Mention of ethical review and informed consent in the reports of research undertaken during the armed conflict in Darfur (2004–2012): a systematic review

Armed conflict in Darfur, west Sudan since 2003 has led to the influx of about 100 international humanitarian UN and non-governmental organizations to help the affected population. Many of their humanitarian interventions included the collection of human personal data and/or biosamples, and these activities are often associated with ethical issues. A systematic review was conducted to assess the proportion of publicly available online reports of the research activities undertaken on humans in Darfur between 2004 and 2012 that mention obtaining ethical approval and/or informed consent

Investigating the pathways from preconception care to preventing maternal, perinatal and child mortality: A scoping review and causal loop diagram

In recent years, there has been a growing recognition that developing preconception care provides an opportunity to significantly reduce maternal and child mortality and morbidity. This involves targeting multiple risk factors through a large array of medical, behavioural and social interventions. In this study, we created a Causal Loop Diagram (CLD) to describe several pathways by which a set of preconception interventions may lead to women’s improved health and better pregnancy outcomes. The CLD was informed by a scoping review of meta-analyses. It summarises evidence on the outcomes and interventions related to eight preconception risk factors. The authors reviewed literature from two databases (PubMed and Embase) and used the framework developed by Arksey and O’Malley. The CLD includes 29 constructs categorised into five different levels (mortality, causes of death, preconception risk factors, intermediate factors, interventions or policies). The model indicates interconnections between five sub-systems and highlights the role of preventing early and rapidly repeated pregnancies, as well as optimising women’s nutritional status in the preconception period. It also shows the prevention of preterm birth as a privileged route for lowering child mortality and morbidity. The CLD demonstrates the potential benefits of strategies that address multiple preconception risk factors simultaneously and can be used as a tool to promote the integration of preconception care into efforts to prevent maternal and child mortality. With further improvements, this model could serve as a basis for future research on the costs and benefits of preconception care. </p

Measuring social exclusion in healthcare settings: a scoping review

Background: Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase “social exclusion”, and the closely associated term “social inclusion”, are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed. Methods: A scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. We focused on those measurement tools developed for use with individual patients in healthcare settings. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated. Results: Twenty-two measurement tools were included in the final scoping review. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. The majority of the tools included were constructed for engaging with patients in mental health settings. The tools varied greatly in their design, the scoring systems and the ways they were administered. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts. Conclusions: There are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. While there are many tools that have been developed for measuring these concepts in healthcare settings, these do not have a primary healthcare focus. There is a need for the development of a tool for measuring social inclusion or social exclusion in primary healthcare settings

Social and traditional practices and their implications for family planning: a participatory ethnographic study in Renk, South Sudan

Background: Understanding what determines family size is crucial for programmes that aim to provide family planning services during and after conflicts. Recent research found that development agents in post conflict settings do not necessarily take time to understand the context adequately, translate their context understanding into programming, or adjust programming in the light of changes. South Sudan, a country that has been suffering from war for almost 50 years, has one of the highest maternal death rates and the lowest contraceptive utilization rates in the world. Methods: This research used Participatory Ethnographic Evaluation and Research (PEER) to provide a contextualised understanding of social and traditional practices and their implications for family planning. Fourteen women were recruited from 14 villages in Renk County in South Sudan in the period 2010–2012. They were trained to design research instruments, conduct interviews, collect narratives and stories and analyse data to identify, prioritize and address their maternal health concerns. Results: As a result of wars, people are under pressure to increase their family sizes and thus increase the nation’s population. This is to compensate for the men perished in war and the high child death rates. Large family size is regarded as a national obligation. Women are caught up in a vicious cycle of high fertility and a high rate of child mortality. Determinants of large family size include: 1) Social and cultural practices, 2) Clan lineage and 3) Compensation for loss of family members. Three strategies are used to increase family size: 1) Marry several women, 2) Husbands taking care of women, and 3) Financial stability. Consequences of big families include: 1) Financial burden, 2) Fear of losing children, 3) Borrowing children and 4) Husband shirking responsibility. Conclusion: The desire to have a big family will remain in South Sudan until families realise that their children will live longer, that their men will not be taken by the war, and that the costs of living will be met. In order to generate demand for family planning in South Sudan, priority should be given first to improve infant and child health

Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland’s drug and alcohol services

Background: The ‘perfect’ journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain ‘trapped’ in the high risk, specialist clinical setting. Methods: Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland’s Health Service Executive (HSE) Drug and Alcohol Services, entitled ‘HSE Mid-West Limerick Drug and Alcohol Service’. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. Results: Participants’ life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants’ loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a ‘time-limit’ on clients to engage with the programme or indeed for their treatment to be postponed. Conclusions: To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross- departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole

Social inclusion in the Irish health context: Policy and stakeholder mapping

Background Social inclusion is a complex concept, and its relationship to health has been widely debated. Across the European Union, there has been a move towards policies promoting social inclusion. Despite this, there has been a limited analysis of how the concept of social inclusion is operationalised in Irish policy. The aim of this research was to document and map the development of social inclusion policies in the Irish context. The objectives were to identify all the relevant stakeholders and policies and to describe the relevance of social inclusion policy in the domain of health. Methods We utilised a widely recognised policy analysis framework. We conducted a systematic search of relevant government policies, grey literature databases, statutory agencies and stakeholders in the Irish context since 2006. The researchers initially identified a total of 954 results. Results The relevant stakeholders discovered were the research community, service providers, civil society organisations, policy makers and government, philanthropists and socially excluded people. Most policy documents included refer to one of two national policies created to drive social inclusion activities. Social inclusion was being operationalised in the context of health, but the relationship between policymakers and those planning and providing services was unclear. Conclusions The concept of social inclusion was being operationalised in the Irish policy context. A multitude of stakeholders were involved, reflecting the wide reach of this concept in society. Social inclusion was a particularly important concept in the realm of health, and in the primary care domain in particular

A qualitative study exploring women’s experiences of unsafe abortion in Sudan

Background: Unsafe abortions contribute significantly to maternal morbidity and mortality. They are found more frequently in developing countries such as Sudan where abortion laws are restrictive and women have poor access to contraceptives. Gaps in the knowledge exist regarding women’s decision making process to perform an unsafe abortion in Sudan. Understanding these factors is vital for planning and implementing family planning services. The aim of the research was to explore the experience of women exposed to an unsafe abortion in Khartoum—Sudan, and to address the underlying factors that affected women’s decision to seek an unsafe abortion. Design: A descriptive qualitative approach was adopted using in-depth semi-structured interviews with women who had undergone unsafe abortions. Interviews were translated from Arabic; and data were analysed using a thematic approach. Setting and Participants: Participants were recruited from 2 settings: New Omdurman Hospital and Academy Teaching Hospital in Sudan. A convenience sample of women was used in the study. Results: Three core themes emerged: 1) There was an unbalanced relationship dynamic between women and their partners, which affected their use of contraceptives. 2) Maintaining secrecy of the unintended pregnancy and the unsafe abortion was paramount to all women for fear of social stigma. 3) Women tried to internalize and understand their negative experiences of unsafe abortion through religious context. Conclusion: Unsafe abortions have a significant impact on the quality of women’s lives in Sudan. Open dialogue between men and women regarding family planning strategies; community education about the hazardous consequences of unsafe abortion as well as facilitating access to contraceptives and stressing their proper use are necessary steps to decrease the number of unsafe abortions in Sudan. More research is needed to fill the gaps in knowledge regarding unsafe abortions and sexual health among Sudanese women

Public health practicum: a scoping review of current practice in graduate public health education

The objectives of this study are to (1) identify Graduate Public Health (GPH) programmes with an integrated practicum, (2) determine current practice for practicum design and (3) use the information to make recommendations to inform the design of Public Health Graduate programme practicums. Design Scoping review. Data sources Academic Ranking World Universities 2019 was used to identify top 10 institutions in each geographical hub offering GPH programmes. Each GPH programme website was searched for practicum information Eligibility criteria GPH programmes offering a practice based component as a requirement in their curriculum. Data extraction and synthesis One reviewer screened GPH websites for eligibility and extracted data. Verification of data for accuracy and completeness was done on 10% of the sample by the second author. Data were compiled into an Excel file and were analysed to describe the duration, timing, credit, contact hours, preceptor requirements, prerequisites, objectives, deliverables and methods of evaluation of the practice-based component

Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months

Background: Opioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine treatment attrition during the first 12 months of this treatment. Methods: We included all heroin dependent patients aged under 18.5 years commencing OST at one outpatient multidisciplinary adolescent addiction treatment service in Dublin, Ireland. Psycho-social needs were also addressed during treatment. Drug use was monitored by twice weekly urine drugs screens (UDS). Change in the proportion of UDS negative for heroin was examined using the Wilcoxon signed rank test. Attrition was explored via a Cox Regression multivariate analysis. Results: OST was commenced by 120 patients (51% female and mean age 17.3 years). Among the 39 patients who persisted with OST until month 12, heroin abstinence was 21% (95% confidence interval [CI] = 9–36%) at month three and it was 46% (95% CI = 30–63%) at month 12. Heroin use declined significantly from baseline to month three (p < 0.001) and from month three to month 12 (p = 0.01). Use of other drugs did not change significantly. People using cocaine during month 12 were more likely to be also using heroin (p = 0.02). Unplanned exit occurred in 25% patients by 120 days. The independent predictors of attrition were having children, single parent family of origin, not being in an intimate relationship with another heroin user and evidence of cocaine use just before treatment entry. Conclusions: We found that heroin dependent adolescent patients achieved significant reductions in heroin use within three months of starting OST and this improved further after a year of treatment, about half being heroin abstinent at that stage. Patient drop out from treatment remains a challenge, as it is in adults. Cocaine use before and during treatment may be a negative prognostic factor

Are secondary school students from the Middle East independent learners?

Several factors influence the quality of higher education, inputs such as quality of students and teachers, the curriculum and the pedagogy. The purpose of our research was to examine whether there were any differences in learner autonomy as measured by self-directed learning readiness (SDLR) between secondary school students who entered medicine with a local Bahraini school certificate and those students who entered with an international school certificate. Using a modified questionnaire we identified how elements such as self-management, desire for learning, self-control and total SDLR scores varied in relation to the student’s previous exit award: ‘A’ levels (or equivalent) or Bahrain Secondary School (BSS) certificate. BSS certificate students had a significantly lower mean standardised desire for learning score (63.5) compared to those entering with ‘A’ levels or equivalent (73.6; p=0.003). BSS certificate students also had a significantly lower mean total self-directed learning readiness score (192.3) compared to those students with the ‘A’ levels and equivalent (214.5; p=0.015). When we controlled for all the other factors, secondary school award certificate was the only independent predictor of self-control (standardised beta 0.4; p=0.02) and SDLR (standardised beta 0.36; p=0.043). Social shifts and changing economic workforce requirements both regionally and globally are driving an increased interest in higher education in the Middle East. Students who exit with a local secondary school certificate are finding it difficult to prepare themselves for independent learning in medical school. This poses a challenge for higher education institutions bringing a more learner autonomous type of curriculum to the Middle East