Background COVID-19 pandemic curfew made it difficult for families to communicate with their loved ones while hospitalized in the intensive care unit (ICU). A hybrid telephone and video conferencing model (VC) was created as a method of communication. This study aims to assess the satisfaction of critically ill non-COVID-19 patients and their families with VC as a mean of communication during the curfew. Methods A prospective observational study was conducted in two academic hospitals. Family visits were replaced by VC during the curfew and visitation restriction. To assess the satisfaction with VC, families were surveyed twice while patients were surveyed once during the ICU admission. Results Among 81 family representatives initially surveyed, 26 (32.1%) underwent a follow-up survey. On a scale of 1-10, high general satisfaction was reported by family representatives in the initial and follow-up surveys (8.68 ± 1.66 and 8.31 ± 1.89, respectively). General satisfaction of 9.64 ± 0.67 was reported by the patients who were surveyed during their ICU admission (n=11). Higher patient’s Glasgow Coma Scale at the time of VC and increased number of VC sessions were associated with higher family satisfaction ( P =0.001 and P =0.019, respectively). Among family representatives, more than 70% preferred video conferencing over traditional means of communication during the curfew. Conclusions Family representatives and their critically ill non-COVID-19 patients were highly satisfied with video conferencing as a mean of communication during the curfew and visiting restriction. Video conferencing offers a great way of communication during pandemics, such as COVID-19.
Background Global initiatives have emphasized the elimination of cervical cancer (CC) among female sex workers (FSW) in Africa. Yet screening remains low, and few interventions have been outlined to target this group. This scoping review sought to understand the knowledge, attitudes, and practices (KAP) among FSW in Africa regarding human papillomavirus (HPV) and CC prevention, and to identify the most effective intervention strategies. Methods A systematic literature search was performed in PubMed, Scopus, Web of Science, and African Index Medicus for work published between January 2012 through August 2022. Eligible studies included those relating to HPV and CC prevention among FSW in Africa. Studies were categorized as KAP, intervention, or both. A Logic Model was used to guide content analysis of the interventions, and a thematic analysis of all studies was performed. Results The search resulted in 79 articles of which 11 were included in the study. Six African countries were represented including South Africa, Mozambique, Uganda, Kenya, Ethiopia, and Nigeria. Five of the articles described KAP, while the other six described interventions. The intervention studies were categorized into 3 groups: “screen and treat”, self-collection HPV testing, and a “diagonal intervention” which included a multi-faceted approach. Conclusions Limited literature exists regarding KAP and interventions for HPV and CC prevention among FSW in Africa. While FSW in the literature had a moderate level of knowledge regarding HPV and CC prevention, studies identified a lack of detailed and nuanced knowledge. Successful uptake of screening was seen when services were provided at convenient locations, integrated into routine or HIV care, and recommended by healthcare providers. Future interventions should be context-specific, include improved counselling and education, and be integrated with other services.
This report details a qualitative methodological approach of developing an Augmented Reality (AR) tool which integrates digital storytelling for context-specific, accessible, scalable participatory research knowledge translation on climate-related sexual health experiences among youth (aged 16-25 years) in Kenya. AR, which engages audiences through virtual images overlayed on the real world in real-time, enhances learning and knowledge retention. This suggests the potential for using this increasingly accessible technology in knowledge translation, despite such use being understudied. Our AR tool meaningfully incorporates seven digital storytelling videos made by youth in Kenya through a study in 2023, to amplify youth voices while illustrating complex pathways between four climate-related factors (drought, floods, extreme heat, and excess winds) and three HIV vulnerabilities (gender-based violence, early marriage, and transactional sex). The aim of this paper is to describe the design of an AR tool for knowledge translation, youth empowerment, and health promotion, and to outline how it can be harnessed for sexual health and climate change education to inform future knowledge translation approaches with youth climate-affected issues.
# Background Oxygen is critical to the prevention of hypoxemia-induced morbidity and mortality; yet, access remains inadequate in most low- and middle-income countries despite billions of dollars spent over decades to increase supply. We present a new method for supplemental oxygen delivery whereby the OXFO System (OXFO Corporation, Boston, MA, USA) converts pressurized oxygen to ambient pressure for patient inhalation on demand at a fixed concentration across fluctuations in respiratory rate or tidal volume. This study's primary aims were to examine the oxygen volume savings and test the non-inferiority of mean peripheral oxygen saturation (S~pO2~) with the OXFO System (OXFO Condition) compared to conventional continuous flow (Standard Condition) in a clinical population of oxygen-dependent hospitalized adults. # Methods We conducted a non-inferiority, single-visit, randomized, crossover design. A total of 20 subjects were randomized to receive either OXFO Condition or Standard Condition first. Subjects were administered oxygen for 20 minutes during each condition after oxygen was titrated to target therapeutic S~pO2~. A one-sample t-test was performed to compare the mean ratio of oxygen volume dispensed (OXFO Condition/Standard Condition) with 100%. A paired t-test for non-inferiority was used to test the hypothesis that the mean S~pO2~ for OXFO Condition is no worse than 2.8% lower (absolute difference) than the mean S~pO2~ for Standard Condition. # Results Nineteen subjects were included in the analyses. When considering the dispensing of oxygen as a ratio (OXFO Condition / Standard Condition) for each subject, the mean was 7.7% (standard deviation(SD)=5.4%; range=0-20%) and this was significantly different from 100% (*P*\<0.001). The savings ratio was not significantly correlated with Standard Condition rate of flow (*P*=0.23). Mean S~pO2~ for OXFO Condition was 91.07% (SD=2.20%) and 91.35% (SD=1.62%) for Standard Condition and the difference was significantly above the non-inferiority margin of -2.80% (*P*\<0.001). # Conclusions The OXFO System saves a significant volume of oxygen while achieving non-inferior mean saturation for hospitalized oxygen-dependent patients. The OXFO System appears to maintain robust volume savings of nearly 13x across doses up to 6 liters per minute (L/min). This has significant implications for advancing equitable access to oxygen.
# Background Increased paternal involvement during childbirth can enhance maternal and neonatal outcomes. However, in resource-constrained settings, cultural and health system factors often hinder the involvement of fathers in the birthing process. This study aimed to identify the factors influencing antenatal clients' attitudes toward their partner's presence during childbirth in northern Nigeria. # Methods We administered a pre-tested, culturally adapted questionnaire to antenatal clients at a tertiary health facility (n=351). Attitudinal scores were measured on a Likert scale, and logistic regression was used to compute adjusted odds ratios (aORs) for predictors. # Results Only 15.4% of respondents agreed or strongly agreed with the presence of their male partner during childbirth. Women opposed or strongly opposed the suggestion that their partner's presence provided emotional support (35.9% and 59.8%, respectively), reduced labor pain perception (45.1% and 33.1%, respectively), strengthened the couple's relationship (40.2% and 52.7%, respectively), or enhanced father-child bonding (32.3% and 46.6%, respectively). More than half of the respondents (57.0%) strongly disagreed that their partner's presence enhanced paternal responsibility. Rather, the presence of the partner was considered unhelpful (49.3%), culturally unacceptable (37.9%), and against religious rulings (51.6%). Younger maternal age (<30 years, aOR=7.6, 95% CI=2.12-14.40) and higher parity (≥5 children, aOR=2.08, 95% CI=1.21-8.38) were associated with a more positive attitude towards the presence of the father during labor. # Conclusions Most women did not favor having their partners present during childbirth. Policymakers and healthcare providers should integrate cultural sensitivity considerations into guidelines and initiatives that promote male involvement in childbirth in similar settings.
# Background Under-5 deaths in urban slum communities are often unnoticed in many cases. However, previous surveys reported a high burden of mortality. Therefore, we presented the distribution of the causes of death of under-5 children in selected urban slum areas in Bangladesh. # Methods Since October 2020, the Urban Health and Demographic Surveillance System (Urban HDSS) has been collecting verbal autopsy information for neonates, children, and adults to report the causes of death. We used the data collected by the trained Field Workers- from all households (30,857) in the ongoing HDSS area, comprising 118,238 people. The causes of deaths were identified by using the WHO-standardized verbal autopsy (VA) questionnaire that was reviewed and coded by a trained physician. Later, the cause-specific fractions of the deaths were evaluated by the child’s age, sex, the mother’s education, occupation, household wealth quintile, slum locations, mode and place of delivery, and antenatal and postnatal care. # Results A total of 155 deaths of children under-5 years were interviewed during October 2020–2021. Most of them were neonates (67.7%), boys (67.7%), belonged to poor households (43.9%), born at home (51%) and had vaginal delivered (77%). Most of the mothers of the deceased children took antenatal care services (80%), and a comparatively lower proportion received postnatal care (39.3% and 47.1% of mothers and children, respectively). In this slum area, birth asphyxia (25.2%) was the major leading cause of under-5 deaths occurred in the neonatal period (37.1%), followed by other infections (14.2%) and pneumonia (16.1%). Other important causes of death were cerebral ischemia (7.7%), prematurity and low birth weights (6.5%), congenital anomalies (5.2%), and other external causes (18.1%), contributed to the under-5 child deaths. The cause of mortality fraction varied by different socioeconomic and delivery-related attributes such as place, mode of delivery, and utilization of ANC and PNC visits. # Conclusions Major causes of under-5 death are birth asphyxia, pneumonia, and infectious diseases. Adequate attention and additional safety measures, education and awareness about child’s health among mothers, and proper delivery care for pregnant slum women and children could prevent under-5 deaths in the slum area.
Background Perinatal depression is a common mental health disorder which spans during and after pregnancy. Unfortunately, there is poor healthcare-seeking behaviour for this treatable condition. Additionally, maternal healthcare workers sometimes overlook the signs and symptoms, failing to diagnose it adequately. This review aims to provide a framework for understanding the in-depth perceptions and implementation gaps surrounding perinatal depression in Nigeria. Methods This study employed a rigorous qualitative evidence synthesis methodology to gather and analyse both published and unpublished qualitative research on the lived experiences and perceptions of perinatal depression in Nigeria. The research was conducted by searching multiple electronic databases, citation chaining, and checking reference lists. The studies were then screened by title, abstract, and full text, and the quality of the included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for appraising a qualitative study. The data extracted from these studies were then synthesized using the ‘best-fit’ framework method, which combines deductive and inductive approaches to analysis. Results 10 eligible papers were identified. Data were organised into themes eight themes mapped to an already existing framework: Recognitions of perinatal mental distress, labelling of mental distress, symptom patterns, social norms, roles and expectations, supernatural factors, physical/bodily issues, coping strategies, help-seeking from professionals/medical institutions. No study was excluded as a result of methodological limitations. Conclusions The review highlights the significance of integrating mental health services into routine perinatal care and the need for comprehensive interventions that consider sociocultural factors. The findings emphasize the importance of increasing awareness and education among women and healthcare providers to improve early detection and intervention. Healthcare professionals play a crucial role in identifying and managing perinatal depression; therefore, it is essential to provide them with comprehensive and regular training.
Background Cardiopulmonary resuscitation is a fundamental intervention for treating cardiac arrest, particularly when executed promptly and accurately. Paediatric Advanced Life Support (PALS), developed by the American Heart Association (AHA), is a specialized training designed for the emergency care of infants and children. Nigeria’s National Surgical Obstetric Anaesthesia and Nursing Plan (NSOANP) has prioritized emergency preparedness and, in collaboration with a cleft-focused organization (Smile Train Incorporated, New York), deployed PALS training across the country. This report evaluates the scope and short-term outcomes of this training initiative, highlighting its potential role in enhancing paediatric surgical safety and outcomes in resource-limited settings. Methods A retrospective review of 106 participants and 2 instructors trained in PALS over a period of 3 years. Results A total of 106 participants, including 67 (70.7%) males and 39 (38.6%) females, from diverse specialties, were trained across the six geopolitical zones of the country. Participants included 75 (70.8%) consultants and 31 (29.2%) junior doctors. All participants passed the post-test and received AHA certification. The median pre-test score was 81% compared to the median post-test score of 92% ( p 0.05). Feedback indicated 100% improvement in skills, confidence in handling paediatric emergencies, and satisfaction with the training quality. Participants expressed willingness to disseminate their newly acquired skills to colleagues. In addition, 2 instructors trained during the period have been involved in training participants for basic life support as well as PALS. Conclusions The implementation of PALS training under NSOANP improved the knowledge and skills of healthcare providers in managing paediatric emergencies. This initiative demonstrates the potential impact of structured life support training in strengthening paediatric surgical safety and outcomes in low-resource settings.
# Background Many people with disabilities in low-income settings, such as Sierra Leone, do not have access to the assistive technology (AT) they need, yet research to measure and address this issue remains limited. This paper presents a case study of the Assistive Technology 2030 (AT2030) funded Country Investment project in Sierra Leone. The research explored the nature and strength of the AT stakeholder network in Sierra Leone over the course of one year, presenting a snapshot of the network before and after a targeted systems level investment. # Methods Mixed-method surveys were distributed via the Qualtrics software twice, in December 2021 and September 2022 to n=20 and n=16 participants (respectively). Qualitative data was analyzed thematically, while quantitative data was analyzed with the NodeXL software and MS Excel to generate descriptive statistics, visualizations, and specific metrics related to indegree, betweenness and closeness centrality of organizations grouped by type. # Results Findings suggest the one-year intervention did stimulate change within the AT network in Sierra Leone, increasing the number of connections within the AT network and strengthening existing relationships within the network. Findings are also consistent with existing data suggesting cost is a key barrier to AT access for both organizations providing AT and people with disabilities to obtain AT. # Conclusion While this paper is the first to demonstrate that a targeted investment in AT systems and policies at the national level can have a resulting impact on the nature and strength of the AT, it only measures outcomes at one-year after investment. Further longitudinal impact evaluation would be desirable. Nonetheless, the results support the potential for systemic investments which leverage inter-organizational relationships and prioritize financial accessibility of AT, as one means of contributing towards increased access to AT for all, particularly in low-income settings.
Background Tripura is hyperendemic for malaria and is one of the few states in India that still fall under Category 3 for malaria elimination (i.e., state annual parasite incidence (API) > 1, i.e., number of malaria cases per thousand inhabitants in a year). Tribal communities in Tripura are largely dependent on Jhum cultivation for their sustenance, and several studies have highlighted Jhum as a major risk factor for malaria. Methods To assess the relationship between Jhum distribution and malaria in Tripura, Jhum hotspots were identified from Landsat-8 OLI spectral images using the Normalized burn ratio index and compared with secondary data on malaria incidence and the state/district-wise total area under Jhum for the years 2017 and 2019. Results The study’s results show that between 2017 and 2019, the total area under Jhum reduced from 39.56 km2 to 27.4 km2, which was accompanied by a shift in several Jhum hotspots from Dhalai and North Tripura in 2017 to West Tripura in 2019. Malaria cases showed a strong correlation with Jhum production both at the district and state level, which was significant at the 95% confidence interval. Furthermore, a stronger correlation in 2019 indicated that the share of malaria cases in Jhum cultivators may be increasing. Conclusions The present study presents preliminary evidence based on secondary data analysis on the possible implications of Jhum cultivation for malaria epidemiology in an endemic north-eastern state of India. It is suggested that real-time evidence should be generated on malaria prevalence among Jhum cultivators and their families. Based on the evidence, future intervention strategies for the state should focus on the elimination of malaria risk from Jhum cultivators by minimizing outdoor exposure to malaria vectors and improving access to diagnostics and treatment.
Background Global health advocacy plays a crucial role in addressing emerging health challenges, including the provision of surgical healthcare care in low- and middle-income countries (LMICs). Nigeria launched its national surgical, obstetrics, anaesthesia, and nursing plan (NSOANP) in 2019 to improve access to surgical services, including cleft lip and palate. This report examines the potential of media engagement as a catalyst for advocacy initiatives to strengthen surgical systems. Methods The study conducted media and advocacy workshops targeting journalists from various media outlets across Nigeria. Workshops included didactic lectures, presentations, role plays, and group discussions. Participants were evaluated through pre- and post-tests. Follow-up activities tracked participants’ reporting and awarded prizes for outstanding reporting on cleft and surgical care. Results One hundred and three journalists, including 61 (59.2%) males and 42 (39.8%) females participated, showing significant improvement in knowledge about cleft lip and palate anomalies and access to surgical care (p = 0.03). Post-workshop outputs included public enlightenment programmes, radio dramas, and published reports. The initiative awarded prizes to 9 journalists for quality reporting. Conclusions Media engagement is a potent tool for advocating for surgical care access. The success of this initiative underscores the importance of collaboration between stakeholders and the need for sustained efforts to support advocacy for access to surgical healthcare.
Background The integration of digital health (eHealth) interventions into primary healthcare systems has gained recognition lately in Low- and Middle-Income Countries (LMICs) to enhance healthcare quality, accessibility, and efficiency. These interventions may offer effective strategies in mitigating the burden of chronic diseases by facilitating access to remote healthcare and optimising its processes. This scoping review aims to identify and assess eHealth interventions implemented in primary care settings in LMICs for further development and adaptation. Methods and analysis We will search two electronic databases, such as Scopus and Embase, to identify peer-reviewed studies reporting on eHealth interventions implemented in primary care settings within LMICs. This review will encompass evidence published in the English language without a time frame restriction. We will remove duplicates from the search, and two reviewers will independently assess all articles for eligibility by first screening the title and abstract, followed by a full-text review. Eligible articles will be extracted, and data will be charted according to types of intervention and settings using a standardised form. Ethics and dissemination There is no ethical review required for this scoping review. We plan to disseminate the findings by presentations at conferences and publishing in open-access journal.
# Background The stigma attached to mental illness impedes diagnosis, treatment, and access to care for people with mental illness. Scalable interventions are needed to enhance attitudes towards seeking treatment, foster community support, and promote acceptance of individuals experiencing mental illness. We worked with community health workers in the Busoga region of eastern Uganda to develop a radio program aimed at reducing mental illness stigma. We piloted the radio program in focus groups, purposively sampling people with families affected by mental illness and people with families unaffected by mental illness, to understand their perspectives about the program’s acceptability and potential effectiveness. # Methods The 45-minute radio program was adapted from a previously studied community-led theater intervention, produced by community health workers, that demonstrated an individual’s recovery from mental illness. Afterward, we conducted 2 focus group discussions, each involving six participants: n=12; and 17 one-on-one, in-depth interviews. We employed the framework method to inductively identify themes and sub-themes. # Results Participants reported greater understanding of causes of mental illness, treatment options, and greater acceptance of those with mental illness as a result of listening to the program. # Conclusions This radio program intervention showed potential to change healthcare seeking behavior for mental illness and to decrease mental illness stigma in rural Uganda. Further investigation is needed to assess the broader applicability of this approach.
Background Indonesia has the second-highest burden of tuberculosis (TB) globally and is experiencing one of the fastest-growing HIV epidemics worldwide. The COVID-19 pandemic disrupted access to essential health services, including those for TB and HIV, due to health system overload, social distancing measures, and negative economic repercussions on the health sector and the population. An in-depth understanding of these challenges and the health system responses to mitigate the negative impact of the pandemic on TB and HIV services is crucial to building health system resilience and preparing for future emergencies. Methods This qualitative study, conducted in two cities in Indonesia, explored the impact of the COVID-19 pandemic on TB and HIV services including mitigation strategies to sustain the provision of testing and treatment in the midst of the pandemic. Between February and June 2022, semi-structured interviews were conducted with 16 healthcare workers and 16 clients at nine health centers (puskesmas), three hospitals, and one Community Center for Lung Health in Bandung and Yogyakarta. Themes were identified from transcripts using open and selective coding and then refined. Results Extraordinary measures were implemented in health facilities to sustain TB and HIV service delivery, and prevent the spread of COVID-19, including testing of clients for COVID-19 before receiving medical care, physical distancing when visiting healthcare facilities, revised schedules for medicine dispensing, involvement of community health workers and peers in community outreach activities such as the home delivery of medicines, and the use of telemedicine. Challenges encountered during the implementation of these strategies included medicine stock-outs, health worker overload, lack of sufficient client-provider interaction and technical difficulties when implementing telemedicine, and the risk or fear of exposure to COVID-19 among the community health workers and peers. Conclusions Significant efforts were made to mitigate disruptions to TB and HIV services during the COVID-19 pandemic. However, some challenges were encountered. Key policy recommendations to strengthen pandemic preparedness include investing in local manufacturing and robust drug supply networks to prevent medicine shortages, and supporting community health workers to alleviate workload issues, reduce the risk of disease exposure, and explore the potential for a financial incentive system. Equally vital is the need to invest in staff training and education, as well as implementing user-friendly telemedicine technologies.
Background Little is known about the challenges of stoma care and potential solutions for patients in low- and middle-income countries (LMICs). This study aimed to assess the outcomes and experience of care for patients with stomas in LMICs using a mixed methods approach. Methods A cross-sectional survey of hospitals assessed health system characteristics relevant to stoma care. A six-month retrospective audit collected data on all patients undergoing new stoma formation, and postoperative complications. Semi-structured interviews with stoma patients and informal caregivers, and key informant interviews with healthcare providers were conducted to gather information on experiences, challenges and coping strategies relating to stoma care. The results were triangulated to develop a questionnaire-based tool to assess patients’ and carers’ knowledge and attitudes towards stoma and stoma care. Results Six hospitals from the Philippines, Malawi, Nigeria and India participated in the study. Data from 446 patients demonstrated diversity case mix, outcomes and postoperative stoma counselling. Interview data from the Philippines highlighted the lack of knowledge on stoma care of the patients and carers, poor access to stoma care and resources and the lack of affordable stoma care supplies. Triangulating these inputs, a 33-item questionnaire was developed to facilitate task sharing of expert stoma care to non-expert nurses and caregivers. Conclusions This study highlighted gaps in capacity to provide stoma counselling and poor access to and affordability of stoma care supplies for patients in LMICs. This novel questionnaire can help close these gaps and improve care for new ostomates in resource limited settings. Registration The study is registered in the Philippine Health Research Registry PHRR No.210805-003783 (https://registry.healthresearch.ph/index.php/registry)
# Background There is an ongoing discussion for decolonization of global health and a resetting of global health partnerships and practices. However, a lack of understanding and agreement on the issues involved remain a major limitation. The aim of this study was to understand and identify the manifestations of neocolonialism in global surgery practice. # Methods This was a qualitative web-based survey of 445 low-and middle-income countries (LMICs) and high-income countries (HICs) global surgery practitioners. We also captured through focussed interviews their perceptions and reported manifestations of neocolonialism in global surgery. # Results The majority (73.9%) came from LMICs, while 26.1% were from HICs. Surgeons formed the largest group (57.6%), with many having extensive experience (38.7% with over 10 years in global surgery). Neocolonialism was defined as an unequal power dynamic favoring HIC agendas. Uncompensated work by LMICs staff and funding disparities were identified as neocolonial practices by HICs participants. Limited research capacity and frustrated LMICs providers were seen as consequences. Factors enabling neocolonialism included limited local funding and training priorities set by funders, not local needs. More than 75% of participants agreed that fear of losing HIC support was a major barrier to open communication about neocolonialism in global surgery. # Conclusions This study among global surgery players unbderscores existence and experiences of neocolonialism in global surgery. The impact of this practice and the enablers need to be urgently addressed by implementing mitigating solutions.
Background The number of studies examining family, community, institutional and policy factors on COVID-19 vaccine perceptions is limited, with most concentrating on high-income countries and using predominantly quantitative methods. To address this gap, the goal of this manuscript is to qualitatively explore these factors and how they shape adolescents’ perspectives on COVID-19 vaccines across diverse contexts. Methods Focus group discussions were conducted among adolescent populations (13 - 18 years) across seven countries: Ghent, Belgium; Sao Paulo, Brazil, Shanghai; China, Kinshasa, Democratic Republic of Congo (DRC); Semarang and Denpasar, Indonesia; Blantyre, Malawi and New Orleans, United States of America (USA). An inductive thematic analytical approach was used to understand the emerging themes across the different countries based on the study’s objectives. Results The study found that all influences were inter-connected and contributed towards vaccine perceptions among adolescents, which were largely positive except in the two African countries and to an extent in the USA. Family and community influences played a large role in vaccine perceptions, however, this differed by context. Our findings suggest adolescents’ perceptions about vaccines were more positive in countries with higher vaccination rates, i.e. China and Indonesia versus countries with lower vaccination rates i.e. Malawi and DRC. Vaccine mandates within schools, offices, and public places were also discussed with varying perceptions based on government trust. Conclusions Adolescents’ perceptions of the Covid-19 vaccine are based on a variety of elements, such as families, community, institutions, and policies. Prioritizing one or another path may not be sufficient to improve vaccine adherence during future pandemics, as we experienced with Covid-19. Strategies to make vaccine perceptions more positive among urban poor adolescents should address both family and community perceptions. However, policies and robust programs around immunization are still needed.
Water is one of the social determinants of health and a key factor towards improving health outcomes and inequalities. Access to safe and adequate water has been identified as an essential component for protecting, maintaining and promoting public health and reducing the total burden of diseases. Though India has made substantial progress in increasing access to safe drinking water in rural areas through household tap connections, there is a lack of contemporary evidence reflecting the progress achieved so far. A desk review of India’s schemes, programmes, and policies on access to drinking water was undertaken for review. Programme and policy documents from various central government websites such as the Ministry of Jal Shakti, Department of Drinking Water and Sanitation, Jal Jeevan Mission, and Central Water Commission websites were reviewed. The paper focuses on the recently launched Jal Jeevan Mission (JJM) in addressing the identified gaps of the former initiatives in rural areas. The broad vision of JJM also aims to reduce the incidence of acute diarrhoeal diseases. It was found that with the launch of JJM in 2019, tap water connections in rural households have increased from 16.69% (2019) to 62.79% (2023). The Government of India (GoI)’s commitment and citizen-centric approach to decentralised governance in providing safe drinking water to all is reflected in the financial allocations made under the JJM to states and fifteen finance commission (FC-XV) grants. The review highlights the need for intersectoral coordination across the levels to realise better results and health outcomes.
# Background Low- and middle-income countries, particularly in the African region in-country distribution and determinants of infertility are understudied. In this study, we aimed to estimate the prevalence, regional distribution, and determinants of infertility in Uganda to inform programming. # Methods We estimated the prevalence of primary and secondary infertility among women aged 20-49 years using data from the three rounds of the Uganda Demographic and Health Survey 2006, 2011, and 2016, and compared the differences across geographic regions. We pooled data sets for all three years and conducted logistic regression to identify factors associated with infertility. # Results We included 16,537 women aged 20-49 years for analysis of primary infertility and 12,628 for secondary infertility. The overall prevalence of infertility (pooled across the three surveys was 6.4%. The prevalence of primary infertility was 1.4% (95% Confidence interval, CI=1.0-1.8), 0.7% (95% CI=0.5-1.0) and 0.8% (95% CI=0.6-1.0) in 2006, 2011 and 2016, respectively. The prevalence of secondary infertility was 7.4% (95% CI=6.5-8.4), 6.9% (95% CI=5.9-8.0) and 7.1% (95% CI=6.4-7.9) in 2006, 2011, and 2016 respectively. The prevalence of primary infertility was similar across regions. Secondary infertility was highest in the Central (7.9%, 95% CI= 6.1-10.3, in 2016) and Northern regions (7.4%, 95% CI=6.1-8.9, in 2016). In all survey years, women with higher education had lower odds of secondary infertility compared to women with no education (adjusted odds ratio, aOR=0.54, 95% CI=0.35-0.83; *P* \< 0.001). # Conclusions Our results suggest that the prevalence of primary infertility is similar across regions, whereas secondary infertility varies by region, with higher prevalence in Central and Northern regions. More research is required to understand the drivers behind the variation of secondary infertility across regions to inform policy and decision making.
This article describes the conceptual and methodological foundation of community-supported chronic disease management. A community-supported approach recognizes the diversity of community residents’ participation outcomes and attempts to maximize self-mobilization to manage chronic diseases in community settings. This paper argues that incorporating ethnographic research to understand a community holistically and promoting an inclusive community organization through a systematic approach has the potential to facilitate community support and improve sustainability in chronic disease management in resource-limited settings.
