A novel methodology for strengthening human rights based monitoring in public health: Family planning indicators as an illustrative example

<div><p>Objective</p><p>The last few years have seen a rise in the number of global and national initiatives that seek to incorporate human rights into public health practice. Nonetheless, a lack of clarity persists regarding the most appropriate indicators to monitor rights concerns in these efforts. The objective of this work was to develop a systematic methodology for use in determining the extent to which indicators commonly used in public health capture human rights concerns, using contraceptive services and programmes as a case study.</p><p>Methods</p><p>The approach used to identify, evaluate, select and review indicators for their human rights sensitivity built on processes undertaken in previous work led by the World Health Organization (WHO). With advice from an expert advisory group, an analytic framework was developed to identify and evaluate quantitative, qualitative, and policy indicators in relation to contraception for their sensitivity to human rights. To test the framework’s validity, indicators were reviewed to determine their feasibility to provide human rights analysis with attention to specific rights principles and standards.</p><p>Findings</p><p>This exercise resulted in the identification of indicators that could be used to monitor human rights concerns as well as key gaps where additional indicators are required. While indicators generally used to monitor contraception programmes have some degree of sensitivity to human rights, breadth and depth are lacking.</p><p>Conclusion</p><p>The proposed methodology can be useful to practitioners, researchers, and policy makers working in any area of health who are interested in monitoring and evaluating attention to human rights in commonly used health indicators.</p></div

Steps to identify and Aasess human rights in public health indicators.

<p>Steps to identify and Aasess human rights in public health indicators.</p

Barriers in accessing and utilising healthcare services during the COVID-19 pandemic by socio-ecological levels.

Barriers in accessing and utilising healthcare services during the COVID-19 pandemic by socio-ecological levels.</p

Pulmonary Marginated Neutrophils: A Novel Target for Vascular Targeted Nanoparticles

Pulmonary disease is one of the leading causes of mortality in the world, and continues to remain in need of effective therapies. To address this need, nanomedicine is a promising strategy that achieves organ specific delivery of RNA and small molecular drugs. Antibody conjugated nanoparticles targeting vascular endothelial moieties such as ICAM, PLVAP and PECAM can concentrate drugs in the lungs up to 300 fold more than standard drug delivery. However, for decades, this organ specificity had been assumed to be solely due to endothelial cell specific uptake in the pulmonary vasculature. Thus, in our study, we sought to determine the cell type specificity of vascular targeted liposomes. We achieved this by conjugating antibodies targeting ICAM, PECAM and PLVAP, and delivered them intravenously in both healthy mice and mice with acute lung injury. Surprisingly, we found that in addition to endothelial cell uptake, there was avid uptake by marginated neutrophils in both healthy and diseased mice. Across the vascular targeting moieties, PLVAP had the most endothelial specific uptake though there was still some uptake by marginated neutrophils. To further understand the mechanisms of uptake, we showed that marginated neutrophil liposome uptake is not mediated by surface presentation of ICAM and PECAM as previously thought. Furthermore, we demonstrated that the mechanism of uptake is similar amongst other forms of vascular targeted conjugated nanoparticles. Finally, we showed that these mechanisms of liposomal uptake can be recapitulated in human lungs. In conclusion, from our data, cell specific targeting remains elusive and will require further engineering to improve specificity. However, neutrophil nanoparticle uptake does present a unique opportunity for innovative drug delivery strategies to ameliorate lung disease.</p

Interview guides.

Global health crises can negatively impact access to and utilisation of essential health services. Access to and utilisation of reproductive health services were already challenged in Sub-Saharan Africa with the COVID-19 pandemic further complicating the critical situation. This cross-sectional qualitative study aimed to assess the impact of the COVID-19 pandemic and policy responses to it on the access to, and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda, and Zambia. It sought to explore the perspectives of women of reproductive age (18–49), frontline health workers and government representatives, all from geographies that are under-researched in this context. Using purposive sampling, key informant and in-depth interviews were carried out with 63 participants across the three countries between November 2020 and February 2021. The study population included women of reproductive age (18–49 years), front-line health service providers, and government representatives We established that COVID-19 and the policy response to it affected access to and utilization of services in the three countries, the most affected being antenatal care, delivery, family planning, and immunization services. Women reported not accessing the health facilities for various reasons. Barriers to access and utilization of services cut across all the socioecological levels. Movement restrictions, particularly in Uganda where they were most severe, and fear of contracting COVID-19 at health facilities were the most reported barriers. Weak structures at community level and inadequate supply of commodities in health facilities exacerbated the situation. Mitigation factors were put in place at different levels. There is need to strengthen the health system, particularly the supply chain and to have services closer to the community to enhance access to and utilisation of services at all times and particularly during crises such as the Covid-19 pandemic.</div

Transcripts.

Global health crises can negatively impact access to and utilisation of essential health services. Access to and utilisation of reproductive health services were already challenged in Sub-Saharan Africa with the COVID-19 pandemic further complicating the critical situation. This cross-sectional qualitative study aimed to assess the impact of the COVID-19 pandemic and policy responses to it on the access to, and utilization of reproductive, maternal, child and adolescent health services in Kenya, Uganda, and Zambia. It sought to explore the perspectives of women of reproductive age (18–49), frontline health workers and government representatives, all from geographies that are under-researched in this context. Using purposive sampling, key informant and in-depth interviews were carried out with 63 participants across the three countries between November 2020 and February 2021. The study population included women of reproductive age (18–49 years), front-line health service providers, and government representatives We established that COVID-19 and the policy response to it affected access to and utilization of services in the three countries, the most affected being antenatal care, delivery, family planning, and immunization services. Women reported not accessing the health facilities for various reasons. Barriers to access and utilization of services cut across all the socioecological levels. Movement restrictions, particularly in Uganda where they were most severe, and fear of contracting COVID-19 at health facilities were the most reported barriers. Weak structures at community level and inadequate supply of commodities in health facilities exacerbated the situation. Mitigation factors were put in place at different levels. There is need to strengthen the health system, particularly the supply chain and to have services closer to the community to enhance access to and utilisation of services at all times and particularly during crises such as the Covid-19 pandemic.</div

Eligibility criteria for selecting the study areas and facilities.

Eligibility criteria for selecting the study areas and facilities.</p

Spatiotemporal expression of Shx genes.

<p>Localisation of ShxA, ShxB, <i>ShxC</i>, <i>ShxD</i>, and <i>Pa-zen</i> transcripts in <i>P. aegeria</i> ovarioles (<b>A–E</b>), 10 h embryos (<b>F–J</b>) and 12 h embryos (<b>K–O</b>). Embryos and oocytes are orientated with the anterior to the top. Embryos dorsal side facing while lower and upper oocytes in <b>C</b> show dorsal and ventral faces respectively. Note that in 12 h embryos the serosal cells have migrated over the germ anlage forming an enveloping layer. Some follicle cells in <b>E</b> are removed to show absence of staining in the oocyte. Labels indicate nurse cells (<b>nc</b>), follicle cells (<b>fc</b>), oocyte (<b>oc</b>), germ anlage (<b>g</b>), and extra embryonic anlage (<b>ee</b>) which differentiates into the serosa (<b>s</b>). Orientation for each panel is indicated in bottom right 3D axis indicating anterior (A), left (L) and ventral (V) when known. AEL, after egg-laying (hours). Scale bars 200 µm.</p

Summary statistics of genome sequencing and assembly.

<p>Summary statistics of genome sequencing and assembly.</p

Lowest energy structural models of deduced (A) ShxA, (B) ShxB, (C) ShxC, (D) ShxD and (E) zen homeodomains from Speckled Wood <i>Pararge aegeria</i> bound to DNA sequences predicted through <i>in silico</i> evolution.

<p>Sequence logos generated from DNA sequences of 50 lowest energy predicted protein-DNA complexes for each protein.</p