Protecting small and sick newborn care in the COVID-19 pandemic: multi-stakeholder qualitative data from four African countries with NEST360.

BACKGROUND: Health system shocks are increasing. The COVID-19 pandemic resulted in global disruptions to health systems, including maternal and newborn healthcare seeking and provision. Yet evidence on mitigation strategies to protect newborn service delivery is limited. We sought to understand what mitigation strategies were employed to protect small and sick newborn care (SSNC) across 65 facilities Kenya, Malawi, Nigeria and Tanzania, implementing with the NEST360 Alliance, and if any could be maintained post-pandemic. METHODS: We used qualitative methods (in-depth interviews n=132, focus group discussions n=15) with purposively sampled neonatal health systems actors in Kenya, Malawi, Nigeria and Tanzania. Data were collected from September 2021 - August 2022. Topic guides were co-developed with key stakeholders and used to gain a detailed understanding of approaches to protect SSNC during the COVID-19 pandemic. Questions explored policy development, collaboration and investments, organisation of care, human resources, and technology and device innovations. Interviews were conducted by experienced qualitative researchers and data were collected until saturation was reached. Interviews were digitally recorded and transcribed verbatim. A common coding framework was developed, and data were coded via NVivo and analysed using a thematic framework approach. FINDINGS: We identified two pathways via which SSNC was strengthened. The first pathway, COVID-19 specific responses with secondary benefit to SSNC included: rapid policy development and adaptation, new and collaborative funding partnerships, improved oxygen systems, strengthened infection prevention and control practices. The second pathway, health system mitigation strategies during the pandemic, included: enhanced information systems, human resource adaptations, service delivery innovations, e.g., telemedicine, community engagement and more emphasis on planned preventive maintenance of devices. Chronic system weaknesses were also identified that limited the sustainability and institutionalisation of actions to protect SSNC. CONCLUSION: Innovations to protect SSNC in response to the COVID-19 pandemic should be maintained to support resilience and high-quality routine SSNC delivery. In particular, allocation of resources to sustain high quality and resilient care practices and address remaining gaps for SSNC is critical.

Toward Strengthening the Capacity of the Health System: A Cross-Sectional Study of Factors Predicting Quality of Life in 545 Nigerian Children Exposed to Sexual Abuse.

In Nigeria, the predictors of quality of life among children exposed to sexual abuse are unknown. Addressing this gap may strengthen the capacity of the health system to care for this population. Thus, this cross-sectional study selected 545 (mean age = 14.4 ± 1.4 years) Nigerian children exposed to sexual abuse. Results show that self-compassion, resilience, and meaning in life jointly predicted quality of life and explained 39% variance. The independent prediction of each predictor variable shows that self-compassion, resilience, and meaning in life have significant independent predictions, with self-compassion showing the greatest independent prediction, followed by resilience and meaning in life. Sex, age, and how long ago respondents were exposed to sexual abuse jointly predicted quality of life and explained 6% variance. However, how long ago respondents were exposed to sexual abuse shows a significant independent prediction. Results offer clinical implications that may strengthen the capacity of the health system to care for this population.

Black People Narrate Inequalities in Healthcare Systems that Hinder COVID-19 Vaccination: Evidence from the USA and the UK.

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented global health emergency. As a novel condition, there is no known definitive treatment for the condition, except for the use of vaccines as a control measure. In the literature, the issue of inequalities in healthcare systems has been documented as a hindrance to COVID-19 vaccination; however, the specific inequalities in healthcare systems that hinder COVID-19 vaccination are poorly understood. Guided by the fundamental cause theory (FCT), this study aims to address this gap among Black people, a minority group vulnerable to inequalities in healthcare systems. Thirty-five Black people (age range = 21-58 years) residing in either the United States of America (USA) or the United Kingdom (UK) participated in this study. Qualitative data were collected and analyzed using thematic analysis. Most USA participants and a few UK participants narrated that no inequalities in healthcare systems hinder them from receiving COVID-19 vaccines. Contrarily, most UK participants and a few USA participants narrated inequalities in healthcare systems that hinder them from receiving COVID-19 vaccines. These are mistrust of the healthcare system, health policies regarding COVID-19 vaccination, historical factors (such as historical abuse of Black bodies by health professionals), residential location, and dissatisfaction with health services. In terms of what governments must do to correct these inequalities, participants recommended the need for acknowledgment and community engagement. This is the first international collaboration to examine this problem. Important implications for theory, healthcare systems, and COVID-19 vaccination program planning are highlighted. Finally, there are members of other minority groups and vulnerable communities who are not Black people. Such groups could face unique inequalities that hinder COVID-19 vaccination. Therefore, future studies should include such groups.

Seeking Professional Help for Mental Illness: A Mixed-Methods Study of Black Family Members in the UK and Nigeria.

Seeking professional help for mental illness is a limited practice among Black family members in low and middle socioeconomic groups in the United Kingdom (UK) and Nigeria. Guided by the theory of planned behavior, we explored some factors restricting professional help-seeking practices among the target groups. This mixed-methods study recruited a heterogeneous sample of 105 ( ranging from 19-64 years) UK and Nigerian Black family members in low or middle socioeconomic groups. Data were collected using a standardized questionnaire and open-ended questions. Collected data were analyzed using IBM SPSS statistics (version 22.0) and thematic analysis. There was no statistically significant difference in professional help-seeking behavior among the UK and Nigerian Black family members in low and middle socioeconomic groups [F (3, 83) = 1.13; p > .05]. The qualitative data analysis revealed that respondents were limited from professional help-seeking due to high consultation fees to see a mental health professional, perceived accessibility to mental health services within their various locations, stigmatization and socio-cultural factors (such as, "The perception that a man should be strong" or "Mental health isn't as important as physical health"), concerns about the safety of information shared during professional help-seeking or therapy sessions, poor knowledge about mental health services, long waiting time to see a professional in face-to-face therapy, and risk of contracting the infectious disease in the hospital setting. Implications of findings for theory and practice and direction for future research are thus discussed.

Underlying factors in the willingness to receive and barriers to receiving the COVID-19 vaccine among residents in the UK and Nigeria: a qualitative study.

Qualitative data on the factors underlying the willingness to receive and barriers to receiving the COVID-19 vaccine were scant in the literature. Therefore, the authors employed a qualitative design with a heterogeneous sample of 60 residents (age range = 18-79 years) in the UK and Nigeria to explore the factors underlying their willingness to receive and barriers to receiving the COVID-19 vaccine. The thematic analysis was employed to analyze data. The results revealed that only a small number of the participants had received the COVID-19 vaccine; they experienced soreness and itchiness, and their motive for receiving the vaccine was its availability. The participants who had not received the vaccine reported the following as determinants of their willingness to receive the vaccine: "concerns about the side/adverse effect", "the perceived benefit of receiving the vaccine", "mistrust (in the pharmaceutical companies that produced the vaccine, the vaccine itself, or governments)", "the need for clarity of information on the vaccine", and "moral obligation to receive the vaccine". The participants who had not received the vaccine further reported the following as other barriers that limit them from receiving the vaccine: "unavailability of the vaccine in the country of residence", "non-membership to a high-risk group", and "membership to a minority group". In terms of what governments can do to encourage public uptake of the vaccine, many participants reported: "provide clear information on the COVID-19 vaccine", "endorsement by public figures", "make the vaccine free to receive", "introduce rewards and punishments", and "honesty from governments". Implications for practice are highlighted.

Gender Differences in Children's Exposure to Domestic Violence in Nigeria.

Children's exposure to domestic violence (DV) remains an understudied problem in African society at present, particularly in Nigeria. This study examined gender differences in children's exposure to domestic violence based on identified gaps in the literature. Through a cross-sectional research design, data were gathered from 280 Nigerian children with a mean age of 14.14 ± 2.36. Data were collected using a standardized questionnaire. The independent sample t-test was utilized for hypothesis testing, with statistical significance set at p < .05. Although female participants scored a slightly higher mean score, there was no significant gender difference in children's exposure to domestic violence [t (278) = .67; p > .05]. The authors conclude that there was no statistically significant gender difference in children's exposure to domestic violence; however, this research informs further exploration into other variables that may affect children's exposure to domestic violence.

Coping strategies of individuals in the United Kingdom during the COVID-19 pandemic.

The United Kingdom (UK) was among the hardest-hit by the COVID-19 pandemic. It is, therefore, imperative to understand the coping strategies of individuals in the UK during the pandemic to develop appropriate programs and policies for them. A heterogeneous sample of 50 UK residents (15 males & 35 females) with an age range of 18-55 years were recruited using a snowball technique from Facebook between April and May 2020. Participants responded to 4 open-ended questions (that were generated through consultation with literature and 2 health practitioners) that sought to explore their coping strategies during the COVID-19 pandemic. Thematic analysis was applied to analyze data using a data-driven method. Eleven themes were found: "socializing with loved ones (e.g., through video calls)", "engaging in exercise", "being occupied with jobs", "being occupied with studies", "avoiding negative news on COVID-19", "consumption of alcohol", "healthy eating", "engaging in meditation activities", "gaming activities", "hope", and "self-care and self-appreciation", in that order. Positive and maladaptive coping strategies were employed by some individuals in the UK during the COVID-19 pandemic. This, therefore, echoes the need for appropriate psychosocial support programs that strengthen positive coping strategies and mitigate maladaptive coping strategies during the COVID-19 pandemic.

Mental health and coping strategies during the COVID-19 pandemic: A qualitative study of unemployed and employed people in Nigeria.

The coronavirus disease 2019 (COVID-19) significantly disrupted human activities all over the world. Despite this, little or nothing is known about mental health and coping strategies during the COVID-19 pandemic among the unemployed and employed people in Nigeria. Therefore, this study was an effort towards bridging this knowledge gap. We employed a qualitative design with 66 participants (age range = 18-62 years) who described how the COVID-19 pandemic affected their mental health and how they coped during the COVID-19 pandemic. The data were analyzed using thematic analysis. Our findings revealed distressing impacts (e.g., depressive and anxious impacts, stress, loss of job, financial challenges, loneliness, etc.) for the unemployed and employed groups. Further, the unemployed group utilized more positive coping strategies (e.g., engaging in activities, hope, relaxation, connecting with others, etc.) than the employed group; whereas, only the employed group utilized a maladaptive coping strategy (alcohol consumption). These data have practical implications for protecting mental health and fostering positive coping in these groups during and beyond the COVID-19 pandemic.

Experiences and predictors of psychological distress in pregnant women living with HIV.

OBJECTIVES: To explore the experiences and predictors of psychological distress in pregnant women living with HIV. DESIGN: A mixed-methods research design. METHODS: A representative randomly sampled 840 (age range 22-46 years) HIV-positive pregnant women in Akwa Ibom, Benue, and Rivers States of Nigeria enrolled for the study. Data were collected using standardized questionnaires and in-depth interviews for 4 months and 3 weeks in 6 HIV treatment centres. Collected data were analysed using IBM SPSS statistics (v. 22.0) and thematic analysis. RESULTS: The mean score on psychological distress was 17.07 ± 5.86. Multiple regression analysis found a significant joint prediction of meaning in life, self-compassion, and acceptance of illness on psychological distress, R = .64, R2  = .41; F (3,828) = 186.18; p = .000, with 41% variance explained. Further, there was a significant independent prediction of each predictor at meaning in life (ß = -.19, t = -5.08; p = .000), self-compassion (ß = -.23, t = -5.59; p = .000), and acceptance of illness (ß = -.30, t = -7.23; p = .000), with acceptance of illness exerting the greatest independent predictive impact. Socio-demographic variables (age, length of living with HIV, high-risk state, highest education attained, marital status, and religious affiliation) had no significant contribution to psychological distress. Qualitative analysis found 'anxious concerns', 'depressive reports, loneliness, and regrets', 'self-blame and guilt feelings', as the experiences of psychological distress, and these experiences were determined by respondents' socio-cultural contexts. CONCLUSION: These findings emphasize the importance of psychosocial care for HIV-positive pregnant women.