Social Mobilization and Compliance with Mass Treatment for Lymphatic Filariasis Elimination in Kenya

This study aimed to establish the role of social mobilization in mass drug administration (MDA) uptake during the National Programme to Eliminate Lymphatic Filariasis (LF) in Kenya. MDA for LF based on diethylcarbamazine (DEC) and albendazole using community-based treatment approach has been conducted for three years (2003, 2005 and 2008) in Kwale and Malindi districts. In each district, one high and one low, compliance locations were selected based on 2008 MDA data. From the four locations, nine villages were systematically sampled and a total of 965 randomly selected household heads interviewed. Sixteen focus group discussions with adult and youth male and female groups and separate in-depth interviews with eighty opinion leaders and eighty LF patients with clinical manifestations, purposively selected were conducted. Semi-structured interviews were held separately with fifteen community drug distributors, five health personnel and four LF coordinators also purposively selected. The results showed that knowledge about MDA for LF was not significantly associated with compliance (P>0.05). Seventy three percent in low and 78% in high compliance villages knew about MDA. The most common source of MDA information given by 49% of respondents in high and 40% in low compliance villages were the community drug distributors (CDDs). The content of MDA information received influenced compliance (P< 0.001), 71% in high compared to 61% in low compliance villages received correct information. The frequency of receiving MDA information also influenced compliance (P< 0.001), 65.5% in high compared to 50% in low compliance villages received the correct information at least once before treatment. Opinion towards the source of MDA information was also associated with compliance, 46% in high compared to 43% in low compliance villages considered the source as adequate (P< 0.001). The study results show that for MDA to be successful, information dissemination should be done by all stakeholders with the health personnel taking the lead role so that more adequate and factual content is relayed. Community sensitization and mobilization should be done repeatedly for all to get the information in good time to comply with treatment. Keywords: Compliance; Lymphatic Filariasis; Mass Drug Administration; Social Mobilizatio

Tackling the urban health divide though enabling intersectoral action on malnutrition in Chile and Kenya

As momentum grows for a sustainable urbanisation goal in the post-2015 development agenda, this paper reports on an action research study that sought to tackle the urban health divide by enabling intersectoral action on social determinants at the local level. The study was located in the cities of Mombasa in Kenya and Valparaíso in Chile, and the impact of the intervention on child nutrition was evaluated using a controlled design. The findings showed that an action research process using the social educational process known as PLA could effectively build the capacity of multisectoral teams to take coordinated action which in turn built the capacity of communities to sustain them. The impact on child nutrition was inconclusive and needed to be interpreted within the context of economic collapse in the intervention area. Four factors were found to have been crucial for creating the enabling environment for effective intersectoral action (i) supportive government policy (ii) broad participation and capacity building (iii) involving policy makers as advisors and establishing the credibility of the research and (iii) strengthening community action. If lessons learned from this study can be adapted and applied in other contexts then they could have a significant economic and societal impact on health and nutrition equity in informal urban settlements

Tackling the urban health divide though enabling intersectoral action on malnutrition in Chile and Kenya

As momentum grows for a sustainable urbanisation goal in the post-2015 development agenda, this paper reports on an action research study that sought to tackle the urban health divide by enabling intersectoral action on social determinants at the local level. The study was located in the cities of Mombasa in Kenya and Valparaíso in Chile, and the impact of the intervention on child nutrition was evaluated using a controlled design. The findings showed that an action research process using the social educational process known as PLA could effectively build the capacity of multisectoral teams to take coordinated action which in turn built the capacity of communities to sustain them. The impact on child nutrition was inconclusive and needed to be interpreted within the context of economic collapse in the intervention area. Four factors were found to have been crucial for creating the enabling environment for effective intersectoral action (i) supportive government policy (ii) broad participation and capacity building (iii) involving policy makers as advisors and establishing the credibility of the research and (iii) strengthening community action. If lessons learned from this study can be adapted and applied in other contexts then they could have a significant economic and societal impact on health and nutrition equity in informal urban settlements

Demonstration of an algorithm to overcome health system-related barriers to timely diagnosis of breast diseases in rural Zambia

Background Long delays to diagnosis is a major cause of late presentation of breast diseases in sub-Saharan Africa. Aims We designed and implemented a single-visit breast care algorithm that overcomes health system-related barriers to timely diagnosis of breast diseases. Methods A multidisciplinary team of Zambian healthcare experts trained a team of mid- and high-level Zambian healthcare practitioners how to evaluate women for breast diseases, and train trainers to do likewise. Working collaboratively, the two teams then designed a clinical platform that provides multiple breast care services within a single visit. The service platform was implemented using a breast outreach camp format, during which breast self-awareness, psychosocial counseling, clinical breast examination, breast ultrasound, ultrasound-guided biopsy, imprint cytology of biopsy specimens and surgical treatment or referral, were offered within a single visit. Results Eleven hundred and twenty-nine (1129) women attended the camps for breast care. Mean age was 35.9 years. The majority were multiparous (79.4%), breast-fed (76.0%), and reported hormone use (50.4%). Abnormalities were detected on clinical breast examination in 122 (10.8%) women, 114 of whom required ultrasound. Of the 114 who underwent ultrasound, 48 had identifiable lesions and were evaluated with ultrasound-guided core needle biopsy (39) or fine-needle aspiration (9). The concordance between imprint cytology and histopathology was 100%, when breast specimens were classified as either benign or malignant. However, when specimens were classified by histopathologic subtype, the concordance between imprint cytology and histology was 85.7% for benign and 100% for malignant lesions. Six (6) women were diagnosed with invasive cancer. Eighteen (18) women with symptomatic breast lesions had next-day surgery. Significance Similar to its impact on cervical cancer prevention services, a single visit breast care algorithm has the potential to overcome health system-related barriers to timely diagnosis of breast diseases, including cancer, in rural African settings

On the limits of sexual health literacy: Insights from Ugandan schoolgirls

This article makes the case that current conceptions of sexual health literacy have limited relevance to the Ugandan context because they assume that knowledge of unsafe sexual practices will lead to changes in behavior and lifestyle. Drawing on a longitudinal case study with 15 Ugandan schoolgirls in rural Uganda from August 2004 to September 2006, this study argues that despite being well-informed about the risks and responsibilities of sexual activity, poverty and sexual abuse severely constrained options for these young women. Although many believed in the value of abstaining from sexual activity until marriage, they engaged in transactional sex to pay for school fees, supplies, clothing, and food. Further, fear of sexual abuse, early pregnancy, and HIV–AIDS compromised attempts to embrace sexuality. The article concludes with implications of the study for research and policy on sexual health literacy in Uganda and other poorly resourced regions of the world

Prioritizing Health-Sector Interventions for Noncommunicable Diseases and Injuries in Low- and Lower-Middle Income Countries: National NCDI Poverty Commissions

Health sector priorities and interventions to prevent and manage noncommunicable diseases and injuries (NCDIs) in low- and lower-middle-income countries (LLMICs) have primarily adopted elements of the World Health Organization Global Action Plan for NCDs 2013–2020. However, there have been limited efforts in LLMICs to prioritize among conditions and health-sector interventions for NCDIs based on local epidemiology and contextually relevant risk factors or that incorporate the equitable distribution of health outcomes. The Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion supported national NCDI Poverty Commissions to define local NCDI epidemiology, determine an expanded set of priority NCDI conditions, and recommend cost-effective, equitable health-sector interventions. Fifteen national commissions and 1 state-level commission were established from 2016–2019. Six commissions completed the prioritization exercise and selected an average of 25 NCDI conditions; 15 conditions were selected by all commissions, including asthma, breast cancer, cervical cancer, diabetes mellitus type 1 and 2, epilepsy, hypertensive heart disease, intracerebral hemorrhage, ischemic heart disease, ischemic stroke, major depressive disorder, motor vehicle road injuries, rheumatic heart disease, sickle cell disorders, and subarachnoid hemorrhage. The commissions prioritized an average of 35 health-sector interventions based on cost-effectiveness, financial risk protection, and equity-enhancing rankings. The prioritized interventions were estimated to cost an additional US$4.70–US$13.70 per capita or approximately 9.7%–35.6% of current total health expenditure (0.6%–4.0% of current gross domestic product). Semistructured surveys and qualitative interviews of commission representatives demonstrated positive outcomes in several thematic areas, including understanding NCDIs of poverty, informing national planning and implementation of NCDI health-sector interventions, and improving governance and coordination for NCDIs. Overall, national NCDI Poverty Commissions provided a platform for evidence-based, locally driven determination of priorities within NCDIs.publishedVersio

Viewpoint: Rigorous monitoring is necessary to guide food system transformation in the countdown to the 2030 global goals

Food systems that support healthy diets in sustainable, resilient, just, and equitable ways can engender progress in eradicating poverty and malnutrition; protecting human rights; and restoring natural resources. Food system activities have contributed to great gains for humanity but have also led to significant challenges, including hunger, poor diet quality, inequity, and threats to nature. While it is recognized that food systems are central to multiple global commitments and goals, including the Sustainable Development Goals, current trajectories are not aligned to meet these objectives. As mounting crises further stress food systems, the consequences of inaction are clear. The goal of food system transformation is to generate a future where all people have access to healthy diets, which are produced in sustainable and resilient ways that restore nature and deliver just, equitable livelihoods

Corrigendum to “Viewpoint: Rigorous monitoring is necessary to guide food system transformation in the countdown to the 2030 global goals” [Food Policy 104 (2021) 100784]

We regret that the original Fig. 3 was based on a spreadsheet later discovered to have an aggregation error, overestimating the number of food system workers. A corrected Fig. 3 has replaced the erroneous figure. We are deeply grateful to Natalia Piedrahita of FAO for her careful attention and discovery of the error

Predictors of linkage to care following community-based HIV counseling and testing in rural Kenya

Despite innovations in HIV counseling and testing (HCT), important gaps remain in understanding linkage to care. We followed a cohort diagnosed with HIV through a community-based HCT campaign that trained persons living with HIV/AIDS (PLHA) as navigators. Individual, interpersonal, and institutional predictors of linkage were assessed using survival analysis of self-reported time to enrollment. Of 483 persons consenting to follow-up, 305 (63.2%) enrolled in HIV care within 3 months. Proportions linking to care were similar across sexes, barring a sub-sample of men aged 18–25 years who were highly unlikely to enroll. Men were more likely to enroll if they had disclosed to their spouse, and women if they had disclosed to family. Women who anticipated violence or relationship breakup were less likely to link to care. Enrolment rates were significantly higher among participants receiving a PLHA visit, suggesting that a navigator approach may improve linkage from community-based HCT campaigns.Vestergaard Frandse