Barriers to vasectomy acceptance and uptake in Nigeria: A review of the literature.

There is growing support of male involvement in reproductive health and the integration of voluntary vasectomy services into national family planning programs in lower resource contexts; yet, the prevalence of women of reproductive age who rely on vasectomy in African countries such as Nigeria, is less than 1 percent. This review was conducted to gain a broader understanding of current sociocultural and health systems' conditions that need to be addressed to expand the integration and acceptability of vasectomy as an option for family planning in Nigeria. To explore this, a scoping of existing literature on vasectomy in Nigeria between 2009 to 2021 was conducted. The review focused on qualitative studies and grey literatures. The findings reveal that there is a strong awareness of vasectomy among men in Nigeria. Yet, several factors such as fear and religious and cultural beliefs prevent men from having the same confidence in vasectomy as they have in female biomedical methods. These findings have implications for future family planning policies, strategies and programmes in the country.

Self-medication practices of pregnant women attending antenatal clinic in northern Ghana: An analytical cross-sectional study.

In Ghana, despite the dangers that self-medication poses to maternal and fetal health, there has been limited examination of self-medication among pregnant women. This study examines the practice of self-medication among pregnant women in Wa Municipality, Ghana. An analytical cross-sectional survey of 367 pregnant women was conducted in three health facilities. The prevalence of self-medication practice was 74.1%. The majority (68.4%) of pregnant women obtained unprescribed medicines from chemical shops; others utilized leftover drugs from previous hospital visits (15.8%) or herbal medications (9.9%), while others took unprescribed drugs from relatives or friends (5.9%). Analgesics (76.1%), antibiotics (24.6%), and antimalarials (16.2%) were the most frequently self-medicated drugs. The most common illnesses or symptoms for which pregnant women self-medicated were headaches (34.2%), back pain (33.1%), waist pain (32.7%), lower abdominal pain (20.6%), and malaria (16.2%). After adjusting for potential confounders, easy access to medication without prescription (AOR= 8.4), illness perceived as minor (AOR=4.1), availability of health facilities (AOR=4.2), and frequent lack of medicines at health facilities (AOR=1.7) were significantly associated with self-medication. Enforcing legislation to prevent the stocking and sale of certain analgesics and antibiotics, increasing service points, and improving service quality at antenatal clinics, outpatient departments and pharmacies could reduce self-medication.

Priority setting for maternal, newborn and child health in Uganda: a qualitative study evaluating actual practice.

BACKGROUND: Despite continued investment, Maternal, Newborn and Child Health (MNCH) indicators in low and middle income countries have remained relatively poor. This could, in part, be explained by inadequate resources to adequately address these problems, inappropriate allocation of the available resources, or lack of implementation of the most effective interventions. Systematic priority setting and resource allocation could contribute to alleviating these limitations. There is a paucity of literature that follows through MNCH prioritization processes to implementation, making it difficult for policy makers to understand the impact of their decision-making on population health. The overall objective of this paper was to describe and evaluate priority setting for maternal, newborn and child health interventions in Uganda. METHODS: Fifty-four key informant interviews and a review of policies and media reports were used to describe priority setting for MNCH in Uganda. Kapiriri and Martin's conceptual framework was used to evaluate priority setting for MNCH. RESULTS: There were three main prioritization exercises for maternal, newborn and child health in Uganda. The processes were participatory and were guided by explicit tools, evidence, and criteria, however, the public and the districts were insufficiently involved in the priority setting process. While there were conducive contextual factors including strong political support, implementation was constrained by the presence of competing actors, with varying priorities, an unequal allocation of resources between child health and maternal health interventions, limited financial and human resources, a weak health system and limited institutional capacity. CONCLUSIONS: Stronger institutional capacity at the Ministry of Health and equitable engagement of key stakeholders in decision-making processes, especially the public, and implementers, would improve understanding, satisfaction and compliance with the priority setting process. Availability of financial and human resources that are appropriately allocated would facilitate the implementation of well-developed policies.

Pre-departure training and the social accountability of International Medical Electives.

BACKGROUND: Due to widespread awareness of global inequities in health and development, participation and interest in International Medical Electives has grown. However, it has been suggested that the benefits of these electives for students and communities may not outweigh the harms. Pre-departure training (PDT) has been proposed as a route through which participants can adequately prepare for their elective experience. METHODS: Through a review of the current literature, this article explores the ethics of international medical electives using a social accountability framework and assesses the success of PDT in mitigating harms for students and communities. RESULTS: We find that the literature on PDT is limited. What is clear from completed studies is that the focus of PDT has often been centered on the clinical experience, while theories of development and health inequity remain minor topics. We argue that a greater benefit for students and communities could be gained from framing health inequity from a critical perspective, and integrating mandatory global health education into medical school curricula. DISCUSSION: We suggest that attention to only PDT is not enough. In a socially accountable program, community partnerships must be bilateral and respect communities as primary stakeholders in the training of students and in program evaluation. Unfortunately, research to-date has focused on the student experience; further studies of the community perspective would help to elicit how PDT and partnership models can be strengthened, improving the experiences of both students and communities. Finally, individual medical schools and organizations that offer global health elective experiences must ensure that they take responsibility for monitoring PDT.

Strengths, disconnects and lessons in local and central governance of the response to the first wave of COVID-19 in Ghana.

Objectives: To explore governance, coordination and implementation actors, structures and processes, facilitators, and barriers within local government and between central and local government in Ghana's COVID-19 response during the first wave of the outbreak. Design: Cross-sectional single case study. Data collection involved a desk review of media, policy and administrative documents and key informant in-depth interviews. Setting: Two municipalities in the Greater Accra region of Ghana. Participants: Local government decentralised decision makers and officials of decentralised departments. Interventions: None. Main Outcome Measures: None. Results: Coordination between the national and local government involved the provision of directives, guidelines, training, and resources. Most of the emergency response structures at the municipal level were functional except for some Public Health Emergency Management Committees. Inadequate resources challenged all aspects of the response. Coordination between local government and district health directorates in risk communication was poor. During the distribution of relief items, a biased selection process and a lack of a bottom-up approach in planning and implementation were common and undermined the ability to target the most vulnerable beneficiaries. Conclusions: Adequate financing and equipping of frontline health facilities and workers for surveillance, laboratory and case management activities, transparent criteria to ensure effective targeting and monitoring of the distribution of relief items, and a stronger bottom-up approach to the planning and implementation of interventions need to be given high priority in any response to health security threats such as COVID-19. Funding: This work is funded by International Development Research Centre Grant No. 109479, Exploring and learning from evidence, policy and systems responses to COVID-19 in West and Central Africa.

The Role of the Private Sector in the COVID-19 Pandemic: Experiences From Four Health Systems.

As societies urbanize, their populations have become increasingly dependent on the private sector for essential services. The way the private sector responds to health emergencies such as the COVID-19 pandemic can determine the health and economic wellbeing of urban populations, an effect amplified for poorer communities. Here we present a qualitative document analysis of media reports and policy documents in four low resource settings-Bangladesh, Ghana, Nepal, Nigeria-between January and September 2020. The review focuses on two questions: (i) Who are the private sector actors who have engaged in the COVID-19 first wave response and what was their role?; and (ii) How have national and sub-national governments engaged in, and with, the private sector response and what have been the effects of these engagements? Three main roles of the private sector were identified in the review. (1) Providing resources to support the public health response. (2) Mitigating the financial impact of the pandemic on individuals and businesses. (3) Adjustment of services delivered by the private sector, within and beyond the health sector, to respond to pandemic-related business challenges and opportunities. The findings suggest that a combination of public-private partnerships, contracting, and regulation have been used by governments to influence private sector involvement. Government strategies to engage the private sector developed quickly, reflecting the importance of private services to populations. However, implementation of regulatory responses, especially in the health sector, has often been weak reflecting the difficulty governments have in ensuring affordable, quality private services. Lessons for future pandemics and other health emergencies include the need to ensure that essential non-pandemic health services in the government and non-government sector can continue despite elevated risks, surge capacity to minimize shortages of vital public health supplies is available, and plans are in place to ensure private workplaces remain safe and livelihoods protected.

Prevalence and Correlates of Likely Major Depressive Disorder among the Adult Population in Ghana during the COVID-19 Pandemic.

BACKGROUND: Emerging research suggests that the novel coronavirus disease (COVID-19) pandemic and associated public health restrictions have caused psychological distress in many contexts. In order for public health authorities and policy makers to effectively address the psychological distress associated with the pandemic, it is important to determine the prevalence and correlates of mental disorders, including depression. OBJECTIVES: We aimed to determine the prevalence, and demographic, social, clinical and other COVID-19 related correlates of major depressive disorder symptoms among the general population in Ghana during the COVID-19 pandemic. METHOD: The study was a cross-sectional survey using online data collection methods. The survey assessed demographic, social and clinical variables as well as COVID-19 related variables. Major depressive disorder symptoms were assessed using the Patient Health Questionnaire-9. The survey link was distributed primarily through WhatsApp-based platforms. Data were analyzed using descriptive and inferential statistics. RESULTS: The overall prevalence of likely MDD symptoms among the sample population was 12.3%. Variables such as employment, loss of jobs during the pandemic and rate of exposure to COVID-related news were independently and significantly associated with the likelihood that respondents had likely MDD. Variables such as gender, relationship, housing status and having a family member or friend who was sick from COVID-19 were not independently significantly associated with the likelihood that respondents had likely MDD, when all other factors in the model were controlled. CONCLUSION: This study has identified the prevalence and correlates of depression symptoms in Ghana during the COVID-19 pandemic. There is the urgent need for mental health policy makers and the government of Ghana to have policies in place to alleviate the potential threat to the mental health of the population.

COVID-19 in sub-Saharan Africa: impacts on vulnerable populations and sustaining home-grown solutions.

This commentary draws on sub-Saharan African health researchers' accounts of their countries' responses to control the spread of COVID-19, including social and health impacts, home-grown solutions, and gaps in knowledge. Limited human and material resources for infection control and lack of understanding or appreciation by the government of the realities of vulnerable populations have contributed to failed interventions to curb transmission, and further deepened inequalities. Some governments have adapted or limited lockdowns due to the negative impacts on livelihoods and taken specific measures to minimize the impact on the most vulnerable citizens. However, these measures may not reach the majority of the poor. Yet, African countries' responses to COVID-19 have also included a range of innovations, including diversification of local businesses to produce personal protective equipment, disinfectants, test kits, etc., which may expand domestic manufacturing capabilities and deepen self-reliance. African and high-income governments, donors, non-governmental organizations, and businesses should work to strengthen existing health system capacity and back African-led business. Social scientific understandings of public perceptions, their interactions with COVID-19 control measures, and studies on promising clinical interventions are needed. However, a decolonizing response to COVID-19 must include explicit and meaningful commitments to sharing the power-the authority and resources-to study and endorse solutions.

Women's nutrient intakes and food-related knowledge in rural Kandal province, Cambodia.

In Cambodia, both anaemia and vitamin A deficiency are serious health problems. Despite this, few comprehensive nutritional surveys have been completed to date. This study evaluates the adequacy of iron and vitamin A intakes, as well as women's nutritional knowledge in rural Kandal province. Twenty-four hour recalls, pile sort activities, socioeconomic surveys, focus groups, and market surveys were carried out with 67 women from 5 villages in rural Kandal Province. Ninety seven percent of women did not meet their daily-recommended intake of iron, while 70% did not meet their daily-recommended intake of vitamin A. Although many women consume vitamin A-rich and iron rich-foods daily, they do not consume large enough quantities of these foods. Results suggest that both the cost of foods as well as the extent of health knowledge is linked to nutritional practice. Most animal-source iron and vitamin A-rich foods are considered expensive; however, small fish, and several plant-source vitamin A-rich foods are inexpensive and easy to access. Despite health education, food restrictions lead some healthy foods to be considered to be harmful to women. Ultimately, this study demonstrates the importance of developing comprehensive nutritional interventions in Cambodia. Health programming must provide women with not only suggestions to include low-cost nutrient-rich foods, but also advise them about the quantities that are likely to have an impact on nutritional status. Programs should take a community-based, inter-sectoral approach that simultaneously combines culturally informed health education with initiatives that combat poverty and increase access to nutrient rich foods.