Global Health Projects Research Articles

Chronicity of disruptive project rhythms: The projectification of the ‘post-Ebola' health system rebuilding in Sierra Leone

Global health development projects are inherently governed by bounded, temporal and linear time frames: the initiation, implementation and ending of time-limited interventions. This projectification of global health programmes has wide-reaching consequences as global health projects, often unsustainable and produces both new life possibilities and uncertain futures. This article highlights the temporal effects of the global health agenda on the primary health system rebuilding efforts in Sierra Leone. Attention is paid to how the projectification of public health programmes affected the primary healthcare management in a district in the southern region of Sierra Leone. Throughout this article, I develop the theoretical concept of chronicity of disruptive project rhythms where local public healthcare actors encounter project disruptions on a continuum of chronic lack. I base this concept on Manderson and Smith-Morris’s definition of chronicity of illness experience, which is marked by punctuated episodes of acute sickness, where chronic patients are temporally transmuted into acute patients, while at the same time continuing to suffer from their ongoing chronic ailments. Drawing on 14 months of ethnographic research, I show how a district health management team (DHMT) contested the bounded time frames of public health funding; how waiting time for funding impacted the operation of the DHMT and, by extension, the district health system as a whole and how DHMT employees and other actors within the health system employed time-tricking strategies to resist this project time.

Barriers and drivers to stakeholder engagement in global mental health projects

BackgroundEngagement with diverse stakeholders, including policy makers, care providers and service users and communities, is essential for successful implementation of global mental health interventions. Despite being a fundamental factor in the implementation process, evidence about challenges and drivers to stakeholder engagement is limited in the global mental health literature.MethodsWe conducted semi-structured qualitative interviews with 29 recipients of Grand Challenges Canada Global Mental Health funding to assess barriers and drivers to global mental health implementation across a portfolio of projects. We used framework analysis to identify key themes related to implementation barriers and drivers. This paper reports on barriers and drivers to stakeholder engagement, with results related to capacity development and service delivery reported elsewhere in this journal.ResultsBarriers and drivers to stakeholder engagement were identified across four themes: (1) Contextual Considerations, (2) Resources, (3) Participation, Uptake and Empowerment, and (4) Stigma. While complex contextual challenges create barriers, mechanisms such as formative research can facilitate a deeper contextual understanding that supports effective implementation planning. Limited financial and human resources and competing priorities can lead to substantial challenges. Investing in and leveraging existing local resources and expertise can help to mitigate these barriers. The challenge of achieving active participation from stakeholders and diverging expectations about the nature of participation were identified as barriers, while providing opportunities for meaningful participation and empowerment acted as drivers. Stigma at the institutional, community and individual level was also identified as a substantial barrier to engagement.ConclusionThe findings of this study are relevant to implementers in global mental health. They also have implications for global mental health funding agencies and policy organizations, who can support improved stakeholder engagement by investing in high-quality formative research, supporting capacity building for policy engagement, investing in longer-term funding schemes to support sustainable partnerships and scale-up, thus fostering successful engagement and supporting effective implementation of global mental health innovations.

Identifying Risk Factors and Spatial Clustering of HIV Infection Among Female Sex Workers in India

Background: The human immunodeficiency virus (HIV) epidemic in India is generally considered to be more concentrated, with the focus on high-risk groups including female sex workers (FSWs). The Integrated Biological and Behavioral Surveillance (IBBS), the first nationwide surveillance conducted during 2014-2015, collected many key indicators, including indicators related to HIV/STI transmission. The purpose of this study was to develop an index score for each domain surveyed and to identify focus areas for interventions among FSWs. Methods: The study population consisted of 27,007 FSWs. Forty high-risk related covariates of HIV/STI transmission, demographic characteristics, sexual history, condom practices, knowledge of HIV/STI and biological variables were considered. The original data set was examined using the correlation matrix and was reduced to 15 highly-correlated factors using principal component analysis. The factors were further improved using varimax rotation and the percentage of variation was used as weights to obtain the initial score for each domain, which were then standardized for comparison. Bartlett’s test of sphericity was examined before the factor extraction. Results: Six factors were extracted, which together explained about 73% of the total variation. The factors were: (1) more number of clients; (2) younger FSW and started selling sex at younger age; (3) experiencing condom breakage; (4) having occasional clients and poor HIV/AIDS knowledge; (5) illiteracy; and (6) a longer period of sex work. Six domains with an index score of above 80, from the states of Maharashtra, Rajasthan, Arunachal Pradesh, Uttar Pradesh, and Jharkhand need greater intervention. Conclusion and Implications for Translation: FSWs’ current age, age at commencement of sex work, and the number of clients were the indicators most-associated with HIV infection. Therefore, program and policy interventions should focus on FSWs who are younger than <25 years, who started selling sex at <22 years, and who have >10 clients. Key words: • Female Sex Worker • Kriged Map • Factor Analysis • Principle Component Analysis • HIV • Sexually Transmitted Infections Copyright © 2021 Elangovan et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

COVID-19 Early Vaccination Rates and Gross Domestic Product Per Capita

Coronavirus disease – 2019 (COVID-19) vaccination is a crucial part of a multi-faceted public health response, and possibly, the best hope for ending the pandemic. In this ecological study, we examined the relationship between Gross Domestic Product (GDP) per capita and early vaccination rates across the world. Spearman’s correlation analysis was utilized to assess the strength and direction of the relationship between countries’ COVID-19 vaccination rates and GDP per capita. We observed that countries with high vaccination rates had higher GDP per capita (Spearman’s ƍ=0.35, p-value=0.01). Our study provides valuable insight into the association of GDP per capita and the early distribution of the COVID-19 vaccination. Copyright © 2021 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Factors Associated with Utilization of Postnatal Care Services in Mali, West Africa

Background and Objective: Postnatal care is recognized as one of the most effective ways of preventing and managing physical and mental disabilities that occur during the postpartum period. Despite the importance of postnatal care, its utilization is low in Mali. The present study investigates factors associated with utilization of postnatal care services in Mali. Methods: A total of 5,778 women who had complete information on all the variables of interest were included in our study. The data were analyzed with Stata version 14.2 by employing a multilevel logistic regression approach. The results were presented using adjusted odds ratios (aOR) at 95% confidence interval (CI). Results: We found that 25.18% of childbearing women in Mali utilized postnatal care. Women with no education (aOR=1.28, 95% CI=1.02-1.62) and those with primary level of education (OR=1.38, 95% CI=1.06- 1.81) had higher odds of postnatal care uptake, compared to those with secondary/higher education. On the contrary, postnatal care service utilization was lower among women who were not covered by health insurance (aOR=0.63, 95% CI=0.46-0.88), those who were not working (aOR=0.82, 95% CI=0.70-0.96), and those who were not exposed to mass media (aOR=0.80, 95% CI=0.70-0.93). Similarly, compared to women in the Mopti region, women in all other regions were less likely to utilize postnatal care services. Postnatal care service utilization was lower among women in communities with low educational level (aOR = 0.42, 95% CI=0.27-0.66) and medium socio-economic status (aOR=0.59, 95% CI=0.36-0.99). Conclusion and Implications for Translation: The study revealed several individual, household and community level factors as predictors of utilization of postnatal care services in Mali. Public health interventions intended to improve postnatal care services uptake in Mali should pay attention to these factors. This will help achieve the Sustainable Development Goal 3.1 which focuses on reducing the global maternal mortality ratio to less than 70 per 100 000 live births by 2030. Copyright © 2021 Ahinkorah et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Early Infant Diagnosis of HIV in Primary Health Care Centers

Background: Early diagnosis of HIV to identify infected children for early therapy is aimed at preventing high mortalities associated with child HIV infection. Early infant diagnosis (EID) intervention occurs across the three tiers of the Nigerian health care delivery system, including the primary health care centers (PHC). This study evaluates the implementation of early infant diagnosis of HIV in PHCs in a southern state of Nigeria. Methods: This was a cross-sectional descriptive study that took place between September and November 2019. Primary data were obtained from an interviewer-administered questionnaire on 120 health workers in six Local Government Areas (LGA) that were selected through a multi-stage, random sampling method. Secondary data were from the records of program implementation at the state headquarters of Ministry of Health and the PHCs. Results: A total of 116 (96.6%) health workers were interviewed; 17.2% were males, and 82.8% were females. More than two-thirds of respondents were aged between 41 and 60 years and 84.5% of them had worked in the PHC system for 11 years and above. Rural or urban location of the PHC, educational level of the health workers, and years of service in the PHC system did not have any significant effect on implementation of EID program in the health facilities. Implementation of EID program was ineffective in both rural and urban PHCs of Akwa Ibom state with the p-value of 0.337. In multiple regression analysis, access to EID program and provision of adequate supplies significantly affected implementation of the program with p = 0.001 and p = 0.000 respectively. Conclusion and Implication for Translation: The study indicates general ineffectiveness in the implementation of EID in a Southern State of Nigeria. There is need to improve access to EID services and provide needed supplies if the state, and by extension Nigeria, hopes to meet the target of joining the global community in ending HIV by 2030. Copyright © 2021 Markson. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

COVID-19 Vaccination Rates by Global Universal Health Care Coverage Status

Healthcare coverage and the type of insurance have always played huge roles in public health outcomes. With coronavirus disease-2019 (COVID-19) vaccination now available across the world, we sought to determine vaccination rates across countries with Universal Health Care (UHC) coverage versus those without. We utilized the vaccination information from the Coronavirus (COVID-19) Vaccinations website, and calculated early vaccination rate for each country as of January, 13, 2021 by dividing the total number of vaccinations given to the total population of the country. We observed that the average early vaccination rate for countries with UHC was 1.55%, whereas that for countries without UHC was 0.51%. Countries with UHC are performing much better than those without UHC in this initial race for providing herd immunity across the globe. Copyright © 2021 Dongarwar and Salihu. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

COVID-19 Pandemic and Medical Education in India

The severe acute respiratory syndrome coronavirus 2, also known as SARS-CoV-2, was the coronavirus strain that caused the COVID-19 disease. The COVID-19 pandemic has emerged as the greatest public health and societal challenge. Imposition of a prolonged-nationwide lockdown as a public health intervention in India to contain transmission impacted all public spheres, including medical education. Academic activities in medical schools came to an abrupt suspension during the lockdown for a period of 10 to 12 weeks. During earlier pandemics, in-person training in hospitals continue in developing the students’ skills and competencies. These include the diagnosis and management of hospital cases and control the communitydisease transmission. However, the current COVID-19 pandemic is distinct. Online training started due to extended lockdown, which require careful planning and further study. Key words: • COVID-19 • Corona virus • Pandemic • Medical education • Medical students • Physician training • Clinical training • Disease transmission • Clinical skills • India Copyright © 2021 Ahmed. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

Predictors of Female Genital Mutilation or Cutting Among Daughters of Women in Guinea, West Africa

Background and Objective: In some African countries like Guinea, female genital mutilation/cutting (FGM/C) has been considered as an essential social norm in ensuring girls’ and women’s virginity by reducing their sexual desires. This study aimed at examining the factors associated with FGM/C among daughters of women aged 15-49 in Guinea. Methods: Using the 2018 Guinea Demographic and Health Survey, we analyzed data on 10,721 women of reproductive age (15-49 years) who had at least one daughter. A two-level multi-level logistic regression analysis was fitted and the random and fixed effects together with their corresponding 95% credible intervals (95% CrIs) were presented. Results: Women of all age categories had higher odds of having circumcised daughters with the substantially highest odds among those aged 35-39 (aOR=26.10, CrI=11.22-53.94) compared to those aged 15-19. “FGM/C was higher among daughters of circumcised mothers (aOR=5.50, CrI=3.11-9.72), compared to those who were not circumcise. Compared to Muslims, women who were either animists or had no religion were more likely to circumcise their daughters (aOR=2.13, CrI=1.12-4.05). Conversely, women with secondary/higher education, whose partners had secondary/higher education, Christians, women of richest wealth index and those who lived in the Faranah and N’zerekore regions were less likely to circumcise their daughters. Conclusion and Implications for Translation: The current study revealed that individual and contextual factors are associated with FGM/C among daughters of women aged 15-49 in Guinea. The findings imply that eliminating FGM/C in Guinea requires multifaceted interventions such as advocacy and educational strategies like focus group discussions, peer teaching, mentor-mentee programs in regions noted with the FGM/C practice. This will help achieve the Sustainable Development Goal 5.3 which focuses on eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030. Copyright © 2021 Ahinkorah. et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Barriers and drivers to service delivery in global mental health projects

BackgroundResearch in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery. There is a need to develop more feasible and evidence-based solutions through implementation research. This paper, one in a series pertaining to implementation in GMH projects worldwide, focuses on implementation factors influencing mental health service delivery.MethodsThis is a qualitative study carried out as part of a Theory of Change-driven evaluation of Grand Challenges Canada’s (GCC’s) Global Mental Health portfolio. Purposive sampling was used to recruit twenty-nine GCC grantees for interviews. A semi-structured interview schedule was used to guide the interviews which were recorded and subsequently transcribed. Transcripts were double-coded and analyzed in NVivo 11 using framework analysis. This paper reports results related to detection and treatment of mental illness, mental health promotion and prevention of mental illness.Results Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system. Formative research was a key driver facilitating the cultural adaptation of mental health detection, treatment, promotion and preventative approaches. Recruiting local providers and utilizing mHealth for improving screening, monitoring and data management were also found to be successful approaches in reducing workforce burden, improving sustainability, mental health literacy, participant engagement and uptake.ConclusionsThe study identifies a number of key barriers to and drivers of successful service delivery from the perspective of grantees implementing GMH projects. Findings highlight several opportunities to mitigate common challenges, providing recommendations for strengthening systems- and project-level approaches for delivering mental health services. Further, more inclusive research is required to inform guidance around service delivery for successful implementation, better utilization of funding and improving mental health outcomes among vulnerable populations in low-resource settings.

Health and Medicine during and after the Pacific War: Pacific Islanders, Institutions, Infrastructure, Ingenuities

This special issue takes a critical look at the history of health and medicine in the Pacific Islands by focusing on medical infrastructure and the professionalisation of Pasifika people during and after the Pacific War. This issue brings together historical and anthropological literatures on health, medicine, and infrastructure and the authors employ methods from both disciplines, combining archival sources from state, mission, and medical institutions with oral histories and participant observation. As histories of a present where the discipline of critical global health emphasises the experiences of people who are implicated in as ‘targets’ in global health projects and technologies, these articles present Pacific centred historical consciousness in relation to health and medicine in the context of social change and upheaval. They are histories that seek to centre Pacific Islanders' experiences with respect to health and medical institutions.

COVID-19 Infection among People with HIV/AIDS in Africa: Knowledge Gaps, Public Health Preparedness and Research Priorities.

The emergence of novel virus SARS-CoV-2 that causes COVID-19 has complicated Africa’s public health challenges, especially with the pre-existing epidemics such as HIV/AIDS. We highlight the known evidence related to COVID-19 infections among people with HIV (PWH) with specific reference to Africa. The knowledge gaps, level of public health preparedness and the potential research priorities are also outlined. Although the epidemiology and clinical course of COVID-19 in HIV patients are evolving, existing evidence indicate that the disease outcomes are comparable to that of the general population. However, PWH with low CD4 cell counts may have worse outcomes than individuals with restored immunity, whereas old age and co-morbidities such as obesity, hypertension and diabetes can further increase their overall risk. While there may be slight disruption of HIV service delivery in selected African countries, the resilience and resourcefulness of others have helped to sustain HIV service delivery and enhanced the level of public health preparedness and fight against the pandemic. The paucity of data and research studies on HIV-COVID-19 coinfection in Africa, call for concerted efforts to address these limitations.

A Review and Analysis of Outcomes from Prevention of Mother-to-Child Transmission of HIV Infant Follow-up Services at a Pediatric Infectious Diseases Unit of a Major Tertiary Hospital in Nigeria: 2007-2020.

Background and Objective:Above 90% of childhood HIV infections result from mother-to-child transmission (MTCT). This study examined the MTCT rates of HIV-exposed infants enrolled in the infant follow-up arm of the prevention of mother-to-child transmission (PMTCT) program in a teaching hospital in Southeast Nigeria.Methods:This was a 14-year review of outcomes of infants enrolled in the infant follow-up arm of the PMTCT program of Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. The majority of subjects were enrolled within 72 hours of birth and were followed up until 18 months of age according to the National Guidelines on HIV prevention and treatment. At enrollment, relevant data were collected prospectively, and each scheduled follow-up visit was recorded both electronically and in physical copy in the client’s folders. Data were analyzed using SPSS version 20. The major outcome variable was final MTCT status.Results:Out of 3,784 mother-infant dyads studied 3,049 (80.6%) received both maternal and infant Antiretroviral (ARV) prophylaxis while 447 (11.8%) received none. The MTCT rates were 1.4%, 9.3%, 24.1%, and 52.1% for both mother and infant, mother only, infant only, and none received ARV prophylaxis respectively. There was no gender-based difference in outcomes. The MTCT rate was significantly higher among mixed-fed infants (p<0.001) and among those who did not receive any form of ARVs (p<0.001). Among dyads who received no ARVs, breastfed infants significantly had a higher MTCT rate compared to never-breastfed infants (57.9% vs. 34.8%; p<0.001). The MTCT rate was comparable among breastfed (2.5%) and never-breastfed (2.1%) dyads who had received ARVs. After logistic regression, maternal (p<0.001, OR: 7.00) and infant (p<0.001, OR: 4.00) ARV prophylaxis for PMTCT remained significantly associated with being HIV-negative.Conclusion and Global Health Implications:Appropriate use of ARVs and avoidance of mixed feeding in the first six months of life are vital to the success of PMTCT programs in developing countries. PMTCT promotes exclusive breastfeeding and reduces the burden of pediatric HIV infection, thereby enhancing child survival.

Associations of Sociodemographic and Clinical Factors with Late Presentation for Early Infant HIV Diagnosis (EID) Services in Kenya.

Background:Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya.Methods:We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing.Results:Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity.Conclusion and Global Health Implications:Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines.

A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV.

Background and Objective:Obstetric fistula affects approximately 2 million women worldwide, predominantly in places with a high Human Immunodeficiency Virus (HIV) burden. In Malawi, where thousands of women live with fistulas, HIV prevalence is 11-13%. Although repair is usually successful, surgical outcomes among immunocompromised women are poorly understood. Inconsistent guidelines regarding the Cluster of Differentiation 4 (CD4) threshold necessary for repair make it difficult for surgeons to make informed decisions. This study compares the postoperative outcomes of women undergoing obstetric fistula repair with and without HIV, stratified by CD4 count.Methods:This is a retrospective case-control study using a database of women who underwent vesicovaginal fistula repair at the Fistula Care Center from 2010-2018. HIV-positive participants, stratified by CD4<350 and CD4>350, were matched to HIV-negative controls by age within 5 years and Goh classification. Controls were matched to cases in a 3:1 ratio. Bivariate analysis and logistic regression were conducted on indicators based on HIV status and CD4 count stratification. Outcomes included dye test results, pad weights, and continence status at 2 weeks post-repair.Results:54 seropositive women were matched to 135 seronegative women. Of the 54 HIV positive women, 22.2% (n=12) had a CD4 count < 350. We found no statistically significant difference in surgical outcomes between HIV-positive and negative patients. 93.5% of HIV positive and 90% of HIV negative women healed completely. In our sub-analysis of 12 seropositive women with CD4<350, we found a statically significant difference in successful closure, with 25% of women with CD4<350 having a positive dye test indicating incomplete closure, compared to 2.8% of women with CD4>350 (p=0.024).Conclusion and Global Health Implications:Our analysis confirms previous research indicating that seropositive women with a CD4>350 can safely undergo obstetric fistula repair. Further research is needed to evaluate postoperative outcomes among women with CD4<350.

Fourth Annual Summer Research Summit on Health Equity Organized by the Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, Texas 77030, USA on May 20, 2021.

ABSTRACT: Strengthening Our Commitment to Racial and Social Justice to Improve Public HealthThe fourth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM) was held on May 20, 2021. The theme of this year’s summit was ‘Strengthening Our Commitment to Racial and Social Justice to Improve Public Health.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, individuals involved in talent acquisition and development such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States, India, Pakistan and the Demographic Republic of the Congo. The content in this Book of s encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse encompassing disparities in relation to maternal and child health (MCH), immigrant heath, cancers, vaccination uptakes and COVID-19 infections. Various solutions were ardently presented to address these disparities including community engagement and partnerships, improvement in health literacy and development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health. The summit received very positive response in terms of zealous participation and outstanding evaluations; and overall, it was a great success.Copyright © 2021 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Child Development Monitoring in Well-baby Clinics in Kenya.

Background:Maternal and child health (MCH) clinics represent an integrated approach for providing healthcare to pregnant women and children 0-59 months of age. Although MCH clinics are also charged with monitoring child development, which involves tracking developmental milestones, it is unclear how these services are provided or perceived within the clinic. This study aimed to describe self-reported knowledge, perceptions, and practice of developmental monitoring in selected MCH clinics in western Kenya.Methods:This cross-sectional descriptive study was conducted within six clinics. We administered a descriptive survey to measure caregiver and healthcare staff attitudes towards and awareness of developmental monitoring; we also reviewed MCH booklets to identify services received at the clinic. Data collection occurred over a period of one day at each of the six clinic sites. The data were analyzed using descriptive statistics.Results:During the study period, 78 caregiver-child pairs presented to the clinics and had their MCH booklets reviewed. The median child age was three months (interquartile range [IQR]: 1-8 months). Most caregivers were aware of weight monitoring and immunization services; however, when asked specifically about developmental monitoring, only 2.6% of caregivers were aware this service was available at the clinics. Nearly 80% of caregivers reported that they would be very interested in developmental monitoring services. Thirty-three MCH healthcare staff were interviewed about services provided and goals of clinical care. Fewer healthcare staff (60.6%) identified their roles in developmental monitoring compared to their roles in growth (90.9%) and nutritional monitoring (84.8%). Developmental milestones had not been recorded in any of the 78 MCH booklets. However, 78.1% of healthcare staff indicated support for developmental screening.Conclusion and Global Health Implications:While developmental monitoring was valued by healthcare providers, it was not consistently performed at the six clinics in our study. We recommend further work to raise awareness about developmental monitoring and to measure the implications of increased caregiver knowledge and perceptions on developmental monitoring practice.

A Framework for Protecting Pregnant Women in the Era of COVID-19 Pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent for the coronavirus disease 2019 (COVID-19) pandemic, highlighted and compounded problems while posing new challenges for the pregnant population. Although individual organizations have provided disparate information, guidance, and updates on managing the pregnant population during the current COVID-19 pandemic, it is important to develop a collective model that highlights all the best practices needed to protect the pregnant population during the pandemic. To establish a standard for ensuring safety during the pandemic, we present a framework that describes best practices for the management of the pregnant population during the ongoing COVID-19 pandemic.

Pregnancy and Birth Outcomes Among Women on Antiretroviral Therapy: A Long-term Retrospective Analysis of Data from a Major Tertiary Hospital in North Central Nigeria.

Background and Objective:Antiretroviral therapy (ART) has transformed human immune deficiency virus (HIV) infection from a death sentence to a chronic syndrome, allowing infected individuals to lead near-normal lives, including achieving pregnancy and bearing children. Notwithstanding, concerns remain about the effects of ART in pregnancy. Previous studies suggested contradictory associations between ART and pregnancy. This study determined birth outcomes in pregnant women who accessed ART between 2004 and 2017 at a major tertiary hospital in North Central Nigeria.Methods:This was a retrospective study of 5,080 participants. Ethical clearance was obtained from the Institutional Review Board of the Harvard T. H. Chan School of Public Health Boston. A pro forma for data abstraction was designed and used to collect data. ed data were sorted and managed using SPSS® version 22. The Chi-square test was used to calculate the proportions of pregnancy outcomes. One-way analysis of variance was used to test the effect of antiretroviral drug regimens on mean birth weight and gestational age at delivery. All levels of significance were set at p 0.05.Results:Pregnancy outcomes were recorded as live birth (99.8%), stillbirth (0.2%), preterm delivery (6.6%), and low birth weight (23%). There was a statistically significant association between ART in pregnancy and low birth weight {χ2 [(5, n = 3439) = 11.99, p = 0.04]}. The highest mean birth weights were recorded in participants who received drug combinations with protease inhibitors or efavirenz, in contrast to participants who received Nevirapine, stavudine and Emtricitabine/Tenofovirbased regimens. However, there was no significant difference in the gestational age of babies at birth for the six ART regimens in the study.Conclusion and Global Health Implications:Findings support the benefits of ART in pregnancy, which is in line with the testing and treatment policies of the 90-90-90 targets for ending HIV by the year 2030.

Strengthening Maternal Death Surveillance Systems for Evidence-Based Decision Making in Sub-Saharan Africa: The Case of the Center Region in Cameroon

Background:The article seeks to document the experience of implementing Maternal Death Surveillance and Response (MDSR) in the Center Region of Cameroon. The paper raises awareness on the need for implementing MDSR, shares progress and lessons learned and reflects on the implications for public health practice.Methods:A desk research involving the collection and analysis of secondary data using tables with specific themes in excel, following the review of existing resources at the Regional Delegation of Public Health-Center from the year 2016 to 2019.Results:The findings depict the existence of MDSR policies and sub-regional committees. Although, the number of regional maternal death notifications increased from 19 to 188 deaths between 2016 and 2019, the implementation of death review recommendations was only estimated at 10% in 2019. While 66% of deaths occurred in Yaoundé, 72% of these were deaths reported to have occurred in tertiary institutions out of which 75% were attributed to late referrals. Hemorrhage constituted 70/144 (48.6%) of the known direct causes of death. Maternal death related co-factors such as the use of partograph during labor had a high non-response rate (84%) and represents a weakness in the data set.Conclusion and Global Health Implications:Across the board, stakeholder engagement towards MDSR was increased through continuous awareness-raising, dissemination of surveillance tools, the institutionalization of the District Health Information Software (DHIS 2) and the “No Name No Blame” policy. However, the reporting and investigation of deaths for informed decisions remain a daunting challenge. For a resource-scarce setting with limited access to blood banks, the application of life-saving cost-effective interventions such as the use of partographs and the institution of a functional referral system among health units is likely to curb the occurrence of deaths from hemorrhage and other underlying causes. The success of these will require a robust strengthening of the health system.