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1.
Public Health Pract (Oxf) ; 8: 100530, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39105105

RESUMO

Objectives: A quarter of West Africa's population are adolescents 10-19 years. Their mental, sexual, and reproductive health is inter-related. We therefore aimed to examine published evidence on effectiveness of interventions for adolescent mental, sexual and reproductive health in the Economic Community of West African States (ECOWAS) to inform development, implementation and de-implementation of policies and programs. Study design: The study design was a scoping review. Methods: We considered all qualitative and quantitative research designs that included adolescents 10-19 years in any type of intervention evaluation that included adolescent mental, sexual and reproductive health. Outcomes were as defined by the researchers. PubMed/Medline, APA PsycINFO, CAIRN, and Google Scholar databases were searched for papers published between January 2000 and November 9, 2023.1526 English and French language papers were identified. After eliminating duplicates, screening abstracts and then full texts, 27 papers from studies in ECOWAS were included. Results: Interventions represented three categories: service access, quality, and utilization; knowledge and information access and intersectionality and social determinants of adolescent health. Most studies were small-scale intervention research projects and interventions focused on sexual and reproductive or mental health individually rather than synergistically. The most common evaluation designs were quasi-experimental (13/27) followed by observational studies (8/27); randomized, and cluster randomized controlled trials (5/27), and one realist evaluation. The studies that evaluated policies and programs being implemented at scale used observational designs. Conclusion: Research with robust evaluation designs on synergistic approaches to adolescent mental, sexual and reproductive health policies, interventions, implementation and de-implementation is urgently needed to inform adolescent health policies and programs.

2.
Lancet Glob Health ; 9(5): e610-e619, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33713630

RESUMO

BACKGROUND: Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. METHODS: We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016-Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. FINDINGS: Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. INTERPRETATION: Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. FUNDING: Wellcome Trust and Volkswagen Foundation.


Assuntos
Antibacterianos/administração & dosagem , Uso Indevido de Medicamentos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , África , Ásia , Bangladesh , Países em Desenvolvimento , Estudos de Avaliação como Assunto , Feminino , Gana , Humanos , Masculino , Moçambique , Pobreza , Pesquisa Qualitativa , Características de Residência , África do Sul , Inquéritos e Questionários , Tailândia , Vietnã
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