Decolonizing a Wretched Healthcare System: The African Public Health Practitioner Case.

Introduction: Over the past two years, public health practitioners in African countries have worked actively to combat the Coronavirus Disease 2019 (COVID-19) pandemic with relatively low fatality rates. This pandemic has forced healthcare professionals to re-think and redesign the healthcare system within their own country. Methods: Using the Afrocentric PEN-3 framework and a letter style, the purpose of this commentary was to describe the positive, existential, and negative socio-cultural values associated with African healthcare systems. The commentary also highlights socio-cultural factors affecting public trust in African healthcare systems and their health agencies and how systematically decolonizing them may decrease foreign reliance and empower efficient locally based solutions. Results: We, as African public health practitioners, make three key points in this commentary. First, African public health practitioners have developed resilience within under-resourced healthcare systems. Secondly, oral tradition in African societies and its byproduct (social media) is the means through which people connect and share what they know about any topics (COVID-19). Thirdly, African leaders have particularly contributed to the high level of distrust in their countries' healthcare systems in favor of the healthcare systems of industrialized countries. Conclusion: This commentary concludes with implications for encouraging African public health practitioners to cultivate the resilience that has led to contributing to the wellness of millions of Africans during this COVID-19 pandemic.

Addressing Stroke Literacy in Nigeria Through Music: A Qualitative Study of Community Perspectives.

BACKGROUND: The incidence of stroke in Nigeria is unknown, but stroke literacy, defined here as awareness of stroke warning symptoms and risk factors may be poor in high-risk communities. Although there is growing recognition of the use of music as a conduit to promote health literacy, African music is often overlooked as a source of health information. We sought to understand community-level perspectives on using African music to promote acute stroke literacy. METHODS: A purposive sample of education, health and music professionals, high school and university students were recruited to participate in the qualitative study. Study participants completed a brainstorming exercise that elicited their perceptions of potential barriers and facilitators to the use of music to promote acute stroke literacy in Nigeria. Content analysis was used to identify key themes emerging from the brainstorming exercise. RESULTS: A total of 44 individuals, comprising of 25 students with a mean age of 15.9 ± 1.6 years (52% females) and 19 professionals with a mean age of 39 ± 7.7 years (57.9% males) participated in the brainstorming exercise. Facilitators to the use of music to promote acute stroke literacy in Nigeria include the cultural relevance of music, the ubiquity of music, and government involvement. Key barriers include religious beliefs that discourage the use of "secular" music, cost-related barriers, and limited government support. CONCLUSIONS: Findings from this study provide guidance aimed at improving acute stroke literacy in Nigeria, particularly the importance of government involvement in the development and implementation of stroke literacy interventions guided by African music. Future work should consider implementing interventions that leverage the cultural elements of African music and further assess the extent to which these identified facilitators and/or barriers may influence stroke literacy.

Differences in Breast and Cervical Cancer Screening Among U.S. Women by Nativity and Family History.

INTRODUCTION: System-level factors such as poor access to health services can help explain differential uptake in breast and cervical cancer screening between U.S.- and foreign-born women. However, few studies have explored the roles of family history and perceived risk of these cancers on screening rates. To address these gaps, this study investigates whether a family history of cancer, perceived risk, and system-level factors independently and additively predict differential screening rates of breast and cervical cancer between U.S.-born and foreign-born women living in the U.S. METHODS: Data were analyzed in 2019 from the 2015 National Health Interview Survey. Descriptive and multivariable logistic regression modeling was performed to test whether there were differences in breast and cervical cancer screening within and between the 2 groups and whether family history of cancer and perceived risk of breast cancer were predictors of uptake. RESULTS: The sample comprised women aged 21-74 years (n=14,047). The mean age of the sample was 45.5 (SD=14.8 years). The majority of the women were U.S.-born (77.5%). U.S.- and foreign-born women had more mammograms and Pap tests with a usual source of care (p<0.001) and insurance (p<0.001). Healthcare access and utilization factors were also predictive for both groups of women. Data analyses were conducted in 2019. CONCLUSIONS: These findings are consistent with previous work. Access and healthcare utilization were associated with screening uptake. However, differences in risk perception, family history of breast and cervical cancers, and screening uptake were found between U.S.- and foreign-born women.

Public trust in the time of the Coronavirus Disease 2019 (COVID-19): the case of the DR Congo.

Over the past half century, the Democratic Republic of the Congo (DRC), a low-income and post-conflict country, has experienced several Ebola Virus Disease outbreaks, with different fatality rates. The DRC is currently experiencing the Coronavirus Disease 2019 (COVID-19) pandemic. Using the PEN-3 cultural model, we assessed the socio-cultural factors affecting public trust in the government and its health agencies. Results of this analysis revealed the perceptions, enablers, and nurturers that impacted public trust in the government and its health agencies among the Congolese population. Future interventions designed to address the COVID-19 in the DRC should account for these socio-cultural factors.

Socio-Structural Factors Influencing the Prevention of Mother-to-Child Transmission of HIV in the Democratic Republic of the Congo: A Systematic Review.

Introduction The Democratic Republic of the Congo (DRC) had the second-highest mother-to-child HIV transmission rate in Sub-Saharan Africa at 29% in 2013, however the uptake of preventive services for mother-to-child transmission of HIV (PMTCT) remains suboptimal. This systematic review explores socio-cultural and structural factors influencing PMTCT service uptake in the DRC. Methods We conducted a search of electronic databases. The PEN-3 model was used as a framework to synthesize factors influencing PMTCT service uptake into perceptions, enablers, and nurturers. Results Sixteen studies, 14 quantitative and two qualitative, were retained. Maternal, socio-economic, structural, and cultural factors were found to influence PMTCT service uptake in the DRC. Cost, accessibility, and quality of PMTCT services were key barriers to service uptake. Integration, male partner involvement, and evolving PMTCT policies improved PMTCT service delivery and uptake. This review also revealed several socio-cultural challenges in involving male partners in PMTCT programs. Discussion Findings highlight the need to address barriers and reinforce enablers of PMTCT uptake. Creating culturally appropriate, male-friendly, and family-oriented PMTCT programs will improve service uptake in the DRC.

HIV serostatus disclosure in the Democratic Republic of the Congo: a systematic review.

HIV status disclosure among people living with HIV/AIDS has been shown to have a number of both personal and public health benefits, but rates of HIV status disclosure remain low in many African countries, including the Democratic Republic of the Congo (DRC). This systematic review uses the Disclosure Process Model to examine the factors involved in serostatus disclosure and nondisclosure to various persons in the lives of people living with HIV/AIDS (PLWHA) in the DRC, as well as the specific outcomes of their disclosure or nondisclosure. MEDLINE/PubMed, Embase, Web of Science, Global Health, and PsycINFO were searched and research studies were included if: (i) the study discussed disclosure of HIV status; (ii) the study population included HIV-infected people in DRC; and (iii) the study was published in English. Fourteen articles met the inclusion criteria and were included in the study. Factors contributing to nondisclosure were generally associated with high stigma of HIV in adults and concern for emotional wellbeing when disclosing to HIV positive minors. Factors contributing to disclosure among adults were increased social support and religion. In disclosing to HIV positive minors, increasing age and health benefits were identified as approach goals that supported disclosure. The findings highlight the importance of understanding the avoidance and approach goals involved in HIV status disclosure among populations living in the DRC. Interventions and future research directed at increasing HIV disclosure among Congolese PLWHA should move beyond individual-level to consider multilevel factors including circumstantial social behaviors.

Dance and Hometown Associations are Promising Strategies to Improve Physical Activity Participation Among US Nigerian Transnational Immigrants.

OBJECTIVE: Lack of physical activity participation has been identified as a determinant for negative health outcomes across various ethnicities worldwide and within the USA. We investigated the perceptions of the prospects of promoting dancing within hometown associations as a form for improving physical activity participation for Nigerian Transnational Immigrants (NTIs) in the USA: a migrant cohort subset of individuals who maintain cross-border ties with their indigenous communities of origin. METHOD: Using PEN-3 cultural model, we conducted semi-structured interviews with 24 transnational African migrants (11 males and 13 females) living in Chicago to explore culturally sensitive strategies to promote physical activity participation among our target population. RESULTS: The findings revealed positive perceptions related to dancing that might help to promote physical activity (PA) among NTI, existential or unique perceptions related to Nigerian parties that may also play a role with PA promotion, and negative perception in the form of limited discussions about PA in Nigerian hometown associations in the USA. CONCLUSION: Results from this study highlight the need for further investigation on culturally sensitive strategies to improve physical activity and participation in diverse Black immigrant populations, specifically in the form of cultural dance and activities such as parties in which this population frequently participate in. Furthermore, hometown associations may also serve as a platform for the implementation of PA programs due to its large reach to a rather covert group.

Understanding Transnational African Migrants' Perspectives of Dietary Behavior.

OBJECTIVE: Dietary behaviors serve as determinants for chronic diseases such as hypertension across various ethnicities worldwide and within the USA. We investigated dietary perspectives specifically for US transnational African migrants, a migrant cohort subset of individuals who maintain cross-border ties with their indigenous communities of origin. METHOD: Using PEN-3 model, focus group interviews with 14 transnational African migrants (seven males and seven females) were conducted in Chicago to explore the perceptions of dietary behavior in regard to chronic disease risk factors among our target population. RESULTS: The findings underscore that transnational African migrants maintain strong ties with their African community of origin, impacting dietary behaviors and attitudes. Further, transnational African migrants maintain traditional dishes through their connections. Despite the ability to import African traditional foods through personal connections, African migrants face a challenge in maintaining culture yet conforming to norms of acculturation. CONCLUSION: Results from this study serve to advocate for further exploration of the interaction between African migrant dietary behaviors and risk factors to chronic diseases.