Justice implications of health and food security policies for Indigenous peoples facing COVID-19: a qualitative study and policy analysis in Peru.

The spread of COVID-19 in Peru resulted in the declaration of a national health emergency, in which Indigenous peoples were identified as being particularly vulnerable due to their pre-existing poor health indicators and disadvantaged social conditions. The aim of this paper is to examine how the Peruvian government responded to the health and food needs of the Shawi and Ashaninka Indigenous peoples of Peru during the first 18 months of the pandemic (March 2020-August 2021). This study uses both official policy documents and real-world experiences to evaluate policy responses in terms of their immediate impact and their longer-term sustainability and contribution to the improvement of health, well-being and justice for Indigenous communities. Four health and food security responses were evaluated: the Amazon Health Plan and Indigenous Command; food aid; cash aid; and COVID-19 vaccination. We employed the Multidimensional Injustice Framework to analyse the justice implications of the design and implementation of responses. Data collection included 71 interviews with government officials (n = 7), Indigenous leaders (n = 31) and community members (n = 33). The results show how national and regional governments released policies to address the health and food needs of Indigenous peoples directly or indirectly, as part of a broader focus on vulnerable people. However, justice implications were not sufficiently addressed in the design or implementation of the responses. On the distributive dimension, Indigenous communities were prioritized to receive health goods and services, nevertheless, the distribution had shortcomings that impeded their collection and Indigenous food systems and livelihoods were largely overlooked. On the procedural dimension, Indigenous representatives were included to provide culturally sensitive feedback on health interventions, but without funding, and furthermore, the community members had only passive participation. This paper points out the importance of considering and addressing justice implications for more effective and fairer health and food policy responses to current and future health crises.

Policy responses to COVID-19 in Sri Lanka and the consideration of Indigenous Peoples.

COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples.

Research involvement among undergraduate health profession students in a resource-limited setting: awareness, attitude, motivators and barriers.

BACKGROUND: Involvement of undergraduate health professions students (HPS) in research will facilitate evidence-based clinical practice among future healthcare practitioners. This study aimed to assess research involvement among undergraduate HPS students and associated factors in Uganda. METHODS: A cross-sectional study was conducted using an online assessment tool sent through WhatsApp groups and E-mail addresses of HPS in 12 medical schools in Uganda between 20th September and 5th October 2021. RESULTS: We enrolled 398 participants with a mean age of 23.9 ± 3.7 years. Of this, 267 (67.1%) were male. One hundred twenty (30.2%) participants previously participated in a research activity: 90 (58.4%) as research assistants, 39 (25.3%) published as first authors, and 25 (16.2%) as co-authors. Training on the conduct of research was received by 242 (65.8%) participants, and 326 (81.9%) had intentions of conducting research in the future. Factors influencing participation in research activities were, age ≥ 25 years (adjusted odds ratio (aOR): 1.9, 95% confidence interval (95% CI): 1.2-3.2, p = 0.012), being male (aOR: 2.1, 95%CI: 1.2-3.6, p = 0.008), and being in a clinical year i.e., year 3 (aOR: 3.2, 95% CI: 1.1-9.3, p = 0.033), year 4 (aOR: 3.3, 95% CI: 1.1-9.5, p = 0.028) and year 5(aOR: 11.6, 95% CI: 3.2-42.1, p < 0.001). Lack of funds (79.6%), and mentorship (63.3%) were reported as major barriers to research. CONCLUSIONS: Despite a high proportion of HPS showing interest in getting involved in research, less than one-third reported previous involvement. Addressing barriers such as funding could potentially improve research involvement and output among undergraduate HPS in resource-limited settings.

Double Face Mask Use for COVID-19 Infection Prevention and Control Among Medical Students at Makerere University: A Cross-Section Survey.

INTRODUCTION: The second wave of COVID-19 greatly affected the health care and education systems in Uganda, due to the infection itself and the lockdowns instituted. Double masking has been suggested as a safe alternative to double-layered masks, where the quality of the latter may not be guaranteed. This study aimed to determine patterns of double mask use among undergraduate medical students at Makerere University, Uganda. METHODS: We conducted a descriptive cross-sectional study using an online questionnaire. All students enrolled at the College of Health Sciences; Makerere University received the link to this questionnaire to participate. Logistic regression analysis was used to assess factors associated with double mask use. RESULTS: A total of 348 participants were enrolled. The majority (61.8%) were male; the median age was 23 (range: 32) years. Up to 10.3%, 42%, and 4.3% reported past COVID-19 positive test, history of COVID-19 symptoms, and having comorbidities, respectively. Up to 40.8% had been vaccinated against COVID-19. More than half (68.7%) believed double masking was superior to single masking for COVID-19 IPC, but only 20.5% reported double masking. Participants with a past COVID-19 positive test [aOR: 2.5; 95% CI: 1.1-5.8, p = 0.026] and participants who believed double masks had a superior protective advantage [aOR: 20; 95% CI: 4.9-86.2, p < 0.001] were more likely to double mask. Lack of trust in the quality of masks (46.5%) was the most frequent motivation for double masking, while excessive sweating (68.4%), high cost of masks (66.4%), and difficulty in breathing (66.1%) were the major barriers. CONCLUSION: Very few medical students practice double masking to prevent COVID-19. Coupled with inconsistencies in the availability of the recommended four-layered masks in Uganda and increased exposure in lecture rooms and clinical rotations, medical students may be at risk of contracting COVID-19.

Knowledge on Infection Prevention and Control and associated factors among undergraduate health professional students at Makerere University College of Health Sciences, Uganda.

INTRODUCTION: To practice adequate Infection Prevention and Control (IPC) measures, health professional students need to have adequate knowledge of IPC. In this study, we assessed the knowledge of health professional students at Makerere University College of Health Sciences on Infection Prevention and Control. METHODS: We conducted a cross-sectional online survey among health professional students studying at Makerere University College of Health Sciences located in Kampala, Uganda. An adapted questionnaire was used to measure knowledge on Infection Prevention and Control among students. RESULTS: A total of 202 health professional students were included in the study. The mean age was 24.43 years. Majority were male 63.37% (n = 128), from the school of medicine 70.79% (n = 143) and used one source of information for IPC 49.50% (n = 100). Being in year three (Adjusted coefficient, 6.08; 95% CI, 2.04-10.13; p-value = 0.003), year four (Adjusted coefficient, 10.87; 95% CI, 6.91-14.84; p < 0.001) and year five (Adjusted coefficient, 8.61; 95% CI, 4.45-12.78; p < 0.001) were associated with a higher mean in total percentage score of knowledge on IPC compared to being in year one. CONCLUSION: IPC knowledge was good among health professional students in Makerere University although more emphasis is needed to improve on their IPC knowledge in various sections like hand hygiene. Infection Prevention and Control courses can be taught to these students starting from their first year of university education.

Factors associated with readiness to start antiretroviral therapy (ART) among young people (15-24 years) at four HIV clinics in Mulago Hospital, Uganda.

Introduction: Globally, the HIV burden continues to rise among young people despite the discovery of ART. This study assessed demographic and psycho-social factors among young people associated with readiness to be initiated on ART. Methods: A quantitative cross-sectional study was conducted among newly diagnosed HIV positive young people aged 15-24 years at 4 HIV clinics at Mulago Hospital. Readiness was measured as a self-report by the individual to the question, "How ready do you feel to start ART? Results: Of the 231 young people enrolled, the mean age (SD) was 20.7years (+/-2.8) and most were female (66.2%). Majority were very ready (53.3%) and very motivated (51.1%) to start ART. Higher treatment readiness was associated with being female (95% CI [5.62, 8.31], p=0.003), thinking that ART cures HIV (95% CI [0.43, 0.86], p=0.005), history of having unprotected sex (95% CI [0.79, 0.87], p=<0.001), anticipating negative HIV results (95% CI [0.26, 0.88], p=0.017), internalized stigma (95% CI [0.83, 0.98], p=0.018) and knowledge of positive ART effects for others (95% CI [0.84, 0.93], p=<0.001). Conclusions: Understanding the underlying factors associated with ART readiness among young people can inform strategies to support and increase individuals' readiness to initiate ART and early engagement in care.