MSc in Global Health

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7204

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HIV Prevalence Decline in Zimbabwe: The Contribution of Behaviour Changes
(Queen Margaret University, 2015)
Background: HIV /AIDS remain an epidemic in Zimbabwe. HIV/AIDS declined in Zimbabwe between 1998 and 2008 amidst a growing number of socioeconomic and political crises Objective of the Study: The purpose of this study is to investigate the reasons given for the declines in HIV incidence and prevalence in Zimbabwe during the period between 1998 and 2008. Findings : There are different and complex reasons to explain why HIV prevalence declined in Zimbabwe and the debate around this is contestable given the socioeconomic and political problems Conclusion; HIV prevalence declined in Zimbabwe and the available evidence points to changes in sexual behaviour, particularly multiple concurrent sexual partnerships.
MEN AND LOSS: Exploring Malawian Men's Experience during Obstetric Emergency and Loss; an effort to improve male participation in maternity care
(Queen Margaret University, 2015)
Background: Male involvement appears not to be improving in Malawi and researchers attribute this sluggish male participation to culture and patriarchy that inadvertently reproduce inequalities among men and women. Using hegemonic masculinity and socio construction theories as lens, this study explored men's perceptions regarding care given to their wives during emergency obstetric and new-born complications and loss. The study would help inform service providers the hindrances and facilitators of male participation. The study is secondary analysis of qualitative data collected from men in Malawi about loss in child bearing. Seven interviews with men whose wives or very close relative e.g. daughter experienced emergency obstetric or new-born complication and/or loss were analysed. Eleven focus group discussions (FGD) with men and women were also analysed to supplement interview data. Data was analysed manually through thematic analysis and categorised into four themes as follows: knowledge of emergency complications, perceived causes and possible prevention of loss; men's care seeking behaviour and its limitations; men's perception of support received; men's perceptions about the health system Findings: men's knowledge of complications was based on what they had been told by either wives themselves or female guardians. Men admitted that they did not know what happened to their wives and babies because they were not there and expressed wish to be there during childbirth. The health system contributed to men's frustration of care given to their wives through lack of resources like blood, ambulance and poor quality of supervision of service providers. Men did not get much support from service providers during emergency complication and loss and most men were supported by relatives. Service providers failed to use men's presence as an opportunity to involve men in maternity care as they isolated men from the actual care provided to their wives and let men stay outside with no regular updates of the progress of their wives. Conclusion: men's failure to participate in maternity care is not merely because of socio constructions and masculine ideals that do not allow men to participate in issues categorised as feminine; but because the health system fail to motivate the few men that seek care together with their wives. Treating women in isolation from those that have been taking care of them since onset of pregnancy can be frustrating to men more especially in time of complication or loss.
Delivering mental health care through community health workers in South Africa: A review of the main challenges
(Queen Margaret University, 2015)
This study examines the challenges that community health workers face when delivering mental health care to people with severe mental health disorders in South Africa. Method of study This study is conducted as a desk study by firstly generalising a review of the literature to identify factors that are already known to have affected community heath workers in delivering mental health care and a further analysis to identify possible strategies that can be used to alleviate the identified challenges. A thematic approach was used for data analysis. Findings Three broad challenges; health system challenges, community related challenges and CHWs' day to day challenges are the main factors that affect community health workers in delivering mental health care. Health system challenges Resources for mental health are in short supply in South Africa given the health and social needs of the population. The health system is burdened by diseases and exacerbated by poverty, trauma due to violence and road accidents, mental health disorders and prevalent maternal deaths. Although resources for health in general are above World health Organisation's recommendations in South Africa, health outcomes are affected by the uneven distribution of resources between health sectors within different geographical areas. Community related challenges Mental health literacy remains a cause for concern in South Africa and those enduring severe mental health disorders are often stigmatised. South Africa, a multicultural society with 11 official languages, often uses interpreters from other ethnic minorities causing interpretation problems which affect health outcomes. Community health workers are mandated to diagnose, treat and refer complicated cases to specialist health workers but often lack understanding of psychiatric disorders and the referral process in South Africa. Furthermore, patient's explanatory models which influence health seeking behaviours result in western treatment options being taken when other options have failed. Community health worker day to day challenges Lack of transport is one of the factors that affect health workers to access and transport patients with severe mental health disorders to clinics and referral hospitals. Often community health workers cover large geographical areas, taking large caseloads in the background of little remuneration and support. Recommendations Training and supervision is a crucial aspect that specialised health workers should undergo for the effectiveness of programmes that involve community health workers. Identifying factors that impact community health workers' delivery of mental health care, the level of support community health workers may need and policy makers to implement policies based on service need are vital aspects for service improvement. Both traditional and western treatment options for mental illness are equally used by service users in South Africa and their collaboration with a referral system is encouraged.
Services for people with communication disabilities in low and middle income countries. A review of the literature.
(Queen Margaret University, 2015)
Services for people with communication disabilities (PWCD) include interventions and approaches to enable them to communicate to fulfil their potential in life. These interventions and approaches are often shaped by models of disability applied by those delivering the services. In low and middle income countries (LMICs), services for PWCD are often extremely limited and need further development. This study reviews current literature regarding services for PWCD in LMICs, finding that a bio-psychosocial model of disability is most frequently applied. Worldwide, the disability movement espouses a human rights based model, and this study uses the Human Rights Based Approach to Disability in Development to review how current services for PWCD in LMICs fit within this framework. The study explores how application of a human rights based model could enable SLTs to develop appropriate, equitable and sustainable services for PWCD in LMICs.
The impact of governance and funding modality of the Global Fund on capacity of middle level managerial staff during the implementation of TB services in Sri Lanka.
(Queen Margaret University, 2015)
The study aimed at investigating the impact of governance and funding modalities of Global Fund on the capacity of middle level managerial staff. The said staff plays an important and responsible role for the implementation of tuberculosis control activities in Sri Lanka. The methodology adopted in this study was a qualitative approach and the data collection was relied on in-depth interviews using 'Skype' e-application. Interviews were conducted with nineteen managers who had direct involvement with tuberculosis control activities and Global Fund financing. The study revealed that the participants had both positive and negative influences of the Global Fund on their capacity level; particularly they were challenging to execute tuberculosis control activities under some GF modalities. Finally, based on the interviewed data and analysis this study discussed that how Global Fund governing and funding modalities have significant impacts on the level of capacity programme implementers and how this can affect the implementation of tuberculosis control activities and outcome of the TB control programme in Sri L
Global Health Diplomacy:Challenges towards Health Equity
(Queen Margaret University, 2015)
Global health diplomacy and health inequities are still growing issue in the 21st century and the current study presents a review and analysis of the existing literature that explores the concept and practice of the Global Health Diplomacy (GHD) and some issues surrounding policy implementation. The goal of the study was to examine the practices of GHD in order to determine the factors impacting health inequity and the main research question guiding the conduct of this study was: What factors affect global health inequity and in what ways do current efforts to coordinate global health diplomacy address this issue? Specifically, the results of this study were intended to contribute with a gap in the literature on global health diplomacy and global health inequity demonstrating the challenges of GHD to respond to health inequities on various world populations. The study sought to explore the health issues considered significant within foreign policy, and how GHD has been applied to address them. Among current and distinguished approaches that countries conduct their GHD, the study highlighted Brazil and the country's ability to combine its economic prowess and diplomatic strategies when responding to global health issues, which can serve as a lesson for other countries - fact that was mentioned at the conclusion among others recommendations.
Towards Universal Health Coverage in Nigeria: Can Community-Based Health Insurance Be Scaled Up?
(Queen Margaret University, 2015)
Background: Poverty impacts on health and vice versa. Thus, health security is fundamental to poverty alleviation and development in general. In Nigeria, about a third of the population incur catastrophic health spending annually. This tips more people into poverty and makes those who are already poor poorer. The concept of UHC was introduced in order to guarantee health for all and ensure that people do not become poor or poorer because of health care costs. To achieve this goal, countries must move away from out of pocket payments as a means to finance health costs, instead, institutionalise prepayment funding mechanisms either by tax revenue or health insurance. CBHI has been proposed for countries with large informal sector and rural population who may not be able to use tax-based health financing due to poor tax administrative system. Methods: A literature survey was carried out to identify and review studies that report factors for scaling up CBHI. Results: Five countries were found to have achieved some level of success scaling CBHI: Rwanda, Ethiopia, Mali, Senegal and the 19th century Japan. The Rwanda and 19th century Japan appear to have achieved more perhaps due to compulsory health insurance for all citizens including those in the informal sector instituted by law and also adopting an income-graduated premium contributions from citizens in the spirit of equity. Furthermore, Rwanda has been able to link CBHI to result-based financing to strategically purchase health services from health care providers. Conclusions: Nigeria shares some contextual similarities with these five countries, thus scaling CBHI nationwide may be an option to consider to move Nigeria close to UHC. Strong political stewardship that would standardised a national CBHI model with equitable enrolment is needed. The government of Nigeria may have to mandate health insurance across populations and pool different schemes into a single fund. Cost of health services is just one of the many identified obstacles to accessing health services especially for the poor. Keywords: Community-Based Health Insurance; CBHI; Scale-up; Universal Health Coverage; UHC; Health care; Health costs; Nigeria.
Critical Appraisal of the Chronic care Model and its applicability in management of HIV and Comorbidities in Botswana clinics
(Queen Margaret University, 2015)
This study appraises the chronic care model and its application in management of HIV and comorbidity in Botswana clinics. HIV/AIDS has transformed from a deadly disease to a manageable condition as a result of scaling up ARV. At the same time, Africa is experiencing an epidemiological transition. The emergence of Non Communicable Diseases is a challenge to Health systems. That said, HIV services are still provided through vertical programs in Sub Saharan Africa. Industrialized countries have shifted from acute care delivery to chronic care models to address chronic illnesses. This study aims to analyze applicability of such a model onto an African context. A chronic care model by Wagner 2001 is used as a framework for this analysis. The model entails several components, but for the purpose of this study only one component will be discussed, that is Delivery System Design. This is to determine the strengths and limitations of the model towards service delivery. Then a discussion on the current challenges Botswana has in dealing with HIV and comorbidities will follow. The identified challenges will form bases for a further discussion on the applicability of the model. Vertical approach to HIV has been viewed to cause imbalances in care and treatment of other diseases. As a result, more research is needed on how to improve the 'status quo' to impact on health outcomes across all diseases.
Impact of Irregular Migration on Health Status in Greece: A Report from Athens.
(Queen Margaret University, 2015)
Keywords: irregular, migration, health, social determinants, rights Irregular migration has been the focus in Greece in the period of economic crisis and measures taken to address the migration issue include the introduction of 'closed host centres' in Greece. This study examines the impact of irregular migration in the health status in Athens, the capital of Greece in the period of the financial crisis. Semi-structured interviews were conducted with organisations and units based in Athens providing medical, psychosocial and/or legal aid to vulnerable groups including irregular migrants during the period May-June 2013. The study explored the contributing factors to the health of irregular migrants and the impact of the introduction of 'closed host centres' to their health in spring of 2012.Thematic analysis was used to analyse the data. Access to healthcare (rights and obstacles) and environmental conditions (nutrition, housing, employment and public attitudes) were the broader themes identified as contributing factors to the health status of irregular migrants. The 'closed host centres' were found to increase the number of detainees and the health risks of irregular migrants'. It is suggested that human rights strategies need to inform policies and actions in order to address irregular migrants' health determinants.
Prevention And Control Of Chagas Disease: Narrowing The Gap Between Policy And Practice. Case Study On Indigenous Communities In Santa Cruz, Bolivia.
(Queen Margaret University, 2015)
Chagas disease (CD) or America Trypanosomiases is a life-threatening disease caused by a protozoan parasite called Trypanosoma cruzi (T. Cruzi). As Table 1 shows, it is most commonly transmitted to humans via a vector known as vinchuca (bug) that lives in the cracks of poorly constructed houses (WHO 2013) (appendix A). Further, this illness is a well-known disease of the poor and one of the most neglected tropical diseases in the world (WHO 2014a).Hence, It is believed to affect almost exclusively rural and powerless people living in rural parts of low-income countries (Hunt 2007). The same way, the disease persists due to deeper poverty and inequalities within sectors (Manderson 2009). Bolivia represents the world's highest prevalence rate on Chagas disease and hosts the peak percentage on indigenous population (Ministerio de Salud 2008). Accordingly, they are commonly recognized as the poorest and most marginalized, facing numerous social and health inequalities (Hunt 2007) Although political commitment has been increasingly expressed towards Chagas, it remains a major public health in Bolivia. (Gazzinelli et al 2012). That adverts that despite various efforts, needs remain unmet on the ground. In the face of that, this study aims to help understand to what extent the National Program for Chagas Disease in Bolivia respond to the reality of indigenous communities. Challenges and barriers of NPCD to respond to healthcare needs will be presented and further discusses. Lastly, in the attempt to help narrow the gaps between policy and practice, recommendations will be suggested.
"IT'S AS THOUGH EBOLA INFECTED THE HEALTH SYSTEM ITSELF…" THE EXPECTATIONS, EXPERIENCES AND REFLECTIONS OF EAST AFRICAN HEALTH WORKERS VOLUNTEERING DURING THE 2014/2015 EBOLA OUTBREAK IN WEST AFRICA
(Queen Margaret University, 2016)
Introduction: This qualitative study aimed to describe Kenyan medical doctors' experiences during their prior to, during, and after their deployment in West Africa during the 2014 /2015 Ebola epidemic. Methods: Snowball sampling was used in July 2016 to recruit 6 Kenyan medical doctors who had recently returned from West Africa. In-depth interviews based on an interview guide were conducted to collect data. Findings: Respondents volunteered as part of career development and out of a sense of ethical responsibility. Prior to deployment, most experienced doubt about their safety and feared infection with Ebola. Their decisions were often questioned by their families, friends, and colleagues. On arrival, they experienced more fear of infection, encountered adverse weather, and were thrust into a rigorous pre-service schedule. Respondents were surprised at how underdeveloped the infrastructure was, how weak the health systems were, and they were often exasperated by the lack of basic resources. They faced emotionally draining situations, struggled to cope with intense work schedules, found leadership tasks and coordination of multi-cultural teams very challenging, and encountered many risky situations. Accountability for their welfare was not always clear. Conclusion: The volunteers were sub-optimally prepared and their psychosocial needs were not adequately met. However, they were still able to perform their duties perhaps partly because of their prior experiences working in resource-limited settings. The welfare of volunteers recruited is of utmost importance especially when the workers recruited have to take up high-risk deployments. There is a need for strategies to safeguard protect the health and wellbeing of health care paying attention to their unique needs.
Challenges in paediatric cancer care in the People's Republic of China - critical reflection from a socio-ecological perspective
(Queen Margaret University, 2016)
Treatment of childhood cancer is demanding and low and middle income countries struggle with provision of such care. This dissertation is a literature review and applies a socio-ecological framework as a means to identify key challenges facing children suffering from cancer in China and their families. Further, existing support services for this specific population are assessed and recommendations for additional interventions are made. Various obstacles that interfere with children's medical care are found at policy, community and institutional levels. For example, social health insurance does not cover total costs for cancer treatment, which means that many children drop out of care when parents can no longer afford it. Perceptions that cancer is not treatable may hinder some caregivers accepting medical care for their child, and China lacks both the facilities and health care professionals for childhood cancer treatment. Communication with children about their disease is a major issue at the interpersonal level, and psychological problems among family members are identified as challenges at the intrapersonal level. As of today, support at the different levels largely derives from the non-governmental sector, through organisations founded by concerned parents. A comprehensive multi-level approach from various agents is necessary to further address the identified problems, including provision of full insurance coverage for treatment, efforts to raise public awareness, and introduction of structured provider-child communication related to the disease.
Prison Health Care and Continuity of Care for HIV Prisoners on Release: A comparative literature review of the health systems in the UK and USA
(Queen Margaret University, 2016)
This systematic literature review investigates the contrast and comparison of the USA and UK health systems surrounding HIV, prison health care and continuity of care. Examining international governance policies from World Health Organisation and United Nations to establish expected standards gives a baseline to work from. Several searches were undertaken to extrapolate literature for "prison health" "HIV" "continuity of care" "Public health UK" "public health USA" with some combination of terms. The literature search revealed a dearth of information for UK versus a very large volume for USA, especially with regards to "HIV" and "continuity of care". This is reflected in this thesis. From the literature, there appears to be many similarities and several differences between the 2 systems which affect HIV prisoner care, but most poignantly revealed an enormous lack of substantiated research in the UK.
Lessons learned for the next generation of mHealth applications supporting maternal care services in Ghana
(Queen Margaret University, 2016)
Background Globally, many technological innovations have been introduced for universal health coverage by increasing accessibility. mHealth ( mobile phone based health ) shows potentiality in improving maternal health service delivery with the help of communication between health care providers and beneficiaries. With the fastest growing mobile market over the last five years in low income setting (LIS) like Sub-Saharan Africa, Government and development partners are being encouraged to use mHealth. This study aims to see recurrent challenges from the program experiences of maternal health care (MHC)-focused mHealth initiatives from Ghana as country case study and how they address those challenges and secondly, supplemented by mHealth experiences in other LIS. Methods Qualitative data was collected mainly from 11 key informant interviews (KIIs) of senior officials of Ghana Health service, development organizations, government facility based health care providers- physician, community health nurse, ICT personnel, e-health specialist, Health MIS analyst and academic searchers. Interviews were face to face and via skype. Findings from Ghana were supplemented by literature review. Data was analysed via thematic analysis and stakeholder analysis was done to see their respective position for overcoming challenges using mHealth. Results Lack of national data ownership & non-sustainable plan for the skilled health force from the MOH, financial and double work burden of community health workers (CHWs), conflict of interest among collaborative partners & inter government departments, incomplete & inconsistent reporting due to distorted mobile network & data bundle and internet disruption, poor infrastructure of electricity and finally, business promotion strategy of telecommunication industries were the key challenges found in Ghana. Though they adapt some local strategies to minimize the acute problem, but like other low income settings, Ghana could not produce adequate scientific research evidences using primary data source. Conclusions: Ghana has many similar challenges to other low income settings; however, they adapt their own strategies to overcome. To increase utilization rate of maternal care, mHealth has been tested by different organizations in Ghana. To expand/scale up, high level negotiation & coordination among the profitable industries and government is necessary especially in staff development. Furthermore, more mHealth field research is expected before developing sustainable plan. Keywords: mHealth, Ghana, Maternal Care, Low income setting (LIS)
Postpartum depression: Prevention strategies and Replication. A study in Bangladesh, India, Pakistan and Nepal
(Queen Margaret University, 2016)
Post partum depression (PPD) (non-psychotic) is a considerable public health problem where nearly 10-15% of women are affected after child birth globally but the women with low socio-economic status are the most affected one especially in low and middle income countries. It is one of the most common complications of childbirth world-wide which usually arises within four to eight weeks of delivery that induces feelings of insignificance, agitation, anxiety or stress, hopelessness which ultimately affects a woman's ability to bond with her child and care for her baby. It is a major public health issue but it mostly goes undetected and underdiagnosed and is barely recognized during or after pregnancy in LMICs where almost 80% of women is believed to suffer from PPD but a very limited amount of research is done to understand how these countries have been working to address PPD especially in South Asian setting (Bangladesh, India and Pakistan). There are even evidence which shows south Asian countries (Pakistan) is one of the highest reported PPD countries. A rigorous literature review of published papers was done using different research data base including medline, pubmed, sciencedirect, google and google scholar, Plos, research gate, scopus. Grey literatures available from UN and WHO are also included in the study. The Socioecological model is used to structure the dissertation especially the literature review and the public health prevention model was used for analysis of different strategies practiced in the study countries to see the possibility of its replication in Nepal. The Findings from the study revealed that a very few work has been done in addressing PPD in these countries. Some of the strategies used such as cognitive behaviour therapy, education for girls, poverty alleviation program, participatory approach for empowerment and involvement of community health workers has shown to have a positive impact on reducing PPD. As the interventions used in these countries were simple and mostly conducted through community health workers, it showed a possibility to be imitated in Nepal as it already has a sufficient workforce working in Maternal and child health at community level. Above it, Nepal has been very progressive in education and is working on battling poverty. But, without strong political commitment and implementation of policies that recognize PPD, addressing the issue is impossible. Keywords: Depression, Post -partum depression , Post natal depression, Perinatal depression, Maternal depression, Maternal mental health , Strategies, Interventions , Prevention, LMICs, South Asia, Causes, Theories on PPD
Human resource retention strategies: Analysis of the factors affecting retention in Uganda's Private-Not-For-Profit hospitals
(Queen Margaret University, Edinburgh, 2016)
Retention of health workers is an area of sustained focus as health care organizations realize the impact of poor retention on cost, quality and continuity of care. An in-depth understanding of the experiences of health workers (HWs) and factors which cause them to leave their jobs is the fundamental basis of forming effective retention strategies. The lack of evidence on these experiences poses a challenge to health managers within the Private-Not-For-Profit (PNFP) sub-sector in Uganda on how to develop effective retention strategies. This research examined HWs experiences of working in PNFP hospitals and how these influence retention decisions. This mixed methods study included a quantitative survey (n=118) examining length of stay in the hospitals and the determinants. Experiences of 32 HWs including managers were explored through semi-structured interviews using a life cycle lens that took into account motivation for joining the profession, experiences of working in the hospitals and current retention strategies and their perceived effectiveness in influencing retention. God's calling, role models in the medical field, death of close relatives and hopes for immediate employment influenced decisions to join the profession and there was a link between some of these reasons and retention. Median duration working in a PNFP facility was 3.8 years. The only individual factors statistically associated with retention were age and cadre. Three perceptions of organizational characteristics namely: having good interpersonal relationships, well-defined reporting lines, and good career growth potential were independently associated with a 75%, 51% and 35% respectively higher working length at a hospital. Interviews with HWs showed that PNFP organizational culture was predominantly bureaucratic with non-participative management styles and emphasized control and efficiency. Hospitals were implementing some limited retention strategies with weak evidence for their effectiveness. Systematic planning of retention strategies and transformation in organizational culture are necessary to improve retention of HWs.
Factors Contributing to Health Workforce Resilience During the 2014-2015 Ebola Outbreak in Sierra Leone
(Queen Margaret University, 2016)
Resilience is an essential characteristic in overcoming adversity (Dyer and McGuinness 1996). An abstract term prevalent in academic literature, the concept of resilience has become more prominent within development assistance and humanitarian support in vulnerable nations. Defined as the ability to bounce back or recover from adversity, resilience is understood as the characteristics, processes and interactions contributing to overcoming adversity. Within health systems resilience is characterized as a sequence of complex interactions between health system components greatly influenced by social capital and cultural context (Ager et. al 2015). As a health system component, the health workforce often has to overcome several challenges in order to provide adequate health services in resource poor settings. It is for this reason resilience has been used as a construct in understanding the basis for health service delivery during adversity (Ager et.al 2015). One such example is service provision during the 2014-2015 Ebola outbreak in Sierra Leone. Being a post conflict country Sierra Leone faced major health worker shortages, poor infrastructure and insufficient supply of protective equipment amidst several other challenges during the Ebola outbreak (MoHS 2015). The ability of the health workforce to not only manage but also recover from the crisis proved challenging requiring assistance from the international community. This dissertation looks at factors which contributed to the health workforce exhibiting resilience and the impact of the international community in maintaining service provision during the outbreak.
Acceptability of Male circumcision for HIV prevention in Kenya
(Queen Margaret University, 2016)
Three randomized control trials in South Africa, Kenya and Uganda, demonstrated that there was a significant risk reduction of acquiring (sexually transmitted) HIV from women to men who are circumcised. Following these trials in 2007, the World Health Organization (WHO) and the Joint United Nations Programme on AIDS (UNAIDS) recommended the use of medical male circumcision (MC) for HIV prevention in eastern and southern Africa. However, the uptake of MC in countries with high HIV prevalence varies and the progress has been patchy. For example, only 3% of the targeted males in Lesotho have been reached, while 63% of the targeted males have been reached in Kenya (Gulland 2014). In this paper, the author explores the challenges and successes of MC for HIV prevention in Kenya.
Effects of community based maternal and infant health interventions through women's groups participations in South Asia
(Queen Margaret University, 2016)
This thesis studies various impacts of community based maternal and infant health interventions implemented in South Asia. Community participation and gender mainstreaming in maternal and infant health programmes are major cross cutting concerns around the world. Particularly in the resource poor settings, the involvement of local women and women's groups in health programmes has been adopted as a specific strategic approach as well as technical and organizational process to achieve the goal. The community based maternal and infant health interventions through the involvement of local women and women's groups has resulted significant impacts on the health of mother and child, especially through the significant modifications in their household behavioral and health care seeking knowledge and practices. Rigorous literature review of published scientific papers was done with special focus on some influential randomized control trial studies conducted in South Asia using various databases including Medline, Cinhahl, Scopus, Science direct, Google scholar, PubMed etc. And the findings from the study has demonstrated that approach of participating women's groups in the maternal and infant health interventions can significantly increase knowledge and skills regarding nutrition, birth preparedness, antenatal check and care, institutional delivery, safe cutting of baby cord, breastfeeding, sanitation, etc. These progresses, which were achieved during prenatal, natal and post periods were important factors for the long term positive impacts in health and social life of the community such as decrease in maternal and infant mortalities rate. Key words: community participation and effects in maternal and infant health, women involvement and impacts of maternal and infant health programmes, community mobilization and maternal and infant health, participatory women groups and effects on maternal and infant health.
How conflict and displacement make women more vulnerable to sexual and gender based violence, and the European Union's response to migrants subjected to such violence.
(Queen Margaret University, 2016)
Women and girls are disproportionately affected by sexual and gender based violence. Living in a conflict affected state or being displaced from one's home increases that vulnerability. There are numerous potential health issues that sexual and gender based violence can cause or aggravate. The situational instability in conflict and displacement settings can make it difficult for women to access services to treat these conditions. This can lead to poor physical, mental, and sexual and reproductive health outcomes for women who have survived acts of sexual and gender based violence. Leaving her home country and applying for refugee status in a safer place does not guarantee that a woman who has experienced sexual and gender based violence will have access to health care to treat any health issues and have better health outcomes. Female migrants in the European Union are consistently less healthy than native populations are. This is a result of vaguely worded policies regarding migrant health packages, the structure of the European Union, and the competing interests of the twenty-eight member states. Cultural differences and language barriers between female migrants and health practitioners can make it difficult to build trust and rapport between these groups, which ultimately can lead to lower service utilisation among migrant populations.