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The aim of this paper was to explore the experiences of perceived prejudices faced in England by Black African mental health nurses. Purposive sampling was used to identify five nurses from sub‐Saharan Africa. They were interviewed using face‐to‐face semi‐structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). The findings were reported under two superordinate themes: Judging a book by its cover and opportunities. The findings showed that Black African nurses experience deep‐rooted discrimination and marginalisation. Aside from that, because of their ethnicity and the fact that they speak English as a second language, they face discrimination and have difficulty achieving leadership roles. These findings provide key stakeholders, such as nursing trade unions and professional associations, as well as NHS employers, with the opportunity to act to counter hegemony in the NHS and recognise that discriminatory and racially related barriers hinder Black African nurses from reaching their full professional potential. [ABSTRACT FROM AUTHOR]

As international migration increases, the Australian socio‐cultural and political context in which sub‐Saharan African migrant families are settling is causing tension between traditional sub‐Saharan African migrant definitions of child and childhood experiences and host nation definitions particularly when compared with the child protection system. This paper seeks to explore and highlight the fundamental values and differences that determine perceptions and treatment of children within traditional sub‐Saharan African communities. Using a qualitative design, this study was influenced by acculturation theory. Four major themes emerged from the analysis: (a) culture and the sub‐Saharan African child, (b) moulding good children, (c) family functioning and relationships, and (d) host context: perceptions of Australian mainstream parenting. The study found that in order to successfully make decisions that are in the best interest of sub‐Saharan African migrant children that come to the attention of the child protection system, discussions about children rights can only yield good outcomes when the child's socio‐cultural environment is considered. [ABSTRACT FROM AUTHOR]

Objective: Studies indicate inhaled isopropyl alcohol (IIA) is effective or superior to ondansetron for adult patients. Although quick‐acting and low cost, it cannot be assumed this remedy is suitable for adoption in all settings. We explored how an innovative antiemetic remedy studied in the United States translates to a sub‐Saharan Africa clinic/hospital setting using Rogers' Diffusion of Innovation Framework. Design: Qualitative design with purposive sampling. Sample: Health care staff (n = 11) providing and community members (n = 22) accessing health care services in a sub‐Saharan Africa clinic/hospital. Measurements: Semi‐structured interviews with coding and identification of themes via deductive content analysis using Rogers' Diffusion of Innovation Framework. Results: Nausea and vomiting was a common complaint, with malaria the most common etiology. Participants emphasized treatment of etiology over symptomatic treatment and described previous aromatherapy use. IIA advantages included administration route, quick‐acting, self‐administration, portable, available, and easy trialability. Participants expressed concerns regarding use of term "alcohol" as potentially offensive to others. Conclusion: Use of Rogers' Diffusion of Innovation framework identified barriers and facilitators to translation of a novel antiemetic remedy for sub‐Saharan Africa clinic/hospital settings. Evaluating clinical innovations from perspectives of relative advantage, compatibility, complexity, trialability, and observability enhances adoption of innovations within clinical settings. [ABSTRACT FROM AUTHOR]

Prevalence of child marriage has remained high in many parts of Africa despite its multisectoral adverse effect. As it is now being suggested to have intergeneration impact, we examined if marriage at or after 18th birthday is associated with the risk of anaemia among under‐five children. Cross‐sectional data from Demographic and Health Surveys (DHS) conducted between 2010 and 2018 in 15 African countries as of August 2020 were used. Maternal age of marriage was defined as when they started living with their husband or partner. Children with haemoglobin level below 11.0 g/dl after adjustment for altitude were categorised to be anaemic. The study involved a multivariable logistic regression analysis of 17,033 children data born by women between the childbearing ages. About 65% of under‐five children in Sub‐Saharan Africa (SSA) were anaemic, ranging from 40% in Rwanda to 82% in Mali. Girl child marriage ranged from 40% in South Africa to 97% in Niger with an average of about 60%. We observed a significant reduction (20%) in the risk of anaemia among under‐five children when their mothers married after at or after their 18th birthday. Country‐specific analysis showed that increased risk of anaemia was strongly associated with early marriage in Côte d'Ivoire and Mozambique. This study contributed to the growing evidence that maternal age of marriage might have an intergenerational impact. Maternal marriage at or after their 18th birthday reduces the risk of anaemia among under‐five children in Africa. Interventions aimed at tackling anaemia in Africa should capture and affect household socioeconomic risks and children's exposures. [ABSTRACT FROM AUTHOR]

Female‐initiated HIV prevention methods, such as oral pre‐exposure prophylaxis (PrEP) and the vaginal ring, may be important risk reduction strategies for breastfeeding women. Given their novelty, information about the sociocultural context and how it influences perceptions of and support for their use during breastfeeding is lacking. To address this gap, we conducted 23 focus group discussions separately with pregnant and breastfeeding women, male partners and grandmothers (N = 196) and 36 in‐depth interviews with key informants in Malawi, South Africa, Uganda and Zimbabwe. We analysed the data using a framework analysis method. Overall, breastfeeding was the norm, and participants described the transference of health (e.g., nutrition) and disease (e.g., HIV) to children through breast milk. Participants considered the early breastfeeding period as one of high HIV transmission risk for women. They explained that male partners tend to seek outside sexual partners during this period because women need time to recover from delivery, women focus their attention on the child, and some men are disgusted by breast milk. Participants highlighted concerns about the drugs in oral PrEP transferring to the child through breast milk, but fewer worried about the effects of the vaginal ring because the drug is localized. Women, grandmothers and key informants were supportive of women using these HIV prevention methods during breastfeeding, while male partners had mixed opinions. These findings can be used to tailor messages for promoting the use of PrEP or the vaginal ring during breastfeeding in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Objectives: Late presentation (LP) to HIV care disproportionally affects individuals from sub‐Saharan Africa (SSA). We explored the reasons for late presentation to care among this group of patients in the Swiss HIV Cohort Study. Methods: The prevalence of LP was compared between patients from Western Europe (WE) and those from SSA enrolled between 2009 and 2012. Patients were asked about HIV testing, including access to testing and reasons for deferring it, during face‐to‐face interviews. Results: The proportion of LP was 45.8% (435/950) among patients from WE, and 64.6% (126/195) among those from SSA (P < 0.001). Women from WE were slightly more likely to present late than men (52.6% versus 44.5%, respectively; P = 0.06), whereas there was no sex difference in patients from SSA (65.6% versus 63.2%, respectively; P = 0.73). Compared with late presenters from WE, those from SSA were more likely to be diagnosed during pregnancy (9.1% versus 0%, respectively; P < 0.001), but less likely to be tested by general practitioners (25.0% versus 44.6%, respectively; P = 0.001). Late presenters from SSA more frequently reported 'not knowing about anonymous testing possibilities' (46.4% versus 27.3%, respectively; P = 0.04) and 'fear about negative reaction in relatives' (39.3% versus 21.7%, respectively; P = 0.05) as reasons for late testing. Fear of being expelled from Switzerland was reported by 26.1% of late presenters from SSA. Conclusions: The majority of patients from SSA were late presenters, independent of sex or education level. Difficulties in accessing testing facilities, lack of knowledge about HIV testing and fear‐related issues are important drivers for LP in this population. [ABSTRACT FROM AUTHOR]

Abstract: Stigma of mental illness and substance misuse can deter help seeking, especially in immigrants who are often reluctant to seek help early for these issues. The aim of the present study was to explore the stigma experience surrounding mental illness and substance misuse, and its implications for improving help seeking, for youths and parents from sub‐Saharan African immigrant communities. A qualitative, descriptive design was used. Individual interviews were undertaken with 28 youths, and focus group discussions were held with 41 parents and community leaders in Melbourne, Australia. The findings indicated that public stigma and self‐stigma were common and deterred participants’ help seeking within sub‐Saharan African communities. There was concern about the consequences of disclosure. Personal shame, fear of community rejection, and being labelled a ‘lunatic’ deterred help seeking. Programmes are needed to address stigma, promote help seeking, and increase mental health knowledge. Mental health nurses and other clinicians in the mental health and alcohol and other drug fields can make an important contribution. Steps are needed to employ more sub‐Saharan African immigrant clinicians to help increase help seeking from their communities. [ABSTRACT FROM AUTHOR]

Context Although many studies have demonstrated the benefits of mentoring in academic medicine, conceptual understanding has been limited to studies performed in North America and Europe. An ecological model of mentoring in academic medicine can provide structure for a broader understanding of the role of culture in mentoring. Objective The goal of this study was to explore the role of culture in the development and maintenance of mentoring relationships within the context of the University of Malawi College of Medicine. Methods A qualitative study using in-depth, semi-structured interviews and thematic analysis was conducted to explore the meaning of mentorship at the study institution. Criterion sampling was used to identify and recruit medical students, interns, registrars and faculty members. Study team members developed a codebook through open coding and applied it to all interview transcripts. Thematic analysis was used to identify and categorise themes according to an ecological model. Results A total of 46 participants from two major centres in Malawi were interviewed. Themes were identified within three domains: the intrapersonal; the interpersonal, and the institutional. Intrapersonal themes included Malawian politeness, mentoring needs, and friendliness and willingness to help. Interpersonal themes included understanding the role of the mentor, respect for elders, personal and professional boundaries, and perceptions of others. Institutional themes included the supervisor versus mentor, time pressures, tension about the scope of training, and the mentoring cycle. Conclusions This study highlights the strengths of and challenges imposed by culture to the provision of mentoring relationships at the study institution. It also highlights the central role of culture in mentoring and proposes an updated model for mentoring in academic medicine. This model can inform future research on mentoring and may serve as a model in the larger effort to provide faculty development in mentoring across sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Alcohol is heavily consumed in sub-Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth). Methods: Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 ( n = 77). PEth in whole blood was compared with prior 7-, 14-, and 21-day alcohol consumption. Results: (i) The receiver operator characteristic area under the curve (ROC-AUC) was highest for PEth versus any consumption over the prior 21 days (0.92; 95% confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0% (95% CI: 76.0 to 95.6) and the specificity was 88.5% (95% CI: 69.8 to 97.6). (ii) The ROC-AUC of PEth versus any 21-day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women ( p = 0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21 days (Spearman r = 0.74, p < 0.001) and BRAC ( r = 0.75, p < 0.001). Conclusions: The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC-AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable. [ABSTRACT FROM AUTHOR]