Barriers to the practice of exclusive breastfeeding among HIV-positive mothers in sub-Saharan Africa: A scoping review of counselling, socioeconomic and cultural factors

The World Health Organization (WHO) recommends exclusive breast-feeding (EBF) for HIV exposed infants for six months; this is considered best practice for reducing mother-to-child transmission of HIV in the postpartum period. This is a scoping review of the barriers affecting women's decision-making and choice to sustain the practice of EBF in sub-Saharan Africa (SSA). An online literature search via PubMed, Science Direct, Google Scholar, WHO and Joint United Nations programme on HIV and AIDS (UNAIDS) websites identified research studies and reports that explored socio-economic, cultural and infant feeding counselling-related barriers to EBF among HIV-positive mothers in SSA. A total of 341 relevant articles were identified only 35 (23 qualitative, 3 quantitative and 9 mixed methods) met the inclusion criteria. Findings reveal that key barriers to choice and sustained practice of EBF are healthcare workers’ personal biases, inadequate counselling skills and guideline knowledge, a culture of mixed feeding norms, and maternal lack of decision-making power and fear of vertical transmission. Transmission of HIV programs in countries where major challenges persist should evaluate and address the identified healthcare worker and community-level factors impeding EBF

Discussions around Primary Health Care and the Private Sector during the Global Symposia on Health Systems Research 2018

The aim of this report is to provide an overview of core discussions around Primary Health Care (PHC) and the Private Sector, which took place during the 5th Global Symposium on Health Systems Research 2018: Advancing health systems for all in the SDG era. Universal Health Coverage (UHC) and how health systems are working to deliver this global goal by 2030 was a major theme of the conference. Conference sub-themes revolved around broad topics of: Multi-sectoral Action; Engaging the Private Sector; Leaving No-one Behind and Community Health Systems. Discussions were captured through two core methods: ‘in session data capture’ and semi-structured interviews. 26 conference rapporteurs captured data in 93 sessions; and 21 interviews were conducted with policy makers, implementers and practitioners from the public and private sector. The findings are mainly focused on research from low and middle-income countries (LMIC) with some examples from upper middle and high-income countries. This focus was chosen as the opportunities to promote and report health research from resource-poor settings is limited (Siriwardhana, 2015). The conference provided an opportunity for shared learning due to the many scholarships that supported attendance of health actors and researchers from LMICs. Ethical clearance was obtained from the Liverpool John Moores University (LJMU) Ethics Committee. The following broad themes were identified through data capture and interviews. Findings that are more detailed can be located in the main body of the report and include case study examples

Knowledge of and Adherence to Health Advice among Adults with Diabetes in Libya

Background: Non-adherence to medical and health care advice is a common problem, though reasons for non-adherence can differ across different groups and societies as well as between individuals. Objective: to examine diabetes knowledge among people with both type1 and type2 diabetes in Libya and explore any other factors that enhance adherence to treatment and management of the condition. Methods: A cross-sectional survey design was used to collect data from adults with type1 or type2 diabetes who have been diagnosed for 12 months or more, in Benghazi Diabetes Centre, which is one of the oldest and largest diabetes registries in Libya. A total of 855 participants were asked to fill in two questionnaires; the Michigan Diabetes Knowledge Test to investigate the level of diabetes knowledge and the Confidence in diabetes Self-care Scale to assess self-efficacy. For the purpose of the study descriptive statistics and inferential statistical tests were conducted. Results: Diabetes knowledge is very poor especially among females and those classed as illiterate within the sample. The Mean HbA1c of 9.39 was higher than the recommended levels. Four variables namely knowledge about diabetes, duration of illness, family history and self-efficacy significantly predicted levels of HBA1c. Conclusion: Based on the above findings two different programmes of diabetes education would be recommended. The first programme of education would focus primarily on those with inadequate levels of knowledge about diabetes, particularly female and people with long duration diabetes. The second programme would be for both healthcare professionals and people with type 1 and type2 diabetes, which would consider the psychological factors that are involved in the process of diabetes management

Reflexivity, positionality and power in cross-cultural participatory action research with research assistants in rural Cambodia

This paper draws on the experiences of a doctoral student undertaking a cross-cultural, cross-language participatory action research (PAR) project in rural Cambodia. Cambodia is a largely Buddhist country with a complex history of religion, invasion, colonisation, war and oppression. Despite a democratic constitution, political control and fear of challenging authority are ever present; and all had an impact on the participation and development of this project. I recruited eight volunteer community health workers (CHWs) and two research assistants (RAs) with an aim to explore methods and challenges faced when trying to improve health with and for community members. Over eight participatory workshops and a two-day training session CHWs identified, implemented and reflected on solutions to community health problems. Simultaneously, the RAs and I reflected on the processes and challenges we faced. Creating opportunity for reflexivity allowed for discussion to emerge around culture, position and power and how these were impacting on the research process and outcomes. Established social hierarchical power structures in Cambodia presented challenges to undertaking a PAR project with emancipatory and social change aims. Such structures also impacted on the ability and readiness of participants to be critical and analytical. The importance of the RAs as cultural navigators and the necessity of embracing their situated knowledge as both an insider and outsider is a key finding. Keywords: Participatory action research (PAR), reflexivity, positionality, cross-language/culture, power, research assistant

Estimating the furrow infiltration characteristic from a single advance point

Management and control of surface irrigation, in particular furrow irrigation, is limited by spatio-temporal soil infiltration variability as well as the high cost and time associated with collecting intensive field data for estimation of the infiltration characteristics. Recent work has proposed scaling the commonly used infiltration function by using a model infiltration curve and a single advance point for every other furrow in an irrigation event. Scaling factors were calculated for a series of furrows at two sites and at four points down the length of the field (0.25 L, 0.5 L, 0.75 L and L). Differences in the value of the scaling factor with distance were found to be a function of the shape of the advance curves. It is concluded that use of points early in the advance results in a substantial loss of accuracy and should be avoided. The scaling factor was also strongly correlated with the furrow-wetted perimeter suggesting that the scaling is an appropriate way of both predicting and accommodating the effect of the hydraulic variability

Professionalization of Public Health in Nepal

Background: The need for a professionalized and highly skilled public health workforce is essential to improving and protecting the health of populations. This is fundamental in Nepal given the current burden of disease, both communicable and non-communicable. This study aimed to explore: (i) the current trends in public health in Nepal and (ii) the opportunities and barriers to the professionalization of the sector. Methods: We employed an exploratory qualitative research design and used a combination of semi-structured interviews with senior public health professionals who had worked for more than two years. Besides, we convened a small focus group discussion with recently qualified public health practitioners in Nepal. A total of nine professional stakeholders were interviewed and five junior practitioners joined the focus group discussion. Data was collected via Skype due to COVID-19 restrictions. Thematic analysis was used to analyze the data. Results: Four core themes emerged from the research: understanding the public health approach; health priorities; federalization and the impact on public health practice; professionalization and workforce development. Conclusion: Political federalization and more recently COVID-19 have impacted the development, capacity, and employment of this oftenneglected workforce. Public health graduates with their broad-ranging knowledge and skills are often overlooked in the health sector. This is related to a general lack of understanding of what public health is and what public health practitioners do amongst politicians and the general public

Nepal's Response to Earthquake 2015: Experience of Emergency Responders and Humanitarian Assistance providers in Inclusive and Accessible Humanitarian Assistance Delivery

The earthquake that hit Nepal in 2015 received worldwide attention for the devastation it caused to lives and infrastructures. Yet, the impact of it on people with disabilities (PWDs) and experiences of emergency responders and humanitarian assistance providers have remained under researched. This study aims to explore first hand experiences faced by emergency responders and humanitarian assistance providers to evaluate the effectiveness in implementation of disability inclusive and accessible emergency response during disaster; and to identify good practices and barriers faced by them in facilitating inclusive and accessible recovery and rehabilitation post disaster. Lessons learnt from barriers and challenges faced by the service providers, when addressed, will promote improved policies, processes and programmes around inclusive and accessible emergency and humanitarian response, recovery and rehabilitation. This study is based on semi-structured interviews with 20 key informants/stakeholders, and thematic analysis of the data generated. Findings suggest that most stakeholders were engaged in disability inclusive disaster risk management (DiDRM), capacity building and resilience developing awareness campaigns. However, there are significant gaps in policies, training and practices. These gaps include, a dire lack of inclusive and accessible equipment and resources; lack of and failure to implement and utilise knowledge and resources available; lack of data and guidelines on disability inclusive emergency response (DIER); and lack of communication and coordination between emergency responders and DPOs. These challenges hindered search and rescue (SAR) and relief efforts resulting in inappropriate and slow recovery and rehabilitation for PWDs. This study recommends for including PWDs in planning, designing and building inclusive and accessible emergency preparedness, response, SAR toolkit and emergency shelters. Nepal now has opportunities to integrate accessible infrastructures, DiDRM and implementation at community level. One way of achieving DiDRM at community level could be building a bank of desegregated data, skilled volunteers and accessible equipment to meet the emergency needs of PWDs

A scoping review of women 's navigation of co-morbid HIV and non-communicable disease (NCD) health conditions and integrated HIV/NCD health services in sub-Saharan Africa.

Background: The 2030 Agenda for Sustainable Development recognises the importance of addressing HIV and NCDs, and establishes the need to address female and child specific health outcomes as a whole. Women experience a triple burden of ill-health spanning non-communicable diseases (NCDs), reproductive and maternal health conditions and human immune deficiency virus (HIV) in sub-Saharan Africa (SSA). Method: A scoping review methodology was used to map and describe what is known about the health needs, service experiences and health outcomes of women living with HIV (WLHIV), diabetes and/or hypertension in SSA. Results: The final data set of 15 records represented seven SSA countries (Kenya, South Africa, Tanzania, Uganda, Ghana, Malawi and Zimbabwe). Following final charting and analysis of the data, four themes emerged: Prevalence of NCD and related co-morbidities; Environmental, biological and cultural determinates of health; Access to healthcare services and medication; and Integrated HIV.NCD care. Conclusion: The evidence base with detail on this gendered health topic within the African sustainable development agenda is limited. subject is small. Further research which involves women in the community and female patients receiving integrated care for HIV and NCDs at hospital and primary care levels in SSA is warranted on a larger scale

Cross-protection against European swine influenza viruses in the context of infection immunity against the 2009 pandemic H1N1 virus : studies in the pig model of influenza

Pigs are natural hosts for the same influenza virus subtypes as humans and are a valuable model for cross-protection studies with influenza. In this study, we have used the pig model to examine the extent of virological protection between a) the 2009 pandemic H1N1 (pH1N1) virus and three different European H1 swine influenza virus (SIV) lineages, and b) these H1 viruses and a European H3N2 SIV. Pigs were inoculated intranasally with representative strains of each virus lineage with 6- and 17-week intervals between H1 inoculations and between H1 and H3 inoculations, respectively. Virus titers in nasal swabs and/or tissues of the respiratory tract were determined after each inoculation. There was substantial though differing cross-protection between pH1N1 and other H1 viruses, which was directly correlated with the relatedness in the viral hemagglutinin (HA) and neuraminidase (NA) proteins. Cross-protection against H3N2 was almost complete in pigs with immunity against H1N2, but was weak in H1N1/pH1N1-immune pigs. In conclusion, infection with a live, wild type influenza virus may offer substantial cross-lineage protection against viruses of the same HA and/or NA subtype. True heterosubtypic protection, in contrast, appears to be minimal in natural influenza virus hosts. We discuss our findings in the light of the zoonotic and pandemic risks of SIVs

Compliance with the smoke-free public places legislation in Nepal: A cross-sectional study from Biratnagar Metropolitan City

Background Smoke-free legislation banning tobacco smoking in public places was implemented across Nepal in 2014 with the ambition to reduce the impact of second-hand smoking. As part of a comprehensive policy package on tobacco control, the implementation of the legislation has seen a marked reduction in tobacco consumption. Yet there remains uncertainty about the level of compliance with smoke-free public places. Objectives This study assesses the compliance with smoke-free laws in public places and the factors associated with active smoking in public places in Biratnagar Metropolitan City, Nepal. Methods A cross-sectional study was conducted in the Biratnagar metropolitan city in Province 1 of Nepal from July to December 2019. A total of 725 public places within the metropolitan city were surveyed using a structured survey tool. Active smoking was the primary outcome of the study which was defined as smoking by any person during the data collection time at the designated public place. Results The overall compliance with smoke-free legislation was 56.4%. The highest compliance (75.0%) was observed in Government office buildings. The lowest compliance was observed in eateries, entertainment, and shopping venues (26.3%). There was a statistically significant association between active smoking and the presence of ‘no smoking’ notices appended at the entrance and the odds of active smoking in eateries, entertainment, hospitality, shopping venues, transportations and transits was higher compared to education and health care institutions. None of the ‘no smoking’ notices displayed fully adhered to the contents as prescribed by the law. Conclusion As more than half of the public places complied with the requirements of the legislation, there was satisfactory overall compliance with the smoke-free public places law in this study. The public venues (eateries, shopping venues and transportations) that are more frequently visited and have a high turnover of the public have lower compliance with the legislation. The content of the message in the ‘no smoking’ notices needs close attention to adhere to the legal requirements