Postgraduate

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Drug treatments for high cholesterol blood levels, with Atorvastatin versus Simvastatin: A Systematic review and Meta-analysis
(Queen Margaret University, 2008-08) Siddiqui, Muhammad A.
Objectives: Diabetes mellitus is a strong risk factor for atherosclerosis and is often characterized by hyperlipidemia. This review was done to evaluate the effectiveness of pharmacological management of hyperlipidemia with atorvastatin versus simvastatin in lowering high cholesterol among diabetic and cardiac patients. Sources: Trials were identified by searching four electronic databases (Medline, Cochrane, Pub Med, Scopus and Highwire) and the reference lists of eligible publications. Keywords: Dyslipidemia, statins and diabetes, atheroscelerosis, statins, atorvastatin, simvastatin Methods: We performed a systematic review of trials that randomly assigned participants to receive atorvastatins versus simvastatin or simvastatin versus placebo or atorvastatin versus placebo for a minimum of 6 week. A meta-analysis was performed using a fixed-effects model, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate pooled treatment effects. All statistical tests were two sided. Revman 5.0 version have been used to assess the difference between two treatment group. Result: Thirteen trials were included, involving a total of 20598 participants. Trials differed considerably in their inclusion criteria; outcomes measured, and type of lipid-lowering therapy used. The pooled results from all eligible trials indicated that atorvastatin therapy had no statistically significant effect than simvastatin on overall mortality (Risk Ratio (RR) 0.88; 95% confidence Interval (CI) 0.34 to 2.27; P = 0.78)) or on total cardiovascular events (RR 0.99; 95% CI 0.69 to 1.42, P = 0.95). However, analysis showed that atorvastatin significantly reduced the total blood cholesterol versus simvastatin (RR 0.74; CI 0.55 to 0.98). This was primarily due to a positive effect on total coronary events (RR 8.24; 95%CI 8.18 to 8.29; P < 0.00001). Greatest evidence of effectiveness came from the use of atorvastatin in people with blood cholesterol 3.5 mmol/litre. Conclusion: The role of statin therapy as a main component of cardiovascular risk reduction in-patients with diabetes. Atorvastatin have significantly better outcomes in lowering blood cholesterol against simvastatin but there was no significant difference in the mortality and total cardiovascular events.
The impact of Mediterranean diet and vitamin D supplementation on adults at high risk of developing type 2 diabetes: a randomised parallel study
(Queen Margaret University, 2015)
Diabetes mellitus is the most prevalent chronic medical condition and a critical public health concern for all nations. Only in 2012, in the United Kingdom 2.9 million people were diagnosed with diabetes, and this number is expect to rise to 5 million by the year 2025. Despite the fact that some diabetes-related risk factors are non-modifiable, it was estimated that 89% of people diagnosed with type 2 diabetes had at least one risk factor which could have been modified by diet or physical activity. These lifestyle modifications might help those patients at high risk to reduce their likelihood of developing type 2 diabetes by 28% to 59%. There is a growing body of research indicating that Mediterranean diet, as well as Vitamin D, might help to prevent from developing type 2 diabetes. Despite this, no research has been conducted to investigate the combined effect of Mediterranean diet and vitamin D supplementation in adults at high risk of developing type 2 diabetes. This study will be carried out as a randomised controlled parallel study with factorial design with 4 groups and 48 weeks of follow-up. The research will take place at the Western General Hospital, in Edinburgh, Scotland, for a duration of 27 months. The research will evaluate the effectiveness of Mediterranean diet and vitamin D3, both alone and together, on diabetes-related risk factors such as BMI, blood pressure, cholesterol levels, insulin sensitivity, and fasting plasma glucose, in a population at high risk of developing type 2 diabetes. The results will be analysed and interpreted statistically every 12 weeks and at the end of the trial to investigate the differences between and within groups. To our knowledge this is the first attempt at studying the potential reduction of diabetes risk factors as a result of a combination of MedDiet and VitD3 supplementation. The results of our study could be compared to existing research on dietary or VitD approaches for diabetes prevention, in order to suggest and implement a new way for effective type 2 diabetes prevention
The Impact of Loss in Childbearing on Women in Southern Malawi
(Queen Margaret University, 2015)
This was a secondary research, the original study being conducted in southern part of Malawi and included 23 women of childbearing age who experienced loss. The women were interviewed about their interpretation of loss with a focus on accountability and blame. The study discussed here involves secondary data analysis of the interviews with women who had experienced loss and community focus group discussions with a focus on the psycho-social consequences Objective The objective of this research was to examine the psychosocial consequences which are faced by women who experience loss in childbearing. Methods For the original study; semi-structure and FGDs were used for data collection. Snowballing procedure was adopted to select respondents. Interviews were conducted in both English and Chichewa with 23 women who experienced loss in the last 2 to 5 years. For second research; the transcript were manually analyzed by using thematic analysis to identify themes. Findings The study found that there was a pressing need for support services targeting women who have experiences loss in form of counselling to deal with the psychosocial emotions. Out of 23 women who experience loss only 1 received counselling. The findings revealed that there were psychosocial consequences which included pain, hurt, guilt, blame and detachment. Also the women expressed anxiety for subsequent pregnancy and most women referred to dead babies as "chithuchi" meaning "the thing". Gender and Family dynamics revealed that women were supported by their spouses, family members and friends. The role of care was inadequate and support for women was not provided. Conclusion: In order for women to receive care for psychosocial support there need to be a change in attitude of people in society like Malawi regarding childbearing loss. More research in this field is desirable to increase the knowledge and also to guide formulation of future policies for the government. The Key Words: Pregnancy; Childbearing loss; Gender; Psychosocial Consequences; Family; Dynamics; Malawi; Medical Staff, sub Saharan Africa
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.
An Exploration Of Teachers' Experiences And Perspectives On Implementation Of The Share Programme
(Queen Margaret University, 2015)
Adolescents sexual health in United Kingdom(UK) remains a public health issue. Although teenage pregnancies, unsafe abortions, and sexually transmitted infection rates have declined among adolescents in UK in the last six years, the rates are still highest in Europe. The effectiveness of sexual and relationship education programmes in the country has been debatable over the years. Arguments are centred on whether sexual and relationship education impact on behaviour change or not. Objective: To explore the experiences of teachers who teach sexual and relationship education in the Lothians, Scotland, the SHARE programme. Method: This was a qualitative study. Data was carried out using face to face semi structured interviews in secondary schools. Results: Teachers are instrumental in raising sexual health awareness in adolescents. However they encounter significant barriers in implementing sexual and relationship programmes. More is needed to work in collaboration with sexual health programmes to effect behaviour change.
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.
Testing the reliability and validity of the Cluttering Severity Instrument
(Queen Margaret University, 2015)
Background Cluttering is a rather poorly defined fluency disorder, thought to be characterised by an accelerated and/or irregular speech rate with a large amount of disfluencies. As there is not yet a universally agreed upon definition of cluttering, clinicians have faced challenges identifying reliable and efficient assessment tools for the diagnosis of cluttered speech. A lack of diagnostics has also impacted upon the ability to develop treatment strategies and to monitor their success. A recently developed software programme called the Cluttering Severity Instrument (CSI; Bakker and Myers 2011) is anticipated to be the first acceptable, reliable and valid diagnostic tool for identifying cluttered speech. The CSI requires clinicians to provide perceptual ratings for eight speech characteristics, and to complete a task estimating the percentage of the sample that is cluttered. The CSI programme uses these two factors to calculate an overall CSI score. Aims The principle aim of the present study is to investigate whether the CSI programme can be regarded as a reliable and valid method of diagnosing cluttered speech. To achieve this, interrater and intra-rater reliabilities were determined. A second aim was to establish whether the CSI provides raters with the means to discriminate between impaired and unimpaired speech. A final aim is to identify whether raters' familiarity with speech analysis impacted upon rater reliability. Methodology Twelve raters provided perceptual ratings of eight speech characteristics and indicated the duration of the speech sample that they perceived to be cluttered. Raters recorded their judgements using the CSI programme and an overall cluttering percentage was calculated. Raters completed the experiment for five separate speech samples. Results Overall, inter-rater reliability was poor. The combined ratings of speakers and subtests found a high percentage of correlations, but not many with a strong coefficient value. Additionally, many of these correlations were determined to have significantly different means. Separate analysis of subtests indicated that although scores correlated, they often differed in range, with some raters giving consistently lower scores than others. These correlation analyses indicate that the CSI does not have strong inter-rater reliability. Intra-rater reliability was examined by re-testing four participants. Of these four, three had a strong correlation between their score sets, which provided some evidence of intra-rater reliability. When speakers were analysed separately, results indicated that raters were successfully discriminating between impaired and unimpaired speech. Correlation analysis of speech and language therapists (SLT) and laypersons groups did not determine a familiarity of speech analysis to have an influencing factor on perceptual judgements. Conclusions Based on the results of this study, we cannot conclude that the CSI programme is a reliable or valid diagnostic tool. Ratings provided by the SLT group were not found to be more reliable or less variable than the laypersons group. This indicated that a familiarity with speech analyses did not impact upon perceptual judgements of speech. Although the present study did not find significant evidence to support the CSI programme as a reliable and valid assessment tool, it did indicate that it provides raters with the means to successfully discriminate between impaired and unimpaired speech.
The Acute Effect of Espresso Coffee and Caffeine on Measures of Cardiovascular and Cognitive Function, a Single Blinded Cross Over Study
(Queen Margaret University, 2015)
Coffee is one of the most popular beverages in the UK. This study investigated the acute effects of espresso coffee and caffeine on markers of cardiovascular health and cognitive performance. The study had two hypotheses: Caffeine and coffee would increase blood pressure and arterial stiffness; caffeine and coffee would improve cognitive function. Blood pressure (BP) and haemodynamic parameters of pulse wave velocity (PWV), heart rate (HR) and augmentation index (AIx) were measured. Cognitive function was analysed using four validated tests. There were three interventions: coffee, decaffeinated coffee and caffeine. Caffeine content corresponded to 1.5mg/kg bodyweight. Seven healthy female participants took part. Measurements were taken at baseline and 45 minutes post-intervention. Coffee and caffeine significantly raised PWV (P≤0.05), with values rising from 6.46±0.96m/s to 6.8±1.03m/s and 6.32±0.95m/s to 6.73±0.93m/s respectively. Caffeine significantly raised systolic BP (P≤0.05) from 108.67±7.92mmHg to 114.67±7.92mmHg. There was no significant effect on HR and augmentation index. All interventions significantly improved Stroop test performance (P≤0.05), coffee resulted in improvements from 26.55±7.39s to 23.5±7.98s, decaffeinated coffee from 25.7±5.44s to 21.80±4.69s and caffeine from 25.36±6.08s to 21.84±6s. Decaffeinated coffee significantly increased Corsi block tap test scores (P≤0.05), with mean scores improving from 42.86±16.23 to 61.87±19.05. An acute negative effect on central arterial stiffness following ingestion of both coffee and caffeine was observed in habitual consumers, with caffeine alone having a more detrimental effect on cardiovascular health. Only decaffeinated coffee induced positive results in every test and also had significant improvements in two out of four cognitive tests. This study shows the importance of considering both coffee and caffeine ingestion prior to analysing arterial stiffness. Neither hypothesis was fully proven: Caffeine alone has a more detrimental effect on cardiovascular health compared to coffee; coffee and caffeine did not increase overall cognitive performance in habitual consumers.
Investigation into the relationship between adherence to a Mediterranean dietary pattern and nutritional knowledge among cardiac rehabilitation patients in NHS Lothian
(Queen Margaret University, 2015)
Background: Coronary Heart Disease (CHD) is the leading cause of death and ill-health in Scotland. There is a growing need for effective cardiac rehabilitation programmes to help patients successfully self-manage their condition. A Mediterranean-style diet is recommended in the secondary prevention of CHD. Evidence has shown that adherence to a Mediterranean diet can be determined by factors such as nutritional knowledge and social deprivation. The aims of this study were 1) to investigate the relationship between adherence to a Mediterranean diet and nutritional knowledge among cardiac rehabilitation patients and 2) to identify the relationship between these two variables and participants' levels of deprivation. Methods: Participants were recruited at their initial cardiac rehabilitation assessment. Baseline measurements of adherence to a Mediterranean diet were assessed using the 14-point Mediterranean Diet Adherence Screener (MEDAS-14) and participants' baseline nutritional knowledge was measured using a validated 100-item, four-section nutritional knowledge questionnaire (NKQ). Participants' postcodes were collected and area-based levels of deprivation were determined using the Scottish Index of Multiple Deprivation (SIMD). Results: A significant positive association was found between participants' SIMD rank and MEDAS-14 scores (r = 0.792, p<0.01), as was a significant positive correlation between SIMD rank and the 'sources of nutrients' section scores of the NKQ (r = 0.636, p<0.05). There was no relationship found between SIMD rank and total NKQ score, nor was a relationship found between participants' MEDAS-14 and NKQ scores. Conclusions: These findings are in line with previous studies that highlight the existence of a social gradient in dietary quality and nutritional knowledge. Non-significant results may have occurred due to small sample size. Further research is required to strengthen the evidence for associations between dietary quality and nutritional knowledge and their determinants in Scottish populations. Key Words: Cardiac rehabilitation, Mediterranean diet, nutritional knowledge, social deprivation
Indigenous Beliefs, HIV and Health Seeking Behaviour.
(Queen Margaret University, 2015)
Background: Globally there are 34 million people living with HIV and AIDS, with 68% of these individuals living in sub-Saharan Africa. Uganda is often cited as the success story in the fight against HIV and AIDS due to their reduction in both prevalence and incidence early in the epidemic. However, HIV and AIDS remains a significant burden with 7.7% of people aged 15-49 infected with the virus (UAC, 2012). Despite the high HIV prevalence within the country, there is a huge shortage of bio-medical health care personnel, with first line care delivered by traditional health practitioners to 70% of the population. Aim: This study aims to ascertain the perceived role of traditional health practitioners in the management and treatment of HIV and AIDS, and how indigenous spiritual beliefs are perceived to affect individuals' HIV health seeking behaviour. Methods: The work of Jean-François Lyotard and Arthur Kleinman were used as a framework to understand human experiences of suffering and illness. This study utilized Qualitative research methods, using both semi-structured interviews and group interviews as research methods with twenty three participants. Data was recorded, transcribed and then analyzed using a thematic analysis. Findings/discussion: findings presented illustrate the diverse work of THPs, often encompassing both herbal and spiritual aspects of diagnosis and treatment. THPs present in this study illustrated valuable counseling services in the management of HIV and AIDS. Amongst the respondents it was perceived that the symptoms of HIV were often misinterpreted as witchcraft. Additionally, a tension between bio-medical health workers and traditional health practitioners about the effectiveness of the treatments provided by each health care provider was highlighted. Furthermore, the dangers of the use of traditional health practitioners in the treatment and management of HIV is highlighted by bio-medical health practitioners present in this study. The implications of these findings for collaboration between the two health sectors are discussed. It is argued that identifying opportunities for collaboration, and trusted networks of THPs working within communities, with the aim understanding diverse explanatory models off illness and promoting greater collaboration between the two systems would be extremely valuable in this context.
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.
A Critical re-conceptualization of Traditional Ecological Knowledge: First Nations psychosocial narratives of Healing, Advocacy, Expression and Reciprocity
(Queen Margaret University, 2015)
Spiritual, ceremonial, socio-ecological and socio-emotional conceptualizations of First Nations relationship with the land was explored through the space of 'Traditional Ecological Knowledge'. Utilizing a qualitative methodology combining observation, community participation and semi-structured interviews this study engaged in a case study of Taykwa Tagamou and area First Nations in Northern Ontario, Canada. Through participation and observation in medicine picking, traditional food preparation, women's drumming, co-management policy and environmental meetings, Indigenous knowledge and restoration conference and interviews conducted both on Taykwa Tagamou First Nations reserve and in the town of Cochrane this research was holistic in its approach. The findings from this study suggest that socio-emotional connections and conceptualizations of First Nations in the TTN community and area in relation to the 'land', 'being on the land' and 'traditional medicines' impact their emotional, social, physical and spiritual wellbeing and 'healing' capacities and are central components of Traditional Ecological Knowledge in the First Nations context.
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
An Examination of the Factors Influencing Contraceptive Behavior in African American College Students
(Queen Margaret University, 2015)
Introduction: African American women experience higher rates of unintended pregnancies compared to their white counterpart. Recently similar trends were discovered among African American college students. The purpose of this study is to examine the factors that influence contraceptive behavior in African American college students. Methods: Qualitative data was collected from one Focus Group Discussion (FGDs) and six Semi Structured Interviews (SSIs) consisting of African American college students attending The George Washington University or The University of Maryland, College Park. The sample group consisted of 9 females and one male. Data was analyzed via thematic analysis and various analytic matrices. Findings: Participants held knowledge of contraception and had various modes of receiving sexual health information. Condoms and withdrawal were the most popular form of contraception use, followed by birth control and emergency contraception. Concerns about side effects, convenience, and experiences from peers or family members created hesitation to utilize hormonal contraception. Peers and partners were highly influential on one contraceptive behavior, followed my family and media. Conclusion: Socio-cultural factors such as peer, partner, family and media are more influential than other factors (i.e. socioeconomic status, structural factors or knowledge base).
A Study To Determine The Impact Of Permaculture On Dietary Diversity And Nutritional Status In Children Below 5 Years In Malawi.
(Queen Margaret University, 2015)
Introduction: Every year, 3.1 million child deaths are associated with poor nutritional status, the majority occurring in the most socio-economically deprived areas (Black et al. 2013). Malawi is a Sub-Saharan African country where over 60% of people live below the international poverty line and 1 in 2 children are chronically malnourished (UNICEF 2013). Interventions in the agricultural sector have the potential to reduce the burden of malnutrition by increasing food production, diversity and consequently, dietary intake and nutritional status (Heywood 2013). Permaculture is an alternative agricultural design which mimics natural ecosystems to create a diverse productive system and has been reported to produce thrice as many crop varieties as the commonly practiced maize monocropping in Malawi (Conrad 2014). This study investigates the impact of permaculture farming on dietary diversity and nutritional status in children below the age of 5 years living in Malawi. Methods: A sample of 10 children was taken from permaculture-practicing families in Central Malawi and matched with 10 controls of similar ages. They were compared based on diversity of dietary intake and nutritional status. Dietary diversity was scored based on number of food groups consumed during the previous 24-hours, while nutritional status was defined by comparing anthropometric measurements against international growth standards (Kennedy et al. 2010; WHO 2006). Results: Mean dietary diversity scores were significantly higher in the intervention group than in controls (p=.003) and prevalence of consumption of 7 or more food groups was 40% higher in the intervention group. Anthropometric measurements revealed a 20% higher prevalence of underweight and wasting and a 30% higher prevalence of severe stunting among controls than intervention group (p>.05). Conclusion: Permaculture has a positive impact on dietary diversity in Malawian children; however the evidence for impact on nutritional status was not strong hence conclusions could not be drawn. Keywords: Permaculture, Malnutrition, Dietary Diversity, Malawi
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.
Determining the patient-perceived impact of foot health education for patients with diabetes mellitus
(Queen Margaret University, 2015)
The impact of foot problems in diabetes on the National Health Service (NHS) is extremely large, accounting for 10% of the entire NHS budget for England and Wales (Global Diabetes Community, 2015). The annual NHS spend on diabetes is predicted to rise from £9.8 billion currently to £16.9 billion by 2035 (Diabetes UK, 2012). The NHS (2011) commissioned a report which cited patient education as a key factor in the overall care package of optimum diabetic foot management. Indeed, patient education in diabetes mellitus is viewed as a vital part of a patient-centred care philosophy which is a pillar of the Diabetes National Service Framework (DoH and Diabetes UK, 2005). So much so, that National Institute of Clinical Excellence [NICE] (2009) list patient education as a key target for diabetes management with structured education programmes to be delivered at the point of diagnosis with annual reinforcement and review. However, what is not clear from many studies in this area is the patients perceptions of the education that they received and what impact they feel that this has had on their management of diabetes particularly in relation to their foot health. This study looked to determine the patient-perceived impact of foot health education for patients with diabetes mellitus via a qualitative methodology. 20 participants who have type 1 or type 2 diabetes mellitus who fit the inclusion criteria were randomly selected and invited for in-depth semi structured interviews relating to their experience of patient education in diabetes mellitus, with a focus on their foot health. The results of this study indicate that the individuals interviewed had a very inconsistent patient education experience, particularly in relation to their foot health with a large proportion of these individuals not receiving services in line with national commissioning reports and guidelines. This was most notably identified with almost half of all participants interviewed indicating that they received no patient education whatsoever, with those that did receive structured patient education not having this education reinforced annually. Furthermore, where patient education pertaining to foot health was received by individuals, the patient-perceived impacts of this education were varied and did not demonstrably lead to a sustained change in foot health perception or behaviours.
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.