Policy implementation challenges and barriers to access sexual and reproductive health services faced by people with disabilities: An intersectional analysis of policy actors’ perspectives in post-conflict Northern Uganda

Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors’ perceptions of existing prodisability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities.Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people’s organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers

Maternal and neonatal health care service utilisation in the wake of active conflict and socio-economic downturn in Torit County, Republic of South Sudan: a multimethod locally driven study

Recurrent conflicts and economic downturn hamper access to health care. We examined how renewed conflict in July 2016 in Torit County, South Sudan affected health facility utilization for pregnancy care. We analyzed key quantitative indicators before and since renewed conflict through monthly facility data covering January 2015 to December 2016 on Antenatal Care (ANC) visits, facility-based births, and major obstetric complications. A qualitative descriptive study explored perceptions on access through key informant interviews and focused group discussions. ANC visits declined by 21%; health facility births declined from 23.6% to 16.7% while the proportion of all obstetric complications treated declined from 58.9% to 43.9%. Lack of human resources, inadequate medicines supply, perceived poor quality of care and economic hardships were the main factors affecting access to care. Our multidisciplinary and multistakeholder approach and leadership by South Sudanese team members enhanced research quality and its potential impact on practice and policy.   Les conflits armés récurrents et la récession économique entravent l'accès aux services de santé. Au mois de juillet 2016, des conflits armés ont repris au Soudan du Sud. Nous avons mené une étude mixte sur l’impact de la reprise des conflits armés de 2016 sur l’utilisation des services de santé maternelle dans le comté de Torit au Soudan du Sud. La composante quantitative a évalué les consultations prénatales, les accouchements en milieu hospitalier, et les complications obstétricales majeures. Nous avons consulté les données des établissements de santé durant la période de janvier 2015 à décembre 2016. La composante qualitative a exploré les perceptions de l’accès aux services de santé. Nous avons mené des entretiens individuels et des groupes de discussion avec des informateurs clés (ministère de la Santé du comté de Torit, gestionnaires et professionnels de la santé, membres d’organisations non gouvernementales).Les résultats quantitatifs ont montré que les consultations prénatales ont diminué de 21%. Les accouchements en milieu hospitalier sont passés de 23.6% à 16.7% tandis que la proportion des complications obstétricales majeures traitées est passée de 58.9% à 43.9%. L’absence des ressources humaines en santé, les problèmes d’approvisionnement en médicaments, la qualité perçue des soins, et le manque de ressources économiques des ménages sont les principaux facteurs influençant l’accès aux services de santé maternelle. L’implication des décideurs politiques, la multidisciplinarité de l’équipe de recherche et le leadership des membres de l’équipe sud-soudanaise ont contribué à améliorer la qualité de la recherche et à son impact potentiel sur les pratiques et les politiques sanitaire

Communities and service providers address access to perinatal care in postconflict Northern Uganda : socialising evidence for participatory action

Participatory service improvement is feasible and acceptable in post-conflict settings like Northern Uganda. The study engaged stakeholder participants who identified obstructions to accessing perinatal care: lack of savings for childbirth costs in facility-based delivery, lack of male partner support, and poor service provider attitudes. The civil war in Northern Uganda (1986– 2006) displaced more than 90% of the population of that region. Northern Uganda has among the highest global maternal mortality rates (610 per 100,000 live births). Engaging communities in identifying perinatal service delivery issues can generate community-led solutions and increases trust between community members and service providers.Grand Challenges Canad

Community views on short birth interval in Northern Uganda : a participatory grounded theory

Women, men, and youth have clear understandings of the benefits of adequate child spacing. As women are disempowered to exercise child spacing, this knowledge is difficult to translate into practice. Women who use contraceptives without their husbands’ consent risk losing financial and social assets and are likely to be subject to intra-partner violence including forced intercourse. This detailed paper explores women’s experiences and community views on short birth intervals, to inform and promote culturally safe child spacing in Northern Uganda. A shorter breastfeeding period and the female gender of the previous child have been factors consistently associated with short birth intervals.Grand Challenges Canad

Exploring the impact of a community participatory intervention on women’s capability : a qualitative study in Gulu Northern Uganda

Community-based women’s groups using a participatory learning and action (PLA) cycle are effective in promoting maternal and child health. The PLA women’s group intervention encouraged health promotion activities and community mobilization in Gulu district, Uganda (2017). This area has a high burden of unmet needs in family planning, neonatal mortality, teenage pregnancy, and child mortality. The women’s group enabled participants to adopt behaviours to protect their health and their children’s health at individual and community levels. Women extended their agency to control financial resources and developed strategies to stop domestic violence. As a result, there was a reduction in mistreatment of children.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

“Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing” : institutional delivery and postnatal care in Torit County, South Sudan - a mixed method study

This detailed study examines the prevalence of factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan. Women were more likely to plan and prepare for home delivery than for institutional delivery, and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health personnel and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. All categories of participants reported insecurity, distance and the lack of transport as important deterrents to access for health care services.Foreign Affairs, Trade and Development Canada (DFATD)Canadian Institutes of Health Research (CIHR

Policy implementation challenges and barriers to access sexual and reproductive health services faced by people with disabilities : an intersectional analysis of policy actors’ perspectives in post-conflict Northern Uganda

Emerging from 20 years of armed conflict, Uganda adopted laws and policies to protect the rights of people with disabilities, including sexual and reproductive health (SRH) rights. This study reflects on the difficulty of implementing disability-focused policy in Uganda. One fifth of the country’s population was estimated to live with some disability (2008). Armed conflict between the Government and the Lord’s Resistance Army caused breakdowns in social systems, and generated widespread trauma for Northern Ugandans. An intersectionality-informed analysis enables policy makers and researchers to examine intersecting social identities and diverse sources of knowledge that can contribute to improved policy solutions.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR)Fonds de Recherche du Québec – Sant

Why women die after reaching the hospital : a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda

After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving emergency obstetrics and newborn care (EmONC). Five reasons were identified: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways. Improvement of skills, better management of meagre human resources, and availability of essential medical supplies in health facilities may help increase emergency readiness

Prozone in malaria rapid diagnostics tests: how many cases are missed?

<p>Abstract</p> <p>Background</p> <p>Prozone means false-negative or false-low results in antigen-antibody reactions, due to an excess of either antigen or antibody. The present study prospectively assessed its frequency for malaria rapid diagnostic tests (RDTs) and <it>Plasmodium falciparum </it>samples in an endemic field setting.</p> <p>Methods</p> <p>From January to April 2010, blood samples with <it>P. falciparum </it>high parasitaemia (≥ 4% red blood cells infected) were obtained from patients presenting at the Provincial Hospital of Tete (Mozambique). Samples were tested undiluted and 10-fold diluted in saline with a panel of RDTs and results were scored for line intensity (no line visible, faint, weak, medium and strong). Prozone was defined as a sample which showed no visible test line or a faint or weak test line when tested undiluted, and a visible test line of higher intensity when tested 10-fold diluted, as observed by two blinded observers and upon duplicate testing.</p> <p>Results</p> <p>A total of 873/7,543 (11.6%) samples showed <it>P. falciparum</it>, 92 (10.5%) had high parasitaemia and 76 were available for prozone testing. None of the two Pf-pLDH RDTs, but all six HRP-2 RDTs showed prozone, at frequencies between 6.7% and 38.2%. Negative and faint HRP-2 lines accounted for four (3.8%) and 15 (14.4%) of the 104 prozone results in two RDT brands. For the most affected brand, the proportions of prozone with no visible or faint HRP-2 lines were 10.9% (CI: 5.34-19.08), 1.2% (CI: 0.55-2.10) and 0.1% (CI: 0.06-0.24) among samples with high parasitaemia, all positive samples and all submitted samples respectively. Prozone occurred mainly, but not exclusively, among young children.</p> <p>Conclusion</p> <p>Prozone occurs at different frequency and intensity in HRP-2 RDTs and may decrease diagnostic accuracy in the most affected RDTs.</p

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century