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1126 to 1150 of 2,047Determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea: evidence from the 2018 Guinea Demographic and Health Survey data.
Background: Globally, maternal health remains a major priority. Most of maternal deaths globally occur in sub-Saharan Africa, with most of these deaths linked to lack of access to antenatal care and skilled assistance during delivery. This study assessed the determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea.
Methods: Data for this study were obtained from the 2018 Guinea Demographic and Health Survey (GDHS). Data of 4,917 childbearing women were considered as our analytical sample. The outcome variables for the study were utilization of antenatal care and skilled birth attendance. Analysis was carried out using chi-square tests and multivariable logistic regression.
Results: The results showed that women aged 15-24 (AOR=1.29, CI=1.03-1.62), women who had secondary/higher level of education (AOR=1.70, CI=1.33-2.19), and tho…
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Confronting COVID-19 in under-resourced, African American neighborhoods: a qualitative study examining community member and stakeholders' perceptions.
Objective: The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama.
Design: Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities using secure Zoom meetings. Community residents and stakeholders (N = 36 total) participated; meetings were audio- and video-recorded, transcribed, and analyzed according to Thematic Analysis. Themes were organized by the PRECEDE portion of the model in Predisposing, Reinforcing, and Enabling barriers and facilitators in three focus areas: prevention, coping, and testing.
Results: Prevention barriers included apathy, difficulty with social distancing, lack of information, mixed messages from authority figures, and lack of personal protective equipment (PPE). Prevention facilit…
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Dowhaniuk N (2021)MEDLINE-indexed journal, not yet read by usInternational journal for equity in health76 citations Exploring country-wide equitable government health care facility access in Uganda.
Background: Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor.
Methods: An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking…
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Gendered health institutions: examining the organization of health services and men's use of HIV testing in Malawi.
Introduction: Men in sub-Saharan Africa are less likely to use HIV testing services than their female counterparts. Norms of masculinity are frequently cited as the main barrier to men's use of HIV testing services, but very little is known about how health institutions are organized to facilitate or impede men's care. We examined the organization of health institutions in Malawi, and implications for men's use of HIV testing services.
Methods: A mixed methods ethnography was conducted in Malawi between October 2013 and September 2014. National Ministry of Health guidelines from 2012 to 2014 were analysed, counting the frequency of recommended preventative services by sex. In-depth interviews were conducted with 18 healthcare workers and 11 national key informants (29 total). Five rural health facilities participated in direct observation and 52 observational journals were completed to d…
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Peters DJ (2020)MEDLINE-indexed journal, not yet read by usThe Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association156 citations Community Susceptibility and Resiliency to COVID-19 Across the Rural-Urban Continuum in the United States.
Purpose: This study creates a COVID-19 susceptibility scale at the county level, describes its components, and then assesses the health and socioeconomic resiliency of susceptible places across the rural-urban continuum.
Methods: Factor analysis grouped 11 indicators into 7 distinct susceptibility factors for 3,079 counties in the conterminous United States. Unconditional mean differences are assessed using a multivariate general linear model. Data from 2018 are primarily taken from the US Census Bureau and CDC.
Results: About 33% of rural counties are highly susceptible to COVID-19, driven by older and health-compromised populations, and care facilities for the elderly. Major vulnerabilities in rural counties include fewer physicians, lack of mental health services, higher disability, and more uninsured. Poor Internet access limits telemedicine. Lack of social capital and social service…
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Factors Associated With Child Stunting, Wasting, and Underweight in 35 Low- and Middle-Income Countries.
Importance: Evidence on the relative importance of various factors associated with child anthropometric failures (ie, stunting, underweight, and wasting) and their heterogeneity across countries can inform global and national health agendas.
Objective: To assess the relative significance of factors associated with child anthropometric failures in 35 low- and middle-income countries (LMICs).
Design, setting, and participants: This cross-sectional study of 299 353 children who were born singleton and aged 12 to 59 months with nonpregnant mothers and valid anthropometric measures assessed the strengths of associations of 26 factors with child stunting, underweight, and wasting, using Demographic and Health Surveys (2007-2018) from 35 LMICs. Data analysis was conducted from July 2019 to February 2020.
Exposures: A total of 9 direct factors (ie, dietary diversity score; breastfeeding initiati…
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Wathelet M, Duhem S, Vaiva G, Baubet T, Habran E, Veerapa E, Debien C, Molenda S, Horn M, Grandgenèvre P, Notredame CE, D'Hondt F (2020)MEDLINE-indexed journal, not yet read by usJAMA network open435 citations Factors Associated With Mental Health Disorders Among University Students in France Confined During the COVID-19 Pandemic.
Importance: The coronavirus disease 2019 (COVID-19) pandemic and quarantine measures have raised concerns regarding their psychological effects on populations. Among the general population, university students appear to be particularly susceptible to experiencing mental health problems.
Objectives: To measure the prevalence of self-reported mental health symptoms, to identify associated factors, and to assess care seeking among university students who experienced the COVID-19 quarantine in France.
Design, setting, and participants: This survey study collected data from April 17 to May 4, 2020, from 69 054 students living in France during the COVID-19 quarantine. All French universities were asked to send an email to their students asking them to complete an online questionnaire. The targeted population was approximately 1 600 000 students.
Exposure: Living in France during the COVID-19 q…
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Vaccine hesitancy towards childhood immunisation amongst urban pregnant mothers in Malaysia.
Background: Vaccine hesitancy is a complex behaviour which involves various degrees of indecision about specific vaccines or vaccination uptake. Access to antenatal care had been associated with positive vaccine behavior.
Objective: To determine the prevalence of vaccine hesitancy towards childhood immunisation amongst urban pregnant mothers and the associated socio-demographic factors.
Methods: A cross-sectional study was conducted among 1081 women who received antenatal care at a teaching hospital in Kuala Lumpur. Vaccine hesitancy was assessed using the Parent Attitudes about Childhood Vaccines (PACV) Survey in both English and validated Malay versions. The sociodemographic data of the mothers and their partners, source of vaccine information and reasons for hesitancy were analysed.
Results: Eighty-six (8.0%) pregnant mothers were vaccine hesitant. Ethnicity, religion, number of child…
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Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence.
Long-term control of the COVID-19 pandemic hinges in part on the development and uptake of a preventive vaccine. In addition to a segment of population that refuses vaccines, the novelty of the disease and concerns over safety and efficacy of the vaccine have a sizable proportion of the U.S. indicating reluctance to getting vaccinated against COVID-19. Among various efforts to address vaccine hesitancy and foster vaccine confidence, evidence-based communication strategies are critical. There are opportunities to consider the role of emotion in communication efforts. In this commentary, we highlight several ways negative as well as positive emotions may be considered and leveraged. Examples include attending to negative emotions such as fear and anxiety, raising awareness of emotional manipulations by anti-vaccine disinformation efforts, and activating positive emotions such as altruism a…
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Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand.
Background: Cultural competency describes interventions that aim to improve accessibility and effectiveness of health services for people from ethnic minority backgrounds. Interventions include interpreter services, migrant peer educators and health worker training to provide culturally competent care. Very few studies have focussed on cultural competency for migrant service use in Low- and Middle-Income Countries (LMIC). Migrants and refugees in Thailand and Malaysia report difficulties in accessing health systems and discrimination by service providers. In this paper we describe stakeholder perceptions of migrants' and health workers' language and cultural competency, and how this affects migrant workers' health, especially in Malaysia where an interpreter system has not yet been formalised.
Method: We conducted in-depth interviews with stakeholders in Malaysia (N = 44) and Thailand (N…
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Walker PGT, Whittaker C, Watson OJ, Baguelin M, Winskill P, Hamlet A, Djafaara BA, Cucunubá Z, Olivera Mesa D, Green W, Thompson H, Nayagam S, Ainslie KEC, Bhatia S, Bhatt S, Boonyasiri A, Boyd O, Brazeau NF, Cattarino L, Cuomo-Dannenburg G, Dighe A, Donnelly CA, Dorigatti I, van Elsland SL, FitzJohn R, Fu H, Gaythorpe KAM, Geidelberg L, Grassly N, Haw D, Hayes S, Hinsley W, Imai N, Jorgensen D, Knock E, Laydon D, Mishra S, Nedjati-Gilani G, Okell LC, Unwin HJ, Verity R, Vollmer M, Walters CE, Wang H, Wang Y, Xi X, Lalloo DG, Ferguson NM, Ghani AC (2020)MEDLINE-indexed journal, not yet read by usScience (New York, N.Y.)576 citations The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries.
The ongoing coronavirus disease 2019 (COVID-19) pandemic poses a severe threat to public health worldwide. We combine data on demography, contact patterns, disease severity, and health care capacity and quality to understand its impact and inform strategies for its control. Younger populations in lower-income countries may reduce overall risk, but limited health system capacity coupled with closer intergenerational contact largely negates this benefit. Mitigation strategies that slow but do not interrupt transmission will still lead to COVID-19 epidemics rapidly overwhelming health systems, with substantial excess deaths in lower-income countries resulting from the poorer health care available. Of countries that have undertaken suppression to date, lower-income countries have acted earlier. However, this will need to be maintained or triggered more frequently in these settings to keep be…
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Factors related to preventive COVID-19 infection behaviors among people with mental illness.
Background/purpose: Because of the spread of novel coronavirus disease 2019 (COVID-2019), preventive COVID-19 infection behaviors become important for individuals, especially those who are vulnerable. The present study proposes a model to explain the preventive COVID-19 infection behaviors among people with mental illness in Taiwan.
Methods: A cross-sectional design was carried out and 414 patients with mental illness (230 males [55.6%]; mean age = 46.32 [SD = 10.86]) agreed to participate in the study. All the participants completed the Preventive COVID-19 Infection Behaviors Scale, Self-Stigma Scale-Short, Believing COVID-19 Information Scale, Fear of COVID-19 Scale, and Depression Anxiety Stress Scale-21. Regression models and structural equation modeling (SEM) were applied to examine the factors associated with preventive COVID-19 infection behaviors.
Results: Both regression models …
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Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil.
Background: Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil.
Objective: To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics.
Method: We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed usi…
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Cohen SP, Baber ZB, Buvanendran A, McLean BC, Chen Y, Hooten WM, Laker SR, Wasan AD, Kennedy DJ, Sandbrink F, King SA, Fowler IM, Stojanovic MP, Hayek SM, Phillips CR (2020)MEDLINE-indexed journal, not yet read by usPain medicine (Malden, Mass.)122 citations Pain Management Best Practices from Multispecialty Organizations During the COVID-19 Pandemic and Public Health Crises.
Background: It is nearly impossible to overestimate the burden of chronic pain, which is associated with enormous personal and socioeconomic costs. Chronic pain is the leading cause of disability in the world, is associated with multiple psychiatric comorbidities, and has been causally linked to the opioid crisis. Access to pain treatment has been called a fundamental human right by numerous organizations. The current COVID-19 pandemic has strained medical resources, creating a dilemma for physicians charged with the responsibility to limit spread of the contagion and to treat the patients they are entrusted to care for.
Methods: To address these issues, an expert panel was convened that included pain management experts from the military, Veterans Health Administration, and academia. Endorsement from stakeholder societies was sought upon completion of the document within a one-week perio…
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A Pilot Evaluation of a Smartphone Application for Workplace Depression.
Interventions delivered via mobile apps show particular promise in tackling the burden of common mental disorders. Appropriately targeting these interventions to at-risk populations is critical to their success. This pilot study aimed to assess the usability, feasibility, acceptability, and preliminary effects of an app-based intervention designed to target depressive symptoms in a stressed working population. Anchored, a smartphone app including a 30-day program of mindfulness and cognitive and behavioural therapeutic components, was tested in a pre-post pilot study with participants recruited via social media advertisements. Eligible participants (N = 81) were Australian adults who were employed and reported elevated stress levels on a single-item screening measure. Follow-up assessment occurred 5 weeks after baseline. The primary outcome measure was change in depressive symptoms, with…
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Impact of coronavirus disease 2019 (COVID-19) pandemic on patients with migraine: a web-based survey study.
Background: Since the declaration COVID-19 as a pandemic, healthcare systems around the world have faced a huge challenge in managing patients with chronic diseases. Patients with migraine were specifically vulnerable to inadequate medical care. We aimed to investigate the "real-world" impact of COVID-19 pandemic on migraine patients, and to identify risk factors for poor outcome.
Methods: We administered an online, self-reported survey that included demographic, migraine-related, COVID-19-specific and overall psychosocial variables between July 15 and July 30, 2020. We recruited a sample of patients with migraine from headache clinic registry and via social media to complete an anonymous survey. Outcomes included demographic variables, change in migraine frequency and severity during the lockdown period, communication with treating physician, compliance to migraine treatment, difficulty…
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Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic.
Background: Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond.
Methods: We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support.
Results: We found substantially elevated anxiety and depression symptoms compare…
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What General and Pain-associated Psychological Distress Phenotypes Exist Among Patients with Hip and Knee Osteoarthritis?
Background: Psychological distress can negatively influence disability, quality of life, and treatment outcomes for individuals with hip and knee osteoarthritis (OA). Clinical practice guidelines recommend a comprehensive disease management approach to OA that includes the identification, evaluation, and management of psychological distress. However, uncertainty around the best psychological screening and assessment methods, a poor understanding of the heterogeneity of psychological distress in those with OA, and lack of guidance on how to scale treatment have limited the growth of OA care models that effectively address individual psychological needs.
Questions/purposes: (1) Across which general and pain-related psychological distress constructs do individuals seeking conservative care for hip or knee OA report higher scores than the general population of individuals seeking conservativ…
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Termorshuizen JD, Watson HJ, Thornton LM, Borg S, Flatt RE, MacDermod CM, Harper LE, van Furth EF, Peat CM, Bulik CM (2020)MEDLINE-indexed journal, not yet read by usThe International journal of eating disorders205 citations Early impact of COVID-19 on individuals with self-reported eating disorders: A survey of ~1,000 individuals in the United States and the Netherlands.
Objective: We evaluated the early impact of COVID-19 on people with self-reported eating disorders.
Method: Participants in the United States (US, N = 511) and the Netherlands (NL, N = 510), recruited through ongoing studies and social media, completed an online survey that included both quantitative measures and free-text responses assessing the impact of COVID-19 on situational circumstances, eating disorder symptoms, eating disorder treatment, and general well-being.
Results: Results revealed strong and wide-ranging effects on eating disorder concerns and illness behaviors that were consistent with eating disorder type. Participants with anorexia nervosa (US 62% of sample; NL 69%) reported increased restriction and fears about being able to find foods consistent with their meal plan. Individuals with bulimia nervosa and binge-eating disorder (US 30% of sample; NL 15%) reported increas…
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PTSD's blame criterion and mental health outcomes in a community mental health treatment-seeking sample.
Objective: Posttraumatic stress disorder (PTSD) is a severe psychiatric condition that can manifest as a combination of debilitating symptoms, one of which is a distorted sense of responsibility for the traumatic event. The inclusion of DSM-5's PTSD D3 criterion (blaming self or others for the stressful experience) has received little research attention in regard to its relation to post-trauma mental health outcomes. To address this gap in literature, we examined the relevance of the clinical endorsement of the D3 criterion to PTSD symptomology and other posttrauma mental health outcomes.
Method: Participants were 123 trauma-exposed, treatment-seeking individuals (Mage = 35.70, 68.3% female) who completed a series of self-report questionnaires assessing PTSD symptomology, depression severity, distress intolerance, rumination, and anger reactions.
Results: Independent t tests comparing th…
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Wong SYS, Zhang D, Sit RWS, Yip BHK, Chung RY, Wong CKM, Chan DCC, Sun W, Kwok KO, Mercer SW (2020)MEDLINE-indexed journal, not yet read by usThe British journal of general practice : the journal of the Royal College of General Practitioners258 citations Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care.
Background: The COVID-19 pandemic has impacted the psychological health and health service utilisation of older adults with multimorbidity, who are particularly vulnerable.
Aim: To describe changes in loneliness, mental health problems, and attendance to scheduled medical care before and after the onset of the COVID-19 pandemic.
Design and setting: Telephone survey on a pre-existing cohort of older adults with multimorbidity in primary care.
Method: Mental health and health service utilisation outcomes were compared with the outcomes before the onset of the COVID-19 outbreak in Hong Kong using paired t-tests, Wilcoxon's signed-rank test, and McNemar's test. Loneliness was measured by the De Jong Gierveld Loneliness Scale. The secondary outcomes (anxiety, depression, and insomnia) were measured by the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder tool, and t…
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Koschollek C, Kuehne A, Müllerschön J, Amoah S, Batemona-Abeke H, Dela Bursi T, Mayamba P, Thorlie A, Mputu Tshibadi C, Wangare Greiner V, Bremer V, Santos-Hövener C (2020)MEDLINE-indexed journal, not yet read by usPloS one24 citations Knowledge, information needs and behavior regarding HIV and sexually transmitted infections among migrants from sub-Saharan Africa living in Germany: Results of a participatory health research survey.
Background: A total of 3,419 new HIV diagnoses were reported in Germany in 2016, with migrants from sub-Saharan Africa (misSA) accounting for 14.1%. To understand the driving factors behind the epidemiological situation, we conducted a quantitative cross-sectional survey on knowledge, attitudes, behavior, and practices regarding HIV and sexually transmitted infections (STIs) among misSA living in six German cities utilizing participatory health research.
Methods: Participants were recruited by peer researchers. Levels of knowledge, information needs, and preferred methods of information dissemination were analyzed to inform future prevention planning. Additionally, we analyzed sexual behavior and other risk factors for contracting HIV and STIs. The results may facilitate the formulation of targeted prevention messages in the future.
Results: We included 2,432 participants in the analysis…
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Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective.
Background: All pregnancies are at risk and have to be attended by skilled professionals. In Ethiopia however nearly half (45.7%) of the women were giving birth at home after antenatal care (ANC) visits in which skilled professionals were not available. Therefore, the aim of this study was to assess spatial clustering and the determinant factors of home delivery after antenatal care visits in Ethiopia.
Methods: A case control study was conducted on 2110 mothers who gave birth at home after ANC (cases), and 2510 mothers who gave birth at health institutions after attending ANC (controls), based on EDHS 2016 data. As per the recommendations of the DHS program, we weighed the data before analysis. ArcGIS 10.3 was used to show spatial pattern and SaTScan™ 9.4 to identify significant clusters. Stata 14 was used for data cleaning, weighing, and the analysis of the determinant factors. Bi varia…
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Patient experiences of fertility clinic closure during the COVID-19 pandemic: appraisals, coping and emotions.
Study question: What are appraisals, coping strategies and emotional reactions of patients to coronavirus disease 2019 (COVID-19) fertility clinic closures?
Summary answer: Clinic closure was appraised as stressful due to uncertainty and threat to the attainability of the parenthood goal but patients were able to cope using strategies that fit the uncertainty of the situation.
What is known already: Psychological research on COVID-19 suggests that people are more anxious than historical norms and moderately to extremely upset about fertility treatment cancellation owing to COVID-19.
Study design, size, duration: The study was of cross-sectional design, comprising a mixed-methods, English language, anonymous, online survey posted from April 9 to 21 to social media. Eligibility criteria were being affected by COVID-19 fertility clinic closure, 18 years of age or older and able to complete …
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Ahmed SAKS, Ajisola M, Azeem K, Bakibinga P, Chen YF, Choudhury NN, Fayehun O, Griffiths F, Harris B, Kibe P, Lilford RJ, Omigbodun A, Rizvi N, Sartori J, Smith S, Watson SI, Wilson R, Yeboah G, Aujla N, Azam SI, Diggle PJ, Gill P, Iqbal R, Kabaria C, Kisia L, Kyobutungi C, Madan JJ, Mberu B, Mohamed SF, Nazish A, Odubanjo O, Osuh ME, Owoaje E, Oyebode O, Porto de Albuquerque J, Rahman O, Tabani K, Taiwo OJ, Tregonning G, Uthman OA, Yusuf R, Improving Health in Slums Collaborative (2020)MEDLINE-indexed journal, not yet read by usBMJ global health195 citations Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements.
Introduction: With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.
Methods: In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.
Results: Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment …
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