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Using meta-ethnographic methods, we conducted a systematic review of qualitative research to understand gender-related reasons at individual, family, community and health facility levels why millions of children in low and middle income countries are still not reached by routine vaccination programmes. A systematic search of Medline, Embase, CINAHL, Cochrane Library, ERIC, Anthropological Lit, CSA databases, IBSS, ISI Web of Knowledge, JSTOR, Soc Index and Sociological Abstracts was conducted. Key words were built around the themes of immunization, vaccines, health services, health behaviour, and developing countries. Only papers, which reported on in-depth qualitative data, were retained. Twenty-five qualitative studies, which investigated barriers to routine immunisation, were included in the review. These studies were conducted between 1982 and 2012; eighteen were published after 2000. The studies represent a wide range of low- to middle income countries including some that have well known coverage challenges. We found that women's low social status manifests on every level as a barrier to accessing vaccinations: access to education, income, as well as autonomous decision-making about time and resource allocation were evident barriers. Indirectly, women's lower status made them vulnerable to blame and shame in case of childhood illness, partly reinforcing access problems, but partly increasing women's motivation to use every means to keep their children healthy. Yet in settings where gender discrimination exists most strongly, increasing availability and information may not be enough to reach the under immunised. Programmes must actively be designed to include mitigation measures to facilitate women's access to immunisation services if we hope to improve immunisation coverage. Gender inequality needs to be addressed on structural, community and household levels if the number of unvaccinated children is to substantially decrease. [ABSTRACT FROM AUTHOR]

Over half of the world’s mortality is associated with chronic diseases. Living with chronic diseases can significantly affect patients’ quality of life. The daily management of these diseases falls mostly on patients themselves. Self-management interventions have become increasingly used as a complementary intervention to treatment and care. The Chronic Disease Self-Management Programme (CDSMP) is the most widespread self-management intervention. It aims to empower patients and provide them with the skills to manage their disease and prevent complications. A locally adapted CDSMP was piloted in the Republic of Moldova in 2018/2019 in five villages across three rural districts. In five groups led by peer facilitators, 63 participants were enrolled in the programme. Four participants were lost to follow-up. To evaluate the intervention, we used the Self-Efficacy for Managing Chronic Diseases six-item scale questionnaire with participants before and after the programme, along with a questionnaire to assess satisfaction with the programme. Additionally, we conducted a focus group discussion (FGD) with the 10 programme facilitators. We found that, not only did participants’ self-efficacy significantly increase between baseline and follow-up (from mean score of 5.3 to 8.3; t(58) = -12.2, p < 0.001), they also improved their knowledge on every individual item on how to manage a chronic disease (p < 0.001). Participants’ satisfaction was high, with 96% of respondents satisfied with content, format and delivery elements of the intervention. Hence, we believe the CDSMP is locally acceptable and effective at least in the short-term, and offers promises for scale-up in the Republic of Moldova. [ABSTRACT FROM AUTHOR]

Introduction: The Moldovan-Swiss Perinatology Project started in 2006 with support from the Swiss Development and Cooperation Agency (SDC). Major reforms and investments were made in the perinatal system, but some assessments revealed that vulnerable women from remote rural communities still faced access barriers to mother and child health services. There was a need to strengthen the referral system to direct the most-at-risk pregnant women in the community to the first level of care. Aims: A community mobilisation project was designed and piloted in selected rural localities to better identify barriers to care for vulnerable people and to test mechanisms for mobilising community actors for better access to and use of perinatal health services. Results: The community mobilisation project followed the principles of the World Health Organisation's approach to working with individuals, families and communities (the IFC model). Informal groups of voluntary motivated individuals ("Family Clubs") were created to champion the cause of healthy families and to organise numerous public events to raise community awareness of health issues. The communication and counselling skills of community health specialists were strengthened to improve the provider-patient relationship, particularly in the area of antenatal education. Multidisciplinary teams of community specialists and local public authorities were supported to better coordinate the case management of vulnerable pregnant women. Teams of Youth-Peer volunteers were created and supported to promote reproductive health among young people. Conclusions: Family Clubs and Youth-Peer teams were successful in reaching out to community members and largely contributed to health promotion efforts at the local level. The sustainability of Family Clubs was encouraged by strengthening their links to the local public authorities. Working within multidisciplinary teams reinforced linkages between community workers and the first level of care for better identification and referral of pregnant women. Stigmatisation of vulnerable populations is high among community specialists: further capacity building and incentives are needed to improve providers' attitudes. [ABSTRACT FROM AUTHOR]