Comprehensive sexuality education in six Southern African Countries: Perspectives from learners and teachers

Comprehensive sexuality education (CSE) promotes young people’s healthy sexual decisions. This study assessed the level of provision of CSE in schools in ten sites in six Southern African countries from the perspectives of learners and teachers. The data was from a needs assessment preceding the baseline evaluation of the SRHR-HIV Knows no Borders Project conducted in ten sites in six Southern African countries. A total of 161 learners from 10 schools and 96 teachers from 96 schools were interviewed. Among the teachers, 82.3% reported CSE was part of the school curriculum. Although basic education policies in Southern African countries are in tandem with international, regional and national policies, complete implementation of the policies remains unfulfilled owing to conflicting policies and socio-cultural values of diverse stakeholders. Awareness campaigns and trainings may help to promote positive perceptions among stakeholders about sensitive CSE topics and the distribution of SRH commodities in schools.   L’éducation sexuelle complète (CSE) encourage les jeunes à prendre des décisions sexuelles saines. Cette étude a évalué le niveau de fourniture d'ESI dans les écoles de dix sites dans six pays d'Afrique australe du point de vue des apprenants et des enseignants. Les données provenaient d'une évaluation des besoins précédant l'évaluation de base du projet SRHR-HIV Knows no Borders mené dans dix sites dans six pays d'Afrique australe. Au total, 161 apprenants de 10 écoles et 96 enseignants de 96 écoles ont été interrogés. Parmi les enseignants, 82,3% ont déclaré que l'ESC faisait partie du programme scolaire. Bien que les politiques d'éducation de base dans les pays d'Afrique australe soient en tandem avec les politiques internationales, régionales et nationales, la mise en oeuvre complète des politiques reste inachevée en raison des politiques contradictoires et des valeurs socioculturelles des diverses parties prenantes. Les campagnes de sensibilisation et les formations peuvent aider à promouvoir des perceptions positives parmi les parties prenantes sur les sujets sensibles de l'ESC et la distribution de produits de SSR dans les écoles. &nbsp

Willingness to pay for COVID-19 mitigation measures in public transport and paratransit in low-income countries

In order to combat the spread of COVID-19, various measures were taken in most countries to make public transit and paratransit safer. These additional measures, which include restrictions on number of passengers, provision of hand sanitisers and face coverings, and more frequent cleaning, add to the costs of operations or reduce profitability. The resulting financial pressure on the transport operators raises an important question on who pays for these additional measures. In most countries, this has been covered by one-time government bailouts to operators or strategies to increase fare, the latter of which directly affects the users. However, even without these interventions, there could be a demand and as such willingness to pay (WTP) for some of these intervention measures from the consumers concerned about safety. Knowing such WTP will not only help operators set their fare, but also help the governments decide the appropriate bailout needed. This paper addresses the issue by estimating the user's willingness to pay for selected COVID-19 mitigation measures in public transport and paratransit (motorcycle taxis) using survey data collected from two cities in low-income countries as case studies – Kampala, Uganda and Dhaka, Bangladesh. For public transport, these measures are - (1) social distancing (passenger loading at half capacity), and (2) mandatory hand sanitisation and increased cleaning of surfaces, while for paratransit, they are - (1) provision of a transparent shield between the rider and the passenger, and (2) provision of cleaned helmets at the start of each trip. The study analyses stated preference data using the utility maximisation framework and finds that the implementation or provision of COVID-19 mitigation measures improves the attractiveness of the associated public transport or paratransit alternatives, and transport users make trade-offs between safety and cost when making travel decisions. We find positive willingness to pay for all four mitigation measures, suggesting potential existence of a market for these measures. We also find that the typical mode choice factors such as costs, travel time and convenience became less important during the pandemic and the safety measures became more important considerations

The Uptake and Accuracy of Oral Kits for HIV Self-Testing in High HIV Prevalence Setting: A Cross-Sectional Feasibility Study in Blantyre, Malawi

Augustine Choko and colleagues assess the uptake and acceptability of home-based supervised oral HIV self-testing in Malawi, demonstrating the feasibility of this approach in a high-prevalence, low-income environment

High acceptance of home-based HIV counseling and testing in an urban community setting in Uganda

<p>Abstract</p> <p>Background</p> <p>HIV testing is a key component of prevention and an entry point into HIV/AIDS treatment and care however, coverage and access to testing remains low in Uganda. Home-Based HIV Counseling and Testing (HBHCT) has potential to increase access and early identification of unknown HIV/AIDS disease. This study investigated the level of acceptance of Home-Based HIV Counseling and Testing (HBHCT), the HIV sero-prevalence and the factors associated with acceptance of HBHCT in an urban setting.</p> <p>Methods</p> <p>A cross-sectional house-to-house survey was conducted in Rubaga division of Kampala from January-June 2009. Residents aged ≥ 15 years were interviewed and tested for HIV by trained nurse-counselors using the national standard guidelines. Acceptance of HBHCT was defined as consenting, taking the HIV test and receipt of results offered during the home visit. Multivariable logistic regression analysis was performed to determine significant factors associated with acceptance of HBHCT.</p> <p>Results</p> <p>We enrolled 588 participants, 408 (69%, 95% CI: 66%-73%) accepted testing. After adjusting for confounding, being male (adj. OR 1.65; 95%CI 1.03, 2.73), age 25-34 (adj. OR 0.63; 95% CI 0.40, 0.94) and ≥35 years (adj. OR 0.30; 95%CI 0.17, 0.56), being previously married (adj. OR 3.22; 95%CI 1.49, 6.98) and previous HIV testing (adj. OR 0.50; 95%CI 0.30, 0.74) were significantly associated with HBHCT acceptance. Of 408 who took the test, 30 (7.4%, 95% CI: 4.8%- 9.9%) previously unknown HIV positive individuals were identified and linked to HIV care.</p> <p>Conclusions</p> <p>Acceptance of home-based counseling and testing was relatively high in this urban setting. This strategy provided access to HIV testing for previously untested and unknown HIV-infected individuals in the community. Age, sex, marital status and previous HIV test history are important factors that may be considered when designing programs for home-based HIV testing in urban settings in Uganda.</p

Voluntary HIV counselling and testing among men in rural western Uganda: Implications for HIV prevention

<p>Abstract</p> <p>Background</p> <p>Voluntary HIV counselling and testing (VCT) is one of the key strategies in the prevention and control of HIV/AIDS in Uganda. However, the utilization of VCT services particularly among men is low in Kasese district. We therefore conducted a study to determine the prevalence and factors associated with VCT use among men in Bukonzo West health sub-district, Kasese district.</p> <p>Methods</p> <p>A population-based cross-sectional study employing both quantitative and qualitative techniques of data collection was conducted between January and April 2005. Using cluster sampling, 780 men aged 18 years and above, residing in Bukonzo West health sub-district, were sampled from 38 randomly selected clusters. Data was collected on VCT use and independent variables. Focus group discussions (4) and key informant interviews (10) were also conducted. Binary logistic regression was performed to determine the predictors of VCT use among men.</p> <p>Results</p> <p>Overall VCT use among men was 23.3% (95% CI 17.2–29.4). Forty six percent (95% CI 40.8–51.2) had pre-test counselling and 25.9% (95%CI 19.9–31.9) had HIV testing. Of those who tested, 96% returned for post-test counselling and received HIV results. VCT use was higher among men aged 35 years and below (OR = 2.69, 95%CI 1.77–4.07), the non-subsistence farmers (OR = 2.37, 95%CI 2.37), the couple testing (OR = 2.37, 95%CI 1.02–8.83) and men with intention to disclose HIV test results to sexual partners (OR = 1.64, 95%CI 1.04–2.60). The major barriers to VCT use among men were poor utilization of VCT services due to poor access, stigma and confidentiality of services.</p> <p>Conclusion</p> <p>VCT use among men in Bukonzo West, Kasese district was low. In order to increase VCT use among men, the VCT programme needs to address HIV stigma and improve access and confidentiality of VCT services. Among the more promising interventions are the use of routine counselling and testing for HIV of patients seeking health care in health units, home based VCT programmes, and mainstreaming of HIV counselling and testing services in community development programmes.</p

Protocol for the Birth Asphyxia in African Newborns (Baby BRAiN) Study: a Neonatal Encephalopathy Feasibility Cohort Study

BACKGROUND: Neonatal encephalopathy (NE) is a leading cause of child mortality worldwide and contributes substantially to stillbirths and long-term disability. Ninety-nine percent of deaths from NE occur in low-and-middle-income countries (LMICs). Whilst therapeutic hypothermia significantly improves outcomes in high-income countries, its safety and effectiveness in diverse LMIC contexts remains debated. Important differences in the aetiology, nature and timing of neonatal brain injury likely influence the effectiveness of postnatal interventions, including therapeutic hypothermia. METHODS: This is a prospective pilot feasibility cohort study of neonates with NE conducted at Kawempe National Referral Hospital, Kampala, Uganda. Neurological investigations include continuous video electroencephalography (EEG) (days 1-4), serial cranial ultrasound imaging, and neonatal brain Magnetic Resonance Imaging and Spectroscopy (MRI/ MRS) (day 10-14). Neurodevelopmental follow-up will be continued to 18-24 months of age including Prechtl’s Assessment of General Movements, Bayley Scales of Infant Development, and a formal scored neurological examination. The primary outcome will be death and moderate-severe neurodevelopmental impairment at 18-24 months. Findings will be used to inform explorative science and larger trials, aiming to develop urgently needed neuroprotective and neurorestorative interventions for NE applicable for use in diverse settings. DISCUSSION: The primary aims of the study are to assess the feasibility of establishing a facility-based cohort of children with NE in Uganda, to enhance our understanding of NE in a low-resource sub-Saharan African setting and provide infrastructure to conduct high-quality research on neuroprotective/ neurorestorative strategies to reduce death and disability from NE. Specific objectives are to establish a NE cohort, in order to 1) investigate the clinical course, aetiology, nature and timing of perinatal brain injury; 2) describe electrographic activity and quantify seizure burden and the relationship with adverse outcomes, and; 3) develop capacity for neonatal brain MRI/S and examine associations with early neurodevelopmental outcomes