Ebola Treatment and Prevention are not the only Battles: Understanding Ebola-related Fear and Stigma

Although Ebola Virus Disease (EVD) had already taken hundreds of lives in Liberia, Guinea, and Sierra Leone, it was only declared an ‘Public Health Emergency of International Concern’ in early August when the world started to panic from the possibility of EVD getting out of African borders - a fear that was spreading much faster than the virus itself (1,2). The underlying causes of this fear, however, go far behind the uncertainties surrounding EVD’s pathogenesis and could stem from the past (3). The western perception of associating West Africa with deadly diseases such as malaria, yellow fever and EVD, and representing the region as white man’s grave is not just fueled by superstition or ignorance and has roots in history (3,4). For instance, the yellow fever outbreak in Liberia in the 20s that led to the loss of several prominent American and British medical researchers and instructors, has left the West with painful memories of the region (3)

Solidarity with strangers : the challenges posed by the Great Lakes region refugees to the Ministry of the Anglican Cathedral of the Holy Nativity, Pietermaritzburg.

Thesis (M.Th.)-University of KwaZulu-Natal, Pietermaritzburg, 2007.This thesis focuses on the challenges posed by the refugees from the Great Lakes Region to the ministry of the Anglican Cathedral of the Holy Nativity in Pietermaritzburg, South Africa. It intends to inform the Christian world in general and specifically the Anglican Cathedral of the Holy Nativity of the current refugee situation and its causes. Furthermore, this study shows that understanding the refugees' livelihood strategies is a prerequisite to improved interventions. Using the Sustainable Livelihood Framework, this study describes some of the positive and negative outcomes from the mechanisms and strategies developed by refugees in order to stabilize and enhance their situation. Looking at the livelihood challenges faced by the Great Lakes Region refugees, this study shows how UNHCR (United Nations High Commission for Refugees) has been in a weak position to challenge the policies of its funders and host governments even when those policies fail to respond adequately to refugee problems

Women's empowerment in the post-1994 Rwanda: the case study of Mayaga Region

This research looks at the process of women’s empowerment in post- 1994 Rwanda, with special focus on twelve cooperatives working in Mayaga region and the way these cooperatives empower women, their households and the community at large. Traditional Rwandan society has been always bound by patriarchy which has not valued the reproductive roles of women as economically productive in their households and the society as a whole. On the one hand, this understanding was reversed in the post-1994 Rwanda by the commitment of the government to gender equality at the highest level of political leadership through progressive policies and legislation. On the other hand, in Mayaga region, cooperatives brought about socio-economic development and changed relationships of gender and power in a patriarchal post-conflict society. The findings from cooperatives in Mayaga region show that to prevent women from reaching their full potential is economic folly. If women are empowered, they can generate important development outcomes such as improved health, education, income levels and conflict resolution. The findings further indicate how women’s empowerment is determined by the livelihood strategies women adopt themselves to respond to their vulnerability, and by the ways in which they express their agency in making a living in a sustainable way, with the available community assets that they have access to (financial, social, human, natural and physical). This research highlights that the accessibility of the community assets used by women in Mayaga region and in Rwanda as a whole is also determined by policies, institutions and processes that are able to influence their livelihoods positively

Self-perceived Mental Health Status and Uptake of Fecal Occult Blood Test for Colorectal Cancer Screening in Canada: A Cross-Sectional Study

Background: While colorectal cancer (CRC) is one of the most preventable causes of cancer mortality, it is one of the leading causes of cancer death in Canada where CRC screening uptake is suboptimal. Given the increased rate of mortality and morbidity among mental health patients, their condition could be a potential barrier to CRC screening due to greater difficulties in adhering to behaviours related to long-term health goals. Using a population-based study among Canadians, we hypothesize that self-perceived mental health (SPMH) status and fecal occult blood test (FOBT) uptake for the screening of CRC are associated. Methods: The current study is cross-sectional and utilised data from the Canadian Community Health Survey 2011-2012. Multinomial logistic regression analysis was undertaken to assess whether SPMH is independently associated with FOBT uptake among a representative sample of 11386 respondents aged 50-74 years. Results: Nearly half of the respondents reported having ever had FOBT for CRC screening, including 37.28% who have been screened within two years of the survey and 12.41% who had been screened more than two years preceding the survey. Respondents who reported excellent mental health were more likely to have ever been screened two years or more before the survey (adjusted odds ratio [AOR] = 2.08; 95% CI, 1.00-4.43) and to have been screened in the last two years preceding the survey (AOR = 1.53; 95% CI, 0.86-2.71) than those reported poor mental health status. Conclusion: This study supports the association between SPMH status and FOBT uptake for CRC screening. While the efforts to maximize CRC screening uptake should be deployed to all eligible people, those with poor mental health may need more attentio

Evaluating the implementation of the emergency, triage, assessment and treatment plus admission care intervention in Rwanda

Background: Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) intervention – a locally adapted pediatric advanced life support program – introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The current thesis was undertaken as part of a larger program of research that aims to evaluate the ETAT+ implementation in Rwanda. Methods: Data were gathered during a cross-sectional study in 8 district hospitals across Rwanda; an audit in these hospitals was undertaken to establish a baseline description of the availability of essential resources and process of care related to the leading causes of under-five mortality in Rwanda. To determine changes in participating healthcare providers’ knowledge and practical skills (n=374) between pre- and post ETAT+ implementation, a one group pre-posttest design was used. Paired t-test was used to assess the effect of ETAT+ training on knowledge improvement; and, linear and logistic regression models were fitted to examine factors associated with healthcare providers’ performance on ETAT+ knowledge and skills assessments in Rwanda. Results: Baseline assessment reveals some deficiencies in processes of care (i.e. assessment, treatment and follow-up care), poor organization of some hospital services (e.g., triage), and poor uptake of current pediatric clinical practice guidelines (e.g., dehydration). Post ETAT+, participants’ knowledge scores improved on average by 22.8% (95% CI 20.5, 25.1). Compared to participants who identified as proficient in French, those who identified as proficient in both English and French had on average a higher improvement in knowledge (least square mean=6.64; 95% CI 3.79, 9.49) and were more likely to pass the practical skills assessment (adjusted odds ratio=2.58; 95% CI 1.28, 5.48). Conclusions: The audit of medical records reveals gaps in the process of pediatric care; and these gaps were found to be consistent with knowledge gaps among healthcare providers, as assessed through the ETAT+ pre-assessment. Improvements in post-ETAT+ performance were significant and a number of factors (e.g., language barriers) were identified as important influences on ETAT+ training outcomes. These factors need to be taken in account when implementing ETAT+ and other continuing medical education interventions within the Rwandan context.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Self-perceived Mental Health Status and Uptake of Fecal Occult Blood Test for Colorectal Cancer Screening in Canada: A Cross-Sectional Study

Background: While colorectal cancer (CRC) is one of the most preventable causes of cancer mortality, it is one of the leading causes of cancer death in Canada where CRC screening uptake is suboptimal. Given the increased rate of mortality and morbidity among mental health patients, their condition could be a potential barrier to CRC screening due to greater difficulties in adhering to behaviours related to long-term health goals. Using a population-based study among Canadians, we hypothesize that self-perceived mental health (SPMH) status and fecal occult blood test (FOBT) uptake for the screening of CRC are associated. Methods: The current study is cross-sectional and utilised data from the Canadian Community Health Survey 2011-2012. Multinomial logistic regression analysis was undertaken to assess whether SPMH is independently associated with FOBT uptake among a representative sample of 11386 respondents aged 50-74 years. Results: Nearly half of the respondents reported having ever had FOBT for CRC screening, including 37.28% who have been screened within two years of the survey and 12.41% who had been screened more than two years preceding the survey. Respondents who reported excellent mental health were more likely to have ever been screened two years or more before the survey (adjusted odds ratio [AOR] = 2.08; 95% CI, 1.00-4.43) and to have been screened in the last two years preceding the survey (AOR = 1.53; 95% CI, 0.86-2.71) than those reported poor mental health status. Conclusion: This study supports the association between SPMH status and FOBT uptake for CRC screening. While the efforts to maximize CRC screening uptake should be deployed to all eligible people, those with poor mental health may need more attention

Ebola Treatment and Prevention are not the only Battles: Understanding Ebola-related Fear and Stigma

Although Ebola Virus Disease (EVD) had already taken hundreds of lives in Liberia, Guinea, and Sierra Leone, it was only declared an ‘Public Health Emergency of International Concern’ in early August when the world started to panic from the possibility of EVD getting out of African borders - a fear that was spreading much faster than the virus itself (1,2). The underlying causes of this fear, however, go far behind the uncertainties surrounding EVD’s pathogenesis and could stem from the past (3). The western perception of associating West Africa with deadly diseases such as malaria, yellow fever and EVD, and representing the region as white man’s grave is not just fueled by superstition or ignorance and has roots in history (3,4). For instance, the yellow fever outbreak in Liberia in the 20s that led to the loss of several prominent American and British medical researchers and instructors, has left the West with painful memories of the region (3)

Correlates of Performance of Healthcare Workers in Emergency, Triage, Assessment and Treatment plus Admission Care (ETAT+) Course in Rwanda: Context Matters.

BACKGROUND:The Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) course, a comprehensive advanced pediatric life support course, was introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The impact of the course on improving healthcare workers (HCWs) knowledge and practical skills related to providing emergency care to severely ill newborns and children in Rwanda has not been studied. OBJECTIVE:To evaluate the impact of the ETAT+ course on HCWs knowledge and practical skills, and to identify factors associated with greater improvement in knowledge and skills. METHODS:We used a one group, pre-post test study using data collected during ETAT+ course implementation from 2010 to 2013. The paired t-test was used to assess the effect of ETAT+ course on knowledge improvement in participating HCWs. Mixed effects linear and logistic regression models were fitted to explore factors associated with HCWs performance in ETAT+ course knowledge and practical skills assessments, while accounting for clustering of HCWs in hospitals. RESULTS:374 HCWs were included in the analysis. On average, knowledge scores improved by 22.8/100 (95% confidence interval (CI) 20.5, 25.1). In adjusted models, bilingual (French & English) participants had a greater improvement in knowledge 7.3 (95% CI 4.3, 10.2) and higher odds of passing the practical skills assessment (adjusted odds ratio (aOR) = 2.60; 95% CI 1.25, 5.40) than those who were solely proficient in French. Participants who attended a course outside of their health facility had higher odds of passing the skills assessment (aOR = 2.11; 95% CI 1.01, 4.44) than those who attended one within their health facility. CONCLUSIONS:The current study shows a positive impact of ETAT+ course on improving participants' knowledge and skills related to managing emergency pediatric and neonatal care conditions. The findings regarding key factors influencing ETAT+ course outcomes demonstrate the importance of considering key contextual factors (e.g., language barriers) that might affect HCWs performance in this type of continuous medical education

Quantitative analysis of multiple sclerosis patients’ preferences for drug treatment: a best–worst scaling study

Background: With recent developments in drug therapy for multiple sclerosis (MS), new treatment options have become available presenting patients with complex treatment decisions. Objectives: The objective of this study was to elicit patients’ preferences for different attributes of MS drug therapy. Methods: A representative sample of patients with MS across Canada ( n =189) participated in a best–worst scaling study to quantify preferences for different attributes of MS drug therapy, including delaying progression, improving symptoms, preventing relapse, minor side effects, rare but serious adverse events (SAEs), and route of administration. Conditional logit models were fitted to estimate the relative importance of each attribute in influencing patients’ preferences. Results: A latent-class analysis revealed heterogeneity of preferences across respondents, with preferences differing across five classes. The most important attributes of drug therapy were the avoidance of SAEs for three classes and the improvement of symptoms for two other classes. Only a smaller group of patients demonstrated a specific preference for avoiding SAEs, and route of administration. Conclusion: This study shows that preferences for drug therapy among patients with MS are different, some of which can be explained by experiences with their disease and treatment. These findings can help to inform the focus of interactions that healthcare practitioners have with patients with MS, as well as further drug development