other factors, such as cost and ethical considerations, are critical dimensions that need to be acknowledged and addressed before integrating gene-based advice into nutrition practice.

Readiness for Use of HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in Malawi: Qualitative Focus Group and Interview Study.

BackgroundMen who have sex with men (MSM) are a key group for HIV interventions in Malawi considering their high HIV prevalence (17.5% compared to 8.4% among men in the general population). The use of oral preexposure prophylaxis (PrEP) presents a new opportunity for MSM to be protected. We present the findings from a qualitative assessment designed to assess awareness of and willingness and barriers to using PrEP among MSM in Malawi.ObjectiveThe 3 main objectives of this assessment were to determine: (1) awareness of PrEP, (2) factors that influence willingness to use PrEP, and (3) potential barriers to PrEP use and adherence among MSM in order to guide the design and implementation of a PrEP program in Malawi.MethodsAhead of the introduction of PrEP in Malawi, a qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in October 2018 in Blantyre, Lilongwe, and rural districts of Mzimba North and Mangochi. With support of members of the population, study participants were purposively recruited from 4 MSM-friendly drop-in centers where MSM receive a range of health services to ensure representativeness across sites and age. Participants were asked what they had heard about PrEP, their willingness to use PrEP, their barriers to PrEP use, and their preferences for service delivery. The data were analyzed using a thematic content analysis framework that was predetermined in line with objectives.ResultsA total of 109 MSM were interviewed—13 through IDIs and 96 through FGDs. Most participants were aware of PrEP as a new HIV intervention but had limited knowledge related to its use. However, the majority were willing to use it and were looking forward to having access to it. IDI participants indicated that they will be more willing to take PrEP if the dosing frequency were appropriate and MSM were involved in information giving and distribution of the drug. FGD participants emphasized that places of distribution and characteristics of the service provider are the key factors that will affect use. Knowing the benefits of PrEP emerged as a key theme in both the IDIs and FGDs. Participants highlighted barriers that would hinder them from taking PrEP such as side effects which were cited in IDIs and FGDs. Key factors from FGDs include cost, fear of being outed, drug stockouts, fear of being known as MSMs by wives, and lack of relevant information. FGDs cited stigma from health care workers, forgetfulness, and community associated factors.ConclusionsDespite having inadequate knowledge about PrEP, study participants were largely willing to use PrEP if available. Programs should include an effective information, education, and communication component around their preferences and provide PrEP in MSM-friendly sites.