4,037 research outputs found
A Multi-level Analysis on Implementation of Low-Cost IVF in Sub-Saharan Africa: A Case Study of Uganda.
Introduction: Globally, infertility is a major reproductive disease that affects an estimated 186 million people worldwide. In Sub-Saharan Africa, the burden of infertility is considerably high, affecting one in every four couples of reproductive age. Furthermore, infertility in this context has severe psychosocial, emotional, economic and health consequences. Absence of affordable fertility services in Sub-Saharan Africa has been justified by overpopulation and limited resources, resulting in inequitable access to infertility treatment compared to developed countries. Therefore, low-cost IVF (LCIVF) initiatives have been developed to simplify IVF-related treatment, reduce costs, and improve access to treatment for individuals in low-resource contexts. However, there is a gap between the development of LCIVF initiatives and their implementation in Sub-Saharan Africa. Uganda is the first country in East and Central Africa to undergo implementation of LCIVF initiatives within its public health system at Mulago Women’s Hospital.
Methods: This was an exploratory, qualitative, single, case study conducted at Mulago Women’s Hospital in Kampala, Uganda. The objective of this study was to explore how LCIVF initiatives have been implemented within the public health system of Uganda at the macro-, meso- and micro-level. Primary qualitative data was collected using semi-structured interviews, hospital observations informal conversations, and document review. Using purposive and snowball sampling, a total of twenty-three key informants were interviewed including government officials, clinicians (doctors, nurses, technicians), hospital management, implementers, patient advocacy representatives, private sector practitioners, international organizational representatives, educational institution, and professional medical associations. Sources of secondary data included government and non-government reports, hospital records, organizational briefs, and press outputs. Using a multi-level data analysis approach, this study undertook a hybrid inductive/deductive thematic analysis, with the deductive analysis guided by the Consolidated Framework for Implementation Research (CFIR).
Findings: Factors facilitating implementation included international recognition of infertility as a reproductive disease, strong political advocacy and oversight, patient needs & advocacy, government funding, inter-organizational collaboration, tension to change, competition in the private sector, intervention adaptability & trialability, relative priority, motivation &advocacy of fertility providers and specialist training. While barriers included scarcity of embryologists, intervention complexity, insufficient knowledge, evidence strength & quality of intervention, inadequate leadership engagement & hospital autonomy, poor public knowledge, limited engagement with traditional, cultural, and religious leaders, lack of salary incentives and concerns of revenue loss associated with low-cost options.
Research contributions: This study contributes to knowledge of factors salient to implementation of LCIVF initiatives in a Sub-Saharan context. Effective implementation of these initiatives requires (1) sustained political support and favourable policy & legislation, (2) public sensitization and engagement of traditional, cultural, and religious leaders (3) strengthening local innovation and capacity building of fertility health workers, in particular embryologists (4) sustained implementor leadership engagement and inter-organizational collaboration and (5) proven clinical evidence and utilization of LCIVF initiatives in innovator countries. It also adds to the literature on the applicability of the CFIR framework in explaining factors that influence successful implementation in developing countries and offer opportunities for comparisons across studies
WHY DO REGIONAL SOCIAL POLICIES FAIL? Gendered Institutions and the Maputo Plan of Action
In 2005, the African Union (AU) developed a regional policy on sexual reproductive health (SRH) and rights aimed at improving member states’ SRH delivery, the Maputo Plan of Action (MPoA). It initially ran from 2006 to 2015 and was then extended to 2016 to 2030. However, the MPoA’s implementation has been slow and largely ineffective. This thesis explores the factors behind this ineffectiveness despite the apparent commitment to improving SRH delivery on the part of the AU member states as demonstrated by their collective development and adoption of the policy.
The thesis addresses reproductive health policy from a social policy perspective and begins its investigation by exploring existing regionalism literature that provides insights into why regionally integrated social policies oftentimes fail. The thesis finds that existing literature highlights specific institutional structures and path dependencies as factors that undermine regionalism’s efforts in social policy. In this thesis, I argue that these explanations, while relevant, offer only part of the story, because they do not consider the gendered character of regional organisations and the impact of this on policy formulation and implementation processes. I address this gap by exploring the role of gendered institutions in the design and delivery of regional social policies using the MPoA as a case study.
To develop this analysis, I use Feminist Institutionalism (FI) to study the gendered factors behind the ineffectiveness of the MPoA. Overall, I argue that the design, development and implementation processes of the MPoA are shaped by the gendered institutions of its host organisation, the AU, which undermine its priority setting, strategy development and resource allocation processes by undervaluing and trivialising the needs of women and girls, contributing to weak delivery. These gendered institutions are indicated by the exclusion of women in the AU structure, gendered sharing of roles and responsibilities and unequal opportunities to participate and influence AU processes. The thesis therefore concludes that the MPoA fails to deliver on SRH for women and girls due to the underlying gendered institutions of the AU that shaped the policy and drives in implementation in gendered ways. More broadly, the thesis concludes that regionally integrated social policies oftentimes fail because of the gendered character of regional organisations, which undermines policy formulation and implementation processes
The Diasporic Sublime in the Works of Bharati Mukherjee, Jhumpa Lahiri, and Chitra Banerjee Divakaruni
The doctoral research aims to redefine the theory of the sublime within the transcultural identities through the works of Bharati Mukherjee, Jhumpa Lahiri, and Chitra Banerjee Divakaruni. The involvement and elevation of Indian American women in migration has not been emphasised enough in the discussion of indentured labour, globalization and effects of cultural appropriation. Considering the German traditions of aesthetics, specifically Immanuel Kant’s theorization of the sublime in his Observations on the Feeling of the Beauty and the Sublime (1790/2011), the dissertation focuses to challenge the specific Kantian notion of female inability to be the sovereign and elevated (sublime) subject. ‘Diasporic sublime’ hence highlights the journey of Indian immigrant women in the United States of America and facing the conflicts to reach the sublime state of body and mind. The dissertation structures the conceptualisation of the postcolonial fear, power and agency through the changes of body, food and home to evince the manifestation of the sublime. Following the contemporary works of Christina Battersby, Bonnie Mann and Barbara Claire Freeman, the dissertation renegotiates the term sublime as a process to confront the submissive identity, dehumanised socio-economical state of immigrant women
Weather or not? The role of international sanctions and climate on food prices in Iran
IntroductionThe scarcity of resources have affected food production, which has challenged the ability of Iran to provide adequate food for the population. Iterative and mounting sanctions on Iran by the international community have seriously eroded Iran's access to agricultural technology and resources to support a growing population. Limited moisture availability also affects Iran's agricultural production. The aim of this study was to analyze the influence of inflation, international sanctions, weather disturbances, and domestic crop production on the price of rice, wheat and lentils from 2010 to 2021 in Iran.MethodData were obtained from the statistical yearbooks of the Ministry of Agriculture in Iran, Statistical Center of Iran, and the Central Bank of Iran. We analyzed econometric measures of food prices, including CPI, food inflation, subsidy reform plan and sanctions to estimate economic relationships. After deflating the food prices through CPI and detrending the time series to resolve the non-linear issue, we used monthly Climate Hazards group Infrared Precipitation with Stations (CHIRPS) precipitation data to analyze the influence of weather disturbances on food prices.Results and discussionThe price of goods not only provides an important indicator of the balance between agricultural production and market demand, but also has strong impacts on food affordability and food security. This novel study used a combination of economic and climate factors to analyze the food prices in Iran. Our statistical modeling framework found that the monthly precipitation on domestic food prices, and ultimately food access, in the country is much less important than the international sanctions, lowering Iran's productive capability and negatively impacting its food security
Air pollution, nanotoxicity and neurodegeneration; exploring the relationship between environmental metallic nanoparticles and human health
Air pollution and Alzheimer’s disease (AD) are two of the largest global health issues faced by society today; air pollution is a recognised risk factor for AD. Particulate matter (PM) is a major component of air pollution and refers to the solid and liquid particulates of varying sizes and compositions that are resuspended in the air. Of these particles, metallic particles in the nanometre range (ultrafine, UFPs; < 0.1 µm) are particularly hazardous due to their pervasiveness, ability to penetrate all major organs in the human body, and ability to generate both inflammatory and oxidative stress responses in humans. Magnetite (Fe3O4) nanoparticles (MNPs) and related iron oxides may be of relevance to neurodegeneration. MNPs are found within PM, typically in association with toxic metals, and have been found throughout the human brain, including in association with senile plaques (a key pathological hallmark of AD). MNPs have also been shown to accelerate amyloid beta (Aβ) toxicity and aggregation. MNPs have previously been quantified in a handful of studies to compare AD and control tissue, with mixed results. Improved understanding of the development of AD, the toxic effects of air pollution (especially magnetite and metals), and the relationship between these two phenomena would be highly beneficial to global health. In order to explore the potential causal link between air pollution and AD, two approaches were taken; metallic and magnetic quantification of post-mortem human brain tissue via superconducting quantum interference device (SQUID) magnetometry and inductively couple plasma mass spectrometry (ICP-MS), and exploration of the cytotoxic effects of ultrafine roadside dust particles (UF-RDPs) on human lung epithelial cells (Calu-3) using different in vitro assays. The concentration of magnetite (measured as magnetic remanence, SIRM) in human brain tissue was not statistically different when comparing AD cases to aged-matched controls. Similarly, there were no differences in metal content between the two groups. Principal component analysis grouped the metals into four components, which are potentially indicators of pollution sources: (1) traffic-related and crustal, (2) fuel oil combustion, (3) biological and tyre/brake wear, and (4) catalytic converters and dental alloys. The distributions of magnetite and metals were heterogenous across different individuals. Significantly lower concentrations of both MNPs and metals were reported in UK samples, compared topreviously reported Mexico City samples. Differences were also seen when comparing the in vitro response to UF-RDPs from three contrasting cities; Lancaster UF-RDPs increased cell viability, whilst Mexico City UF-RDPs were the most toxic and induced the highest amount of oxidative stress (ROS production), and Birmingham UF-RDPs were the most pro-inflammatory. These responses are not fully reflected in conventional mass metrics like PM10, as although the greatest cytotoxicity and ROS production was seen with Mexico City UF-RDPs (highest PM10 exposure), the strongest pro-inflammatory responses were seen in response to Birmingham UF-RDPs and a potentially tumorigenic or fibrosis related increase in cell viability was seen in response to Lancaster UF-RDPs despite the lower PM10 and PM2.5 exposures in the UK cities. There is a need for localised air pollution limits which use biologically relevant metrics that address particle size and cover non-exhaust emission sources of PM like road dust to minimize the health risks of air pollution exposure. Overall, this work demonstrates the presence of exogenous, pollution-derived metals and magnetic nanoparticles within the human brain. Highly reactive and toxic metals and MNPs may exert toxic effects in the brain and have been causally linked to neurodegeneration and AD. The geriatric blood-brain barrier is likely compromised allowing for universal incursion in both AD and age-matched controls, so the use of younger highly exposed individuals such as Mexico City urbanites is critical to identify any changes in metal/magnetic content in the brain decades prior to the presentation of AD. Clear differences were seen across geographical locations when looking at absolute concentrations of MNPs, as well as the composition and induced biological effects of UF-RDPs from different cities. It is thus important to focus on highly localised air pollution regulations to mitigate risk to human health
Trends, inequalities and factors associated with infant and young child feeding practices: mixed-methods research in Indonesia
Background: Indonesia’s progress in achieving infant and young child feeding (IYCF) recommendations has been slow over the last decade despite socioeconomic improvement. Aim: To examine trends, inequalities, and factors associated with IYCF practices in Indonesia. Methods: This study used a mixed-methods design. For quantitative methods, I used data from 2007, 2012 and 2017 Indonesia Demographic and Health Surveys and the 2018 Basic Health Research. Quantitative data analyses included multiple logistic regression and decomposition analysis of the concentration index. For the qualitative methods, I conducted in-depth interviews with caregivers and key informant interviews in rural and urban Central Java. To analyse the qualitative data, I used thematic analysis. Results: The minimum dietary diversity (MDD) trend stagnated from 2007 to 2017. The child’s age, maternal education, access to media, paternal occupation, antenatal care visits, household wealth, living residency, and geographic area were associated with MDD. The MDD proportion was more concentrated in children with wealthier households and higher education mothers. The contributory factors to pro-rich and pro-educated inequalities in MDD were household wealth, maternal education, paternal occupation, and antenatal care visits. Breastfeeding duration, MDD, and animal-source food were associated with stunting. IYCF knowledge and perceptions were more favourable in urban, but exclusive and continued breastfeeding were more typical in rural. Urban children consumed more varied animal-source foods, pulses, and fruits. Different factors had specific roles in influencing IYCF practices in each area. Conclusions: Multiple-level factors affect IYCF practices. These factors are contextually specific and may interact with each other. A well-coordinated multilevel and multisectoral approach is needed to improve IYCF in Indonesia, thus optimal child nutrition
- …