Challenges associated with the implementation of institutional quarantine and isolation strategies during major multicountry viral outbreaks in Africa (2000-2023): a scoping review.

BACKGROUND: Quarantine and isolation (Q&I) are interrelated but not mutually exclusive public health practices for disease control, which may face public resistance in the context of health emergencies due to associated challenges. Hence, it is often tough for most countries to implement Q&I even in the context of health emergencies. Therefore, this scoping review examines the challenges associated with the implementation of institutional Q&I strategies during major multicountry viral outbreaks (Ebola, Lassa and COVID-19) in Africa between 2000 and 2023. METHODS: This scoping review was designed based on Arksey and O'Malley's guidelines. A systematic literature search, using nine online research databases, was conducted with the aid of relevant search terms, Boolean operators and truncations. All articles obtained from the literature search were electronically imported into Rayyan web application for deduplication based on specific inclusion and exclusion criteria. From the included literature, relevant data were charted, summarized, collated, and presented. RESULTS: This review included 24 of the 787 retrieved articles. Sixteen of the 24 selected articles investigated issues related to COVID-19 prevention and control in Africa. Two assessed precautionary practices for Lassa fever, while five were on Ebola virus disease. However, one article explored knowledge, preventive practices, and general isolation precautions. The review identified various challenges that hindered the implementation of successful Q&I practices during viral infection outbreaks in Africa. Essential healthcare infrastructure, equipment (medical supplies including personal protective equipment and testing kits) and facilities that are essential for Q&I were deficient. Q&I implementation was often threatened by low human resource capacity and inefficiencies in the healthcare system which portray Africa as unprepared to handle complex public health crises. CONCLUSIONS: This review shows that Q&I implementation in Africa is often threatened by low human resource capacity and inefficiencies in the healthcare system and also portrays Africa as unprepared to handle complex public health crises. Hence, Q&I for major multicountry outbreaks in Africa is very challenging. Therefore, continuous efforts to address these identified challenges are crucial to enhancing health emergency preparedness in Africa.

A scoping review of cultural issues concerning institutional quarantine and isolation during major multi-country outbreaks in Africa: 2000-2023.

Background and Aims: Infectious disease outbreaks pose significant challenges in Africa due to its ecology, socioeconomic conditions, and weak health systems. Implementing institutional quarantine and isolation (Q&I) measures is crucial for managing major outbreaks. However, the cultural context often determines the success of these measures. This scoping review aims to examine existing evidence on the cultural aspects of institutional Q&I in Africa over the past two decades, focusing on the COVID-19 pandemic and other major multi-country disease outbreaks. Methods: This scoping review's protocol was registered with the Open Science Framework registry. Nine research databases were systematically searched to retrieve all relevant literature, followed by deduplication and a two-stage screening process using the Rayyan web application. The inclusion of any literature into this review was based on a set of eligibility criteria. Also, manual searching of the reference lists of included literature was done to retrieve any other eligible literature. From the included literature, data were charted, collected, and summarized. Findings: Out of the 787 articles retrieved from the database searches, this review found only one to be eligible for inclusion. Also, no other eligible article was obtained after manual searching of the reference list for this article. The reviewed article presented empirical findings on the impact of COVID-19 Q&I protocols on traditional burial rites in Ghana. Many Ghanaian families were against their country's protocol because they felt it was insensitive to their traditional values and burial practices. Also, the way the protocol was implemented made some Ghanaian families feel that foreign burial practices were imposed on them, which bred feelings of cultural exclusion and neglect (by the government) among Ghanaians. Conclusion: Research evidence on the cultural implications of Q&I in Africa is very scanty. More research is needed on this topic of public health interest.

Qualitative Analysis of Coping Strategies Among Older Persons During COVID-19 Lockdown in Nigeria: Considerations for Community Health Promotion.

Background: The challenge of COVID-19 and the disease control restrictions in Nigeria directly affected social life. Older adults were disproportionately affected because of social vulnerabilities, socio-economic dependency, and the high risk of COVID-19 infectious disease in the population.Purpose: To this end, the study explored the instrumental coping strategies of older adults duirng the COVID-19 lockdown in Nigeria.Research Design: An exploratory research design using qualitative approach based on in-depth interviews was adopted.Study Sample: Twenty-seven (27) older adults aged 60 years and more in Ibadan, Nigeria were purposively selected for participation in the research.Data Collection and/or Analysis: Community living older adults participated in in-depth telephone interviews during the COVID-19 restrictions. Using Atlas ti 8.4, the 27 transcripts were analyzed and validated through content analysis.Results: Older adults coped with fear, anxiety, depression, and other health challenges, and three major themes emerged as problem-focused coping strategies. Older adults explored spirituality, engaged in their social networks through telephones, and focused on a healthy diet and physical activities.Conclusions: Community health promotion strategies for older adults should explore the identified problem-focused coping strategies to optimize the health and wellbeing of older adults.

Mother's education and nutritional status as correlates of child stunting, wasting, underweight, and overweight in Nigeria: Evidence from 2018 Demographic and Health Survey.

Aim: This study examined the nexus between mother's education and nutritional status and their relationships with child stunting, wasting, underweight, and overweight. Methods: The data of 34,193 under-five (U-5) children from the 2018 Nigeria Demographic and Health Survey (NDHS) were analyzed using descriptive statistics, and binary and complementary log-logistic regression models. Results: The prevalence of child stunting, wasting, underweight, and overweight were 36.51%, 6.92%, 21.73%, and 2.05%, respectively. Compared to children born to mothers with at least secondary education, uneducated women's children (odds ratio (OR) = 1.55; 95% confidence interval (CI) = 1.32-1.82) and those of women with primary education (OR = 1.49; 95% CI = 1.28-1.72) were more likely to be stunted. Similarly, children born to uneducated women (OR = 1.51; 95% CI = 1.24-1.83) were more likely to be underweight than women with at least secondary education. The likelihood of child underweight (OR = 1.71; 95% CI = 1.45-2.01) and wasting (rate ratio (RR) = 1.82; 95% CI = 1.47-2.26) were higher among underweight mothers, respectively, than those with normal body mass index (BMI). The likelihood of child stunting (OR = 0.75; 95% CI = 0.67-0.84) and underweight (OR = 0.66; 95% CI = 0.57-0.77) were lower among obese/overweight mothers compared to those with normal BMI, but their children were more likely to be overweight (RR = 1.77; 95% CI = 1.27-2.48). Conclusion: Attainment of higher education by mothers should be promoted to prevent childhood nutritional imbalances, and sensitization on healthy dietary habits and lifestyles should be promoted among women, especially the overweight/obese, to reduce their risk of having overweight children.

Ethical Relativism and Circumstances of Social and Cultural Contingencies on Informed Consent in the Conduct of Research: Clinical Trials in Nigeria.

There have been debates across the globe for a social and culturally sensitive ethics to meditate a catalyst of template for informed consent (IC) in the conduct of social researches and clinical trial. The study adopted ethical relativism theory to explore social and cultural contingencies on IC with descriptive research design and snowball sampling techniques with a pool of 23 participants randomly and purposively selected amongst the stakeholders including researchers. Seven lecturers and 5 medical practitioners from selected universities, 5 clergy members of different genders and denominations with 2 Imams, 1 chief and 2 traditional health practitioners completing the pool. The data were compiled separately with pseudonym to maintain the anonymity of the participants and content analysed thematically to probe awareness, understanding, patriarchy and religious dimensions on IC. The paper argued that ethics and law regulations must be strengthened to leverage on different individual values, norms and social indices. The paper concluded and suggested that researchers can avoid and resolve ethical dilemmas and maintain research regularity when ethical obligations are well understood and strictly adhered to, and to develop the Informed Consent Evaluation Feedback Tool (ICEFbT) with oversight function from Institution Review Board (IRB) in the universities and research institutes before the commencement of research and/or medical procedures.

Prostate cancer knowledge gaps among community stakeholders in rural Nigeria: implications for seeking screening.

PURPOSE: In Nigeria, knowledge about prostate cancer (PCa) is poor, so are the availability, accessibility, and utilization of PCa screening services. Poor knowledge increases the burden of disease, this is more so in rural settings. PCa, being gender-specific, has underlying cultural connotations. There is a dearth of evidence on the rural-cultural understanding of PCa onset. The study examined community stakeholders' knowledge, risk perception, as well as the perceived barriers to seeking PCa screening. Rosenstock's Health Belief Model provided the theoretical framing for the study. METHODS: The study design was descriptive and a cross-sectional approach to the social constructionist ideas of the qualitative tradition was adopted. There were twenty-one interviews with purposively selected community stakeholders; Fourteen key informant (traditional healers and medical doctors) interviews and seven In-depth Interviews (traditional leaders) held in the Ijebu culture cluster of Ogun State, Nigeria. Narratives were analyzed based on the following theoretical themes: knowledge, risk perception, and perceived barriers to PCa screening. These themes derived their structures from content-analyzed findings. RESULTS: Results show that traditional healers and leaders have limited scientific knowledge of PCa etiology. Folk beliefs form the basis of PCa knowledge among most stakeholders. However, all stakeholders consider PCa a threat to men. The cultural sense of 'maleness' and access to appropriate information about PCa are essential approaches to establishing perceived threat/susceptibility. Cancer health education and distance of screening facilities are primary barriers to seeking screening. CONCLUSION: Stakeholders' knowledge of PCa and PCa screening should be improved by educating them and developing integrative community engagement strategies.

Developing a framework for successful research partnerships in global health.

BACKGROUND: The Centre for Global Health, Trinity College Dublin has as one of its goals, strengthening health systems in developing countries. In realising this goal we work across more than 40 countries with third-level, civil society, government, private sector and UN partners. Each of these requires that different relationships be established. Good principles must guide all global health research partnerships. An exploratory research project was undertaken with research partners of, and staff within, the Centre for Global Health. The aim was to build an evidence-based framework. METHODS: An inductive exploratory research process was undertaken using a grounded theory approach in three consecutive phases: Phase I: An open-ended questionnaire was sent via email to all identified partners. Phase II: A series of consultative meetings were held with the staff of the Centre for Global Health. Phase III: Data sets from Phases I and II were applied to the development of a unifying framework. Data was analysed using grounded theory three stage thematic analysis - open, axial and selective coding. RESULTS: Relational and operational aspects of partnership were highlighted as being relevant across every partnership. Seven equally important core concepts emerged (focus, values, equity, benefit, leadership, communication and resolution), and are described and discussed here. Of these, two (leadership and resolution) are less often considered in existing literature on partnerships. CONCLUSIONS: Large complex partnerships can work well if all parties are agreed in advance to a common minimum programme, have been involved from the design stage, and have adequate resources specifically allocated. Based on this research, a framework for partnerships has been developed and is shared.