Accelerating onchocerciasis elimination in humanitarian settings: lessons from South Sudan

DOI: 10.1093/inthealth/ihae051There is persistent meso- and hyperendemicity of onchocerciasis (river blindness) in South Sudan, a country that has endured armed conflict for many years. In 2018, Amref Health Africa, in collaboration with local communities, the South Sudan Ministry of Health and other stakeholders, initiated some interventions, among which was Innovative Approaches to Reduce the Burden of Disease Caused by Onchocerciasis (IARDO) project. This project implemented several strategies, including identifying areas where onchocerciasis elimination programs need strengthening, switching from annual to biannual community-directed treatment with ivermectin (CDTI), additional ivermectin administration to postpartum women and school children and a community-based 'slash and clear' vector control strategy. These measures resulted in increased CDTI coverage, fewer bites from blackfly vectors and decreased onchocerciasis-related morbidity. The feasibility of these interventions, low cost, national government support and community ownership suggest their long-term sustainability

Influence of government policies on handwashing and vaccine uptake in Kenya, Uganda, and Tanzania to prevent and control COVID-19: a systematic review

Introduction: The government's role in influencing policies related to Coronavirus disease 2019 (COVID-19) vaccine distribution and handwashing practices is essential in controlling the spread of severe acute respiratory syndrome coronavirus 2. Methods: This study aimed to systematically review published studies to explore the influence of government policies on handwashing and vaccine uptake in Kenya, Uganda and Tanzania to prevent and control COVID-19. A comprehensive search strategy was applied across three databases, and eligibility was determined using strict inclusion and exclusion criteria. We reviewed 9 of 136 research papers following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Results: The findings revealed that the government has a role in influencing policies related to COVID-19 vaccine distribution and handwashing uptake. Employment of public health campaigns and communication strategies by the government in Uganda increased vaccine acceptance and hand hygiene uptake. Similarly, government efforts to make hand hygiene accessible increased the uptake of handwashing in Tanzania. In Kenya, government efforts to increase access to soap and clean water in informal settlements and markets resulted in increased adherence to handwashing practices. Further, government incentives such as cash increased vaccination rates while vaccination reminders combined with cash incentives increased childhood immunization coverage. Discussion: Overall, this review indicates that monitoring and enforcing compliance increases vaccine and handwashing uptake across the three countries. The effectiveness of government policies on handwashing and vaccine uptake is influenced by factors such as safety, efficacy and access to information, among others. Therefore, there is a need to address these factors for the successful implementation of these policies

A cross-sectional study

Aims: The purpose of this study was to examine barriers to the utilization of skilled birth attendance among women in North Horr ward, Marsarbit County. Specific aims were to assess potential demographic, economic, sociocultural, and health facility barriers that facilitate home deliveries. Methods: A mixed methods approach was used. A survey questionnaire captured quantitative data from 306 women, while 15 semi-structured interviews were conducted to support the quantitative findings. Quantitative data were analyzed through descriptive and inferential statistics using Stata version 15, while qualitative data were analyzed thematically using NVIVO and presented in tabular form. Results: A total of 306 women participated (mean age=33 years). 92% (n=281) were married, 97% (n=297) had children, unemployment was 98% (n=300). Age, costs of transport, poor infrastructures, lack of money, and all health-related factors were significantly associated with place of delivery (p=0.0001). 50% (n=153) reported health facility as place of last delivery, 47% (n=144) delivered at home, though sociocultural factors like traditional birth attendant (TBA) availability (80% [n=123]) influenced the choice. The regression model showed no significant relationships for sociocultural barriers (p>0.05). Qualitative findings revealed financial constraints, sociocultural norms, and health infrastructure deficits as major barriers to skilled birth attendance utilization. Conclusion: Multifaceted barriers interact as barriers to the utilization of skilled birth attendance among women in North Horr ward, Marsarbit County. Initiatives aimed at improving skilled birth attendance utilization must judiciously tackle poverty, remoteness, inconsistent quality care and traditional mindsets

The complexities of global health negotiations: Power dynamics and the politics of the pandemic agreement

doi: 10.1371/journal.pgph.000384