Disrupting Bias Without Trainings: The Effect of Equity Advocates on Faculty Search Committees.

Many institutions of higher education have implemented workshops for hiring committee members to familiarize them with the pernicious effects of implicit bias and how to counteract them. Unfortunately, the enthusiasm for implicit bias trainings is not matched by the evidence for their effectiveness. Recognizing the difficulty of removing entrenched biases and the potential for trainings to backfire, we introduced the role of equity advocate (EA) at one institution. EAs are trained volunteer faculty and staff members who serve on search committees outside their home departments to identify behaviors and judgments that might have a disparate racial effect in hiring. We conducted focus groups to document the perspectives of both EAs and non-EA search committee members who completed a cycle of academic hiring. Search committee members credited EAs with helping to mitigate bias by questioning their assumptions and introducing standardized tools for evaluating candidates. By contrast, EAs reported a more contentious relationship with the rest of the search committee and expressed less confidence that the process was free from bias. Both groups agreed that the EAs added valuable race-conscious equitable practices, and untrained committee members identified ways they could apply the lessons of bias reduction in other parts of their professional roles. Our study provides evidence for how to engage all faculty and staff members in sustainable, equity-minded efforts.

Intersection of HIV and Anemia in women of reproductive age: a 10-year analysis of three Zimbabwe demographic health surveys, 2005-2015.

BACKGROUND: Women of reproductive age 15-49 are at a high risk of iron-deficiency anemia, which in turn may contribute to maternal morbidity and mortality. Common causes of anemia include poor nutrition, infections, malaria, HIV, and treatments for HIV. We conducted a secondary analysis to study the prevalence of and associated risk factors for anemia in women to elucidate the intersection of HIV and anemia using data from 3 cycles of Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2005, 2010, and 2015. METHODS: DHS design comprises of a two-stage cluster-sampling to monitor and evaluate indicators for population health. A field hemoglobin test was conducted in eligible women. Anemia was defined as hemoglobin < 11.0 g/dL in pregnant women; < 12.0 in nonpregnant women. Chi-squared test and multivariable logistic regression analysis accounting for complex survey design were used to determine the prevalence and risk factors associated with anemia. RESULTS: Prevalence (95% confidence interval (CI)) of anemia was 37.8(35.9-39.7), 28.2(26.9-29.5), 27.8(26.5-29.1) in 2005, 2010, and 2015, respectively. Approximately 9.4, 7.2, and 6.1%, of women had moderate anemia; (Hgb 7-9.9) while 1.0, 0.7, and 0.6% of women had severe anemia (Hgb < 7 g/dL)), in 2005, 2010, and 2015, respectively. Risk factors associated with anemia included HIV (HIV+: 2005: OR (95% CI) = 2.40(2.03-2.74), 2010: 2.35(1.99-2.77), and 2015: 2.48(2.18-2.83)]; Residence in 2005 and 2010 [(2005: 1.33(1.08-1.65), 2010: 1.26(1.03-1.53)]; Pregnant or breastfeeding women [2005: 1.31(1.16-1.47), 2010: 1.23(1.09-1.34)]; not taking iron supplementation [2005: 1.17(1.03-1.33), 2010: 1.23(1.09-1.40), and2015: 1.24(1.08-1.42)]. Masvingo, Matebeleland South, and Bulawayo provinces had the highest burden of anemia across the three DHS Cycles. Manicaland and Mashonaland East had the lowest burden. CONCLUSION: The prevalence of anemia in Zimbabwe declined between 2005 and 2015 but provinces of Matebeleland South and Bulawayo were hot spots with little or no change HIV positive women had higher prevalence than HIV negative women. The multidimensional causes and drivers of anemia in women require an integrated approach to help ameliorate anemia and its negative health effects on the women's health. Prevention strategies such as promoting iron-rich food and food fortification, providing universal iron supplementation targeting lowveld provinces and women with HIV, pregnant or breastfeeding are required.

Oral rehydration solution coverage in under 5 children with diarrhea: a tri-country, subnational, cross-sectional comparative analysis of two demographic health surveys cycles.

BACKGROUND: More than 3 million children under 5 years in developing countries die from dehydration due to diarrhea, a preventable and treatable disease. We conducted a comparative analysis of two Demographic Health Survey (DHS) cycles to examine changes in ORS coverage in Zimbabwe, Zambia and Malawi. These surveys are cross-sectional conducted on a representative sample of the non-institutionalized individuals. METHODS: The sample is drawn using a stratified two-stage cluster sampling design with census enumeration areas, typically, selected first as primary sampling units (PSUs) and then a fixed number of households from each PSU. We examined national and sub-regional prevalence of ORS use during a recent episode of diarrhea (within 2 weeks of survey) using DHSs for 2007-2010 (1st Period), and 2013-2016 (2nd Period). Weighted proportions of ORS were obtained and multivariable- design-adjusted logistic regression analysis was used to obtain Odds Ratios (aORs) and 95% confidence intervals (CIs) and weighted proportions of ORS coverage. RESULTS: Crude ORS coverage increased from 21.0% (95% CI: 17.4-24.9) in 1st Period to 40.5% (36.5-44.6) in 2nd Period in Zimbabwe; increased from 60.8% (56.1-65.3) to 64.7% (61.8-67.5) in Zambia; and decreased from 72.3% (68.4-75.9) to 64.6% (60.9-68.1) in Malawi. The rates of change in coverage among provinces in Zimbabwe ranged from 10.3% over the three cycles (approximately 10 years) in Midlands to 44.2% in Matabeleland South; in Zambia from - 9.5% in Eastern Province to 24.4% in Luapula; and in Malawi from - 16.5% in the Northern Province to - 3.2% in Southern Province. The aORs for ORS use was 3.95(2.66-5.86) for Zimbabwe, 2.83 (2.35-3.40) for Zambia, and, 0.71(0.59-0.87) for Malawi. CONCLUSION: ORS coverage increased in Zimbabwe, stagnated in Zambia, but declined in Malawi. Monitoring national and province-level trends of ORS use illuminates geographic inequalities and helps identify priority areas for targeting resource allocation.. Provision of safe drinking-water, adequate sanitation and hygiene will help reduce the causes and the incidence of diarrhea. Health policies to strengthen access to appropriate treatments such as vaccines for rotavirus and cholera and promoting use of ORS to reduce the burden of diarrhea should be developed and implemented.

Burden and changes in HIV/AIDS morbidity and mortality in Southern Africa Development Community Countries, 1990-2017.

BACKGROUND: The 16 Southern Africa Development Community (SADC) countries remain the epicentre of the HIV/AIDS epidemic with the largest number of people living with HIV/AIDS. Anti-retroviral treatment (ART) has improved survival and prevention of mother-to-child transmission (PMTCT) of HIV, but the disease remains a serious cause of mortality. We conducted a descriptive epidemiological analysis of HIV/AIDS burden for the 16 SADC countries using secondary data from the Global Burden of Diseases, Injuries and Risk Factor (GBD) Study. METHODS: The GBD study is a systematic, scientific effort by the Institute for Health Metrics and Evaluation (IHME) to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time. We analyzed the following outcomes: mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to HIV/AIDS for SADC. Input data for GBD was extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service utilisation, disease notifications, and other sources. Country- and cause-specific HIV/AIDS-related death rates were calculated using the Cause of Death Ensemble model (CODEm) and spatiotemporal Gaussian process regression (ST-GPR). Deaths were multiplied by standard life expectancy at each age-group to calculate YLLs. Cause-specific mortality was estimated using a Bayesian meta-regression modelling tool, DisMod-MR. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases to calculate YLDs. Crude and age-adjusted rates per 100,000 population and changes between 1990 and 2017 were determined for each country. RESULTS: In 2017, HIV/AIDS caused 336,175 deaths overall in SADC countries, and more than 20 million DALYs. This corresponds to a 3-fold increase from 113,631 deaths (6,915,170 DALYs) in 1990. The five leading countries with the proportion of deaths attributable to HIV/AIDS in 2017 were Botswana at the top with 28.7% (95% UI; 23.7-35.2), followed by South Africa 28.5% (25.8-31.6), Lesotho, 25.1% (21.2-30.4), eSwatini 24.8% (21.3-28.6), and Mozambique 24.2% (20.6-29.3). The five countries had relative attributable deaths that were at least 14 times greater than the global burden of 1.7% (1.6-1.8). Similar patterns were observed with YLDs, YLLs, and DALYs. Comoros, Seychelles and Mauritius were on the lower end, with attributable proportions less than 1%, below the global proportion. CONCLUSIONS: Great progress in reducing HIV/AIDS burden has been achieved since the peak but more needs to be done. The post-2005 decline is attributed to PMTCT of HIV, resources provided through the US President's Emergency Plan For AIDS Relief (PEPFAR), and behavioural change. The five countries with the highest burden of HIV/AIDS as measured by proportion of death attributed to HIV/AIDS and age-standardized mortaility rate were Botswana, South Africa, Lesotho, eSwatini, and Mozambique. SADC countries should cooperate, work with donors, and embrace the UN Fast-Track approach, which calls for frontloading investment from domestic or other sources to prevent and treat HIV/AIDS. Robust tracking, testing, and early treatment are required, as well as refinement of individual treatment strategies for transient individuals in the region.

Conducting Community-Based Research in An African Immigrant Population: Lessons Learned.

Background: Although small, the African immigrant population is one of the fastest growing immigrant populations in the United States. Emerging research indicates a high prevalence of noncommunicable preventable chronic conditions in this population. Like other African Americans, African immigrants are mistrustful of the health care system, hampering efforts for prevention and intervention research. Purpose: To describe our experiences conducting 2 studies in an African immigrant community, discuss the lessons learned, and provide advice to researchers interested in conducting research in similar populations. Design: The 2 published studies for which we derive lessons learned for this paper were a cross-sectional study and a qualitative study using focus group interviews. Participants included Zimbabwean immigrants in the Eastern United States recruited at religious festivals and community events. The 2 studies enrolled a total of 135 participants. Results: Of our recruitment goal of 120 in the first study, we enrolled only 98 despite numerous efforts. However, after strategically partnering with a community advisory board (CAB), in the second study, we met our recruitment goal within 4 months. With the CAB, we recruited a larger proportion of men (38% versus 24%). Without the CAB, 350 individuals agreed to participate, but only 98 (28%) returned the questionnaire, whereas with the CAB, 40 agreed to participate, and 37 (93%) successfully completed the study. Conclusion: Conducting health-related research in immigrants requires strategic partnerships with the community to build strong relationships between the research team and the target community. By nurturing these relationships, research teams can effectively access this hard-to-reach population and achieve high participation.

Justice, Equity, and Inclusion in a School of Nursing: A Quality Improvement Program.

BACKGROUND: Despite the increased racial and ethnic diversity in the general population of the United States, the nursing workforce remains mostly White. Schools of nursing (SON) have increased recruitment and enrollment; however, students who represent racial and ethnic minoritized groups experience microaggressions, injustice, and social exclusion. This quality improvement program sought to equip faculty with skills to create a just and inclusive SON. The program was guided by the Institute for Healthcare's Model for Improvement. METHOD: Five workshops were developed and implemented during two semesters. Workshops were led and moderated by a diversity, equity, and inclusion consultant. RESULTS: After the workshops, participants committed to create an inclusive environment, intervene when microaggressions occurred, implement curricular changes, and recognize themselves as members of a privileged group. Postworkshop discussions and reflections led to new initiatives in the SON. CONCLUSION: This faculty development program demonstrates programs to enhance justice, equity, and inclusion can be implemented successfully within SON. [J Nurs Educ. 2023;62(1):20-27.].

Microaggressions: Black students' experiences - A qualitative study.

BACKGROUND: Studies in other disciplines have shown that Black college students experience microaggressions on campus. This affects campus learning climates, posing a risk to students' success. PURPOSE: The purpose of this secondary analysis is to describe Black nursing students' experiences with microaggression at a predominantly white institution. METHODS: In this secondary analysis of a descriptive qualitative study, principles of thematic analysis were used to code, categorize, and synthesize interview data from 16 nursing alumni participants specifically to examine microaggression. RESULTS: The thematic analysis of the data revealed microaggressive behaviors experienced by Black nursing students. Three salient themes emerged: microaggressions among peers, from faculty members to students, and in the clinical setting. CONCLUSION: This study offers critical insights into the microaggressions that Black students experience. These microaggressions interfere with students' learning and highlight the need for academic institutions to take measures to dismantle these behaviors. These findings can illuminate to faculty and students the roles they play in perpetuating racism and subjecting students of color to detrimental psychological distress.

African Immigrant Health: The Health Promotion Beliefs of Zimbabwean Immigrants in the United States.

To examine the health beliefs that can influence engagement in cardiovascular disease (CVD) risk reduction health promotion activities among Zimbabwe-born immigrants in the US. Focus group interviews with 37 New England-based Zimbabwean immigrants in the US conducted between January and April 2019. Focus groups were led by study investigators who were members of the Zimbabwean community. Interviews were audio-recorded and transcribed. Data were analyzed using framework analysis. Five themes emerged: (1) negative attitudes toward ill health, (2) mistrust toward western medicine, (3) stigma and taboo toward ill health, (4) a negative change in eating habits and (5) negative attitudes toward physical exercise. The participants' attitudes and beliefs may interfere with their engagement in health promotion activities aimed at reducing the burden of CVD risk in this population. Understanding these beliefs paves the way for development of culturally congruent health promotion interventions in Zimbabwean and other African immigrant populations.

Creating a culture of success: A framework for addressing at-risk student.

The lack of diversity in nursing and the projected nursing shortage is a clarion call for higher education to create inclusive programs where all students can thrive. Despite an increase in enrollment, attrition remains an issue. To address the looming nursing shortage, colleges and universities are expected to increase the enrollments in baccalaureate and accelerated baccalaureate programs. As traditional and nontraditional students are admitted into nursing programs, institutions and nursing programs will be faced with tackling issues students who are historically labeled as "at-risk" may have. To help these students succeed, colleges and universities must come up with new ways to work with at-risk students. In this paper, we are proposing a new framework for how faculty in nursing programs can perceive "at-risk" students by systematically examining the factors that lead to this at-risk status. The framework proposes that students encounter a plethora of individual and institutional critical elements, categorized into domains. By understanding the critical elements that impact student outcomes, nursing programs will be better able to strategize ways to effectively support and sustain student success.

The Health Status of Zimbabwean Immigrants in the US: A Needs Assessment.

Many Zimbabwean immigrants have settled in the US in the past 20 years. These immigrants originate from a country highly burdened with HIV and other non-communicable diseases. The health needs of these immigrants are not known. To determine the prevalence of health conditions, and healthcare utilization of Zimbabwean immigrants. A cross-sectional study of 98 Zimbabwean immigrants recruited at religious festivals, completed questionnaires and had blood pressure and weight measurements taken. Three quarters (74.4%) were overweight/obese, 34.7% had hypertension, 79.6% were health insured, 87% had regular PCPs. In the year prior 78.7% had seen a provider, and 25% had utilized the ER for care. Despite regular visits to providers participants, Zimbabwean immigrants utilized the ER more frequently than other populations and had high prevalence of preventable cardiovascular disease risk factors. Providers need to partner with this population to come up culturally appropriate prevention and management interventions.

Changes in body mass index, obesity, and overweight in Southern Africa development countries, 1990 to 2019: Findings from the Global Burden of Disease, Injuries, and Risk Factors Study.

BACKGROUND: High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data. METHODS: GBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI. RESULTS: Obesity in adult females increased 1.54-fold from 12.0% (uncertainty interval [UI]: 11.5-12.4) to 18.5% (17.9-19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3-4.8) to 8.8 (8.5-9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6-23.1) to 23.1 (22.3-24.0) in adult males, and by 1.0 from 23.8 (22.9-24.7) to 24.8 (23.8-25.8) in adult females. South Africa 44.7 (42.5-46.8), Swaziland 33.9 (31.7-36.0) and Lesotho 31.6 (29.8-33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5-20.7), 19.3 (17.7-20.8), and 9.2 (8.4-10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8-6.4) and 7.0 (6.1-7.9), respectively in females in 2019, and in males from 4.9 (4.3-5.4) in the DRC to 3.9 (3.4-4.4) in Madagascar. CONCLUSIONS: The prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity.

"What Will Become of Me if They Take This Away?" Zimbabwean Women's Perceptions of "Free" ART.

The evolution of antiretroviral therapies (ART) has redefined HIV infection from a life-threatening disease to a chronic manageable condition. Despite ART, HIV infection remains a serious health burden in Zimbabwe, particularly among women of reproductive age. In this interpretive phenomenology study, we interviewed 17 women with advanced HIV infection to uncover and understand their experiences of living with HIV infection in the ART era. Two themes (knowing the restorative power of ART and the heavy burden of being infected with HIV) reflected the women's experiences. ART brought physical and mental relief, but did not change the sobering reality of poverty or the challenges posed by the infective nature of HIV. The heavily donor-funded Zimbabwean ART program has been a success story, but there is uncertainty over its long-term sustainability. In resource-limited countries, clinicians and other stakeholders should continue to focus on HIV prevention as the cornerstone of HIV programming.

The context and experience of becoming HIV infected for Zimbabwean women: unheard voices revealed.

Zimbabwean women are at high risk for HIV infection but often are not the focus of inquiry unless they are participants in controlled trials. In this phenomenological study, we interviewed 17 women living with advanced HIV infection to better understand their experiences and the aftermath of being diagnosed with HIV. Open-ended interviews were audiotaped, transcribed, translated into English, and analyzed. Two themes (living with suspicion of HIV infection and sensing the engulfing anguish of being HIV infected) emerged and were found to reflect the essence of the phenomena. Even though the women had suspected being HIV infected from internal and external cues, a confirmed diagnosis threw them into a state of anguish prompted by the possibility of dying from a disease they "did not deserve." When designing prevention and treatment interventions, for the interventions to be effective, clinicians working with this population should consider the complexity of issues involved.