Leveraging health infrastructure to optimize HPV vaccination for adolescents in Zambia: Protocol for an implementation study

BACKGROUND: Cervical cancer is the leading cause of cancer death in Zambia, where HIV prevalence is also high (11.3%). HIV heightens the risk of developing and dying from cervical cancer. The human papillomavirus (HPV) vaccine can prevent 90% of cervical cancers, and in Zambia is recommended for adolescent girls ages 14-15 years, including those with HIV. Currently they mainly deliver HPV vaccination via school-based campaigns, which may exclude the most vulnerable adolescents-those out-of-school or who irregularly attend. Adolescents living with HIV (ALHIV) are more likely to have these vulnerabilities. Further, school-based campaigns are not tailored to the WHO-recommended HPV vaccination schedule for ALHIV (3 versus 2 doses). Integrating HPV vaccination into routine care in adolescent HIV clinics may ensure that ALHIV have access to vaccine at the WHO-recommended schedule. Such integration requires a multilevel approach, stakeholder engagement, and diversified implementation strategies, given known challenges of providing the HPV vaccine in LMICs, including Zambia. METHODS: Our study aims to integrate HPV vaccination into routine care in adolescent HIV clinics. To achieve success, we will co-design a package of implementation strategies using a previously successful implementation research approach developed for cervical cancer prevention in LMICs: the Integrative Systems Praxis for Implementation Research (INSPIRE). INSPIRE is a novel, comprehensive approach to develop, implement, and evaluate implementation science efforts. Following key elements of INSPIRE, our specific aims are to: 1) Identify the unique multilevel contextual factors (barriers and facilitators) across HIV settings (rural, urban, peri-urban) that influence HPV vaccine uptake; 2) Use Implementation Mapping to translate stakeholder feedback and findings from Aim 1 into a package of implementation strategies to integrate HPV vaccine into HIV clinics; 3) Conduct a Hybrid Type 3 effectiveness-implementation trial to evaluate the package of multilevel implementation strategies for integrating HPV vaccine into HIV clinics. DISCUSSION: Our research team has strong support, technical expertise, and resources (e.g., vaccines) from the Zambian Ministry of Health; and political will for scale-up. This stakeholder-based implementation model has the potential to be transported to HIV clinics across Zambia and serve as a model to address cancer prevention priorities for those with HIV in other LMICs. TRIAL REGISTRATION: To be registered prior to Aim 3, when implementation strategies finalized

From the horse’s own mouth: Gender perception in some Akan and Ewe proverbs

Issues about women have engaged the attention of many scholars over the years, especially in recent times. These issues span much of marginalization of women in national affairs, male dominance over women, sexual harassment and recently in Ghana domestic violence against women and children among others. Most of these have been analysed from various dimensions. The sociologists, the psychologists and the humanists have all touched on an aspect nor other of womanhood however trite it may seem. This paper is a contribution to the discussion on women. It invites the reader to look at the issue of women in two ethnic communities in Ghana - Akan and Ewe from the literary point of view, specifically from the proverbs that these communities have themselves formulated and been using about women. One cannot deny the fact that creative writers, both males andfemales have portrayed women from a point of view that has close relations with societal determinants. The sexuality of the Ghanaian woman in general and those in the two communities studied has been expressed in their proverbs. The analysis of the proverbs has some relations with the findings of some researchers concerning the old perceptions about the woman as a weakling who depends on the male for sustenance and her total wellbeing

The role of commercial agriculture in meeting sustainable development goals in South Africa: Evidence from municipal-level total factor productivity analysis

Improving agricultural productivity is critical, both locally and globally, particularly in the pursuit of the Sustainable Development Goals (SDGs) of eradicating poverty (SDG 1), increasing food production for food security (SDG 2), and promoting efficient use of agricultural resources and sustainable farming practices (SDG 12). This study examines and compares total factor productivity efficiency (TFPE) in the South African commercial agricultural sector, along with its drivers, using local municipal-level data. We used the Fare-Primont ¨ index to assess municipalities' TFPE levels, considering both traditional (economic) factors (labour, land, and operating expenses) and environmental variables (temperature, rainfall, and soil moisture index). Our TFPE index results are not only lower, but they show more variation across municipalities than the economic TFPE index, which is commonly used in agricultural productivity research. This implies that ignoring environmental variables may bias analysis" therefore, future studies should consider including environmental factors in their analyses. We then used hierarchical clustering to group municipalities with similar TFPE levels and components, followed by fractional regression to identify the drivers of efficiency levels. The cluster analysis results reveal that the best performing municipalities are in cluster 4, comprising municipalities from the Western Cape Winelands specialising in horticulture production, municipalities near urban areas with better market proximity, those engaged in the global value chain, and those with a high proportion of farmers who own most of their farmland. Furthermore, the fractional regression results show that age, gender, race, market proximity, land use types, and production diversification are significant drivers of TFPE and its components. Our study offers insights into the divergent agricultural TFPE performance among municipalities and the underlying factors causing these disparities. The findings can inform the development of targeted strategies, particularly at the local level, aimed at enhancing agricultural productivity and making significant contributions to achieving the SDGs

Raw_data_for_antimalarial_drug_resistant_alleles_Navrongo_Kintampo_Accra

We investigated the prevalence of chloroquine and antifolate resistant alleles and the allele combination of the latter in Navrongo, Kintampo and Accra