Demographic dividend-favorable policy environment in two pre-dividend African nations: review of national policies and prospects for policy amendments in Nigeria and Tanzania.

BACKGROUND: In collaboration with local partners, we reviewed 18 national policy documents across two sub-Saharan African countries identified as pre-dividend nations by the World Bank in 2017: Nigeria and Tanzania. Our aim was to assess national policies in pre-dividend countries and to determine whether national strategies were primed to capitalize on changing demographic structures, maximally attain the demographic dividend, and augment socio-economic growth. METHODS: We conducted policy reviews by focusing on five key sectors of the Gates Institute Demographic Dividend Framework: Family Planning, Maternal and Child Health, Education, Women's Empowerment, and Labor Market. This framework was developed as a tool for countries to apply targeted policies for accelerating the demographic dividend based on their demographic structure. For each component we used a comprehensive list of indicators, defined via a systematic literature review, through which we assessed national policies aimed at maximizing the demographic dividend. RESULTS: Between the two countries, we observed persistent gaps in policies targeting family planning. Although more comprehensive, policies addressing maternal and child health, education, women's empowerment, and labor market still lagged in their specificity and measurability. We identified specific policy amendments and alternatives that Nigeria and Tanzania could consider to mitigate these gaps. We also stress the importance of designing measurable policy initiatives across sectors. CONCLUSIONS: Based on these recommendations, as Nigeria, Tanzania, and other pre-dividend nations start experiencing rapid demographic changes, they may consider implementing routine policy reviews to strengthen policies across the five key sectors and harness the benefits of a demographic dividend.

Implementation of 100% smoke-free law in Uganda: a qualitative study exploring civil society's perspective.

BACKGROUND: In 2016, Uganda became one of few sub-Saharan African countries to implement comprehensive national smoke-free legislation. Since the World Health Organisation recommends Civil Society Organisation's (CSO) involvement to support compliance with smoke-free laws, we explored CSOs' perceptions of law implementation in Kampala, Uganda, and the challenges and opportunities for achieving compliance. Since hospitality workers tend to have the greatest level of exposure to second-hand smoke, we focussed on implementation in respect to hospitality venues (bars/pubs and restaurants). METHODS: In August 2016, three months after law implementation, we invited key Kampala-based CSOs to participate in face-to-face semi-structured interviews. Interviews probed participants' perceptions about law implementation, barriers impeding compliance, opportunities to enhance compliance, and the role of CSOs in supporting law implementation. Interviews were recorded and transcribed. Qualitative content analysis was conducted using the interview transcripts. RESULTS: Fourteen individuals, comprising mainly senior managers from CSOs, participated and reported poor compliance with the smoke-free law in hospitality venues. Respondents noted that contributing factors included low awareness of the law amongst the general public and hospitality staff, limited implementation activities due to scarce resources and lack of coordinated enforcement. Opportunities for improving compliance included capacity building for enforcement agency staff, routine monitoring, rigorous enactment of penalties, and education about the smoke-free law aimed at hospitality venue staff and the general public. Allegations of tobacco industry misinformation were said to have undermined compliance. Civil Society Organisations saw their role as supporting law implementation through education, stakeholder engagement, and evidence-based advocacy. CONCLUSIONS: This study suggests that the process of smoke-free law implementation in Uganda has not aligned with World Health Organisation (WHO) guidelines for implementing smoke-free laws, and highlights that low-income countries may need additional support to enable them to effectively plan for policy implementation and resist industry interference.

Development of the Demographic Dividend Effort Index, a novel tool to measure existing efforts to create a favourable environment to harness a demographic dividend: results from an experts' survey from six sub-Saharan African countries.

OBJECTIVE: This study aimed to develop a tool to measure the extent of national efforts in policies, services, research and programmes implemented to cultivate and harness the benefits of a potential demographic dividend in six sub-Saharan African countries. DESIGN: The survey was self-administered online using the SurveyMonkey platform. The survey questionnaire covered six key sectors: family planning, maternal and child health, education, women's empowerment, labour market, and governance and economic institution. Each sector-specific questionnaire was structured around five practice domains: policymaking, services and programmes, advocacy, research and civil society. Each item was scored from 1 to 10. Factor analysis was used to select the items to be retained for final score estimation. Simple averages were computed to estimate sectoral and domain scores and overall country scores were estimated using weighted country mean scores. Internal consistency, construct validity and reliability were examined using factor analysis and Cronbach's alpha. SETTING: Sub-Saharan Africa. PARTICIPANTS: A total of 440 knowledgeable informants from six countries; namely, Ethiopia (73), Kenya (69), Nigeria (67), Rwanda (54), Senegal (81) and Tanzania (96). RESULTS: Based on the results from factor analysis, 38 items were dropped from the analysis and Cronbach's alpha results ranged from 0.84 to 0.98 across domains. The overall demographic dividend effort index (DDEI) scores ranged between 5.4 (95% CI 5.1 to 5.8) in Ethiopia to 7.7 (95% CI 7.5 to 8.0) in Rwanda. In most countries, the disaggregated scores by sector revealed low scores in the labour market and women's empowerment. CONCLUSION: The DDEI scores highlight important gaps in key health and development sectors. The DDEI proved to be a reliable and internally consistent tool for effort measurement in key demographic dividend sectors. The DDEI can serve as a self-evaluation tool for local actors and may complement existing quantitative tools such as the Global Gender Gap and the Human Capital Index.

Challenges in Access and Utilization of Sexual and Reproductive Health Services Among Youth During the COVID-19 Pandemic Lockdown in Uganda: An Online Cross-Sectional Survey.

Introduction: Sexual and Reproductive Health access to Information services is still a pressing need for youth in Uganda even during the COVID-19 pandemic, which has disrupted health care access in many countries. The aim of this study was to explore the challenges in access and utilization of sexual and reproductive health services as faced by youth during the COVID-19 pandemic lockdown in Uganda. Methods: This was a cross-sectional study carried out from 28th April 2020 to 11th May 2020 in Uganda. An online questionnaire was disseminated to youth aged between 18 and 30 years over a period of 14 days. The snowball sampling method was used to recruit participants. STATA version 14.2 was used for statistical analysis. Results: Of 724 participants, 203 (28%) reported that they did not have access to information and/or education concerning sexual and reproductive health (SRH). More than a quarter of the participants (26.9%, n = 195) reported that testing and treatment services of sexually transmitted infections were not available during the lockdown, and 27.2% could not obtain contraceptive supplies. Access to HIV/AIDS care services and menstrual supplies was also impaired. Lack of transportation was the commonest factor cited as limiting access to SRH services during the lockdown (68.7%), followed by the long distance from home to SRH facilities (55.2%), high cost of services (42.2%) and the curfew (39.1%). Sexually transmitted infections were the commonest SRH problems related to SRH during the lockdown (40.4%) followed by unwanted pregnancy (32.4%) and sexual abuse (32.4%). Marital, educational, and employment status were significantly correlated with the reported experiences of the participants. Conclusion: Access to SRH information and services for Ugandan youth was restricted during the COVID-19 lockdown and leaving them vulnerable to various SRH risks and adverse outcomes. Lack of transportation, long distances to health facilities, and high cost of services were important limiting factors. The Government and other stakeholders should incorporate SRH among the priority services to be preserved during future outbreaks.

Generating and capitalizing on the demographic dividend potential in sub-Saharan Africa: a conceptual framework from a systematic literature review.

Background: Africa will double its population by 2050 and more than half will be below age 25. The continent has a unique opportunity to boost its socioeconomic welfare. This systematic literature review aims to develop a conceptual framework that identifies policies and programs that have provided a favorable environment for generating and harnessing a demographic dividend. This framework can facilitate sub-Saharan African countries' understanding of needed actions to accelerate their demographic transition and capitalize on their demographic dividend potential. Methods: The search strategy was structured around three concepts: economic development, fertility, and sub-Saharan Africa. Databases used included PubMed and EconLit. An inductive approach was employed to expand the reference base further. Data were extracted using literature records following a checklist of items to include when reporting a systematic review suggested in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: The final review consisted of 78 peer-reviewed articles, ten reports from the gray literature, and one book. Data were categorized according to relevant demographic dividend typology: pre-dividend and early-dividend. The results from the literature review were synthesized into a framework consisting of five sectors for pre-dividend countries, namely 1) Governance and Economic Institutions, 2) Family Planning, 3) Maternal and Child Health, 4) Education, and 5) Women's Empowerment. An additional sector, 6) Labor Market, is added for early-dividend countries. These sectors must work together to attain a demographic dividend. Conclusions: A country's demographic transition stage must guide policy and programs. Most sub-Saharan African countries have prioritized job creation and employment for youth, yet their efforts to secure a productive labor market require preliminary and complementary investments in governance, family planning, maternal and child health, education, and women's empowerment. Creating a favorable policy environment for generating and capitalizing on a demographic dividend can support their stated goals for development.

Family planning science and practice lessons from the 2018 International Conference on Family Planning.

Background Since 2009, the International Conference on Family Planning (ICFP) has served as an opportunity for the global reproductive health community to share FP advances and practice lessons in the areas of research, programming, and advocacy. The purpose of this paper was to synthesize the key results and findings presented by members of the FP community at the 2018 ICFP Conference. Methods More than 700 abstracts from all 15 conference tracks were reviewed and 64 abstracts total were selected for this paper based on the novelty and urgency of the findings. The content analysis of conference abstracts were grouped into six final thematic areas. Results 1 ) Investing in family planning for a lifetime of returns. FP continues to face a shortage of funding. Domestically based and locally owned funding models provide alternative financing solutions. 2) Addressing inequities in family planning for key populations. Various populations still face challenges in accessing FP. Youth-inclusive and user-centered programming show promise in addressing such challenges. 3) Reproductive justice, Unsafe abortions tend to be more common among younger, poor, uneducated and rural women. Legislation is still needed to facilitate a culture of safe abortions. 4) Couple dynamics and decision-making. Couples who share equitable responsibility in decision-making processes are more likely to use contraceptives; couple disagreement influences women's decisions to covertly use FP. 5) Male involvement in  programming. Male champions can successfully promote uptake of FP. Gender-transformative programming promotes gender equity and impacts behavior change. 6) Breakthroughs in novel contraceptives and systems improvement in family planning. Recent advances include user-centered contraceptive technologies that allow for self-administration and information systems which optimize supply chain management. Conclusion The research, advocacy, and programmatic abstracts at ICFP 2018 highlighted research advances, showcased implementation science wins, and provided evidence of critical knowledge gaps in global FP access and use.

Knowledge, opinions and compliance related to the 100% smoke-free law in hospitality venues in Kampala, Uganda: cross-sectional results from the KOMPLY Project.

OBJECTIVE: This study evaluated knowledge, opinions and compliance related to Uganda's comprehensive smoke-free law among hospitality venues in Kampala Uganda. DESIGN: This multi-method study presents cross-sectional findings of the extent of compliance in the early phase of Uganda's comprehensive smoke-free law (2 months postimplementation; pre-enforcement). SETTING: Bars, pubs and restaurants in Kampala Uganda. PROCEDURE AND PARTICIPANTS: A two-stage stratified cluster sampling procedure was used to select hospitality sites stratified by all five divisions in Kampala. A total of 222 establishments were selected for the study. One hospitality representative from each of the visited sites agreed to take part in a face-to-face administered questionnaire. A subsample of hospitality venues were randomly selected for tobacco air quality testing (n=108). Data were collected between June and August 2016. OUTCOME MEASURES: Knowledge and opinions of the smoke-free law among hospitality venue staff and owners. The level of compliance with the smoke-free law in hospitality venues through: (1) systematic objective observations (eg, active smoking, the presence of designated smoking areas, 'no smoking' signage) and (2) air quality by measuring the levels of tobacco particulate matter (PM2.5) in both indoor and outdoor venues. RESULTS: Active smoking was observed in 18% of venues, 31% had visible 'no smoking' signage and 47% had visible cigarette remains. Among interviewed respondents, 57% agreed that they had not been adequately informed about the smoke-free law; however, 90% were supportive of the ban. Nearly all respondents (97%) agreed that the law will protect workers' health, but 32% believed that the law would cause financial losses at their establishment. Indoor PM2.5 levels were hazardous (267.6 µg/m3) in venues that allowed smoking and moderate (29.6 µg/m3) in smoke-free establishments. CONCLUSIONS: In the early phase of Uganda's smoke-free law, the level of compliance in hospitality venues settings in Kampala was suboptimal. Civil society and the media have strong potential to inform and educate the hospitality industry and smokers of the benefits and requirements of the smoke-free law.

Enabling Access to Medical and Health Education in Rwanda Using Mobile Technology: Needs Assessment for the Development of Mobile Medical Educator Apps.

BACKGROUND: Lack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care. However, low and middle-income countries (LMIC) like Rwanda have struggled to implement medical education technologies adapted to local settings in medical practice and continuing education. Developing a user-centered mobile computing approach for medical and health education programs has potential to bring continuous medical education to doctors in rural and urban areas of Rwanda and influence patient care outcomes. OBJECTIVE: The aim of this study is to determine user requirements, currently available resources, and perspectives for potential medical education technologies in Rwanda. METHODS: Information baseline and needs assessments data collection were conducted in all 44 district hospitals (DHs) throughout Rwanda. The research team collected qualitative data through interviews with 16 general practitioners working across Rwanda and 97 self-administered online questionnaires for rural areas. Data were collected and analyzed to address two key questions: (1) what are the currently available tools for the use of mobile-based technology for medical education in Rwanda, and (2) what are user's requirements for the creation of a mobile medical education technology in Rwanda? RESULTS: General practitioners from different hospitals highlighted that none of the available technologies avail local resources such as the Ministry of Health (MOH) clinical treatment guidelines. Considering the number of patients that doctors see in Rwanda, an average of 32 patients per day, there is need for a locally adapted mobile education app that utilizes specific Rwandan medical education resources. Based on our results, we propose a mobile medical education app that could provide many benefits such as rapid decision making with lower error rates, increasing the quality of data management and accessibility, and improving practice efficiency and knowledge. In areas where Internet access is limited, the proposed mobile medical education app would need to run on a mobile device without Internet access. CONCLUSIONS: A user-centered design approach was adopted, starting with a needs assessment with representative end users, which provided recommendations for the development of a mobile medical education app specific to Rwanda. Specific app features were identified through the needs assessment and it was evident that there will be future benefits to ongoing incorporation of user-centered design methods to better inform the software development and improve its usability. Results of the user-centered design reported here can inform other medical education technology developments in LMIC to ensure that technologies developed are usable by all stakeholders.

Implementation of 100% smoke-free law in Uganda: a qualitative study exploring civil society's perspective

BACKGROUND:In 2016, Uganda became one of few sub-Saharan African countries to implement comprehensive national smoke-free legislation. Since the World Health Organisation recommends Civil Society Organisation's (CSO) involvement to support compliance with smoke-free laws, we explored CSOs' perceptions of law implementation in Kampala, Uganda, and the challenges and opportunities for achieving compliance. Since hospitality workers tend to have the greatest level of exposure to second-hand smoke, we focussed on implementation in respect to hospitality venues (bars/pubs and restaurants).METHODS:In August 2016, three months after law implementation, we invited key Kampala-based CSOs to participate in face-to-face semi-structured interviews. Interviews probed participants' perceptions about law implementation, barriers impeding compliance, opportunities to enhance compliance, and the role of CSOs in supporting law implementation. Interviews were recorded and transcribed. Qualitative content analysis was conducted using the interview transcripts.RESULTS:Fourteen individuals, comprising mainly senior managers from CSOs, participated and reported poor compliance with the smoke-free law in hospitality venues. Respondents noted that contributing factors included low awareness of the law amongst the general public and hospitality staff, limited implementation activities due to scarce resources and lack of coordinated enforcement. Opportunities for improving compliance included capacity building for enforcement agency staff, routine monitoring, rigorous enactment of penalties, and education about the smoke-free law aimed at hospitality venue staff and the general public. Allegations of tobacco industry misinformation were said to have undermined compliance. Civil Society Organisations saw their role as supporting law implementation through education, stakeholder engagement, and evidence-based advocacy (cont) (AU)

Knowledge, opinions and compliance related to the 100 per cent smoke-free law in hospitality venues in Kampala, Uganda: cross-sectional results from the KOMPLY Project

OBJECTIVE:This study evaluated knowledge, opinions and compliance related to Uganda's comprehensive smoke-free law among hospitality venues in Kampala Uganda.DESIGN:This multi-method study presents cross-sectional findings of the extent of compliance in the early phase of Uganda's comprehensive smoke-free law (2 months postimplementation; pre-enforcement).SETTING:Bars, pubs and restaurants in Kampala Uganda.PROCEDURE AND PARTICIPANTS:A two-stage stratified cluster sampling procedure was used to select hospitality sites stratified by all five divisions in Kampala. A total of 222 establishments were selected for the study. One hospitality representative from each of the visited sites agreed to take part in a face-to-face administered questionnaire. A subsample of hospitality venues were randomly selected for tobacco air quality testing (n=108). Data were collected between June and August 2016.OUTCOME MEASURES:Knowledge and opinions of the smoke-free law among hospitality venue staff and owners. The level of compliance with the smoke-free law in hospitality venues through: (1) systematic objective observations (eg, active smoking, the presence of designated smoking areas, 'no smoking' signage) and (2) air quality by measuring the levels of tobacco particulate matter (PM2.5) in both indoor and outdoor venues (cont) (AU)