MSc in Global Health
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7204
Browse
38 results
Search Results
Item Exploring experiences of perinatal mental health conditions in ethnic minority women living in the UK and barriers to access maternal mental health services: A review of literature.(2019)Perinatal mental health is a major public health issue as it can affect the mother’s wellbeing, as well as child’s cognitive development. Early diagnosis and treatment are imperative to avoid negative effects on mother as well as child’s development. It can be challenging to identify symptoms of perinatal mental health in ethnic minority women as there are variations cross culturally and regionally. The aim of the study was to explore experiences of perinatal mental health in ethnic minority women living in the UK. This was to examine efficacy of maternal mental health services to meet the needs of divers communities in the UK. A literature search was conducted using databases Medline, CINAHL and Psych info In EBSCEO host. In addition searches of grey literature was carried out. In total 20 papers were identified. The Institution of Medicine’s Social Ecological framework was used to organize and analyse the results. The most inner level was individual behaviour. Individual behaviour in the context of this study was ‘help seeking behaviour’ and the review identified barriers such as knowledge and awareness, stigma, communication difficulties. Other levels used as framework :Social, family and community networks, working and living conditions and Broad social, economic, cultural, health & environmental conditions and policies. Some frequent barriers included: isolation, culture, religion, language, and importance of being a strong black woman. It is important to ensure health care services are regulated more efficiently to ensure HCPs follow protocols and use available cultural specific resources when required. In order to encourage BEM women to engage with health services we need to raise knowledge and awareness about PNMH conditions in the whole community. Lack of social support and feeling isolated was a frequent theme in this review. We need to consider community based interventions to help these women are supported in the community.Item Women Who Inject Drugs in Mauritius: Understanding the main factors that lead to vulnerability to HCV transmission(2018)Mauritius has a concentrated Hepatitis C epidemic driven by Injecting Drug Use (IDU) with an estimated 95.8% prevalence rate within the People Who Inject Drugs (PWID) population. Women Who Inject Drugs (WID), representing 5-10% of the PWID population, are often the most invisible and their injecting drug-related experiences exposing them to HCV transmission neglected. This study aims to bring an understanding of the main factors making WID vulnerable to HCV transmission in Mauritius and further inform gender sensitive interventions and programmes. The ambition is to shed light on WID experiences, exploring their injecting drug use practices, knowledge of HCV, gender relations and barriers to access information. Through purposive sampling, fifteen women from different regions of Mauritius were invited to participate in a small-scale qualitative study. Face-to-face interviews were carried out to gain in-depth information and a socio-ecological framework was used to guide the analysis of the data. The study has revealed nine factors playing a major role in the HCV transmission among WID: lack of knowledge, HCV status, injecting practices, gender relations dynamics between WID and their partners, rapport with the family, the role of female hit doctors and injecting network, stigmatisation and inadequacies in health care settings at times hindering access to information on prevention and care have been identified. The study demonstrates the urgency for an appropriate concerted response to Hepatitis C with gender-specific and gender-sensitive interventions. Furthermore, it highlights the need for a deeper understanding of IDU practices and WID specific needs and challenges in the Mauritian context. Key words: Injecting Drug Use, Women Who Inject Drugs, Hepatitis C, MauritiusItem ‘WATER IS LIFE’: WASH PROJECTS AS SOCIETY-COHESION TOOLS FOR GRASSROOTS PEACE-BUILDING IN PROTRACTED CRISIS STATES: DEMOCRATIC REPUBLIC OF CONGO(2017)The Democratic Republic of Congo has one of the lowest levels of access to potable water in the world. Potable water is essential for health, to avoid dehydration and illness through water supply, sanitation and hygiene (WASH). Over 20 years of protracted crisis and violence, WASH infrastructure and public services have deteriorated and require rehabilitation, although insecurity delays this process. Participatory WASH projects have previously been implemented to encourage ownership and empowerment of communities. There exists the possibility that WASH projects could additionally promote social-cohesion within fractured communities, leading to sustainable peace-building at grassroots levels. The PHAST initiative (2000) and Tearfund/ODI research (2012) were both consulted to inform the direction of this study, which took the form of a small-scale qualitative study which investigated the perceptions of local professionals on the possibility of WASH projects as localised peace-builders and how current WASH programming could be improved as such. Professionals within communities in Goma, Nyiragongo in DRC were consulted regarding their perceptions of WASH project implementation in the region, and whether they saw a role for WASH projects to play in the peace-building process. Results were analysed through the grounded theory of open coding and four main themes were produced: water availability and quality, Project/NGO interventions, community conflict related to WASH, and perception of WASH projects as social-cohesion tools for grassroots peace-building. Great emphasis was applied by respondents on the link between lack of access to WASH services and risk of sexual violence towards women and girls. Additionally, respondents were concerned that previous WASH programming by NGOS has not involved in-depth participatory methods and so communities regularly feel under-consulted and undermined when projects are implemented without community participation. Finally, perspectives of respondents were positive regarding the use of WASH programming to promote community cohesion, empowerment and resilience. Furthermore, this style of future programming would support ongoing stabilisation of local communities, potentially reducing sexual violence and supporting community-led, sustainable WASH services in turn.Item FACTORS MOTIVATING THE UNITED NATIONS RELIEF AND WORKS AGENCY (UNRWA) HEALTHCARE PROVIDERS TO WORK DURING THE CONFLICT IN GAZA IN 2014(2017)When a conflict occurs, health workers (HWs) can be subject to many challenges such as difficult emotional issues and working longer hours or working in other locations or functions. Despite these challenges, some HWs can be motivated to report to work. The participation of a motivated health workforce is essential for access to health care during the conflict. Understanding the factors that influence their motivation during conflict is still limited. This research investigates the factors that motivated the United Nations Relief and Works Agency (UNRWA) health staff to report to work during the last conflict in Gaza in 2014. There is a severe lack of literature on what motivates HWs during times of insecurity, but the literature on their motivation during times of other catastrophes exists. This literature identifies family concerns, governance and management practices, and knowledge, skills and training on the motivation of HWs as major factors. Others include: working resources availability, financial incentives, working experience, belief in duty, the perception of the value in response, community, and religion. This study involved secondary data analysis of 24 semi-structure of the UNRWA health staff who worked during the conflict in Gaza in 2014. This analysis suggested key motivational factors for these staff during the Gaza conflict were community solidarity, working experience, work commitments, and HWs’ beliefs. This study concluded that having intrinsic motivation can be solely sufficient to motivate the health staff to attend work during insecurity. This study also suggested that extensive periods living through conflict contributed to the factors that motivated the HWs. This research shed light on the topic of the motivation of health workers in conflict zones which is still in its infancy. Therefore, future research in this topic is essential to be conducted. Keywords: motivation; health workers (HWs); war; conflict; UNRWA; Gaza.Item Integration of infectious disease services (HIV, Malria and TB) with antenatal care services; an assessement of service availability and readiness in Tanzania. A secondary quantitative analysis of the Tanzanian Service Provision Assessment (2015)(2017)Background Tanzania remains among the countries with the highest burden of infectious diseases (notably HIV, Malaria and TB) during pregnancy. In response, the country adopted WHO’s latest antenatal care guidelines which recommends comprehensive services including diagnostic screening and treatment for pregnant women during antenatal. However, as Tanzania makes efforts to scale these services under the existing health system resources, it is crucial to understand its capacity to deliver these services in an integrated fashion. Using the WHO’s service availability and readiness assessment framework, this study sought to assess the capacity of the Tanzanian Health System to provide ANC and integrated Malaria, TB and HIV services. Also, the study assessed the relationship of how components of the SARA framework resulted in actual service delivery during antenatal care. Methods Composite indicators of the five components of integration were constructed from primary datasets of the Tanzanian SPA. Appropriate descriptive and inferential statistical tests were employed to determine assess capacity of the health system to integrate the infectious disease area with antenatal care services. The results were disaggregated by background characteristics and location. Finally, a logistic regression model was created to explore relationships by reporting adjusted odds ratios. Results Generally, capacity to integrate malaria services were significantly higher compared to Tuberculosis and HIV services. Diagnostic capacity were generally higher than treatment commodities. Regarding the components of SARA integration, logistic regression found that the adjusted odds of having all five components of integration and receiving integrated care was 1.9 (95% CI 1.4 – 2.7). Among these components, the strongest determinant (predictor) to pregnant women’s receipt of integrated care was having trained staff on site (AOR 2.6 95% CI 1.7 – 4.5). Having infectious disease situated at same site with ANC service had no effect on receiving integrated care (AOR 1). Conclusion Towards a successful integration of these services under the new WHO guidelines in Tanzania, efforts should be channelled into strengthening infectious services especially HIV and TB services. Channelling investments into training health workers (the strongest determinant to integrated care) is likely to result in positive outcomes for the pregnant woman and the unborn child.Item Factors affecting the availability of HIV medical supplies and health workers’ strategies used to address shortages in two Rwandan public hospitals(2017)Background Availability, accessibility and rapid scale up of antiretroviral therapy (ART) has changed what was a fatal disease to a manageable condition resulting in remarkable reduction in the worldwide rates of AIDS associated deaths and new infections. Regardless of global efforts to make ART treatment accessible worldwide, ART coverage differs among countries and regions of the world substantially. The estimated antiretroviral therapy coverage rate in Rwanda is 79%. The expansion of ARVs drugs to reach all patients who meet the eligibility criteria is one of the priorities of the Rwandan ministry of health; however, the achieve this it is still a great challenge and there are many structural bottlenecks. In 2013, one important issue has been the serious shortage of medicines and laboratory supplies in public hospitals of Rwanda especially in those which are in Kigali city and southern province. Aim of study Using the WHO Health systems framework, this cross-sectional, observational study aimed to investigate factors affecting the availability of HIV medical supplies at two hospitals in Rwanda and the coping strategies used by health workers to address the issue of shortages of these supplies. The specific objectives of this study were toidentify factors contributing to HIV medical product shortages in two Rwandan public sector hospitals; and to explore 6 decision-making process and coping strategies used to manage HIV medical product shortages in the two hospitals. Methodology The study adopted a cross-sectional, observational design using qualitative methods to investigate health workers’ views of the factors influencing availability of HIV-related medical supplies and their strategies to manage these shortages. The primary data collection method involved semi-structured interviews with health workers at two public hospitals in Gasabo district, Kigali city of Rwanda: Kibagabaga and Muhima hospitals. In Kibagabaga Hospital, eight health workers were interviewed, in Muhima Hospital, eight health workers were interviewed. Health workers interviewed included: Doctors and nurses who work in ART clinics, laboratory technicians, pharmacists and procurement officers. Interviews covered the frequency of the stock outs of HIV medical products, factors that contributing to these shortages, impact of these shortages on patient and strategies use to manage the scarcity of HIV medical products. They were conducted in Kinyarwanda, recorded, translated and transcribed by the researcher. The researcher coded and arranged the data into descriptive and analytical themes and subthemes by hand. Finally, the result of this analysis was further interpreted and discussed in order to be able to contribute with main identified challenges and call for further action. Findings Findings and emergent themes were organised and presented in three areas: firstly, the broader context of medical product shortages in the Rwandan health system; secondly, the specific factors influencing HIV-related product shortages in the two hospitals, and thirdly, the management and coping strategies used to mitigate HIV medical products shortages. Firstly, in the broader context: negative attitudes of health workers towards ARVs, the misuse of ARVs drugs by feeding them to animals were mention to have a great contribution to the HIV medical products shortages.Secondly, limited financial resources and lack of leadership skills were cited as the main causes of stock outs of HIV medical product shortages. Lack of trainings in store management and procurement practices, shortage of qualified health workers in the procurement and supply management system as well as the ART clinics were mentioned as the main barriers which result in HIV-related product shortages. Inaccurate ARVs drugs consumption records to the Central Medical Store and poor transportation were also reported as the factors that influenced the delays in deliveries of these products. All of these factors were found to have a great impact on the patients’ lives including: drug resistance, poor adherence to treatments and negative treatment outcomes. Finally, strategies used to manage the stock outs of ARVs were acknowledged. Significance of study The study adds to a limited evidence base about what influences medicines stock outs and how health systems and health workers manage these challenges. The study results highlighted that numerous factors interrelate to influence the stock-outs of antiretroviral 8 drugs and other HIV-associated commodities. To ensure the effectivity and sustainability of whole health system; all the factors in the six WHO building blocks need to be strengthened.Item 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-MinoritiesItem An exploration of the contribution of a Sports-for-Development programme on slum-dwelling adolescent girls’ perspectives on their sexual and reproductive health and uptake of sexual and reproductive health services.(2018)This research aims to examine the contribution of a Sports-for-Development programme, Mrembo Girls, to the sexual and reproductive health (SRH) of slum-dwelling adolescent girls and their uptake of SRH services in Nairobi, Kenya. SRH issues such as early pregnancy, abortion, STI’s and HIV are prevalent within the population who are under provided for local services. A lack of accurate information and cultural and religious barriers aggravate the situation resulting in poor SRH outcomes. The Mrembo Girls programme uses football as their vehicle and the Women Win, Goal Curriculum with the aim to empower girls and tackle SRH issues. They incorporate SRH education into an employability programme and vocational training. A qualitative approach was taken to gain in-depth insights into participant and staff perceptions. Focus group discussions explore the girls’ attitudes towards their own SRH and the ways in which the programme has affected their use of services. Semi-structured interviews are used to discuss these issues with staff and coaches to understand their perceptions of the projects’ contribution to girls SRH and service uptake. The study findings indicated that Mrembo is contributing to developing girls social, human, physical and economic assets with positive outcomes for their knowledge and attitudes towards their SRH and service uptake. Furthermore, it highlighted the ways in which the programme is constrained by contextual factors and proposes further research to explore the issues identified.Item 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.Item 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.