Reproductive health policy Saga: Restrictive abortion laws in low- and middle-income countries (LMICs), unnecessary cause of maternal mortality.

Abortion is a common but controversial phenomenon globally. The discourse on the legality of abortion remains intricate, leaving a substantial number of women restricted from accessing safe abortion. There are evidence of an association between restrictive abortion laws, unsafe abortions, and maternal mortality in low-and middle-income countries (LMICs). We explore how restrictive abortion laws violate women's right to health and bodily integrity. We used Carol Bacchi's policy framework to analyze how restrictive abortion laws have been discursively framed (problematization); the assumptions that underpinned the representation; the consequences of the representation; what was left unproblematic; how the representation could be questioned, disrupted and replaced. We found that most of these laws are based on morality and the limited number of women in politics has made them objects rather than subjects in decision-making process. Therefore, we recommend a holistic approach to abortion laws with women leading the process to achieve reproductive justice.

Availability and Use of Essential Opioid Analgesics in Sub-Saharan Africa: A Scoping Review Protocol.

Introduction: The treatment of acute, peri-operative, and chronic pain by healthcare practitioners and health systems requires appropriate access to and availability of essential opioid medications. While opioids are often oversupplied and overprescribed in high-income countries, there are significant inequities as many low- and middle-income countries (LMICs) experience severe shortages. In fact, while the richest 10% in the world reside in countries receiving almost 90% of all available opioids, 50% of the poorest in the world reside in countries receiving just 1% of all available opioids.Understanding the social, economic, cultural, and regulatory barriers to access essential opioid analgesics in LMICs is critical in delineating and prioritizing appropriate interventions. We aim to conduct a scoping review on the availability and usage of essential opioid analgesics in LMICs, specifically in sub-Saharan Africa, to identify barriers, themes, and knowledge gaps. Materials and Methods: We will utilize the framework for conducting scoping reviews by Arksey and O'Malley. We will perform the search for articles in 3 electronic databases (i.e., SCOPUS, PubMed, Embase) and relevant gray literature. Only articles in English will be included. There will be no restriction on the publication period. All articles will directly involve either the availability and/or the use of essential opioid analgesics. Studies will be restricted to focus on sub-Saharan Africa. We will use a tailored extraction frame to extract relevant information from published articles that meet our inclusion criteria. We will analyze the data using both descriptive statistics and thematic analysis on the main study questions. Ethics and Dissemination: Since we will not be collecting primary data, formal ethical approval is not required.Our study findings will be disseminated through abstracts, conference presentations, and peer-reviewed publications. Highlights: 50 percent of the poorest in the world reside in countries receiving just 1 percent of all available opioidsThere is a paucity of data analyzing the inequitable distribution of essential opioid analgesics worldwideOur scoping review will identify barriers, themes, and knowledge gaps on the availability and use of essential opioids in SSAIt will identify areas for further research and potential policy initiatives.

Community participation for reproductive, maternal, newborn and child health: insights from the design and implementation of the BornFyne-prenatal management system digital platform in Cameroon.

Introduction: Across communities in low-middle income countries, digital health is currently revolutionizing the delivery of health services, particularly in the field of reproductive, maternal, newborn, and child health (RMNCH) services. While studies have shown the effectiveness of mHealth in delivering RMNCH services, there is little information about factors that enhance mHealth services utilization in low-cost settings including stakeholders' level of influence on the implementation of digital health intervention in sub-Saharan Africa. This paper seeks to describe important lessons on the levels of stakeholders' direct or indirect influence on the design and implementation of the BornFyne-PNMS digital health platform to support RMNCH services. Methods: A participatory research (PR) design approach was employed to explore stakeholders' perspectives of a new initiative, through direct engagement of local priorities and perspectives. The process of introducing the digital application called the BornFyne-PNMS for district health delivery system and the community, and integrating it within the district health delivery system was guided by research-to-action, consistent with the PR approach. To explore stakeholders' perspectives through a PR approach, we conducted a series of stakeholder meetings fashioned after focus group discussions. Results: Issues around male involvement in the program, sensitization and equity concerns arose. Emergent challenges and proposed strategies for implementation from diverse stakeholders evidently enriched the design and implementation process of the project intervention. Stakeholder meetings informed the addition of variables on the mobile application that were otherwise initially omitted, which will further enhance the RMNCH electronic data collection for health information systems strengthening in Cameroon. Discussion: This study charts a direction that is critical in digital health delivery of RMNCH in a rural and low-income community and describes the important iterative stakeholder input throughout the study. The strategy of stakeholders' involvement in the BornFyne PNMS implementation charts a direction for ownership and sustainability in the strengthening of Cameroon's health information system.

The Plight of Female Cameroonian Migrant Sex Workers in N'Djamena, Chad: A Case of Intersectionality.

In most countries, sex-work is criminalized and frowned upon. This leads to human rights abuses, especially for migrant female sex workers. The burden is heavier on migrant female sex-workers whose gender and foreign citizenship intersect to produce a plethora of adverse health, social, and legal outcomes. This phenomenological study explores the intersectionality of individual factors leading to human rights abuses among migrant Cameroonian female sex workers in N'Djamena, Chad. Ten female sex workers and two key-informants were interviewed, and being a small sample, they gave detailed information about their experiences. The data was later analyzed using thematic analysis. Participants narrated experiences of social exclusion, exposure to diverse abuses, and health risks due to gender, immigrant status, and illegality of sex work. The experiences of female migrant sex workers, within contexts of sex work criminalization, are exacerbated by the intersectionality of these factors. Women endure several vulnerabilities in many African countries, more so when they have to survive on sex work as foreigners in a country where the act is illegal.

Burden of vaccine-preventable diseases, trends in vaccine coverage and current challenges in the implementation of the expanded program on immunization: A situation analysis of Cameroon.

The discovery and development of vaccines remain one of the major successes of global health with millions of lives saved every year through routine vaccination. Although vaccines provide a safe and cost-effective solution to vaccine-preventable diseases (VPDs), VPDs are still a serious public health problem in most parts of the world, especially in sub-Saharan Africa (SSA) and Asia. In this review, we discuss the burden of VPDs and vaccine coverage several decades after the introduction of the Expanded Program on Immunization (EPI) in Cameroon. We also discuss how different factors affect the implementation of the EPI, highlighting context-specific factors such as the ongoing civil conflict in Cameroon, and the presence of other infectious diseases like COVID-19.

The Fight against Female Genital Mutilation/Cutting among the Ejaghams of Cameroon: Kinks in the Legal Approach and Implications for Public Health Practice.

Female genital mutilation/cutting (FGM/C) is one of the most prevalent harmful cultural practices against women and girls in many African countries. We identified reasons for the failure of the legal approach to stop FGC practice in the Ejagham region Southwest of Cameroon through multi-locale ethnographic fieldwork. The reasons revolve around the belief that FGM is useful for the reduction of sexual immorality among women, removal of sexual ambiguity and improving genital esthetics, a feministic symbol and cultural identity, and the government's socio-economic neglect of the Ejagham communities; the basis for resistance. Non-legal approaches involving community development and women empowerment have been proposed for fighting FGC.

Utilization of traditional medicine and its integration into the healthcare system in Qokolweni, South Africa; prospects for enhanced universal health coverage.

Despite the WHO providing a framework for the integration of traditional medicines into the health systems with pandemics like HIV/AIDS and the COVID-19, most countries are yet to adopt the recommendations. This study explored why the integration of traditional medicines with the biomedical healthcare system in Qokolweni in Eastern Cape, South Africa was stalling. The research employed qualitative research methods; participant observation and in-depth ethnographic interviews of community members, traditional healers, and nurses. The study found that: traditional medicines are widely used in Qokolweni due to accessibility and long-built trust; the practice is broad and not certified. To achieve the integration of traditional medicine into the conventional health systems, the central government needs to show political will by setting up regulatory strategies that provide for the scientific evaluation and certification of traditional medicines. This will build confidence among biomedical scientists and health practitioners, thereby fostering easy collaboration and integration.

Armed conflict, a neglected determinant of childhood vaccination: some children are left behind.

Vaccination is an indisputable intervention that has tremendously mitigated the global burden of vaccine-preventable diseases (VPDs). The number of armed conflicts globally seems to be at an all-time high, with devastating effects on vaccination coverage. This paper will examine how armed conflicts affect childhood vaccination and lead to the reemergence and spread of VPDs. Unarguably, socioeconomic factors, population demographics, the apparent long vaccination timetable, multiple vaccine doses, lack of trust in vaccination processes and the rumor of the adverse effects of some vaccines unnerve some parents and create a puzzle. By bringing under the global floodlight, the impact of armed conflicts which contextually affect vaccination coverage, this article will help strengthen the advocacy for vaccination, and call for the fortification of existing treaties on the rule of engagement during conflicts. In order to eliminate or eradicate VPDs, strategies to reach children that are left behind during conflicts is paramount.