MSc in Global Health

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

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CLOSING THE HEALTH GAP—INTERVENTIONS FOR ADRESSING POOR MEN’S HEALTH IN SUB-SAHARAN AFRICA: A SCOPING REVIEW
(2018)
The issue that this study addresses the poorer men’s health outcomes as compared to women in Sub-Saharan Africa (SSA). To address this problem, the purpose of this study scoping review was to take stock of health interventions conducted in SSA to engage men. A search of six electronic databases, a search of reference list of relevant systematic reviews and meta-analysis; and a search of grey literature, all reported in international languages spoken in Africa, were conducted. All studies evaluating health interventions that aimed to engage male young, adults and aged people in SSA, published between January 2000 and January 2018, were included. The electronic literature search identified 2815 original citations, full texts of 25 studies were screened and 12 studies were included. Additionally, 20 studies were retrieved from screening of reference lists of relevant articles and reviews, hence were also included. Main themes that were analysed included: geographic distribution of studies, the type of studies and main study focus, the type of gender programming, and the type of evidence gathered. This review found that Gender transformative interventions, delivered in community settings, using group discussions and workshops, were shown to be the most effective in reaching their goals. However, there is a significant literature and research bias toward HIV and SRH issues, paired with a scarcity of published studies in most SSA countries. Furthermore, the widespread use of cognitive variables to measure effectiveness of interventions may limit reliability of their findings.
FACTORS DETERMINING THE UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN NEPAL
(2018)
Nepal has made an enormous progress in declining maternal mortality and increment in utilization of various maternal health related services. However, there is still a large group of women left behind without access towards maternal health services and maternal mortality is still high if compared to other developed nations. This study aims to find out what are the various determining factors that are responsible for utilization or non- utilization of maternal health care services in context of Nepal. A scoping literature review was used as a method of study where various published journal articles and documents related to maternal health in Nepal were studied and analysed for the derivation of results and discussion. The analysis was based on Andersen’s Behavioural Model for health service utilization, various factors like socio-cultural, physical and economic accessibility and perceived need were identified as major determinants for utilization/non-utilization of maternal health care in Nepal. This study shows the huge disparity in the utilization of maternal health care services among women in rural and urban areas because of above mentioned factors. The government of Nepal in collaboration with various national and international partner is running various programs related to maternal health for coverage and utilization of maternal health care services in Nepal. However there seems to be lack of effort in addressing socio-cultural factors in relation to health care delivery system. Nepal must now focus on sustaining the major priority towards improvement in overall maternal health and should focus on growing financial, structural and human resources to improve the coverage of maternal health services and community -based approach to meet the need of marginalized population specially women from remote areas.
Increasing Adherence to Treatment Regimens for Ethnic Minorities Affected by Cardiovascular Disease in High Income Countries: The Role of Mind-Body-Interventions
(2018)
Background: Adherence to treatment regimens is vital for the control and management for CVDs. Yet only 40-60% of patients adhere to their treatment plan, increasing the likelihood of adverse cardiac events, re-hospitalization or even death. The symptom burden of CVD’s, low self-efficacy, and lacking confidence in foreign health systems makes patients from ethnic minority groups (EMG) especially vulnerable to low adherence. As current interventions to address low adherence have fallen short of effective long-term increases, Mind-Body-Interventions (MBI) might provide a novel secondary prevention approach to close this gap. The aim of this desk review was to shed light on whether MBIs have the potential to increase adherence in EMG in high income countries diagnosed with CVD. Method: A systematic literature search has been conducted using MEDLINE, CINAHL, and PsychINFO databases. In total, 17 studies have been critically reviewed. Results: Findings for EMGs are poor, however, evidence for the general population demonstrated predominantly positive effects of MBIs on adherence, self-efficacy, health outcomes, and quality of life. Yet, heterogeneous study design and methodology prohibits the generalizability of evidence. Conclusion: Overall, the evidence present encouraging findings on the potential of MBIs to increase adherence in the general population. Nonetheless, further research is warranted to investigate whether this holds true for EMGs. Moreover, research should consider potential cultural implications in EMGs and address the lacking consensus in the operationalization of adherence and MBI. Keywords: Adherence, Self-efficacy, Cardiovascular-Disease, Mind-Body-Intervention, Ethnic-Minorities
Policy Interventions to address childhood and adolescent obesity linked to 'Junk Food' consumption: 'Lessons for Nepal'
(2018)
Childhood and adolescent obesity is increasing at an alarming rate and is a public health concern worldwide. Childhood and adolescent obesity, once considered as a problem only in developed countries, are now causing double burden of malnutrition in developing countries. Junk food industry and its consumption are also increasing in South Asia in the past decade. This study provides a comprehensive overview of the recent documents, articles and reports on childhood and adolescent obesity and different food policies to prevent obesity. Methods: Different articles, documents, reports were searched using QMU online library, Cinahl, Scopus, Medline, PubMed, Google Scholar and Science direct to conduct scoping review. Findings: Risk factors of overweight and obesity among children and adolescent in South Asia are lack of physical activity, watching television and playing with modern technologies, family history of obesity, socio-economic status (SES) and dietary behaviour. Due to nutrition transition in South Asia, the dietary behaviour has been changed to junk food due to change in lifestyle and adaptation of meal patterns, popularity of street foods, growing business of supermarkets, fast food industry and role of advertising. Junk food creates enabling environment for physical inactivity, high calorie intake and replaces other nutritious food and causes childhood and adolescent obesity. Different food policies like national nutrition guideline, nutrition labelling, school focussed food policy, economic policy and food marketing policies have been adopted across the globe. National nutrition guideline and nutrition labelling is somehow being implemented and other policies requires enabling environment to implement in Nepal. However, no policies have been intended directly to address childhood and adolescent obesity due to 'junk food' consumption. Key words: childhood, adolescent, obesity, food policy, and junk food.
The relationship between nurse staffing levels and patient outcomes: A scoping review of the evidence from high-income countries.
(2018)
Aims This dissertation aims to explore the relationship between nurse staffing levels and patient outcomes. It proposes to summarise the evidence regarding this link and expose and discuss the gaps and limitations in these studies. Background As healthcare has developed, quality of care has become a focal problem for the healthcare system and nurses. Increasing concerns about patient outcomes and the quality of care have resulted in several studies, focused on identifying adequate nurse staffing levels and the relationship between nurse staffing and quality of care. An extensive amount of literature over the last 10 years reports the importance of the role of nurses and their duty to provide safe, good quality care and the relationship between low nurse staffing levels and adverse patient outcomes, for example: falls, missed care and even death. Despite the size of the existing evidence, there are numerous limitations in these studies that have not been reported extensively. Amongst these gaps is the theory of endogeneity, which is a form of bias that occurs when estimating causal effects between variables. While there are no discrepancies in current literature about the causal pathway between nurse staffing and patient outcomes, endogeneity points to the fact that the scope of the effects may be biased or incorrect. This topic is of great importance, as the research is still unclear about what constitutes as adequate nurse staffing levels that will promote high-quality patient outcomes. Design Scoping review to synthesise existing knowledge in the literature on the relationship between nurse staffing levels and patient outcomes. Methods 29 primary studies conducted in hospitals in high income countries were reviewed between 2008 and 2018. Findings Numerous gaps were found in the literature. This scoping review found that most of the current evidence did not discuss the forms of bias that could affect the causal path between nurse staffing and patient outcomes. Overall, the evidence shows an increase in nurse staffing levels has a positive effect on patient outcomes. However, a majority of the studies showed that although nurse staffing levels were vital to patients’ safety, there were other confounding factors that mediated this relationship or by themselves had a strong impact on patient outcomes. Conclusion As previous research suggests, this paper confirms that there is a indeed a correlation between nurse staffing levels and patient outcomes. However, many studies have also revealed that nurse staffing is not the only variable involved in patient outcomes. More research is warranted, to identify other variables that affect patient outcomes, so that recommendations can be made for policy and guidelines will be able to assure the best possible care is provided. Keywords Nurse staffing, patient outcomes, relationship
Understanding factors influencing adolescent girls who run away from home in an arranged marriage society: implications for policy An exploratory qualitative study from Tigray, Ethiopia
(2018)
Little is known about adolescent female runaways in Ethiopia. The study examines the main factors influencing adolescent girls who run away from home in Tigray, northern Ethiopia. An exploratory qualitative approach was adopted to address why and how the seven runaway girls of the sample decided to escape. Data was collected through in-depth interviews, key informant interviews and field observation in two different settings, Wukro town and Mekelle city. Although the runaway girls´ cases are the foci of the study, semi-structured interviews and a focus group discussion with a second cohort of older women married off at an early age, were conducted in order to explore community response toward adolescent female runaways, and contrast changing human behaviour across generations. Findings reveal that the immediate trigger that led all young participants to run away was to escape arranged marriage, except in one ‘romantic’ elopement case. Individual and structural factors, such as child maltreatment and educational aspirations, and new family legislation and campaigns against early marriage, respectively, also contributed to a parental resistance and the decision to escape. At a theoretical level, looking through the lens of Giddens' (1984) structuration theory, the study indicates a possible shift in social norms that affect gender roles in Tigray, and from a social constructivist perspective, it seems that adolescent runaways might be an ‘unconstructed’ child protection problem, as most runaway participants were supported temporary by relatives and the decision to run away is considered part of the migration phenomena. Thus, these vulnerable girls remain unprotected and exposed to a range of risks, such as early and unwanted pregnancies, labour exploitation, dropping out of school, and transactional sex relationships. Therefore, it is recommended that the issue of adolescent girl runaways is elevated to the policy agenda in Tigray. Keywords: adolescent female runaways; elopements; arranged marriage; early marriage; child protection; reproduction and social change, Ethiopia.