African migrant women acquisition of clay for ingestion during pregnancy in London: a call for action.

OBJECTIVES: This study aimed to explore how African migrant women go about acquiring clay for ingestion during pregnancy in London against a backdrop of restrictions and warnings by the Food Standard Agency and Public Health England due to the potential health risks to expectant mothers and their unborn babies. STUDY DESIGN: This was a qualitative study using an interpretative phenomenological approach. METHODS: Individual in-depth interviews and a focus group discussion were used for data collection. Data collection took place between May and August 2020. RESULTS: Participants acquired clay from African shops and markets in London, countries of origin and online/social media platforms. Due to official restrictions and warnings, transactions were conducted under the counter based on trust between sellers and the women underpinned by shared community identities. However, clay was acquired, social networks emerged as crucial facilitators. The current top-down approach, which is also lacking a regulatory policy framework, has pushed clay transactions underground, thereby leaving pregnant women potentially ingesting toxic clay with little chances of dictation by authorities. CONCLUSION: We call on the UK Health Security Agency (UKHSA) and public health practitioners to collaborate with communities to design multilevel/multisectoral interventions as well as the Food Standards Agency (FSA) to consider an appropriate regulatory policy framework.

Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries.

BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution.CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.

Air pollution interventions and respiratory health: a systematic review.

BACKGROUND: Indoor and ambient air pollution exposure is a major risk to respiratory health worldwide, particularly in low- and middle-income countries (LMICs). Interventional trials have mainly focused on alternatives to cooking stoves, with mixed results. Beyond cooking, additional sources of particulate matter also contribute to the burden of air pollution exposure. This review explores evidence from current randomised controlled trials (RCTs) on the clinical effectiveness of interventions to reduce particulate matter in LMICs.METHODS: Twelve databases and the grey literature (e.g., Government reports and policy papers) were searched. Eligible studies were RCTs conducted in LMICs aiming to reduce particulate exposure from any source and reporting on at least one clinical respiratory outcome (respiratory symptoms, lung function or clinical diagnoses). Data from relevant studies were systematically extracted, the risk of bias assessed and narrative synthesis provided.RESULTS: Of the 14 included studies, 12 tested 'improved' cookstoves, most using biomass, but solar and bioethanol cookers were also included. One trial used solar lamps and another was an integrated intervention incorporating behavioural and environmental components for the treatment and prevention of chronic obstructive pulmonary disease. Of the six studies reporting child pneumonia outcomes, none demonstrated significant benefit in intention-to-treat analysis. Ten studies reported respiratory symptom outcomes with some improvements seen, but self-reporting made these outcomes highly vulnerable to bias. Substantial inter-study clinical and methodological heterogeneity precluded calculation of pooled effect estimates.CONCLUSION: Evidence from the RCTs performed to date suggests that individual household-level interventions for air pollution exposure reduction have limited benefits for respiratory health. More comprehensive approaches to air pollution exposure reduction must be developed so their potential health benefits can be assessed.

A disease called stigma: the experience of stigma among African men with TB diagnosis in London.

OBJECTIVES: Tuberculosis (TB) is a highly stigmatised disease. This paper sought to explore the experiences and meanings of stigma among African men with a previous TB diagnosis. STUDY DESIGN: Qualitative approach with ten men recruited from a community based organisation offering health support to the men. METHODS: In-depth semi-structured interviews. RESULTS: Men were unable to recognise TB symptoms and subsequently made late clinical presentation when they were also diagnosed with HIV. A few were diagnosed when in immigration detention centres. The experience of late diagnosis informed their understanding of the word stigma. The link between HIV and TB compounded experiences of stigma which led to depression and compromised HIV confidentiality. CONCLUSION: TB late diagnosis among the men has implications for population health. Multidisciplinary teams supporting ongoing TB education programmes should include African men's organisations, due to the close supportive links such organisations have with African men.

Factors that affect the food choices made by girls and young women, from minority ethnic groups, living in the UK.

BACKGROUND: Lower birth weight, often found in infants from minority ethnic groups, may be partly because of the disproportionate representation of ethnic minority groups in low-income areas. To develop an intervention, to improve the nutritional intake of young women from populations at risk of low-birth-weight babies, which would be culturally sensitive and well received by the intended recipients, a community development approach was used to investigate factors that might influence food choice and the nutritional intake of girls and young women from ethnic minority groups. METHODS: Focus group discussions were conducted across the UK, to explore factors that might affect the food choices of girls and young women of African and South Asian decent. The data was analysed using deductive content analysis (Qual. Soc. Res., 1, 2000, 1). Discussions were around the broad themes of buying and preparing food, eating food and dietary changes, and ideas for an intervention to improve diet. RESULTS: The focus group discussions indicated that all the communities took time, price, health and availability into consideration when making food purchases. The groups were also quite similar in their use of 'Western' foods which tended to be of the fast food variety. These foods were used when there was not enough time to prepare a 'traditional' meal. CONCLUSION: Many issues that affect the food choice of people who move to the UK are common within different ethnic groups. The idea of a practical intervention based on improving cooking skills was popular with all the groups.

HIV testing and high risk sexual behaviour among London's migrant African communities: a participatory research study.

OBJECTIVES: To describe the demographic and behavioural factors associated with HIV testing among migrant Africans in London. METHODS: A cross sectional survey of migrants from five sub-Saharan African communities (Congo, Kenya, Uganda, Zambia, Zimbabwe) resident in London was carried out. The study formed part of a larger community based participatory research initiative with migrant African communities in London-the MAYISHA project. Trained, ethnically matched interviewers recruited study participants in a variety of community venues. A brief self completion questionnaire collected data on demographic characteristics, utilisation of sexual health services, HIV testing history, sexual behaviour, and attitudes. RESULTS: Valid questionnaires were obtained from 748 participants (396 men and 352 women), median ages 31 and 27 years, respectively. Median length of UK residence was 6 years. 34% of men and 30% of women reported ever having had an HIV test. HIV testing was significantly associated with age and previous STI diagnosis among women; and additionally, nationality, education, employment, and self perceived risk of acquiring HIV among men. After controlling for significant demographic variables, previous diagnosis of an STI (adjusted odds ratio and 95% confidence interval for men: 2.96, 1.63 to 5.38, and women 2.03, 1.06 to 3.88) and perceived risk of acquiring HIV for men (adjusted OR 2.28, 95%CI 1.34 to 3.90) remained independently associated. CONCLUSION: Among these high HIV prevalence migrant communities, these data suggest that HIV testing remains largely associated with an individual's STI history or self perceived risk. This strategy may be inappropriate given the potential for onward and vertical transmission. Antenatal HIV testing combined with proactive targeted HIV testing promotion should be prioritised.

HIV transmission risk among sub-Saharan Africans in London travelling to their countries of origin.

Migrant black African communities bear the brunt of heterosexual HIV/AIDS epidemic in the UK. This study confirms the close links that exist between UK resident black Africans and their countries of origin. A total of 43% of men and 46% of women visited their home countries within the last five years. While there, men were more likely than women to have acquired a new sexual partner. Previous diagnosis with a sexually transmitted disease, and the use of condoms at last intercourse were independently associated with this practice. This represents a potential risk of HIV transmission, and highlights an area for targeted health promotion within these communities.