Migrant workers' perceptions, expectations and experiences of occupational health services in Finland

The northward rising trend in the number of international migrants has resulted to unprecedented implications on healthcare sector. Events accompanying migration have impact on both the migrant population and the hosting community. To understand the challenges encountered by the migrant workers in the host country, it is imperative to explore their encounters with the services by listening to the lived experiences. The aim of this study was to bring out immigrant workers’ expectations and experiences of occupational health services in Finland. The study explored the expectations and lived experiences of the migrant workers. A qualitative research method was used for this study. The study population consisted of 12 participants who were sampled purposively. Data was collected through face-to-face interviews. The data was analyzed by thematic content analysis method. The results of the study identified barriers to occupational health services to include language and communication, difficulties arising from navigation through the Finnish healthcare system and issues related to cultural differences. The study also identified workplace safety as being associated to migration and health. In conclusion, the study recognized the process of healthcare access by the migrant worker as being multidimensional. Therefore, the study recommends for enhanced collaborative approach by employers, employees and other relevant stakeholders. The efforts invested towards strengthening health providers’ relationship with care seekers would go a long way in improving occupational health service access

IMMIGRANTS’ EXPECTATIONS AND EXPERIENCES OF CHILD HEALTH SERVICES : A study of African families in Jyväskylä region, Finland

The purpose of the study was to explore the needs, expectations and experiences of African immigrant families of child health services within Jyväskylä region, Finland. The aim of the study was to gain insight and increase care providers’ understanding of care needs of the minority population from the immigrant’s perspective. The research method used to implement the study was qualitative method. Semi-structured interview questions were used to collect the data. Sampled study population consisted of three fathers and three mothers. Data collection period spread over three months. Content analysis method was used to analyze the data. The study results indicated that the participants were generally satisfied with the services they receive from child health clinics. Nevertheless, language and communication were highlighted as some of the challenges to health care access. Subsequently, the role played by the interpreter was identified and over-emphasized in facilitating effective communication. The results also pointed out that the participants’ expectations were centered on cultural care; sensitivity to cultural diversity a major concern raised by the participants. Additionally, the study results indicated the other hurdles the participants felt they are facing while accessing specialized health care services, such as long waiting periods. The study results would be useful to the health care providers, policy makers and other stakeholders in formulation, planning and implementation of culturally sensitive health care services.Tämän tutkimuksen tarkoituksena oli selvittää afrikkalaisten maahanmuuttajaperheiden tarpeita, odotuksia ja kokemuksia suomalaisen lastenneuvolan palveluista Jyväskylässä. Tutkimuksen tavoitteena oli lisätä lastenneuvolan työntekijöiden ymmärrystä maahanmuuttajien neuvolapalveluiden tarpeista kulttuurisesta näkökulmasta katsottuna. Tutkimus toteutettiin laadullisen menetelmän avulla. Tiedot kerättiin kolmen kuukauden aikana. Tutkimukseen osallistui kuusi henkilöä, kolme isää ja kolme äitiä, joilla oli neuvolaikäisiä lapsia. Kerätyt tiedot analysoitiin sisällönanalyysin avulla. Tulokset osoittivat, että tutkimukseen osallistuneet olivat pääsääntöisesti tyytyväisiä lastenneuvolasta saamiinsa palveluihin. Epäkohtana vastaajat korostivat yhteisen kielen puuttumista ja viestinnän ongelmia lastenneuvolapalveluissa. Lisäksi tutkimukseen osallistuneet tunnistivat tulkin roolin ja korostivat sen merkitystä tehokkaan viestinnän syntymisen kannalta. Tutkimukseen osallistuneet kokivat myös, että lastenneuvolan henkilökunnan tulisi antaa heille mahdollisuus kertoa enemmän lasten kasvatukseen liittyvissä asioista omankulttuurinsa näkökulmasta. Tuloksissa tuli esiin myös ongelmia, joita tutkimukseen osallistuneet olivat kohdanneet muun terveydenhuollon parissa. Tällaisena ongelmana esiin nousivat muun muassa pitkät odotusajat. Tutkimustulokset hyödyttäisivät terveydenhuollon palveluiden tuottajia, päättäjiä sekä muita sidosryhmiä jotka laatiessaan, suunnitellessaan ja toimeenpannessaan monikulttuurisia hoitokäytäntöj

Building laboratory capacity to detect and characterize pathogens of public and global health security concern in Kenya

Since 1979, multiple CDC Kenya programs have supported the development of diagnostic expertise and laboratory capacity in Kenya. In 2004, CDC's Global Disease Detection (GDD) program within the Division of Global Health Protection in Kenya (DGHP-Kenya) initiated close collaboration with Kenya Medical Research Institute (KEMRI) and developed a laboratory partnership called the Diagnostic and Laboratory Systems Program (DLSP). DLSP built onto previous efforts by malaria, human immunodeficiency virus (HIV) and tuberculosis (TB) programs and supported the expansion of the diagnostic expertise and capacity in KEMRI and the Ministry of Health. First, DLSP developed laboratory capacity for surveillance of diarrheal, respiratory, zoonotic and febrile illnesses to understand the etiology burden of these common illnesses and support evidenced-based decisions on vaccine introductions and recommendations in Kenya. Second, we have evaluated and implemented new diagnostic technologies such as TaqMan Array Cards (TAC) to detect emerging or reemerging pathogens and have recently added a next generation sequencer (NGS). Third, DLSP provided rapid laboratory diagnostic support for outbreak investigation to Kenya and regional countries. Fourth, DLSP has been assisting the Kenya National Public Health laboratory-National Influenza Center and microbiology reference laboratory to obtain World Health Organization (WHO) certification and ISO15189 accreditation respectively. Fifth, we have supported biosafety and biosecurity curriculum development to help Kenyan laboratories safely and appropriately manage infectious pathogens. These achievements, highlight how in collaboration with existing CDC programs working on HIV, tuberculosis and malaria, the Global Health Security Agenda can have significantly improve public health in Kenya and the region. Moreover, Kenya provides an example as to how laboratory science can help countries detect and control of infectious disease outbreaks and other public health threats more rapidly, thus enhancing global health security

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated