The challenges for women's health in sub-Saharan Africa: Lessons learned from an integrative multistakeholder workshop in Gabon.
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ABSTRACT:
SUBMITTER: Habib M
PROVIDER: S-EPMC8442509 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:There is an urgent need for data to inform coronavirus disease (COVID-19) pandemic response efforts. At the same time, the pandemic has created challenges for data collection, one of which is interviewer training in the context of social distancing. In sub-Saharan Africa, in-person interviewer training and face-to-face data collection remain the norm, requiring researchers to think creatively about transitioning to remote settings to allow for safer data collection that respects government guidelines. Performance Monitoring for Action (PMA, formerly PMA2020) has collected both cross-sectional and longitudinal data on key reproductive health measures in Africa and Asia since 2013. Relying on partnerships with in-country research institutes and cadres of female interviewers recruited from sampled communities, the project was well-positioned to transition to collecting data on COVID-19 from the onset of the pandemic. This article presents PMA's development of a remote training system for COVID-19 surveys in the Democratic Republic of the Congo, Kenya, and Nigeria, including challenges faced and lessons learned. We demonstrate that remote interviewer training can be a viable approach when data are critically needed and in-person learning is not possible. We also argue against systematic replacement of in-person trainings with remote learning, instead recommending consideration of local context and a project's individual circumstances when contemplating a transition to remote interviewer training.
| S-EPMC8087422 | biostudies-literature
Project description:Numerous national public initiatives offering first-line combination antiretroviral therapy (cART) for HIV infection have commenced in sub-Saharan Africa since 2002. Presently, 2.1 million of an estimated seven million Africans in need of cART are receiving treatment. Analyses from the region report favorable clinical/treatment outcomes and impressive declines in AIDS-related mortality among HIV-1-infected adults and children receiving cART. While immunologic recovery, virologic suppression and cART adherence rates are on par with resource-rich settings, loss to follow-up and high mortality rates, especially within the first 6 months of treatment, remain a significant problem. Over the next decade, cART coverage rates are expected to improve across the region, with attendant increases in healthcare utilization for HIV- and non-HIV-related complications and the need for expanded laboratory and clinical services. Planned and in-progress trials will evaluate the use of cART to prevent primary HIV-1 infection with so-called 'test and treat' expansions of coverage and treatment. Education and training programs as well as patient-retention strategies will need to be strengthened as national cART programs are expanded and more people require lifelong monitoring and care.
| S-EPMC2774911 | biostudies-literature
Project description:BackgroundYaoundé Central Hospital (YCH), located in the capital of Cameroon, is one of the leading referral hospitals in Cameroon. The hospital has several departments, including the Department of Gynecology-Obstetrics (hereinafter referred to as "the Maternity"). This clinical department has faced numerous problems with clinical information management, including the lack of high-quality and reliable clinical information, lack of access to this information, and poor use of this information.ObjectiveWe aim to improve the management of clinical information generated at the Maternity at YCH and to describe the challenges, success factors, and lessons learned during its implementation and use.MethodsBased on an open-source hospital information system (HIS), this intervention implemented a clinical information system (CIS) at the Maternity at YCH and was carried out using the HERMES model-the first part aimed to cover outpatient consultations, billing, and cash management of the Maternity. Geneva University Hospitals supported this project, and several outcomes were measured at the end. The following outcomes were assessed: project management, technical and organizational aspects, leadership, change management, user training, and system use.Implementation (results)The first part of the project was completed, and the CIS was deployed in the Maternity at YCH. The main technical activities were adapting the open-source HIS to manage outpatient consultations and develop integrated billing and cash management software. In addition to technical aspects, we implemented several other activities. They consisted of the implementation of appropriate project governance or management, improvement of the organizational processes at the Maternity, promotion of the local digital health leadership and performance of change management, and implementation of the training and support of users. Despite barriers encountered during the project, the 6-month evaluation showed that the CIS was effectively used during the first 6 months.ConclusionsImplementation of the HIS or CIS is feasible in a resource-limited setting such as Cameroon. The CIS was implemented based on good practices at the Maternity at YCH. This project had successes but also many challenges. Beyond project management and technical and financial aspects, the other main problems of implementing health information systems or HISs in Africa lie in digital health leadership, governance, and change management. This digital health leadership, governance, and change management should prioritize data as a tool for improving productivity and managing health institutions, and promote a data culture among health professionals to support a change in mindset and the acquisition of information management skills. Moreover, in countries with a highly centralized political system like ours, a high-level strategic and political anchor for such projects is often necessary to guarantee their success.
| S-EPMC10620639 | biostudies-literature
Project description:The current health-care environment is demanding evidence-based medicine that relies on clinical trials as the basis for decisions. Clinician investigators are more often finding that they are personally responsible for coordinating large, multisite trials. We present strategies for successful implementation and management of multisite clinical trials and knowledge gained through an international, multisite randomized clinical trial. Topics include team composition, regulatory requirements, study organization and governance, communication strategies, recruitment and retention efforts, budget, technology transfer, and publication.
| S-EPMC3935288 | biostudies-literature
Project description: Not available
| S-EPMC8134793 | biostudies-literature
Project description:BackgroundThe mass media have excellent potential to promote good sexual and reproductive health outcomes, but around the world, media often fail to prioritize sexual and reproductive health and rights issues or report them in an accurate manner. In sub-Saharan Africa media coverage of reproductive health issues is poor due to the weak capacity and motivation for reporting these issues by media practitioners. This paper describes the experiences of the African Population and Health Research Center and its partners in cultivating the interest and building the capacity of the media in evidence-based reporting of reproductive health issues in sub-Saharan Africa.MethodsThe paper utilizes a case study approach based primarily on the personal experiences and reflections of the authors (who played a central role in developing and implementing the Center's communication and policy engagement strategies), a survey that the Center carried out with science journalists in Kenya, and literature review.ResultsThe African Population and Health Research Center's media strategy evolved over the years, moving beyond conventional ways of communicating research through the media via news releases and newspaper stories, to varying approaches that sought to inspire and build the capacity of journalists to do evidence-based reporting of reproductive health issues. Specifically, the approach included 1) enhancing journalists' interest in and motivation for reporting on reproductive health issues through training and competitive grants for outstanding reporting ; 2) building the capacity of journalists to report reproductive health research and the capacity of reproductive health researchers to communicate their research to media through training for both parties and providing technical assistance to journalists in obtaining and interpreting evidence; and 3) establishing and maintaining trust and mutual relationships between journalists and researchers through regular informal meetings between journalists and researchers, organizing field visits for journalists, and building formal partnerships with professional media associations and individual journalists.ConclusionOur experiences and reflections, and the experiences of others reviewed in this paper, indicate that a sustained mix of strategies that motivate, strengthen capacity of, and build relationships between journalists and researchers can be effective in enhancing quality and quantity of media coverage of research.
| S-EPMC3121138 | biostudies-literature
Project description:BackgroundIn November 2016, the WHO four-visit focused antenatal care (FANC) model adopted in sub-Saharan Africa (SSA) was reverted to eight contacts or more as a response to reducing the global perinatal and maternal deaths and in achieving the sustainable development goal (SDG) 3. Women's empowerment, which connote the social standing, position and the ability of women to make life decisions and choices has been associated with the maternal health seeking behaviour and outcomes. This study examined the association between women's empowerment and the WHO ANC model of eight visits or more, and early first antenatal visit among pregnant women. In addition, we explored the association between women's empowerment and the WHO FANC model to allow for comparison for countries that have not adopted the recent WHO ANC model.MethodsThe most recent (2018) Demographic and Health Survey (DHS) datasets conducted in SSA were used for analyses. We used all available indicators of women's empowerment captured in the DHS. The 30 variables on women's empowerment were classified into eight components using exploratory factor analysis. We fitted separate ordinal logistic regression to assess association between antenatal care utilization (number of visits and time of first antenatal visit) and women empowerment factors while adjusting for other covariates. Analysis was performed with STATA 15.0 and adjusted for complex survey design, p-value< 0.05 were used for interpretation of results.ResultsThe proportion of women who attended eight or more ANC visits were 1.4, 2.7 and 3.5% in Zambia, Guinea and Mali, respectively. Zambia had the lowest prevalence of 8 or more ANC visits also had the highest prevalence of at least 4 visits (63.8%) and early first ANC visit (38.2%), while Nigeria with the highest prevalence of women with at least 8 visits (17.7%) had the lowest prevalence (17.6%) of women that attended ANC visit in their first trimester. Women's empowerment was associated with more ANC visits and attending first ANC visit in the first trimester. However, these association with the women empowerment components varied significantly across the four SSA countries.ConclusionThis study highlights the significant impact of women's empowerment as a key factor for improving maternal health outcomes in SSA. It is imperative that government and development partners invest more on empowerment of women as part of strategic intervention to improve maternal health outcomes.
| S-EPMC7944901 | biostudies-literature
Project description:We re-evaluate the Women's Health Initiative findings and their implications for clinical practice. Menopausal hormone therapy (HT) was effective for relief of vasomotor symptoms, and the risk of coronary heart disease (CHD) tended to be reduced in women close to menopause compared with the increased risk in women more distant from menopause. In recently menopausal women, short-term absolute risks of stroke and venous thromboembolism were small. Estrogen plus progestin therapy, but not estrogen therapy, increased the risk of breast cancer with a suggestion of greater risk when initiated close to the menopause. Menopausal HT increased the risk of CHD in women more than 20 years distant from menopause, particularly in women with vasomotor symptoms. It remains unknown whether the suggestive benefit for CHD in younger women will translate into benefits or harms if menopausal HT is continued into older ages. Based on Women's Health Initiative data, the use of menopausal HT for fewer than 5 years is a reasonable option for the relief of moderate to severe vasomotor symptoms. The risks seen with estrogen plus progestin therapy suggest careful periodic reassessment of the ongoing therapy needs for women taking estrogen plus progestin therapy. The more favorable profile of estrogen therapy allows for individualized management with respect to duration of use when symptoms persist. For both estrogen therapy and estrogen plus progestin therapy, the baseline risk profile of the individual woman needs to be taken into account. Menopausal HT is not suitable for long-term prevention of CHD given risks of stroke, venous thromboembolism, and breast cancer (for estrogen plus progestin therapy) found in both clinical trials and in observational studies.
| S-EPMC3547645 | biostudies-other
Project description:•The burden of gynecologic cancers in low resource settings is overwhelming.•Areas with the highest needs have few human resources and limited infrastructure.•Cancer specialists can best help by leveraging ongoing work to assist local leaders.
| S-EPMC5548333 | biostudies-other
Project description:BackgroundThe Healthy Communities Study (HCS) was a national study of community programs and policies that aimed to address childhood obesity; it necessitated recruitment of a large sample of children from communities throughout the United States.ObjectiveThe HCS aimed to complete visits with an average of 45 children and 12 key informants from at least 120 communities, diverse with respect to region of the country, urbanicity, socioeconomic status, race, ethnicity and intensity of community programs and policies that aim to address childhood obesity.MethodsPurchased address lists were utilized to select households for recruitment during Wave 1 of the study, and recruitment of families through schools was employed for Wave 2.ResultsThe HCS successfully obtained approval from 149 school districts and 478 schools in 130 communities, recruited 5138 families, and interviewed 1421 key informants to allow for characterization of overall intensity of obesity prevention/treatment efforts in each community.ConclusionsLessons learned are presented. Future studies should plan for inclusion of the following in development of recruitment strategies: literature review, formative research, pilot testing, and ongoing monitoring and adjustment.
| S-EPMC6424514 | biostudies-literature