Implementation Of Health Policies Research Articles

ESTUDO DE EMERGÊNCIAS ONCOLÓGICAS EM PACIENTES PEDIÁTRICOS: REVISÃO OBSERVATÓRIA

Care activities in intensive care units and for cancer patients are guided by the humanization of care and contribute to hospital management, seen as a challenge to be faced in order to promote advances in the implementation of health policy in Brazil. In this way, it is feasible to analyze in this study a reflection on the humanization of care provided to critically ill patients, the strategies of humanization and care in the ICU and in patients under palliative care, in order to identify improvements in the care of critically ill patients in a humanized way. The aim of this study is to identify, through literature reviews, the interventions of nursing professionals in assisting patients in palliative care in the area of pediatric oncology. The methodology used is bibliographical research, based on articles available on the internet. In Brazil, a number of problems persist in health institutions on a daily basis, which are rooted in the system and make it difficult to achieve the principles of universality, comprehensiveness and equity, which are fundamental to the Unified Health System (SUS). To work in the Oncology Unit and provide palliative care. Thus, health professionals must have specialized and qualified training, including experience acquired throughout their careers, as well as personal and professional development.

A comprehensive statistical analysis of Malaria dynamics in the Adamawa region of Cameroon, from 2018 to 2022

Malaria remains a prominent public health concern in Cameroon, with the potential for epidemic outbreaks, necessitating a robust understanding of its dynamics. This paper uses routinely collected surveillance data from health facilities in the Adamawa Region since January 2018. By applying statistical analysis, this study aims to enhance comprehension, enable data predictions, and facilitate informed decision-making for public health policy implementation. Focusing on weekly health districts data spanning from 2018 to 2022, our analysis employs key statistical metrics for central tendency, data spread, distribution shape, and variable dependence. The study reveals distinctive trends, highlighting peak malaria transmission periods consistently occurring between August and November each year. The highest weekly recorded case count in any health district reached 1,294. The data exhibits leptokurtic distributions, skewed to the left of the median. And in 2022, 11% of the population was reported to have contracted malaria. Despite an overall region-wide average growth rate of -1.21% over the past five years, maintaining vigilant attention to this critical health issue is imperative. Auto dependence analysis indicates that observations are weekly correlated, assuming the time series as stationary. The stationarity has been confirmed by ADF and KPSS tests that we performed. This comprehensive data analysis helps our understanding of the malaria landscape in the Adamawa Region of Cameroon. The paper also recommends the inclusion of additional variables in data collection for a more holistic perspective. These findings provide a basis for the formulation and implementation of targeted interventions by relevant stakeholders, aiding in the prediction of future cases and ultimately contributing to the effective management of malaria in the region.

Inclusion of people with disabilities in Chilean health policy: a policy analysis

BackgroundAround 18% of the population in Chile has disabilities. Evidence shows that this population has greater healthcare needs, yet they face barriers to accessing healthcare due to health system failures. This paper aims to assess the inclusion of people with disabilities in health policy documents and to explore the perceptions of key national stakeholders regarding the policy context, policy processes, and actors involved.MethodsA policy content analysis was conducted of 12 health policy documents using the EquiFrame framework, adapted to assess disability inclusion. Documents were reviewed and rated on their quality of commitment against 21 core concepts of human rights in the framework. Key national stakeholders (n = 15) were interviewed, and data were thematically analysed under the Walt and Gilson Policy Analysis Triangle, using NVivo R1.ResultsCore human rights concepts of disability were mentioned at least once in nearly all health policy documents (92%). However, 50% had poor policy commitments for disability. Across policies, Prevention of health conditions was the main human rights concept reflected, while Privacy of information was the least referenced concept. Participants described a fragmented disability movement and health policy, related to a dominant biomedical model of disability. It appeared that disability was not prioritized in the health policy agenda, due to ineffective mainstreaming of disability by the Government and the limited influence and engagement of civil society in policy processes. Moreover, the limited existing policy framework on disability inclusion is not being implemented effectively. This implementation gap was attributed to lack of financing, leadership, and human resources, coupled with low monitoring of disability inclusion.ConclusionsImprovements are needed in both the development and implementation of disability-inclusive health policies in Chile, to support the achievement of the right to healthcare for people with disabilities and ensuring that the health system truly “leaves no one behind”.

Indicators of scientific production on Health Policy

Introduction: health and its maintenance constitute one of the main assets of man at any stage of his history. The implementation of health policies is aimed at solving global health problems that affect the population.Objective: characterize the scientific production on Health Policy in SCOPUSMethod: an observational, descriptive, bibliometric study was developed. A total of 229,339 articles were worked on. The SCOPUS database was used to collect the information; especially the SciVal tool for the analysis of information and the study of indicators. Descriptive statistics were applied to analyze the information.Results: a total of 229,339 articles were analyzed; equivalent to 2,471,305 appointments in the study period. I highlight the year 2023 with the highest number of articles published (31,982; 13.94%). The United States stood out with the highest number of articles published with 79,708 investigations (34.75%). The articles published in the journal BMC Health Services Research stood out with 10,425 investigations (23%). The largest number of articles were located in the health and health services categoryConclusions: scientific production related to Health Policy showed heterogeneous but constant growth, in contrast to the number of citations. The publications were related to the largest centers of scientific production. The research topics were directed with greater interest towards the quality of health services and assistance according to age groups

Electric buses as an air pollution and meteorological observation network: Methodology and preliminary results

Many local agencies in the United States and other countries are tasked to install air pollution monitoring systems of highly accurate sensors that have high acquisition, operating, and maintenance costs. The need for expanded coverage of air quality measurements across Salt Lake County (SLCO), Utah is being met by mounting air quality and temperature sensors on an expanding fleet of battery electric buses (BEBs). Monitoring air quality from a mobile sensor network provides real-time insights into air pollution patterns at high temporal and spatial resolution. Mobile measurements contribute to assessing residents' exposure to air pollution, facilitating the implementation of cost-effective public health policies and highlighting disparities. The Electric Bus Air Quality Observation Project was launched in SLCO during July 2021 and has collected millions of observations to date. A BEB traveling at typical traffic speeds (~10 m s−1) can provide multiple measurements along city block lengths of up to ~200 m. With careful analysis that factors in the time response of the differing sensors, variability from block-to-block may be attributed to fine-scale factors (e.g., pollution and heat sources, tree shading and urban vegetation, etc.). Preliminary findings showcase the value of increased coverage and resolution. During an extreme heat event in July 2023, both the morning and afternoon temperature readings showed differences of over 6.5 °C (12 °F), primarily as an east-west gradient with similar gradients in ozone. We conclude that temperature and pollutant concentration readings, at fine spatial and temporal resolutions, will facilitate future health studies and equitable policy and mitigation strategies. Our study demonstrates that our partnerships established with governmental, non-profit, and transit agencies facilitate the successful transfer of research and development to operational real-time mobile air quality monitoring.

High silent prevalence of human herpesvirus 1 (HSV-1) infection affecting the indigenous reservation of the municipality of Dourados, Central-West Brazil

BackgroundThe indigenous population located in the central region of Brazil, is the second largest in terms of population size in the country. The Indigenous Reserve of Dourados has risk factors that increase the vulnerability of the indigenous population to infectious diseases, especially Human alphaherpesvirus (HSV-1), a neglected disease with high prevalence in priority populations in developing countries. The virus can also cause many more severe diseases, including widespread neonatal infections, herpetic keratitis, and herpes encephalitis, which can be fatal if left untreated. We estimated the prevalence of anti-HSV-1 antibodies and correlated it with the demographic and behavioral characteristics of the Indigenous population of the Jaguapirú and Bororó villages (Dourados, Mato Grosso do Sul (MS), Brazil).MethodsOur approach was cross-sectional. From March 2017 to November 2018. Using anti-HSV-1 (Gg1) IgM and anti-HSV-1 (gG1) IgG Euroimmun and the detection and quantification of HSV-1 viral load in plasma samples, through real-time PCR. The maps were constructed using QGIS and the statistical analyses using R Studio software.ResultsA total of 1138 individuals (> 18 years old) were enrolled. The prevalence of anti-HSV-1 IgM and IgG were 20% and 97.5%, respectively. The prevalence of anti-HSV-1 antibodies for IgG was higher in both sexes. Anti-HSV-1 IgM antibodies were present in 17.1%, 21.2%, 12.5%, and 22% of the participants with urinary problems, genital wounds, genital warts, and urethral discharge, respectively. Real-time PCR was used for confirmatory testing; HSV-1 DNA was detected in 25.6% (54/211) of anti-HSV1 IgM-positive samples. Viral loads ranged from 5.99E + 02 to 3.36E + 13.ConclusionsThe seroprevalence of HSV-1 IgM and detection of HSV-1 DNA in the Indigenous population confirmed high silent prevalence. Furthermore, the seroprevalence of HSV-1 in the Indigenous population was higher than that reported in the general adult Brazilian population. Various socioeconomic factors, drug use, and health and sexual behaviors could contribute to the facilitation of HSV-1 transmission in the Indigenous population. Our results may help develop culturally appropriate intervention programs that eliminate health access barriers and improve the implementation of public health policies aimed at promoting information regarding the prevention, treatment, and control of HSV-1 infection in Brazilian Indigenous populations.

The role of nurses in implementation of public policy on adolescent health in Colombia, Ecuador, and Peru

BackgroundIn Latin America, interventions aimed at adolescents’ health suffer from a shortfall of investment and lack of sustainability. Nurses, as an integral part of health services and systems, can lead the implementation and development of public health policies to improve adolescent health.ObjectiveTo identify and analyze the role of nurses in the development and implementation of public policies and in the provision of health care to adolescents in Colombia, Ecuador, and Peru.MethodsThe research was carried out in three phases: a documentary analysis, an online survey, and semi-structured focus groups. A total of 48 documents were analyzed, 288 nurses participated in the survey, and 29 nurses participated in the focus groups.ResultsState policies aim to guarantee rights, with special protection for children and adolescents. It is an incremental process, with greater involvement of civil society and governments. Participants reported a lack of synergy between law and practice, as well as differences in regulatory compliance in rural areas and in populations of different ethnicities and cultures. Their perception was that the protection of adolescents is not specifically enshrined in the legal bases and regulatory structures of the countries, meaning that there are both protective factors and tensions in the regulatory framework. While nurses are highly committed to different actions aimed at adolescents, their participation in policy development and implementation is low, with barriers related to a lack of specialized training and working conditions.ConclusionsGiven nurses’ involvement in different actions aimed at adolescents, they could play a fundamental role in the development of policies for adolescents and ensure their effective implementation. Policymakers should consider revising the budget to make compliance viable, incorporating and using monitoring indicators, and increasing the involvement of educational institutions and the community.

건강도시 기본 조례 제정 및 운영이 성인의 건강 생활실천에 미친 영향

The World Health Organization’s “Healthy Cities” initiative seeks to enhance community well-being by improving urban environments and promoting healthy lifestyles such as smoking cessation, moderate alcohol consumption, and increased physical activity. These efforts aim to reduce chronic diseases and manage obesity. However, the effectiveness of these initiatives often lacks quantitative evaluation, especially regarding the impact on the health lifestyle practices of adults in the community. This study evaluates the impact of the Healthy City Ordinance on local adult health behaviors in 214 Korean municipalities by analyzing data on smoking cessation, alcohol consumption, and walking practice from 2008 to 2020, using ecological analysis. This study assesses the impact of Korea’s Healthy Cities Basic Ordinance on adult healthy lifestyle practices using ecological analyses from 2008 to 2022, finding a significant reduction in smoking and high-risk drinking rates, but no significant change in walking rates, suggesting that while the ordinance positively influences some health behaviors, its effects are not uniformly distributed across all health behavior areas. This study highlights the importance of healthy city ordinances in public health by providing evidence that supports the development of sustainable health promotion strategies, emphasizing the role of ordinances in policy-making, and offering insights that aid in the effective design and implementation of health policies, potentially guiding future research and strategic approaches in the field.

NALYSIS OF FOREIGN TRENDS IN THE FIELD OF OCCUPATIONAL SAFETY AND HEALTH

In this article, the author analyzes current trends in occupational safety and health in Japan, South Korea and the United States, including the development of a compliance strategy, staff training, provision of appropriate equipment, ensuring safe performance of work duties, accident reporting and reduction of injuries and morbidity. Thus, the author identifies several key aspects on which the enterprises of the above-mentioned countries focus. In the course of the study, the author came to the conclusion that an active labor protection policy not only ensures the safety of employees, but also allows enterprises to function optimally even in difficult times and conditions. The author also emphasizes that policies aimed at identifying and eliminating workplace hazards before they lead to injury or illness are not only necessary in many jurisdictions, but also provide value by increasing trust between employers and employees, improving safety and communication, leading to an overall improvement in operational performance. The author argues that the successful implementation of workplace health and safety policies should continue to be a top priority for employers, employees, other stakeholders and governments around the world. Based on the analysis, the article also provides recommendations on the partial implementation of foreign experience into domestic practice.

De facto health governance policies and practices in a decentralized setting of Ghana: Implication for policy making and implementation

BackgroundCurrent Universal Health Coverage (UHC) considerations confirm the need for strong governance in improving health sector performance. However, empirical evidence on the effects of decentralized health system governance remains limited in Low-and-middle-income countries (LMICs). This paper assesses the de facto health governance policies and practices of the decentralized health system of Ghana and its implications, for better policy formulation and implementation. Material and methodsThe study employed a cross-sectional design, comprising of systematic literature review (SLR) and in-depth interviews on health governance components. The literature review (n=103) was performed to document the factors that affect health governance management and policy uptake. A total of 32 purposively sampled key health system actors were individually interviewed face-to-face between January and February, 2018. Thematic content analyses of literature and interviews were done. ResultsTension regarding power relationships exists between the policies governing the health sector of Ghana, which has rendered the decentralization reform effort in health governance policies and practices uncoordinated, incoherent and sometimes contradictory. Implication of the de facto decentralized health governance policies and practice include: limited involvement of sub-national level in policy development; weak interaction between policy formulators and implementers; and political interference in policy implementations compromising evidence-based policy formulation. Originality/valueDrawing on diverse literatures and opinions of key health actors, this paper contributes to knowledge on health governance practices in a decentralized and resource constrained health system, and offers practical accounts of the implications of the de facto health governance system of Ghana for health policy formulation and implementation.

Avoidable Mortality in Korea 1997-2001: Temporal Trend and its Contribution to All-cause Mortality.

This study analyzed the mortality trends from avoidable causes in Korea from 1997 to 2021, to estimate its contribution to the overall mortality in different subgroups, including. Gender, age, and cause of disease. The all-cause and avoidable mortality were presented as a time series plot and average annual percent change. Trend of avoidable mortality was also analyzed by subgroups, disease causes and the percentage attributed to each causes. The decline in avoidable mortality accounted for 82.6% of all-cause mortality reduction. Preventable mortality showed a more pronounced decline than treatable mortality, explaining 72.3% of the avoidable mortality reduction. In 1997-2001, avoidable death occurred in 72.2% (537,024 cases) of all-cause deaths, which declined to 60.0% (342,979 cases) in 2017-2021. The contribution of avoidable mortality in the decline of all-cause morality was greater in males (83.6%) than in females (79.3%). The decline in avoidable mortality and its contribution to the all-cause mortality reduction implies general improvement of the population health in Korea. Nevertheless, the heterogenous trend within different subgroups warrants more equitable design and implementation of health services and policies.

Impact of digital infrastructure construction on the migrants’ utilization of basic public health services in China

BackgroundGlobal digitalization significantly impacts public health by improving healthcare access for marginalized populations. In China, socioeconomic disparities and the Hukou system create significant barriers for the migrant population to access basic public health services (BPHS). This study aimed to assess how digital infrastructure construction (DIC) affects BPHS utilization among China’s migrant populations, filling a gap in the literature regarding the relationship between digital advancements and health service accessibility.MethodsThis research used micro-level data from the 2018 China Migrants Dynamic Survey and incorporated variables aligned with the Broadband China policy to employ a comprehensive empirical strategy. It included baseline regressions, robustness checks through propensity score matching and machine learning techniques, and heterogeneity analysis to explore the differential impacts of DIC based on gender, age, education level, and Hukou status.ResultsThe findings revealed that DIC significantly enhances the likelihood of migrants establishing health records and registering with family doctors, demonstrating quantifiable improvements in health service utilization. Heterogeneity analysis further indicated that the beneficial impacts of DIC were more pronounced among female migrants, those with higher education levels, younger populations, and urban Hukou holders.ConclusionsDIC plays a crucial role in bridging the accessibility gap to BPHS for migrant populations in China, contributing to narrowing health disparities and advancing social equity. These results emphasize the significance of digital infrastructure in public health strategies and offer valuable insights for policymakers, healthcare providers, and researchers. Future research should prioritize longitudinal studies on the sustained effects of DIC and tailor digital health initiatives to meet the unique needs of migrant populations, promoting inclusive health policy planning and implementation.

A Scoping Review and Assessment of the Area-Level Composite Measures That Estimate Social Determinants of Health Across the United States

Objectives: Evidence-informed population health initiatives often leverage data from various sources, such as epidemiologic surveillance data and administrative datasets. Recent interest has arisen in using area-level composite measures describing a community’s social risks to inform the development and implementation of health policies, including payment reform initiatives. Our objective was to capture the breadth of available area-level composite measures that describe social determinants of health (SDH) and have potential for application in population health and policy work. Methods: We conducted a scoping review of the scientific literature from 2010 to 2022 to identify multifactorial indices and rankings reflected in peer-reviewed literature that estimate SDH and that have publicly accessible data sources. We discovered several additional composite measures incidental to the scoping review process. Literature searches for each composite measure aimed to contextualize common applications in public health investigations. Results: From 491 studies, we identified 31 composite measures and categorized them into 8 domains: environmental conditions and pollution, opportunity and infrastructure, deprivation and well-being, COVID-19, rurality, food insecurity, emergency response and community resilience, and health. Composite measures are applied most often as an independent variable associated with disparities, risk factors, and/or outcomes affecting individuals, populations, communities, and health systems. Conclusions: Area-level composite measures describing SDH have been applied to wide-ranging population health work. Social risk indicators may enable policy makers, evaluators, and researchers to better assess community risks and needs, thereby facilitating the evidence-informed development, implementation, and study of initiatives that aim to improve population health.

The darkness of reacculturation: examining factors influencing depression among Chinese international student returnees in the post-COVID-19 era.

In the aftermath of the COVID-19 pandemic, the reintegration of Chinese international student returnees intersects with China's critical effort to combat a significant brain drain of highly skilled talents, highlighting an unprecedented psychological battleground. This convergence underscores the urgent need for nuanced research to navigate the uncharted territory of their mental health. Employing Bayesian analysis supported by Markov Chain Monte Carlo (MCMC) algorithms, this study examined depression prevalence and associated factors among 1,014 Chinese returnees. The sample comprised 44.87% male participants (455), 51.58% female participants (523), and 3.55% identifying as "Others" (36), with an age distribution of 61.74% aged 18-30 (626), 28.80% aged 31-40 (292), and 9.47% aged 41-50 (96). The mean age of participants was 29.6 years, ranging from 18 to 50 years. PHQ-9 diagnoses revealed alarming levels of depression, with 47.9% exhibiting a moderately severe degree of depressive disorder. Our findings highlight the intricate interplay between identity clusters- "homestayers" (those leaning towards a Chinese cultural identity), "navigators" (those with a bicultural identity), and "wayfarers" (those leaning towards a foreign cultural identity)-and the likelihood of depression. Specifically, homestayers showed a clear and strong negative association, navigators demonstrated a positive association, and wayfarers had a positive yet unclear correlation with depression levels. Furthermore, acculturation, age, and gender showed no significant effects, whereas education mildly mitigated depression. Based on these findings, we suggest the implementation of better-tailored mental health support and policies to facilitate smoother reintegration.

Addressing Mental Health Challenges in Nepal: A Review of Policies, Status, and Strategies for Improvement

Mental health is a crucial aspect of overall well-being, encompassing an individual's emotional, psychological, and social well-being. In Nepal, mental health issues are a significant concern, with challenges related to governance, policy implementation, and service delivery. This review examines the mental health status in Nepal, analyzes existing policies, and proposes strategies for improvement. Databases, including ScienceDirect, Springer, NepJol, PubMed, and Google Scholar, were searched to gather relevant literature. The review identified key challenges in Nepal's mental health system, including the lack of a revised and fully implemented mental health policy, discriminatory provisions in the legislation, inadequate planning and funding at the district level, and limited workforce and resources. Despite positive developments, such as including mental health in general health policies and NGO involvement, significant barriers remain. To improve mental health in Nepal, it is essential to implement public policies favoring mental health, train individuals in personal skills, promote healthy lifestyles, and intervene through community actions. These strategies aim to create supportive environments and increase awareness of mental health issues, ultimately improving the population's overall well-being.

INTERINSTITUTIONAL COLLABORATION FOR THE DEVELOPMENT OF APS, THE EXPERIENCE OF THE UNIVERSITY CONSORTIUM OF HEALTH AND FAMILY MEDICINE

Chile faces the challenge of responding to the complexities in addressing and managing issues arising from the current demographic, epidemiological, social, and cultural profile. The country’s public health policies have followed the guidelines of Alma Ata Primary Health Care (PHC), Renewed PHC, Astana PHC, Universalization of PHC, and have enabled the sustained devel­opment of care networks by implementing a model of comprehensive family and community health care, with a focus on promotion, prevention, and anticipatory management of harm within networks. Throughout these processes, in line with the Mission and Social Responsibility of the University and the Global Consensus on the Social Responsibility of Medical Schools, institu­tions responsible for training health professionals and specialists have played a supportive and facilitating role, with particular emphasis on developing human resources within and through practical experiences and supporting teams in the territorial implementation of health policies. The presented experience aims to share the contributions and lessons learned from an alliance of diverse academic institutions that, through collaboration and the formation of a community of learning and practice, are shaping a process of social innovation, a rhizomatic learning initia­tive, and a good formative practice: the Chilean University Consortium of Family Health and Medicine from 2004 to 2014. Its development, progress, results and projections are analyzed.

Türk Yetişkinler İçin Öznel Yaşam Kalitesi Ölçeği Geçerlik ve Güvenirlik Çalışması

As defined by the World Health Organization, quality of life is a concept that is associated with the individual's personal perception in the context of the culture, value systems, and life experiences in which they live. Therefore, quality of life measurement requires a multifaceted process consisting of both objective and subjective dimensions. However, the fact that quality of life is based on subjective perceptions leads to the lack of a standardized measurement tool and a lack of consensus in the measurement of quality of life. This research is based on the assumption that subjective perceptions are the main determinant in the evaluation of quality of life. In this context, the aim of the study is to develop a valid and reliable measurement tool that can measure non-economic quality of life elements based on people's subjective perceptions. The study group consisted of 742 adults aged 18 and over, including Kırıkkale High Specialization Hospital staff and Ankara Yenimahalle Municipality employees. As a result of the analyses, a structure consisting of five sub-dimensions and 17 items that can be considered a valid and reliable measurement tool for measuring subjective quality of life was obtained. This study emphasizes the subjective dimension of the concept of quality of life and focuses on individuals' evaluation of quality of life based on their own experiences and perceptions. The obtained measurement tool can be used in further research in the field of quality of life and can contribute to the literature in this field. It can also be an important source of information for the planning and implementation of health policies and services. Keywords: World Health Organization, subjective quality of life, Kırıkkale Yüksek İhtisas Hospital, Ankara Yenimahalle Municipality

Health Policy: Health Policy Implementation

Health Policy: Health Policy Implementation

Public health policies in dental traumatology: A call for action!

Traumatic dental injuries (TDI) are a prevalent public health concern, requiring preventive measures as well as timely and appropriate interventions to prevent adverse outcomes and optimize patients' prognosis. Although dental trauma injuries require prompt clinical intervention, some challenges persist in effectively managing these injuries. In dental traumatology, the implementation of public health policies assumes critical importance, these policies play an important role in addressing preventive measures and mitigating the repercussions of TDI. This review aims to emphasize the importance of developing comprehensive public health policies in dental traumatology, recognizing the strategic importance of this approach and its benefits. By proactively addressing issues associated with dental injuries, these policies have extensive implications for individual quality of life and public health in general. Furthermore, this review will present a suggested structured framework for the development of public health policies, encompassing key domains including prevention, intervention, and education in dental traumatology. The creation and implementation of these policies will address dental trauma through prevention programs, research, and development, and will provide a significant step toward enhancing the well-being of the population and dental trauma victims' prognosis promoting a more resilient healthcare system.

"He'll come with some sugar." A qualitative study exploring the drivers and consequences of schoolgirls transactional sex behaviours.

Transactional sex (TS) is common in areas of sub-Saharan Africa, motivated by reasons beyond financial support. Through this qualitative study we sought to understand the motivation driving TS among adolescent schoolgirls in rural western Kenya where rates are reportedly high. Identifying and understanding drivers within the local context is necessary for implementation of successful public health policy and programming to reduce the associated harms impacting health and wellbeing. To understand the drivers of sexual behaviors, individual views, and socio-cultural norms, we spoke with schoolgirls, male peers, parents and teachers. The three latter groups may influence, encourage, and shape girls' views and behaviors and thus contribute to the perpetuation of cultural and societal norms. One hundred and ninety-nine participants took part across 20 FGDs; 8 comprised of schoolgirl groups, and 4 each of schoolboy, parent or teacher groups. Through thematic analysis, poverty emerged as the key driver of TS and a normative behaviour amongst secondary school girls. Subthemes including parental influence, need for menstrual pads, pressure from boda boda drivers, peer pressure, and blame were part of a complex relationship linking poverty with TS. We conclude that whilst TS is perceived as inevitable, normal and acceptable it is not really a choice for many girls. Exploring ways to encourage communication between families, including around menstruation, may help enable girls to ask for help in acquiring essential items. In addition, education at a community level may shift social norms over time and decrease the prevalence of age-disparate TS among schoolgirls and older, wealthier men in the community.