New Approaches for Improved Service Delivery in Rural Settings

The health status of the people in rural areas is faced with challenges primarily due to availability, acceptability, financial accessibility to healthcare services. These include traditional and cultural beliefs, behavioural norms that explain community viewpoints of social roles and various community members’ functions. Rural and remote areas are medically underserved, access to healthcare services is difficult sometimes. Distance covered to access the nearest available health facility by some rural dwellers is discouraging. Thus, moving critically ill or injured persons is hampered because of long-distance or poor transportation means. In the end, many prefer to use traditional medicine than travel that long distance for medical treatment. Recently, healthcare delivery systems have focused on innovative approaches to improve health outcomes, control costs, and foster achieving the Sustainable Development Goals (SDGs). One of these innovations is mHealth (Short Messaging Service) [SMS] texts, which have peculiar attributes, making it particularly suitable for health care in rural and hard-to-reach areas in Low and Middle-Income Countries (LMICs). Moreover, text-messaging interventions are uniquely suited for underserved populations. This chapter highlights some interventions on the uses and benefits of SMS text applications in healthcare service delivery

Comparison of instructions to authors and reporting of ethics components in selected African Biomedical Journals: 2008 and 2017.

Masters Degree. University of KwaZulu-Natal, Pietermaritzburg.Journal editors are expected to provide instructions to prospective authors to describe human participants’ protection measures before, during and after data collection for any original research. However, little is known about authors' adherence to editors’ instructions in African biomedical or health journals. Therefore, the study was designed to review and investigate changes in editors’ instructions to authors and authors’ reporting of research ethics information, based on the recommendations of the International Committee of Medical Journal Editors (2018) and Committee on Publication Ethics (2018) in selected African biomedical journals between the years 2008 and 2017. A review of twelve selected African biomedical journal websites and online articles were reviewed in Eastern, Southern, and Western African [ESWA] countries. Data were collected using a pretested schema and checklist from the selected journal websites, and online articles published in 2008 and 2017 were analysed using descriptive and inferential statistics. Findings showed that more than half of the journals (58.3%) mentioned elements of ICMJE and COPE guidelines in their instruction to authors. Half of the editors requested prospective authors to disclose ethics approval issues in their manuscripts. One-third of the journals (33.3%) requested information from authors on informed consent. Only 16.7% of the journals assessed requested information on protecting research participants from prospective authors. There was a significant increase in the instructions to authors on the request for information on the protection of research participants between 2008 and 2017. Instructions to authors in the selected journals showed requests for information on ethics approval, informed consent, and human participant protection as requirements for publishing in 2008. There was an improvement in these requirements in 2017, and more authors complied with these requirements

SOCIO-CULTURAL CONTEXT OF DEVELOPMENTAL MILESTONES IN INFANCY IN SOUTH WEST NIGERIA: A QUALITATIVE STUDY

Developmental milestones are generally understood to be milestones of neurological development such as neck control, sitting without support, crawling and standing. Child health care providers routinely use normative data on such milestones to evaluate child development. However, there is often a cultural context to expectations of developmental milestones. The goal of this research is to explore the socio-cultural context of developmental milestones in infancy in a Nigerian community. In-depth interview was conducted with 30 mothers enrolled from an infant welfare clinic, southwest, Nigeria The transcripts were coded and analyzed using the Atlas ti 7.0 software package in a combination of thematic and narrative approaches. Mean age of participants was 33.3 (SD 5.1) years, 73% were married, 80% had two or more older children. Mothers expect that a child will be able to sit unaided, crawl and be able to stand by the age of one year. Opinion was divided about if it was possible to predict the age a child will attain a specific milestone. Most mothers reported that the age at which babies attain developmental milestones depends on childrearing practices utilized by the mother. Other factors they perceive as influencing developmental milestones include: having siblings, the age at which siblings and/or parents achieve similar milestones and the environment the child is reared in. Teething was considered an important milestone which has specific culture-bound connotations. Walking was considered one of the most significant milestones, not only indicating normal development but also signifying some independence for both mother and child. In this study of Nigerian mothers, developmental milestones in the first year of life have recognized influencing factors and a number of specific culturebound associated beliefs. This exploratory study provides insights into intersections between biomedical and cultural concepts of childhood development

SOCIO-CULTURAL CONTEXT OF DEVELOPMENTAL MILESTONES IN INFANCY IN SOUTH WEST NIGERIA: A QUALITATIVE STUDY

Developmental milestones are generally understood to be milestones of neurological development such as neck control, sitting without support, crawling and standing. Child health care providers routinely use normative data on such milestones to evaluate child development. However, there is often a cultural context to expectations of developmental milestones. The goal of this research is to explore the socio-cultural context of developmental milestones in infancy in a Nigerian community. In-depth interview was conducted with 30 mothers enrolled from an infant welfare clinic, southwest, Nigeria The transcripts were coded and analyzed using the Atlas ti 7.0 software package in a combination of thematic and narrative approaches. Mean age of participants was 33.3 (SD 5.1) years, 73% were married, 80% had two or more older children. Mothers expect that a child will be able to sit unaided, crawl and be able to stand by the age of one year. Opinion was divided about if it was possible to predict the age a child will attain a specific milestone. Most mothers reported that the age at which babies attain developmental milestones depends on childrearing practices utilized by the mother. Other factors they perceive as influencing developmental milestones include: having siblings, the age at which siblings and/or parents achieve similar milestones and the environment the child is reared in. Teething was considered an important milestone which has specific culture-bound connotations. Walking was considered one of the most significant milestones, not only indicating normal development but also signifying some independence for both mother and child. In this study of Nigerian mothers, developmental milestones in the first year of life have recognized influencing factors and a number of specific culturebound associated beliefs. This exploratory study provides insights into intersections between biomedical and cultural concepts of childhood development

Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. Methods: Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds. Findings: We estimated that, in 2019, the world had 104·0 million (95% uncertainty interval 83·5–128·0) health workers, including 12·8 million (9·7–16·6) physicians, 29·8 million (23·3–37·7) nurses and midwives, 4·6 million (3·6–6·0) dentistry personnel, and 5·2 million (4·0–6·7) pharmaceutical personnel. We calculated a global physician density of 16·7 (12·6–21·6) per 10 000 population, and a nurse and midwife density of 38·6 (30·1–48·8) per 10 000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10 000 population, at least 20·7 physicians, 70·6 nurses and midwives, 8·2 dentistry personnel, and 9·4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6·4 million physicians, 30·6 million nurses and midwives, 3·3 million dentistry personnel, and 2·9 million pharmaceutical personnel. Interpretation: Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment

Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18 : a geospatial modelling study

Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.Methods We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km x 5 km resolution in 98 LMICs based on 2.1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution.Findings Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205000 (95% uncertainty interval 147000-257000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution.Interpretation Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Knowledge, perception and child care practices among adolescent mothers in Ibadan Metropolis, Nigeria

Introduction. There is little information regarding childcare practices among adolescent mothers in the study areas. Aim. This study was aimed at investigating knowledge, perception and childcare practices among adolescent mothers. Material and methods. A descriptive cross-sectional survey was conducted on randomly select 382 adolescent mothers. A validated semi-structured questionnaire was used to collect data, which were analysed using, descriptive and multivariate analyses with p-value set at 0.05. Age of respondents was 18.5±0.7 years. Results. Majority (80.6%) had poor knowledge of when to start ante-natal care. Also, 70.0% of the respondents could not perceive growth monitoring as a necessary strategy for child survival and 86.4% perceived diarrhoea as normal for children during the teething period. Many (58.4%) did not practise exclusive breastfeeding. Respondents with secondary education were less likely to have poor knowledge than those with primary education (OR: 0.2, CI: 0.6-0.9, 95%). Respondents, who received supervision from older women during childcare, were less likely to have poor childcare practice than those who did not (OR: 0.2, CI: 0.4-0.7, 95%). Conclusion. Respondents had poor knowledge of childcare practices when childcare survival strategies were used as the yardstick for evaluation. Involvement of older women is suggested to assist adolescent mothers improve their knowledge and practices of childcare

Assessing health and education in the context of COVID-19 pandemic

The COVID-19 pandemic has impacted Africa and the global communities in various ways. This article looked into the impact of the pandemic on healthcare and education in Africa, especially countries with limited technology for education and weak healthcare systems, highlights the emergency and preparedness in the health and education sector. The COVID-19 pandemic has disrupted learning activities in the educational systems globally, especially in Africa. This has led to increase in out-of-school in many countries. In addition to the loss of learning activities, school closures will deprive many children of protection from home-related hazards such as domestic violence and child abuse. Others will lose access to the only nutritious meal of their day, and many will miss immunisations often given at school.However, much of the situation has created an opportunity for the governments to catch up with the technological way of learning in the 21st century, thereby bridging the digital and education/literacy gap. The article emphasises the particular concerns for care for persons with disabilities in preventing the spread of the virus