Geographical Access to Child and Family Healthcare Services and Hospitals for Africa-Born Migrants and Refugees in NSW, Australia; A Spatial Study.

Background: African-born migrants and refugees arriving from fragile states and countries with political and economic challenges have unique health needs requiring tailored healthcare services and support. However, there is little investigation into the distribution of this population and their spatial access to healthcare in Australia. This paper reports on research that aimed to map the spatial distribution of Africa-born migrants from low and lower-middle-income countries (LLMICs) and refugees in New South Wales (NSW) and access to universal child and family health (CFH) services and hospitals. Methods: We analysed the Australian Bureau of Statistics 2016 Census data and Department of Social Services 2018 Settlement data. Using a Geographic Information System mapping software (Caliper Corporation. Newton, MA, USA), we applied data visualisation techniques to map the distribution of Africa-born migrants and refugees relative to CFH services and their travel distance to the nearest service. Results: Results indicate a spatial distribution of 51,709 migrants from LLMICs in Africa and 13,661 refugees from Africa live in NSW, with more than 70% of the total population residing in Sydney. The Africa-born migrant and refugee population in Sydney appear to be well served by CFH services and hospitals. However, there is a marked disparity between local government areas. For example, the local government areas of Blacktown and Canterbury-Bankstown, where the largest number of Africa-born migrants and refugees reside, have more uneven and widely dispersed services than those in Sydney’s inner suburbs. Conclusion: The place of residence and travel distance to services may present barriers to access to essential CFH services and hospitals for Africa-born refugees and migrants. Future analysis into spatial-access disadvantages is needed to identify how access to health services can be improved for refugees and migrants

Preventing female genital mutilation in high income countries: A systematic review of the evidence

© 2019 The Author(s). Background: Female genital mutilation (FGM) is prevalent in communities of migration. Given the harmful effects of the practice and its illegal status in many countries, there have been concerted primary, secondary and tertiary prevention efforts to protect girls from FGM. However, there is paucity of evidence concerning useful strategies and approaches to prevent FGM and improve the health and social outcomes of affected women and girls. Methods: We analysed peer-reviewed and grey literature to extract the evidence for FGM prevention interventions from a public health perspective in high income countries by a systematic search of bibliographic databases and websites using appropriate keywords. Identified publications were screened against selection criteria, following the PRISMA guidelines. We examined the characteristics of prevention interventions, including their programmatic approaches and strategies, target audiences and evaluation findings using an apriori template. Findings: Eleven documents included in this review described primary and secondary prevention activities. High income countries have given attention to legislative action, bureaucratic interventions to address social injustice and protect those at risk of FGM, alongside prevention activities that favour health persuasion, foster engagement with the local community through outreach and the involvement of community champions, healthcare professional training and capacity strengthening. Study types are largely process evaluations that include measures of short-term outcomes (pre- and post-changes in attitude, knowledge and confidence or audits of practices). There is a dearth of evaluative research focused on empowerment-oriented preventative activities that involve individual women and girls who are affected by FGM. Beattie's framework provides a useful way of articulating negotiated and authoritative prevention actions required to address FGM at national and local levels. Conclusion: FGM is a complex and deeply rooted sociocultural issue that requires a multifaceted response that encompasses socio-economic, physical and environmental factors, education and learning, health services and facilities, and community mobilisation activities. Investment in the rigorous longitudinal evaluation of FGM health prevention efforts are needed to provide strong evidence of impact to guide future decision making. A national evidence-based framework would bring logic, clarity, comprehension, evidence and economically more effective response for current and future prevention interventions addressing FGM in high income countries

The role of the Maternity Liaison Officer in provision of primary health care: A values-based service model

Background: A policy directive of the New South Wales government focused on ensuring that all ethnic groups within the community have appropriate and equitable access to services led to the introduction of the maternity liaison officer (MLO) program in the late 1990s. The role of the MLO is to work alongside health professionals to provide education, social support and counselling to pregnant refugee and migrant women of culturally and linguistically diverse backgrounds (CALD). Methods: We reviewed reports and policy documents from 2008 to examine the attributes of this hospital-based service model and share insights into how the MLOs deliver care to meet the needs of mothers and babies. Findings: Maternity liaison officers have readily assumed the responsibility of maintaining current knowledge and building competency in improving the health and wellbeing of refugee and migrant women and newborns. They act as important bridge between women and the health system enabling vulnerable women to competently navigate their maternity journey, gynaecological care and the care of newborn infants in a culturally sensitive and appropriate manner. Discussion and conclusion: This service model offers an acceptable way to support the delivery of maternity care to women and include those from refugee and CALD- backgrounds. Investment in the rigorous evaluation of this service is needed to provide strong evidence to optimise service delivery and guide future decision making

Porn video shows, local brew, and transactional sex: HIV risk among youth in Kisumu, Kenya

Background: Kisumu has shown a rising HIV prevalence over the past sentinel surveillance surveys, and most new infections are occurring among youth. We conducted a qualitative study to explore risk situations that can explain the high HIV prevalence among youth in Kisumu town, Kenya Methods: We conducted in-depth interviews with 150 adolescents aged 15 to 20, held 4 focus group discussions, and made 48 observations at places where youth spend their free time. Results: Porn video shows and local brew dens were identified as popular events where unprotected multipartner, concurrent, coerced and transactional sex occurs between adolescents. Video halls - rooms with a TV and VCR - often show pornography at night for a very small fee, and minors are allowed. Forced sex, gang rape and multiple concurrent relationships characterised the sexual encounters of youth, frequently facilitated by the abuse of alcohol, which is available for minors at low cost in local brew dens. For many sexually active girls, their vulnerability to STI/HIV infection is enhanced due to financial inequality, gender-related power difference and cultural norms. The desire for love and sexual pleasure also contributed to their multiple concurrent partnerships. A substantial number of girls and young women engaged in transactional sex, often with much older working partners. These partners had a stronger socio-economic position than young women, enabling them to use money/gifts as leverage for sex. Condom use was irregular during all types of sexual encounters. Conclusions: In Kisumu, local brew dens and porn video halls facilitate risky sexual encounters between youth. These places should be regulated and monitored by the government. Our study strongly points to female vulnerabilities and the role of men in perpetuating the local epidemic. Young men should be targeted in prevention activities, to change their attitudes related to power and control in relationships. Girls should be empowered how to negotiate safe sex, and their poverty should be addressed through income-generating activities.</p

Citizen science pioneers in Kenya – A crowdsourced approach for hydrological monitoring

Although water is involved in many ecosystem services, the absence of monitoring data restricts the development of effective water management strategies especially in remote regions. Traditional monitoring networks can be expensive, with unaffordable costs in many low-income countries. Involving citizens in monitoring through crowdsourcing has the potential to reduce these costs but remains uncommon in hydrology. This study evaluates the quality and quantity of data generated by citizens in a remote Kenyan basin and assesses whether crowdsourcing is a suitable method to overcome data scarcity. We installed thirteen water level gauges equipped with signboards explaining the monitoring process to passers-by. Results were sent via a text-message-based data collection framework that included an immediate feedback to citizens. A public web interface was used to visualize the data. Within the first year, 124 citizens reported 1175 valid measurements. We identified thirteen citizens as active observers providing more than ten measurements, whereas 57% only sent one record. A comparison between the crowdsourced water level data and an automatic gauging station revealed high data quality. The results of this study indicate that citizens can provide water level data of sufficient quality and with high temporal resolution

Controlled Human Malaria Infection in Semi-Immune Kenyan Adults (CHMI-SIKA): a study protocol to investigate in vivo Plasmodium falciparum malaria parasite growth in the context of pre-existing immunity [version 2; peer review: 2 approved]

Malaria remains a major public health burden despite approval for implementation of a partially effective pre-erythrocytic malaria vaccine. There is an urgent need to accelerate development of a more effective multi-stage vaccine. Adults in malaria endemic areas may have substantial immunity provided by responses to the blood stages of malaria parasites, but field trials conducted on several blood-stage vaccines have not shown high levels of efficacy. We will use the controlled human malaria infection (CHMI) models with malaria-exposed volunteers to identify correlations between immune responses and parasite growth rates in vivo. Immune responses more strongly associated with control of parasite growth should be prioritized to accelerate malaria vaccine development. We aim to recruit up to 200 healthy adult volunteers from areas of differing malaria transmission in Kenya, and after confirming their health status through clinical examination and routine haematology and biochemistry, we will comprehensively characterize immunity to malaria using >100 blood-stage antigens. We will administer 3,200 aseptic, purified, cryopreserved Plasmodium falciparum sporozoites (PfSPZ Challenge) by direct venous inoculation. Serial quantitative polymerase chain reaction to measure parasite growth rate in vivo will be undertaken. Clinical and laboratory monitoring will be undertaken to ensure volunteer safety. In addition, we will also explore the perceptions and experiences of volunteers and other stakeholders in participating in a malaria volunteer infection study. Serum, plasma, peripheral blood mononuclear cells and whole blood will be stored to allow a comprehensive assessment of adaptive and innate host immunity. We will use CHMI in semi-immune adult volunteers to relate parasite growth outcomes with antibody responses and other markers of host immunity. / Registration: ClinicalTrials.gov identifier NCT02739763

Data Quality in Citizen Science

This chapter discusses the broad and complex topic of data quality in citizen science – a contested arena because different projects and stakeholders aspire to different levels of data accuracy. In this chapter, we consider how we ensure the validity and reliability of data generated by citizen scientists and citizen science projects. We show that this is an essential methodological question that has emerged within a highly contested field in recent years. Data quality means different things to different stakeholders. This is no surprise as quality is always a broad spectrum, and nearly 200 terms are in use to describe it, regardless of the approach. We seek to deliver a high-level overview of the main themes and issues in data quality in citizen science, mechanisms to ensure and improve quality, and some conclusions on best practice and ways forwards. We encourage citizen science projects to share insights on their data practice failures. Finally, we show how data quality assurance gives credibility, reputation, and sustainability to citizen science projects

Enhancing employability opportunities for Pharmacy students; a case study of processes to implement competency‐based education in Pharmacy in Kenya

This paper challenges the western concept of graduate employability as a measure of student success through a case study of a collaboration between pharmacy colleagues in universities in Nairobi, Kenya and Nottingham, UK. As Pharmacy programmes globally adapt their courses to a competency-based education (CBE) approach, we outline the implications of this for graduate success in Kenya. The Ministry of Education in Kenya recently announced a move to CBE across all educational sectors. This has led to a reconfiguring of how pharmacy is not only taught, but also assessed, and what success means for pharmacy graduates in Kenya. The collaboration has highlighted the need for key stakeholders to work together and influence policy change, and redefine employability in terms of behaviours that meet country-wide needs. We outline some of the processes and collaborations we formed to redevelop pharmacy programmes in Kenya, and suggest recommendations for continuing partnerships and sustainability

Vendor Characteristics, Practices, Microbial Contamination of Fish and Oil Quality in the Street Vending of Deep-fried Fish in Peri-urban Nairobi, Kenya: Case of Kasarani Sub-county

Aim: The main objective of the study is to assess the vendor and environmental hygiene, microbial contamination of deep-fried tilapia sold, and the quality of the oil used in the streets of Kasarani sub-county Study Design: Cross-sectional study. Place and Duration of Study: Kasarani Sub-county and The University of Nairobi Department of Food Science, Nutrition, and Technology laboratory between January 2019 to July 2020. Methodology: Structured questionnaires, checklists, analytical observations, and market observations were used to collect data from the street vendors. After the collection of the fish samples, microbial analysis of the fish samples was carried out using standard methods for Total coliforms and Staphylococcus aureus. The deep-frying oil was sampled for analysis of color and viscosity. Results were evaluated using national standards. Results: The findings indicated that all the vendors have received a basic education and that all vendors fall under the low-income group. The most contaminated part of the fish by Staphylococcus aureus and total coliforms is the gills. The highest contamination was from Clay city ward (2.46 ± 0.43) while the least contaminated was from the Mwiki ward (1.28 ± 1.17). The total coliforms and Staphylococcus aureus concentration are significantly different between wards p (&lt;0.05) as the p-value was 0.003 and 0.043 respectively. Conclusion: The findings indicate that the vending practices carried out are unsanitary. The fish as sold were contaminated with total coliforms and Staphylococcus aureus at high levels indicating poor hygiene procedures. The environment is characterized by poor sanitation and hygiene. The oil used for deep frying was characterized by dark color and high viscosity indicating prolonged usage of the same oil. Policies governing street vending and the environment should be reinforced to prevent the occurrence of hazards resulting from street vended fish