Revisiting zoonotic human African trypanosomiasis control in Uganda

Objectives: Human migration and concomitant HIV infections are likely to bring about major changes in the epidemiology of zoonotic parasitic infections. Human African trypanosomiasis (HAT) control is particularly fraught with intricacies. The primarily zoonotic form, T.b. rhodesiense, and the non-zoonotic T.b. gambiense coexist in Northern Uganda, leading to a potential geographic and genetic overlap of the two foci. This region also has the highest HIV prevalence in Uganda plus poor food security. We examine the bottlenecks facing the control program in a changed political and economic context. Method: We searched the literature in July 2015 using three databases: MEDLINE, Google Scholar, and Web of Science. Findings: Decentralized zoonotic HAT control for animal reservoirs and vectors compromise sustainability of the control programs. Human transmission potential may be underestimated in a region with other endemic diseases and where an HIV-HATepidemic, could merge two strains. Conclusion: Our comprehensive literature review concludes that enhanced collaboration is imperative not only between human and animal health specialists, but also with political science. Multi-sectorial collaborations may need to be nurtured within existing operational national HIV prevention frameworks, with an integrated surveillance framework

A qualitative study of health information technology in the Canadian public health system

Background: Although the adoption of health information technology (HIT) has advanced in Canada over the past decade, considerable challenges remain in supporting the development, broad adoption, and effective use of HIT in the public health system. Policy makers and practitioners have long recognized that improvements in HIT infrastructure are necessary to support effective and efficient public health practice. The objective of this study was to identify aspects of health information technology (HIT) policy related to public health in Canada that have succeeded, to identify remaining challenges, and to suggest future directions to improve the adoption and use of HIT in the public health system. Methods: A qualitative case study was performed with 24 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Results: Identified benefits of HIT in public health included improved communication among jurisdictions, increased awareness of the need for interoperable systems, and improvement in data standardization. Identified barriers included a lack of national vision and leadership, insufficient investment, and poor conceptualization of the priority areas for implementing HIT in public health. Conclusions: The application of HIT in public health should focus on automating core processes and identifying innovative applications of HIT to advance public health outcomes. The Public Health Agency of Canada should develop the expertise to lead public health HIT policy and should establish a mechanism for coordinating public health stakeholder input on HIT policy

Reductions in ambulatory blood pressure in young normotensive men and women after isometric resistance training and its relationship with cardiovascular reactivity

Background: There has been very little published work exploring the comparative effects of isometric resistance training (IRT) on blood pressure (BP) in men and women. Most of the previously published work has involved men and used resting BP as the primary outcome variable. Early evidence suggests that IRT is particularly effective in older women and has a positive influence on ambulatory BP, a better predictor of disease risk. Objectives: With the WHO now placing global emphasis on the primary prevention of hypertension, the goals of this proof-of-concept study were to (i) examine whether sex differences exist in the ambulatory BP-lowering effects of IRT in young, normotensive men and women and (ii) determine whether these reductions can be predicted by simple laboratory stress tasks (a 2-min sustained isometric contraction and a math task involving subtracting a two-digit number from a series of numbers). Results: There were no differences in the IRT-induced reductions in 24-h (men: Δ4 mmHg, women: Δ4 mmHg), daytime (men: Δ3 mmHg, women: Δ4 mmHg), or night-time (men: Δ4 mmHg, women: Δ3 mmHg) ambulatory BP in men (n=13) and women (n=11) (P0.05). Conclusion: Our data suggest that lower ambulatory BP can be achieved, to a similar magnitude in young healthy women as well as men, with IRT; however, the BP-lowering effectiveness cannot be predicted by systolic BP reactivity. Taken together, this work heralds a potentially novel approach to the primary prevention of hypertension in both men and women and warrants further investigation in a larger clinical outcome trial

How to navigate the application of ethics norms in global health research: Refections based on qualitative research conducted with people with disabilities in Uganda

As Canadian global health researchers who conducted a qualitative study with adults with and with‑ out disabilities in Uganda, we obtained ethics approval from four institutional research ethics boards (two in Canada and two in Uganda). In Canada, research ethics boards and researchers follow the research ethics norms of the TriCouncil Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2), and the National Guidelines for Research Involving Humans as Research Participants of Uganda (NGRU) in Uganda. The preparation and implementation of this qualitative research raised specifc ethical issues related to research participant privacy and the importance of avail‑ ability and management of fnancial resources. Our feld experience highlights three main issues for refection. First, we demonstrate that, in a global health research context, methodological and logistic adjustments were necessary throughout the research imple‑ mentation process to ensure the protection of study participants’ privacy, especially that of people with disabilities, despite having followed the prescribed Canadian and Ugandan ethics norms. Data collection and management plans were adapted iteratively based on local realities. Second, securing fnancial support as a key aspect of fnancial management was critical to ensure privacy through disability-sensitive data collection strategies. Without adequate funding, the recruitment of research participants based on disability type, sex, and region or the hiring of local sign language interpreters would not have been possible. Third, although the TCPS2 and NGRU underscore the signif‑ cance of participants’ privacy, none of these normative documents clearly express this issue in the context of global health research and disability, nor broadly discuss the ethical issue related to fnancial availability and management

Policy implementation challenges and barriers to access sexual and reproductive health services faced by people with disabilities : an intersectional analysis of policy actors’ perspectives in post-conflict Northern Uganda

Emerging from 20 years of armed conflict, Uganda adopted laws and policies to protect the rights of people with disabilities, including sexual and reproductive health (SRH) rights. This study reflects on the difficulty of implementing disability-focused policy in Uganda. One fifth of the country’s population was estimated to live with some disability (2008). Armed conflict between the Government and the Lord’s Resistance Army caused breakdowns in social systems, and generated widespread trauma for Northern Ugandans. An intersectionality-informed analysis enables policy makers and researchers to examine intersecting social identities and diverse sources of knowledge that can contribute to improved policy solutions.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR)Fonds de Recherche du Québec – Sant

Understanding and attenuating pandemic‑related disruptions : a plan to reduce inequalities in child development

The Secretary General of the United Nations described the impact of COVID-19-related school closures as a “generational catastrophe.” What will be the legacy of the 2020–2021 pandemic-related disruptions in 5, 10, 20 years from now, as regards education and well-being of children and youth? Addressing the disproportionate impact on those growing up in socio-economically disadvantaged areas or on those with pre-existing learning challenges is key to sustainable recovery. This commentary builds on the four literature reviews presented in this Special Section on a Pandemic Recovery Plan for Children and proposes strategies to understand and attenuate the impact of pandemic-related lockdown measures. Importantly, we need a monitoring strategy to assess indicators of child development in three areas of functioning: education and learning, health, and well-being (or mental health). Surveillance needs to begin in the critical prenatal period (with prenatal care to expectant parents), and extend to the end of formal high school/college education. Based on child development indicators, a stepped strategy for intervention, ranging from all-encompassing population-based health and education promotion initiatives to targeted prevention programs and targeted remedial/therapeutic interventions, can be offered. As proposed in the UN plan for recovery, ensuring healthy present and future generations involves a concerted and intensive intersectoral effort from the education, health, psychosocial services, and scientific communities.Selon les Nations Unis, les perturbations scolaires associées à la pandémie de COVID-19 pourraient mener à une « catastrophe générationnelle » en gaspillant un potentiel humain incalculable, sapant des décennies de progrès et exacerbant des inégalités bien ancrées. Le déploiement du vaccin chez les moins de 12 ans n’a pas débuté avant la rentrée scolaire 2021, ce qui laisse présager de nombreuses perturbations pour cette 3e année scolaire pandémique. Quel sera le legs des perturbations entrainées par la pandémie de COVID-19 en matière d’éducation et de bien-être dans 5, 10, ou 20 ans? Une relance durable dépendra des mesures prises pour prévenir l’impact négatif disproportionné sur les enfants/adolescents de milieux socioéconomiques défavorisés et ceux qui ont des défis d’apprentissage préexistants. Ce commentaire propose des stratégies pour comprendre et atténuer l’impact des perturbations pandémiques en se fondant sur les quatre articles de la présente « Section spéciale sur un plan de relance pour les enfants suite à la pandémie ». Trois lignes d’action prioritaires émergent à la lumière des connaissances scientifiques actuelles. Premièrement, le contexte pandémique met en évidence la nécessité d’accéder à données intersectorielles (éducation, santé, services psychosociaux) permettant de distinguer les conséquences à court et à long terme. Deuxièmement, il faut être prêt à déployer une stratégie interventionnelle par étape, avec des interventions universelles en promotion, jusqu’aux interventions plus ciblées et intensives. Troisièmement, il faudra mettre en place des programmes particuliers pour les enfants/adolescents de milieux défavorisés et pour ceux qui présentent des facteurs de risque personnels (défis de santé mentale, retards d’apprentissage). À titre d’exemple, le tutorat scolaire devrait être facilement accessible dans tous les milieux défavorisés. Tel que proposé dans le plan de relance de l’ONU, un effort concerté, intensif et intersectoriel de la part des sciences de l’éducation, de la santé, et des services psychosociaux sera nécessaire pour assurer la santé et l’éducation des générations présentes et futures

Intersectional jeopardy of disability, gender and sexual and reproductive health : experiences and recommendations of women and men with disabilities in Northern Uganda

The study works to better understand and document how people with disabilities perceive the relationships between their use of sexual and reproductive health (SHR) services, legislation and health policy in three Northern districts of post-conflict Uganda (Gulu, Amuru, Omoro). Findings from interview participants reveal that disabled people’s access to SHR services is shaped by intersections of gender, disability, and violence. They experience discrimination across both private-for-profit and public health facilities. The voices of participants reflected in this article add clarity to the findings. The 2030 Sustainable Development Goals committed to “Leave No One Behind” regardless of social identity.Fonds de recherche du Québec - Sant