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Background Effective vaccination communication with parents is critical in efforts to overcome barriers to childhood vaccination, tackle vaccine hesitancy and improve vaccination coverage. Health workers should be able to provide information to parents and other caregivers and support them in reaching decisions about vaccinating their children. Limited information exists regarding the perceptions of caregivers and health workers on the vaccination communication strategies employed in Nigeria. This study, which forms part of the ‘Communicate to vaccinate’ (COMMVAC) project, aims to explore the perceptions and experiences of caregivers and health workers in Nigeria on vaccination communication strategies implemented in their settings. Methodology We conducted the study in two States: Bauchi in Northern Nigeria and Cross River in the south. We carried out observations (n = 40), in-depth interviews (n = 14) and focus group discussions (FGDs) (n = 12) amongst 14 purposively selected health workers, two community leaders and 84 caregivers in the two states. We transcribed data verbatim and analysed the data using a framework analysis approach. Results Caregivers were informed about vaccination activities through three main sources: health facilities (during health education sessions conducted at antenatal or immunization clinics); media outlets; and announcements (in churches/mosques, communities and markets). Caregivers reported that the information received was very useful. Their preferred sources of information included phone text messages, town announcers, media and church/mosque announcements. Some caregivers perceived the clinic environment, long waiting times and health worker attitudes as barriers to receiving vaccination information.When delivering communication interventions, health workers described issues tied to poor communication skills; poor motivation; and attitudes of community members, including vaccine resistance. Conclusion Communication about vaccination involves more than the message but is also influenced by the environment and the attitudes of the deliverer and receiver. It is pertinent for health policy makers and programme managers to understand these factors so as to effectively implement communication approaches.

Incremental implicit theories are associated with a belief regarding it is possible to improve one’s intelligence or ability through efforts. Previous studies have demonstrated that incremental implicit theories contributed to better academic achievement and positive youth development. Our study aimed to examine whether incremental implicit theories of morality significantly influenced change in students’ engagement in voluntary service activities. In our study, 54 Korean college students for Study 1 and 180 Korean 8th graders for Study 2 were recruited to conduct two two-wave studies. We surveyed participants’ implicit theories of morality and participation in voluntary service activities. The effect of implicit theories of morality on change in service engagement was analyzed through regression analysis. In Study 1, the moral growth mindset significantly moderated longitudinal change in service engagement. In Study 2, the moral growth mindset significantly influenced engagement in art-related activities, while it significantly moderated change in engagement in youth-related activities.

The coronavirus disease 2019 (COVID-19) poses a serious global health threat. Without a vaccine, behavior change is the most effective means of reducing disease transmission. Identifying psychological factors that may encourage engagement in preventative health behaviors is crucial. The behavioral immune system (BIS) represents a set of psychological processes thought to promote health by encouraging disease avoidance behaviors. This study examined whether individual differences in BIS reactivity (germ aversion, pathogen disgust sensitivity) were associated with concern about COVID-19 and engagement in recommended preventative health behaviors (social distancing, handwashing, cleaning/disinfecting, avoiding touching face, wearing facemasks). From March 20 to 23, 2020, a US national sample (N = 1019) completed an online survey. Germ aversion and pathogen disgust sensitivity were the two variables most consistently associated with COVID-19 concern and preventative health behaviors, while accounting for demographic, health, and psychosocial covariates. Findings have implications for the development of interventions intended to increase preventative health behaviors.

Background Understanding how knowledge, attitudes and practices regarding leprosy differ in endemic countries can help us develop targeted educational and behavioural change interventions. This study aimed to examine the differences and commonalities in and determinants of knowledge, attitudes, practices and fears regarding leprosy in endemic districts in India and Indonesia. Principle findings A cross-sectional mixed-methods design was used. Persons affected by leprosy, their close contacts, community members and health workers were included. Through interview-administered questionnaires we assessed knowledge, attitudes, practices and fears with the KAP measure, EMIC-CSS and SDS. In addition, semi-structured interviews and focus group discussions were conducted. The quantitative data were analysed using stepwise multivariate regression. Determinants of knowledge and stigma that were examined included age, gender, participant type, education, occupation, knowing someone affected by leprosy and district. The qualitative data were analysed using open, inductive coding and content analysis. We administered questionnaires to 2344 participants (46% from India, 54% from Indonesia) as an interview. In addition, 110 participants were interviewed in-depth and 60 participants were included in focus group discussions. Knowledge levels were low in both countries: 88% of the participants in India and 90% of the participants in Indonesia had inadequate knowledge of leprosy. In both countries, cause, mode of transmission, early symptoms and contagiousness of leprosy was least known, and treatment and treatability of leprosy was best known. In both countries, health workers had the highest leprosy knowledge levels and community members the highest stigma levels (a mean score of up to 17.4 on the EMIC-CSS and 9.1 on the SDS). Data from the interviews indicated that people were afraid of being infected by leprosy. Local beliefs and misconceptions differed, for instance that leprosy is in the family for seven generations (Indonesia) or that leprosy is a result of karma (India). The determinants of leprosy knowledge and stigma explained 10–29% of the variability in level of knowledge and 3–10% of the variability in level of stigma. Conclusion Our findings show the importance of investigating the perceptions regarding leprosy prior to educational interventions in communities: even though knowledge levels were similar, local beliefs and misconceptions differed per setting. The potential determinants we included in our study explained very little of the variability in level of knowledge and stigma and should be explored further. Detailed knowledge of local knowledge gaps, beliefs and fears can help tailor health education to local circumstances., Author summary This study aimed to examine the differences and commonalities in and determinants of knowledge, attitudes, practices and fears regarding leprosy in endemic districts in India and Indonesia. Persons affected by leprosy, their close contacts, community members and health workers were included. We administered questionnaires (the KAP measure, EMIC-CSS and SDS) to 2344 participants. In addition, 110 participants were interviewed in-depth and 60 participants were included in focus group discussions. Knowledge levels were low. In both countries, cause, mode of transmission, early symptoms and contagiousness of leprosy was least known, and treatment and treatability of leprosy was best known. In both countries, health workers had the highest leprosy knowledge levels and community members the highest stigma levels. Data from the interviews indicated that people were afraid of being infected by leprosy. Local beliefs and misconceptions differed. The potential determinants we included in our study explained very little of the variability in level of knowledge and stigma and should be explored further. Our findings show the importance of investigating the perceptions regarding leprosy prior to educational interventions in communities: even though knowledge levels were similar, local beliefs and misconceptions differed per setting.

Background: Despite the development of cultural competence models in response to the increase in cultural diversity in the United States, health disparities based on ethnicity and cross-cultural mismatches in health care practices still exist. Method: This article critically reviews six noteworthy conceptual models of cultural competence and enlists multilayered definitions of culture from cultural anthropology, critical multicultural education, and critical literary theory, as well as critical discourse analytical tools to deconstruct these frameworks. Results: Although these models assist providers to become more culturally sensitive, they can essentialize and oversimplify patients' cultural experience, as well as mask the dynamism and complexities of their communities and power relations. Conclusion: Competence implies that practitioners can master diverse cultural experiences. Building on some of the promising practices of these six models and the practices of cultural humility and relational ethics, processes and practices are proposed for practitioners to reconstruct their ongoing cross-cultural work in nursing. [ J Nurs Educ . 2020;59(6):311–318.]

Corruption is ubiquitous in practice and has severe negative consequences for organizations and societies at large. Drawing on a laboratory experiment, we propose that individuals high in moral commitment are less likely to engage in corrupt behaviors and prefer foregoing financial benefits. Specifically, we posit that individuals refrain from corruption (i) the more they endorse integrity (incorruptibility) as a protected value and (ii) the higher their level of Honesty-Humility. The results of a two-step experiment largely support our expectations: people who treat compromises to integrity as unacceptable were less willing to accept bribes, and Honesty-Humility decreased bribe-giving. The findings are robust to demographic variables (e.g., age, gender, cultural background) and additional personal characteristics (e.g., risk tolerance, dispositional greed) and have important implications for ongoing theory-building efforts and business practice.

Education is a fundamental human right. Yet there remain gaps in our understanding of undocumented children in Malaysia and their vulnerabilities in education access. This study aims to describe and contextualise undocumented children in Malaysia and their access to education. We conducted a desk review and in-depth interviews with 33 key stakeholders from June 2020 to March 2021. Framework analysis was conducted. Salient themes were geographical location and legal identity in terms of citizenship and migration status. We found that the lack of legal identity and non-recognition by the State was the root cause of vulnerability, experienced uniformly by undocumented populations in Malaysia. Only undocumented children with Malaysian parents or guardians can enter public schools under the Malaysian government’s ‘Zero Reject Policy’. Most undocumented and non-citizen children must rely on informal education provided by alternative or community learning centres that typically lack standardised curricula, resources, and accreditation for education progression beyond primary levels. Nevertheless, as non-citizen groups are diverse, certain groups experience more privilege, while others are more disadvantaged in terms of the quality of informal education and the highest level of education accessible. In Peninsular Malaysia, a very small proportion of refugees and asylum-seekers may additionally access tertiary education on scholarships. In Sabah, children of Indonesian migrant workers have access to learning centres with academic accreditation supported by employers in plantations and the Indonesian Consulate, whereas Filipino migrants who were initially recognised as refugees are now receiving little government or embassy support. Stateless Rohingya refugees in Peninsular Malaysia and Bajau Laut children at Sabah are arguably the most marginalised and have the poorest educational opportunities at basic literacy and numeracy levels, despite the latter receiving minimal governmental education support. Implementing a rights-based approach towards education would mean allowing all children equal opportunity to access and thrive in high-quality schools.

Background Maternal education is universally recognised as a major factor in positive societal indicators (health, wellbeing, overall education, etc.) and a country’s growth and economic sustainability, yet the underlying factors contributing to maternal education have not been widely investigated, especially in developing countries. Objective This study investigated the 15-year trend of maternal education in Bangladesh (2004–2018) to identify the factors contributing to maternal education. Method This study used publicly available cross-data from five consecutive Bangladesh Demographic and Health Surveys (2004, 2007, 2011, 2014 and 2018). Level of maternal education was grouped as ‘no education’, ‘incomplete primary’, ‘complete primary’, ‘incomplete secondary’, ‘complete secondary’ and ‘higher education’ (reference group). The differences in factors/exposure variables suspected to contribute to maternal education were measured for these groups for 2004–2018, and a survey multinomial logistic regression was performed to estimate the explanatory value of these factors. Results From 2004–2018, there was a 62% gross reduction of the no education group and a 61% gross increase in the higher education group. A gross increase was also observed for complete secondary (49%), incomplete secondary (39%) and complete primary education (14%). In multivariate analysis, in rural areas, in 2018, the probability of a woman being in the complete primary, incomplete primary or no education groups was increased (adjusted relative risk ratio: 1.21, 1.40 and 1.59), compared to 2004 (0.73, 1.09, 1.12), respectively. From 2004–2018, the factor of no television watching reduced the probability of maternal education levels. Having a husband/partner who had no education increased the probability of a woman’s education level. The probability of all maternal education levels decreased across all wealth index groups. Conclusion The data suggest that average maternal education level in Bangladesh increased from 2004–2018. However, an integrated effort is required to improve factors associated with maternal education to both increase maternal education and Bangladesh’s long-term sustainability.

Objectives Out-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures. Subject and methods This study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed. Results We observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure. Conclusions Our findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.

Understanding what factors influence postpartum contraceptive use among young people (ages 15–24 years) is important since this group often has closely spaced and unintended births. Using secondary data gathered for an evaluation of a Bill & Melinda Gates Foundation funded initiative designed to increase modern contraceptive use in select urban areas of Nigeria, we determine the direct and indirect effects of community beliefs and attitudes on adolescent and youth postpartum contraceptive method choice. Our statistical methods control for the endogenous timing of the initiation of sexual activity and the timing and number of births to each respondent by simultaneous estimation of equations for these choices with the choice of postpartum contraceptive method. We find that community beliefs and attitudes have important effects on our primary outcome of postpartum contraceptive use and we quantify the size of both direct and indirect effects on postpartum contraceptive method choice using simulations. The findings from this study can be used to inform programs seeking to increase young women’s postpartum contraceptive use for healthy spacing and timing of births.

Background Adolescent fertility in Kenya is vital in the development and execution of reproductive health policies and programs. One of the specific objectives of the Kenyan Adolescent Sexual Reproductive Health (ASRH) policy developed in 2015 is to decrease early and unintended pregnancies in an attempt to reduce adolescent fertility. We aimed to establish determinants of adolescent fertility in Kenya. Methods The Kenya Demographic and Health Survey (KDHS) 2014 data set was utilized. Adolescent’s number of children ever born was the dependent variable. The Chi-square test was utilized to determine the relationship between dependent and independent variables. A Proportional-odds model was performed to establish determinants of adolescent fertility at a 5% significance level. Results Over 40% of the adolescent girls who had sex below 17 years had given birth i.e, current age 15–17 years (40.9%) and Conclusion The study established that age at first sex, current age, marital status, and contraceptive use are the main determinants of adolescent childbearing. The stated determinants should be targeted by the government to control the adolescent birth rate in Kenya. Consequently, delaying the age at first sex, discouraging adolescent marriage, and increasing secondary school enrollment among adolescent girls are recommended strategies to control adolescent fertility in Kenya.

Objectives This study investigated the perceptions of Saudi Arabian medical disciplines students undergoing training in various institutes of Australia regarding psychosocial, cultural, and academic challenges. Methods This cross-sectional study was from March 15 to June 15, 2019. Data were collected by an online questionnaire. It consisted of questions regarding demographic, psychosocial, cultural, and academic challenges. Two hundred nineteen students studying in Australia responded to our questionnaire. Results Of the total 219 students, 13(6.0%) were undergraduate, 167(76%) were postgraduate, and 39(18%) were Ph.D. students. For most students (171[79.2%]), Australia was the country of choice for studying. Most of them were satisfied with their academic performance and adjustment to the Australian way of living. Most of the students (180[82.2%]) showed satisfaction over the availability of fair chances of their religious practices in Australia. Few of them faced difficulties coping with the Australian climate (25[11.4%]), homesickness (59[26.9%]), and food and dietary sources (44[20.1%]). Students were overall satisfied with the student advisory system (156[71.2%]), university assessments (147[67.2%]), and available research facilities (170[77.6%]). Among participants, 77 (35.1%), 119(54.3%), and 23(10.5%) students indicated that they wished to stay in Australia only until completion of their studies, temporarily and permanently, respectively. Conclusions Our findings showed that Saudi students in Australia had strong psychosocial well-being, cultural integration, and academic success. Most of them were satisfied and adjusted well to Australian culture.

Context Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20–24 years) who married before age 18 and those who married at age 18 or above. Method Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20–24 (n = 33,630). Results Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57–0.67, p Conclusion Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.

Systematic efforts are needed to prepare persons newly diagnosed with acute or chronic HIV infection to cope. We examined how patients dealt with this news, looking at how readiness to accept an HIV diagnosis impacted treatment outcomes, prevention of transmission, and HIV status disclosure. We examined vulnerability and agency over time and considered implications for policy and practice. A qualitative sub-study was embedded in the Tambua Mapema (“Discover Early”) Plus (TMP) study (NCT03508908), conducted in coastal Kenya between 2017 and 2020, which was a stepped wedge trial to evaluate an opt-out HIV-1 nucleic acid testing intervention diagnosing acute and chronic HIV infections. Diagnosed participants were offered antiretroviral therapy (ART), viral load monitoring, HIV partner notification services, and provision of pre-exposure prophylaxis (PrEP) to their uninfected partners. Data were analyzed using thematic approaches. Participants included 24 individuals who completed interviews at four time points (2 weeks and 3, 6, and 9 months after diagnosis), including 18 patients (11 women and 7 men) and 6 partners (1 woman, 5 men, of whom 4 men started PrEP). Acceptance of HIV status was often a long, individualized, and complex process, whereby participants’ coping strategies affected day-to-day issues and health over time. Relationship status strongly impacted coping. In some instances, couples supported each other, but in others, couples separated. Four main themes impacted participants’ sense of agency: acceptance of diagnosis and commitment to ART; positive feedback after attaining viral load suppression; recognition of partner supportive role and focus on sustained healthcare support whereby religious meaning was often key to successful transition. To support patients with acute or newly diagnosed chronic HIV, healthcare and social systems must be more responsive to the needs of the individual, while also improving quality of care, strengthening continuity of care across facilities, and promoting community support.

Religious responses to COVID-19 as portrayed in a major news source raise the issue of conflict or cooperation between religious bodies and public health authorities. We compared articles in the New York Times relating to religion and COVID-19 with the COVID-19 statements posted on 63 faith-based organizations’ web sites, and with the guidance documents published by the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) specifically for religious bodies. We used computational text analysis to identify and compare sentiments and topics in the three bodies of text. Sentiment analysis showed consistent positive values for faith-based organizations’ texts throughout the period. The initial negative sentiment of religion—COVID-19 coverage in the New York Times rose over the period and eventually converged with the consistently positive sentiment of faith-based documents. In our topic modelling analysis, rank order and regression analysis showed that topic prevalence was similar in the faith-based and public health sources, and both showed statistically significant differences from the New York Times. We conclude that there is evidence of both narratives and counter-narratives, and that these showed demonstrable shifts over time. Text analysis of public documents shows alignment of the interests of public health and religious bodies, which can be discerned for the benefit of communities if parties are trusted and religious messages are consistent with public health communications.

Objective: Several studies have reported that Somalis have negative attitudes about using modern contraceptives. However, little attention has been paid to the differences in Somali women's attitudes toward contraceptives across generations and the attitude change happening overtime in Somali women's attitudes toward contraception. This study explores attitudes toward contraceptives and factors influencing contraceptive use, among first- and second-generation Somali women living in Finland. Methods: The study follows a qualitative design with data collection using in-depth interviews. Sixteen women were interviewed regarding their knowledge of, attitude toward, and use of contraceptives. Eight of the study participants were first-generation and eight were second-generation Somali women living in Finland. The data were analyzed using a thematic approach guided by a cultural anthropology framework. Results: Three main themes emerged in the data analysis: (1) Culture influencing Somali women's attitudes toward contraceptives; (2) information sources can work differently within the same cultural group; and (3) Somali women's perspectives on contraceptives change over time. Cultural, religion, taboo, and knowledge resources are used to understand the whole concept of Somali women's attitude toward and use of contraceptives. Hence, the study shows the diverse opinions of Somali women. According to the informants the main underlying factors influencing Somali women's attitudes toward contraceptives were education, culture, misinterpreted religion, and social pressure. Conclusions: According to the Finish resident women interviewed for this study, Somali culture do not support the use of modern contraceptives. Even though attitudes towards contraceptives are slowly changing, there is a need for SRH education, particularly among first-generation Somalis. Second-generation women are generally more open to the use of modern contraceptives. The study also draws attention to the need to improve the training of health care professionals regarding the handling of culturally sensitive topics such as contraception use.

Background Registering a donation decision is fundamental to increasing the number of people who donate the organs and tissues essential for transplantation, but the number of registered organ donors is insufficient to meet this demand. Most people in Australia support organ donation, but only a third have registered their decision on the Australian Organ Donor Register (AODR). We addressed this paradox by investigating how feelings of community, engendered through an ethic of hospitality and care and a non-proselytizing dialogue about organ donation, facilitated the decision to register. Methods An Immediate Registration Opportunity was set up in a large public hospital in NSW, Australia. The public was approached and invited to engage in an open, respectful dialogic interaction that met people where their beliefs were and allowed their concerns and fears about donation to be discussed. This included a survey that measured positive and negative beliefs about organ donation, mood, atmosphere, and feelings of community coupled with an on-the-spot opportunity to register their donation decision. Results Over four days, we interacted with 357 participants; 75.5% (210) of eligible-to-register participants registered on the AODR. Generalized Structural Equation Modelling highlighted that as connection to community increased, so did the salience of positive beliefs about organ donation. Positive beliefs, in turn, were negatively correlated with negative beliefs about donation and, as the strength of negative beliefs decreased, the probability of registration on the AODR increased. Participants who registered on the AODR reported stronger connection to the broader community than participants who did not register. Conclusion A respectful non-judgmental interaction that allows beliefs and concerns about organ donation to be discussed, coupled with an immediate opportunity to register, encouraged registration. Within this framework, feelings of belonging to a community were a key determinant that enabled many to make the decision to register.

Using the 9thround of European Social Survey (ESS), we explored the relationship between Europeans’ basic values and their attitudes towards immigrants. Employing a latent class analysis (LCA), we classified the respondents based on three items capturing the extent to which participants would support allowing three groups of immigrants to enter and live in their countries: immigrants of same ethnic groups, immigrants of different ethnic groups, and immigrants from poorer countries outside Europe. Fourclassesof Europeans with mutually exclusive response patterns with respect to their inclusive attitudes towards immigrants were found. The classes were named Inclusive (highly inclusive), Some (selective), Few (highly selective), and Exclusive (highly exclusive). Next, using a network technique, a partial correlation network of 10 basic human values was estimated for each class of participants. The four networks were compared to each other based on three network properties namely:global connectivity,community detection, andassortativity coefficient. The global connectivity (the overall level of interconnections) between the 10 basic values was found to be mostly invariant across the four networks. However, results of the community detection analysis revealed a more complex value structure among the most inclusive class of Europeans. Further, according to the assortativity analysis, as expected, for the most inclusive Europeans, values with similar motivational backgrounds were found to be interconnected most strongly to one another. We further discussed the theoretical and practical implications of our findings.

To what extent can the strength of a local urban community impact neighborhood safety? We construct measures of community vibrancy based on a unique dataset of block party permit approvals from the City of Philadelphia. Our first measure captures the overall volume of block party events in a neighborhood whereas our second measure captures differences in the type (regular versus spontaneous) of block party activities. We use both regression modeling and propensity score matching to control for the economic, demographic and land use characteristics of the surrounding neighborhood when examining the relationship between crime and our two measures of community vibrancy. We conduct our analysis on aggregate levels of crime and community vibrancy from 2006 to 2015 as well as the trends in community vibrancy and crime over this time period. We find that neighborhoods with a higher number of block parties have a significantly higher crime rate, while those holding a greater proportion of spontaneous block party events have a significantly lower crime rate. We also find that neighborhoods which have an increase in the proportion of spontaneous block parties over time are significantly more likely to have a decreasing trend in total crime incidence over that same time period.

Introduction Vitamin A has been one of the most important micronutrients which are necessary for the health of the children. In developing countries, the supplementation of vitamins under a regular schedule had different constraints. Awareness, access, and resource limitations were usually the problem. In the current study, we analyzed the data from the demographic health survey (EDHS) 2016 to uncover the spatial distribution, predictors, and to provide additional information for policymaking and interventions. Methods In this analysis, we applied intra-community correlation to measure the random effect; global Moran’s I to test the nature of variance in the null model; proportional change in variance to check the variance of null and neighborhood in subsequent models. We used STATA 15 for prediction; ArcGIS 10.7 for the spatial distribution of vitamin A supplementation; SaTscan 9.6.1 to specify location of clustering were the applied soft wares. After confirming that the traditional logistic regression cannot explore the variances, we applied multilevel logistic regression to examine predictors where p-value Result The vitamin A coverage was 4,029.22 (44.90%) in Ethiopia in 2016. The distribution followed some spatial geo-locations where Afar, Somali were severely affected (RR = 1.46, P-value < 0.001), some pockets of Addis Ababa (RR = 1.47, p-value Conclusion The distribution of vitamin A coverage was not random as per the EDHS 2016 data. Regions like Afar, Somali, and some pocket areas in Addis inquires immediate interventions. Pastoralist, agrarian, and city administrations were all involved from severe to the lesser coverage in order. Since factors like Place of delivery, education, ANC, media exposure, and having work were showed positive associations, interventions considering awareness, access, and availability of service need more attention than ever.

While past empirical studies have explored associations between types of primary and secondary schools and student academic achievement, outcomes beyond academic performance remain less well-understood. Using longitudinal data from a cohort of children (N = 12,288, mean age = 14.56 years) of nurses, this study examined associations between the types of schools participants attended in adolescence and a wide range of subsequent psychological well-being, social engagement, character strengths, mental health, health behavior and physical health outcomes. Results in this sample suggested little difference between attending private independent schools and public schools across outcomes in young adulthood. There were, however, notable differences in subsequent outcomes comparing homeschooling and public schools, and possibly some evidence comparing religious schools and public schools. Specifically, there was some evidence that attending religious schools versus public schools was associated with a higher likelihood of frequent religious service attendance and becoming registered voters, a lower risk of overweight/obese, fewer lifetime sexual partners, and a higher risk of subsequently being binge drinkers; however, these associations were not robust to correction for multiple testing. Homeschooling compared with public schooling was associated with subsequently more frequent volunteering (ß = 0.33, 95% CI = 0.15, 0.52), greater forgiveness (ß = 0.31, 95% CI = 0.16, 0.46), and more frequent religious service attendance (Risk Ratio [RR] = 1.51, 95% CI: 1.27, 1.80), and possibly also with greater purpose in life, less marijuana use, and fewer lifetime sexual partners, but negatively associated with college degree attainment (RR = 0.77, 95% CI: 0.67, 0.88) and possibly with greater risk of posttraumatic stress disorder. These results may encourage education stakeholders to consider a wider range of outcomes beyond academic performance in decision-making.

Getting admission into a university is highly competitive globally and can be regarded as a mental stressor for some individuals. In Bangladesh, most of the universities allow students to repeat the test, whereas repeat test-taking students are supposed to suffer from psychological issues like burnout because of academic non-achievement in their first attempt. But there is no prior study assessing burnout to the population, which was investigated herein. A cross-sectional study was carried out among a total of 911 Bangladeshi university entrance test-taking students (i.e., 49.5% first-time test-takers). The survey measures included socio-demographics, admission-related issues, and mental health problems (depression, anxiety, and burnout). Of the mental health problems, depression, anxiety, and burnout were assessed by the Patient Health Questionnaire (PHQ-9), Generalized anxiety disorder (GAD-7), and Maslach Burnout Inventory—Student Survey (MBI–SS), respectively. In light of two-dimensional and three-dimensional cutoff schemes of the MBI—SS, about 43.7% and 17.3% of the test-taking students, respectively, were classified to be burnout in the total sample. Additionally, 48.1%, 71.4%, and 49.1% of the students in the total sample reported higher emotional exhaustion, higher cynicism, and lower academic efficacy, respectively. In respect to the student status, two-dimensional burnout (48.0% vs. 39.2%; χ2 = 7.164, p = 0.007), and emotional exhaustion (52.2% vs. 43.9%, χ2 = 6.789, p = 0.034) were significantly higher among the repeat test-taking students. Satisfaction with previous mock tests, depression, and anxiety were the associated factors of burnout in all three samples. Based on the present study, it can be concluded that the university entrance test appearing students are highly prevalent to burnout, and the rate increases with academic non-achievement. As the first study assessing burnout to the population, the findings are anticipated to be helpful for policymaking and further studies both inside and outside Bangladesh.

Why have the effects of COVID-19 been so unevenly geographically distributed in the United States? This paper investigates the role of social capital as a mediating factor for the spread of the virus. Because social capital is associated with greater trust and relationships within a community, it could endow individuals with a greater concern for others, thereby leading to more hygienic practices and social distancing. Using data for over 2,700 US counties, we investigate how social capital explains the level and growth rate of infections. We find that moving a county from the 25th to the 75th percentile of the distribution of social capital would lead to a 18% and 5.7% decline in the cumulative number of infections and deaths, as well as suggestive evidence of a lower spread of the virus. Our results are robust to many demographic characteristics, controls, and alternative measures of social capital.

Background Chhaupadi is a deeply rooted tradition and a centuries-old harmful religio-cultural practice. Chhaupadi is common in some parts of Karnali and Sudurpaschim Provinces of western Nepal, where women and girls are considered impure, unclean, and untouchable in the menstrual period or immediately following childbirth. In Chhaupadi practice, women and girls are isolated from a range of daily household chores, social events and forbidden from touching other people and objects. Chhaupadi tradition banishes women and girls into menstruation huts’, or Chhau huts or livestock sheds to live and sleep. These practices are guided by existing harmful beliefs and practices in western Nepal, resulting in poor menstrual hygiene and poor physical and mental health outcomes. This study examined the magnitude of Chhaupadi practice and reviewed the existing policies for Chhaupadi eradication in Nepal. Methods We used both quantitative survey and qualitative content analysis of the available policies. First, a quantitative cross-sectional survey assessed the prevalence of Chhaupadi among 221 adolescent girls in Mangalsen Municipality of Achham district. Second, the contents of prevailing policies on Chhaupadi eradication were analysed qualitatively using the policy cube framework. Results The current survey revealed that most adolescent girls (84%) practised Chhaupadi in their most recent menstruation. The Chhaupadi practice was high if the girls were aged 15–17 years, born to an illiterate mother, and belonged to a nuclear family. Out of the girls practising Chhaupadi, most (86%) reported social and household activities restrictions. The policy content analysis of identified higher-level policy documents (constitution, acts, and regulations) have provisioned financial resources, ensured independent monitoring mechanisms, and had judiciary remedial measures. However, middle (policies and plans) and lower-level (directives) documents lacked adequate budgetary commitment and independent monitoring mechanisms. Conclusion Chhaupadi remains prevalent in western Nepal and has several impacts to the health of adolescent girls. Existing policy mechanisms lack multilevel (individual, family, community, subnational and national) interventions, including financial and monitoring systems for Chhaupadi eradication. Eradicating Chhaupadi practice requires a robust multilevel implementation mechanism at the national and sub-national levels, including adequate financing and accountable systems up to the community level.

Background While vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need to be understood in order to design appropriate interventions. The aim of this study was to explore the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the acceptance and uptake of COVID-19 vaccines in Bangladesh. Methods We employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model [HBM] and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines. Results The behavioral determinants associated with COVID-19 vaccine acceptance in Dhaka included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the HBM, beliefs about the disease itself were highly predictive of vaccine acceptance, and some of the strongest statistically-significant (p Conclusion An effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. National plans for promoting COVID-19 vaccination should address the barriers, enablers, and behavioral determinants found in this study in order to maximize the impact on COVID-19 vaccination acceptance.

Introduction Since ancient times leprosy has had a negative perception, resulting in stigmatization. To improve the lives of persons affected by leprosy, these negative perceptions need to change. The aim of this study is to evaluate interventions to change perceptions and improve knowledge of leprosy. Methodology/Principal findings We conducted a pre-post intervention study in Fatehpur and Chandauli districts, Uttar Pradesh, India. Based on six steps of quality intervention development (6SQuID) two interventions were designed: (1) posters that provided information about leprosy and challenged misconceptions, and (2) meetings with persons affected by leprosy, community members and influential people in the community. The effect of the interventions was evaluated in a mixed-methods design; in-depth interviews, focus group discussions, and questionnaires containing a knowledge measure (KAP), two perception measures (EMIC-CSS, SDS) and an intervention evaluation tool. 1067 participants were included in Survey 1 and 843 in Survey 2. The interventions were effective in increasing knowledge of all participant groups, and in changing community and personal attitudes of close contacts and community members (changes of 19%, 24% and 13% on the maximum KAP, EMIC-CSS and SDS scores respectively, p, Author summary To improve the lives of persons with leprosy, perceptions about leprosy need to change. The aim of this study is to describe the development and evaluation of interventions (posters and community meetings) to change the perception and improve knowledge of leprosy in Fatehpur and Chandauli districts, India. To measure the effect of the interventions we administered questionnaires before and after the interventions and we conducted 48 interviews and eight group interviews afterwards. In total 1067 participants were included in the first survey and 843 in the second. We found that the interventions resulted in more knowledge of leprosy and in changed community and personal attitudes towards (persons affected by) leprosy. The percentage of participants with adequate knowledge of leprosy was higher in the second survey and the percentage of participants with negative community and personal attitudes was lower. In the interviews, many participants indicated that there had been a change in perception in the community. The more posters participants had seen, the better their knowledge of leprosy and the more positive their attitudes. Findings from this study suggest that contextualized posters and community meetings can be effective in changing the perception of leprosy and increasing leprosy-related knowledge.

Syria has been the main country of citizenship of refugees in Germany since 2013. Syrians face numerous human rights violations in their country that can be accompanied by the experience of potentially traumatic events, loss and displacement. Along the migration process, refugees are exposed to various factors that can have an impact on mental health. The aim of this study is to investigate sociodemographic, war- and flight-related as well as post-migration factors as predictors of posttraumatic stress, depression, somatization and anxiety in Syrian refugees with posttraumatic stress symptoms based in Germany. Data were based on the baseline sample of the “Sanadak” randomized-controlled trial. A total of 133 adult Syrian refugees participated in the study. A questionnaire covered sociodemographic and flight-related questions as well as standardized instruments for symptoms of PTSD (PDS-5), depression (PHQ-9), somatization (PHQ-15), anxiety (GAD-7), generalized self-efficacy (GSE), religiousness (Z-Scale), social support (ESSI) and mental health stigma (SSMIS-SF). Linear regression models were executed to predict mental health outcomes. Sociodemographic predictors (i.e., female sex, higher education) and flight-related predicting factors (i.e., variability of traumatic events) have a negative impact on mental health in Syrian refugees with posttraumatic stress symptoms in Germany. Mental health stigma predicts worse mental health outcomes. Post-migration factors have a major impact on mental health, such as low income, lack of social support, low life satisfaction or a strongly felt connection to Syria. Somatization is an important manifestation of mental distress in Syrian refugees with posttraumatic stress symptoms. Our study showed a range of factors predicting the mental health of Syrian refugees with posttraumatic stress symptoms. Measures to foster mental health could be securing financial security, promoting gender equality and tailored psychosocial programs addressing mental health stigma, loss and social support networks.

The use of contraceptives for family planning improves women’s lives and may prevent maternal deaths. However, many women in low and middle-income countries, including the Pacific region, still die from pregnancy-related complications. While most health centres offer family planning services with some basic contraceptive methods, many people do not access these services. More than 60% of women who would like to avoid or delay their pregnancies are unable to do so. This scoping review identifies and analyses evidence about family planning service provision in Pacific Island Countries and Territories (PICTs), with the aim of better informing family planning services for improved maternal health outcomes in the Pacific. We used Arksey and O’Malley’s scoping review guidelines, supported by Levac, Colquhoun and O’Brien to identify gaps in family planning service provision. Selected studies included peer-reviewed publications and grey literature that provided information about family planning services from 1994 to 2019. Publication data was charted in MS Excel. Data were thematically analysed and key issues and themes identified. A total of 45 papers (15 peer-reviewed and 30 grey literature publications) were critically reviewed. Five themes were identified: i) family planning services in the Pacific; ii) education, knowledge and attitudes; iii) geographical isolation and access; iv) socio-cultural beliefs, practices and influences; and v) potential enabling factors for improved family planning, such as appropriate family planning awareness by health care providers and services tailored to meet individual needs. While culture and religion were considered as the main barriers to accessing family planning services, evidence showed health services were also responsible for limiting access. Family planning services do not reach everyone. Making relevant and sustainable improvements in service delivery requires generation of local evidence. Further research is needed to understand availability, accessibility and acceptability of current family planning services for different age groups, genders, social and marital status to better inform family planning services in the Pacific.

Research on Muslim minorities in western societies has mainly focused on offline behavior, such as mosque attendance, whereas little is known about their presence in the online world. This study explores the online visibility and activities of all (478) mosques in the Netherlands. We collected data on personal websites and four social media platforms (Facebook, Twitter, Instagram and YouTube). The majority of mosques have a website (52%) and an account on Facebook (61%). Less often used are Twitter (17%), Instagram (17%) and YouTube (19%). On social media platforms, mosques strongly differ in their activity and number of followers. We find evidence to suggest that Salafist mosques, which tend to have a strict ideology, are more active on Twitter and YouTube, and also attract a larger share of followers on Facebook than non-Salafist mosques. Our more fine-grained analysis on Twitter shows that Salafist mosques in the Netherlands cluster together. Followers of Salafist mosques make up a community of users who are mainly connected to each other ("bonding ties"), and much less so to other users ("bridging ties"). We conclude with a discussion of opportunities for studying the online presence and activities of mosques and Muslims in western societies. Funding Agencies|Royal Netherlands Academy of Arts and Sciences (Ammodo KNAW award 2015)

This study investigates the impact of unconditional cash and food (UCF) assistance on the monthly contraceptive expenditure of rural households in coastal Bangladesh using a fuzzy regression discontinuity design (RDD). Eligibility for UCF assistance was based on the running variable of land ownership in acres. We used eligibility as an instrumental variable to estimate the local average treatment effect of UCF assistance on contraceptive expenditures. The results show that UCF assistance results in increases in monthly contraceptive expenditures.

BackgroundAn ethnobotanical expedition was conducted to document the traditional ethnobotanical (TEB) uses of wild flora of Dawarian and Ratti Gali villages of District Neelam, Azad Jammu and Kashmir (AJK) Pakistan. District Neelam has rich plant diversity and is hub of many endemic plant species while the study areas are not yet explored. The research area: Dawarian and Rati Gali (DRG) area is mountaineous terrain and villages are located on far and farther distances. DRG area has rich biocultural and plant diversity comprising of different ethnic groups of Kashmir state. The current research was aimed to explore and document traditional medicines (TEMs) and other domestic and commercial uses of wild plants. This study will assist to evaluate conservation and commercial worth of wild flora which can be potential candidate for drug discovery through ethnopharmacological analysis.MethodsThe current quantitative ethnobotanical research was carried out in 2018 by interviewing 150 indigenous informants (90 male and 60 female) of DRG area using questionnaire applying structured and semi structured interview methodology. Data analysis was analyzed by using quantitative ethnobotanical statistical tools such as fidelity level (FL), informant consensus factor (ICF), Spearman’s rank correlation (SRC) and data matrix ranking (DMR).ResultsThe indigenous people of DRG area use wild plants in their daily life to cope life necessities i.e. food, vegetables, fodder, fuel, shelter, timber and herbal medicines. TEMs are primarily used to cure different infirmities like diabetics, asthma, dysentery, constipation, cold, fever, joint pain, wound healing, cancer, cardiovascular disorders, epilepsy, kidney infections and many types of skin diseases. Current study revealed the data of 103 wild plants species belonging to 46 plant families from selected areas of District Neelum, AJK. Results depicted that Asteraceae ranked 1st(12 plants spp). Among plant parts used leaf ranked 1st(18%), followed by seed (17%) and root (13%). While prevalent form recipe mode was decoction (20%), followed by powder (17%) and extract (14%) and fodder was highest (37%) EB use-form fodder, followed by food (32%) and fuel (17%). Quantitative ethnobotanical analysis (QEA) was carried to find the reliability and novelty of the study. Five plant species includingBerberis lyceum(FL = 97.78%),Isodon rugosus(FL = 95.71%),Saussurea lappa(FL = 94.74%),Aconitum heterophyllum(FL = 92.71%) andTaxus baccata(91.58%) had shown high fidelity level which confirmed that these plants have high medicinal worth in study area. The highest value (0.94) of ICF was for diseases group “tuberculosis and leucorrhea”, followed by stomachache and flatulence (0.93), diabetics and blood pressure (0.92) and asthma and chest infections (0.88). For other uses fuel with ICF (0.83) ranked first and second was hedging and thatching (ICF = 0.82) where people use plants or their parts for construction. Spearman’s rank correlation (SRC) test indicated that number of TEB uses increases if number of species is increased. Jaccard index (JI) analysis depicted that 56.31% plants are being used as TEMs which are first time explored from the study area. While 26.21% plants are being used in different TEB uses which are different from past cited literature. These novel findings of research indicate that wild flora of the study area has great potential for novel drug discovery and provision of materialist services for the indigenous communities.ConclusionThe present research revealed that TEMs uses of 58 plants are novel being first time reported from the study area (DRG) of District Neelam of AJK. The results showed that plants likeAcer cappadocicum,Ajuga bracteosaandSwertia paniculataare used to cure diabetes,Viscum album,Viola canescens,Taxus baccataare used for cure of cancer,Isodon rugosus,Polygala chinensisare used in TEMs for treating cardiovascular disorders andAnaphalis triplinervisis used for epilepsy.Berberis lyceum,Ajuga bracteosa,Aconitum heterophyllum,Bistorta amplexicaule,Saussurea lapaandJurinea dolomiaeaare severely threatened and there is urgent need to do conservation measures for available of valuable MPs to the indigenous communities for life necessities and for future research. The current study will also be useful addition in ethnobotanical database, preservation of traditional culture and drug discovery and drug development through future ethnopharmacological research.

Background Transcultural self-efficacy is a nurse’s perception of his or her own ability to accomplish activities effectively for culturally diverse clients. This self-efficacy may be affected by different factors, either positively or negatively. Quality care can be improved significantly when nurses provide patient-centered care that considers cultural background of the patients. Thus, this study aimed to assess perceived transcultural self-efficacy and its associated factors among nurses working at Jimma Medical Center. Methods Facility-based cross-sectional study with both quantitative and qualitative methods of data collection was conducted among 244 nurses and 10 key informants from 20 May to 20 June 2020. Bivariate and multivariable linear regression analyses were used to identify factors associated with transcultural self-efficacy. Qualitative data were coded and analyzed thematically. Quantitative results were integrated with qualitative results. Results A total of 236 nurses participated in the study making the response rate 96.7%. The mean transcultural self-efficacy score was 2.89 ± 0.59. Sex, work experience, intercultural communication, cultural sensitivity, interpersonal communication, and cultural motivation were significantly associated with transcultural self-efficacy. Ten in-depth interviews were conducted and the findings of qualitative data yielded four major themes. Conclusion The level of perceived transcultural self-efficacy was moderate among nurses. Transcultural self-efficacy of nurses varies with several factors including sex, experience, intercultural communication, cultural sensitivity, interpersonal communication, and cultural motivation. This calls for the need to offer transcultural nursing training for nurses.

Background There is a wealth of literature exploring the experiences of family caregivers of people with severe mental illness (SMI) in western countries, however, this topic has been neglected in the Middle East, despite families being the main source of caregiving in this context. The purpose of this review was to conduct a systematic review and qualitative meta-synthesis to explore the experiences of family caregivers living in countries in the Middle East caring for a relative with severe mental illness. Methods A systematic review and meta-synthesis were conducted, to comprehensively gain a thorough and detailed overview of what is known about family caregivers’ experiences from published qualitative research in the Middle East geographical area from inception to May 2021. The review protocol was pre-registered with PROSPERO (Ref: CRD42020165519). Results The review identified twelve qualitative studies that explored caregivers’ experiences of caring for relatives with SMI in Middle East countries. Family caregivers’ experiences were captured under seven overarching themes. The participants across all studies reported negative consequences of providing care, increased burden and emotional distress. Many experienced issues with family/marital relationships and stigmatizing attitudes and behaviours from their communities. Caregivers expressed the need for increased support which was perceived to have a critical role in improving family caregivers’ experiences. Conclusions The meta-synthesis revealed many challenges and issues that affect caregivers of people with SMI in the Middle East. Family caregivers experienced distress and burden, and reported significant impact on their psychological well-being. Their experiences highlight the urgent need to provide more support for family caregivers in Middle East countries.

There is ample research supporting White’s (1967) thesis, which postulates that religion and religious belief inhibit ecological concerns. This study thus seeks to explore the relationship between individuals’ acceptability for harming animals as one representation of ecological concern (measured using Animal Issue scale (AIS)) and their religious belief (measured using Religious Orientation Scale (ROS)) and ethical ideology (measured using Ethical Position Questionnaire (EPQ)). The study surveyed 929 Muslim teachers and school staff in East Java, Indonesia. We found that ROS correlates with EPQ whereby intrinsic personal (IP) relates with idealism while extrinsic social religious orientation (ES)—where religion is perceived as an instrument for social gain, membership and support—relates with relativism. However, using multiple regression analysis to examine both EPQ and ROS relation to acceptability for harming animals suggests mixed results. We found that, idealism and IP relate to a lower acceptability for harming animals, while relativism and ES correlate to a higher acceptability for harming animals. In another model where we calculate all the main variables with all the demographical and other determinants, we found that only ROS consistently relates to acceptability for harming animals. Additionally, we identify, explain and discuss significant demographic determinants along with this study’s limitations.

Outdoor Residual Spraying (ORS) technique is a complementary preventive measure for dengue. The alarming number of dengue cases in Malaysia requires an alternative method to control dengue besides the traditional method such as fogging. However, the introduction of new technologies depends on social acceptance. Therefore, this study was important to determine the factors that influence stakeholders’ attitudes towards the ORS and the moderating factor. A validated instrument was used to randomly interview 399 respondents representing two stakeholder groups which consist of scientists, and the public in Klang Valley, Malaysia. The findings revealed that the stakeholders claimed to have a high degree of religiosity, a high level of trust in the key players, perceived ORS as having high benefits, and displayed highly positive attitudes towards the ORS. The attitudes model towards the ORS model was developed using the SmartPLS software version. The perceived benefit was endorsed as the most important direct predictor of attitudes towards the ORS (ß = 0.618, P, Author summary The ups and downs of dengue cases require the Outdoor Residual Spraying (ORS) technique as an alternative method to control dengue in Malaysia. However, the introduction of ORS depends on stakeholders’ acceptance. Here, the purpose of this study was to determine the factors that predict attitude to ORS and the role of religiosity as a moderator. The results indicate positive responses for implementing the ORS as a suitable technique to control dengue in Malaysia. Perceived benefit emerged as the most significant direct predictor of attitude towards the ORS (β = 0.618, p

The pace of decline in fertility rates in sub-Saharan Africa appears to have slowed or stalled in the last few decades. This study examines the socioeconomic associated with cumulative fertility in Ghana. Negative binomial regression models were used to estimate determinants of cumulative fertility using data from the Ghana Demographic and Health Surveys of 2003, 2008, and 2014. The composition of children ever born by women did not change considerably over the study periods. Socioeconomic disparities in educational attainment, household wealth, employment, and employer status are significantly associated with cumulative fertility risks in Ghana. The current age of women, age at sexual debut, and marital status, among others, are also linked to cumulative fertility levels. Place and region of residence are also linked to fertility in Ghana. Cumulative fertility levels in Ghana are underscored by considerable socioeconomic disparities among women of reproductive age. Fertility regulation policies should hinge on improving the socio-economic wellbeing of women in Ghana.

Background A woman’s ability to achieve her preferred family size is critical in addressing issues of high fertility in sub-Saharan Africa. The socio-cultural context in sub-Saharan Africa presents some difficulty for the attainment of preferred fertility for many women. Few studies in sub-Saharan Africa have examined the extent to which women are unable to achieve their preferred family sizes. This study, therefore, examines the factors that are associated with the non-attainment of women’s preferred fertility by the end of their reproductive years. Data and methods The study analyzed pooled cross-sectional data with a sub-sample of 1,888 currently married women aged 45–49 years from five rounds of the Ghana Demographic and Health Survey, 1993 to 2014. Test of associations and multinomial logistic regression analysis were used to examine the predictors of underachieved and overachieved fertility relative to achieved fertility. Results The results indicate that 44 per cent of the women recorded overachieved fertility while about 36 per cent underachieved their fertility. Partner wants more, experiencing child loss and married more than once were significantly associated with overachieved fertility. Nonetheless, increased years of a woman’s education and delaying her at first birth were negatively associated with overachieved fertility. On the other hand, underachieved fertility was significantly associated with having a partner with fewer fertility preference, being of the Islamic faith and ever use of modern contraception. Conclusion Partner’s fertility preference, child loss experience, marrying more than once and ever use of modern contraception were important predictors of a woman’s inability to achieve her fertility preference. Policies to regulate men’s fertility behaviour, delaying age at first birth, use of modern contraception, encouraging longer years of education, and reducing infant and child mortality are important strategies to achieve fertility preference in Ghana.

This paper sets out to briefly explore the definitions of two interrelated subfields of cultural anthropology; psychological anthropology and medical anthropology. This exploration will argue that culture and the individual are intimately intertwined. The theoretical evolution within psychological anthropology will be presented, from the bio-moral classifications of the ‘primitive’ to modern ‘experience near’ ethnographies, and fluid understanding of personhood. Theoretical and methodological approaches to mental health will be discussed briefly. Finally, the conclusion will ask the question: what is the future for medical and psychological anthropology?

Background Hypertension (HPT) is an essential public health problem affecting both lower and middle-income countries disproportionately. Evidence suggests that HPT is the leading risk factor for cardiovascular diseases and chronic kidney disease. Yet, challenges faced by patients with HPT in Ghana are not sufficiently explored. This study, documents the challenges patients with HPT face in Ghana. Methods We used an explorative descriptive qualitative design. Face-to-face in-depth interviews were conducted with 15 patients with HPT. Interviews were recorded and transcribed verbatim. A thematic content analysis procedure was followed to analyse the data. Results Four main themes emerged from interviews; three of which pertained to dimensions of challenges and a fourth which pertained to coping strategies. These include: [1] impairment in physical activities and mobility constraints [2]. Psychological challenges such as suicidal ideations, sadness, fear, anxiety, and reduced sexual affection [3]. Socio-economic challenges identified include loss of friends and social network, difficulty in job demands, and financial burden, and [4] coping strategies such as health system support, social support, and religiosity were identified. Conclusion Patients with HPT experience an array of challenges. We suggest that health care facilities incorporate post HPT diagnosis counseling sessions for HPT patients in the study area. Also, the National Health Insurance Authority (NHIA) should re-examine their scope of services; thus, drugs, laboratory services, and electrocardiogram services to avoid the issue of co-payment. Collaboration between healthcare professionals and family relations of patients with HPT ought to also be strengthened to ensure optimal care.

Religious rituals are associated with health benefits, potentially produced via social bonding. It is unknown whether secular rituals similarly increase social bonding. We conducted a field study with individuals who celebrate secular rituals at Sunday Assemblies and compared them with participants attending Christian rituals. We assessed levels of social bonding and affect before and after the rituals. Results showed the increase in social bonding taking place in secular rituals is comparable to religious rituals. We also found that both sets of rituals increased positive affect and decreased negative affect, and that the change in positive affect predicted the change in social bonding observed. Together these results suggest that secular rituals might play a similar role to religious ones in fostering feelings of social connection and boosting positive affect.

Background Refugees are at increased risk for COVID-19 infection in part due to their living conditions, which make it harder to adopt and adhere to widely accepted preventive measures. Little empirical evidence exists about what refugees know about COVID-19 and what they do to prevent infection. This study explored what refugee women and their health care workers understand about COVID-19 prevention, the extent of their compliance to public health recommendations, and what influences the adoption of these measures. Methods In October 2020, we conducted 25 in-depth interviews with facility and community health care staff (n = 10) and refugee women attending antenatal and postnatal care services (n = 15) in Eastleigh, Nairobi. Findings While researchers found a high level of awareness about COVID-19 and related prevention and control measures among refugee women, various barriers affected compliance with such measures, due in part to poverty and in part to rampant misconceptions informed by religious beliefs and political narratives about the virus. Conclusions These findings indicated that Kenya’s Ministry of Health needs to institute a concerted and continuous education program to bring refugee communities up to speed about COVID-19 and its prevention. In addition to disseminating information about the need to wear masks and repeatedly wash hands, supplies—masks, soap and access to water—need to be made available to poor refugee communities. Future research could explore which measures for disseminating factual information work best in refugee populations with different cultural norms and how best to target interventions to these groups.

BackgroundDue to the dramatic measures accompanying isolation and the general uncertainty and fear associated with COVID-19, patients and relatives may be at high risk for adverse psychological outcomes. Until now there has been limited research focusing on the prevalence of psychological distress and associated factors in COVID-19 patients and their relatives. The objective of our study was to assess psychological distress in COVID-19 patients and their relatives 30 days after hospital discharge.MethodsIn this prospective observational cohort study at two Swiss tertiary-care hospitals we included consecutive adult patients hospitalized between March and June 2020 for a proven COVID-19 and their relatives. Psychological distress was defined as symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS), i.e., a score of ≥8 on the depression and/or anxiety subscale. We further evaluated symptoms of post-traumatic stress disorder (PTSD), defined as a score of ≥1.5 on the Impact of Event Scale-Revised (IES-R).ResultsAmong 126 included patients, 24 (19.1%) had psychological distress and 10 (8.7%) had symptoms of PTSD 30 days after hospital discharge. In multivariate logistic regression analyses three factors were independently associated with psychological distress in patients: resilience (OR 0.82; 95%CI 0.71 to 0.94; p = 0.005), high levels of perceived stress (OR 1.21; 95%CI 1.06 to 1.38; p = 0.006) and low frequency of contact with relatives (OR 7.67; 95%CI 1.42 to 41.58; p = 0.018). The model showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.92. Among 153 relatives, 35 (22.9%) showed symptoms of psychological distress, and 3 (2%) of PTSD. For relatives, resilience was negatively associated (OR 0.85; 95%CI 0.75 to 0.96; p = 0.007), whereas perceived overall burden caused by COVID-19 was positively associated with psychological distress (OR 1.72; 95%CI 1.31 to 2.25; pConclusionA relevant number of COVID-19 patients as well as their relatives exhibited psychological distress 30 days after hospital discharge. These results might aid in development of strategies to prevent psychological distress in COVID-19 patients and their relatives.

Background and aims This online cross-sectional study investigated the severity of depressive, anxiety, and stress symptoms among university students and determined the association between various factors and the levels of depressive and anxiety symptoms in response to the coronavirus disease 2019 (COVID-19) pandemic after the movement control order (MCO) was lifted. Methods A total of 316 participants were administered a self-report questionnaire that collected data on sociodemographic attributes, personal characteristics, COVID-19-related stressors, religious coping, and clinical characteristics. In addition, the Multidimensional Scale of Perceived Social Support (MSPSS) and the 21-item Depression, Anxiety and Stress Scale (DASS-21) were administered. Results Regarding depression, 15.5%, 11.7%, and 9.2% of the participants reported mild, moderate, and severe to extremely severe depression, respectively. For anxiety, 7.0%, 16.5%, and 13.2% of the respondents had mild, moderate, and severe to extremely severe anxiety, respectively. Moreover, 26.3% of participants had mild stress, 9.5% had moderate stress, and 6.6% had severe to extremely severe stress. The multiple linear regression model revealed that frustration because of loss of daily routine and study disruption and having preexisting medical, depressive, and anxiety disorders were associated with elevated depressive symptoms, while a greater degree of family and friends social support was associated with less depressive symptoms after adjusting for age, gender, and marital status. It was also found that frustration because of study disruption and having preexisting medical, depressive, and anxiety disorders were associated with elevated anxiety symptoms, while being enrolled in medicine-based courses and having a greater degree of family support were factors associated with less anxiety symptoms after adjusting for age, gender, and marital status. Conclusion There is a need to conduct a longitudinal study in the future to confirm the causal relationship between the significant predictive factors and depression and anxiety identified in this study, and maintenance of a persistent flow of academic activities and social interaction may be of utmost importance to safeguard the mental wellbeing of university students.

Despite a total prohibition on the practice of female genital mutilation (FGM), young girls continue to be victims in some African countries. There is a paucity of data on the effect of FGM practice in two generations in Africa. This study assessed the current practice of daughters’ FGM among women living in 14 FGM-prone countries in Africa as a proxy to assess the future burden of FGM in the continent. We used Demographic and Health Surveys data collected between 2010 and 2018 from 14 African countries. We analyzed information on 93,063 women-daughter pair (Level 1) from 8,396 communities (Level 2) from the 14 countries (Level 3). We fitted hierarchical multivariable binomial logistic regression models using the MLWin 3.03 module in Stata version 16 at p

Background Leprosy and leprosy-related stigma can have a major impact on psychosocial wellbeing of persons affected and their family members. Resilience is a process that incorporates many of the core skills and abilities which may enable people to address stigma and discrimination. The current study aimed to develop and pilot an intervention to strengthen individual and family resilience against leprosy-related discrimination. Methodology We used a quasi-experimental, before-after study design with a mixed methods approach. The 10-week family-based intervention was designed to strengthen the resilience of individuals and families by enhancing their protective abilities and capacity to overcome adversity. The study was conducted in two sites, urban areas in Telangana state, and in rural areas in Odisha state, India. Persons affected and their family members were included using purposive sampling. Two questionnaires were used pre-and post-intervention: the Connor-Davidson Resilience Scale (CD-RISC, maximum score 100, with high scores reflecting greater resilience) and the WHOQOL-BREF (maximum score of 130, with higher scores reflecting higher quality of life). In addition, semi-structured interviews were conducted post-intervention. Data were collected at baseline, a few weeks after completion of the intervention, and in the Odisha cohort again at six months after completion. Paired t-tests measured differences pre- and post- intervention. Qualitative data were thematically analysed. Findings Eighty participants across 20 families were included in the study (23 persons affected and 57 family members). We found a significant increase in CD-RISC scores for persons affected and family members from Odisha state (baseline 46.5, first follow-up 77.0, second follow-up 70.0), this improvement was maintained at six-month follow-up. There was no increase in CD-RISC scores post-intervention among participants from Telangana state. WHOQOL-BREF scores were significantly higher at follow-up for persons affected in both states, and for family members in Odisha state. No families dropped out of the study. In the qualitative feedback, all participants described drawing benefit from the programme. Participants especially appreciated the social dimensions of the intervention. Conclusion This pilot study showed that the 10-week family-based intervention to strengthen resilience among persons affected by leprosy and their family members was feasible, and has the potential to improve resilience and quality of life. A large-scale efficacy trial is necessary to determine the effectiveness and long-term sustainability of the intervention., Author summary The current study aimed to develop and pilot an intervention to strengthen individual and family resilience against leprosy-related discrimination. The study was conducted in two sites, urban areas in Telangana state, and in rural areas in Odisha state, India. We assessed resilience and quality of life with two questionnaires (the CD-RISC and WHOQOL-BREF) pre-and post-intervention. In addition, semi-structured interviews were conducted post-intervention. Data were collected at baseline, a few weeks after completion of the intervention, and in Odisha state again at six months after completion. Eighty participants across 20 families were included in the study (23 persons affected and 57 family members). We found a significant increase in resilience scores for persons affected and family members from Odisha state, this improvement was maintained at six-month follow-up. There was no increase in resilience scores post-intervention among participants from Telangana state. Quality of life scores were significantly higher at follow-up for persons affected in both states, and for family members in Odisha state. Participants especially appreciated the social dimensions of the intervention. This pilot study showed that the 10-week family-based intervention to strengthen resilience among persons affected by leprosy and their family members was feasible, and has the potential to improve resilience and quality of life.

Interventions to shift the behaviour of consumers using unsustainable wildlife products are key to threatened species conservation. Whether these interventions are effective is largely unknown due to a dearth of detailed evaluations. We previously conducted a country-level online behaviour change intervention targeting consumers of the Critically Endangered saiga antelope (Saiga tatarica) horn in Singapore. To evaluate intervention impact, we carried out in-person consumer surveys with >2,000 individuals pre- and post-intervention (2017 and 2019), and 93 in-person post-intervention surveys with traditional Chinese medicine (TCM) shopkeepers (2019). The proportion of self-reported high-usage saiga horn consumers in the target audience (Chinese Singaporean women aged 35–59) did not change significantly from pre- to post-intervention (24.4% versus 22.6%). However, post-intervention the target audience was significantly more likely than the non-target audience to accurately recall the intervention message and to report a decrease in saiga horn usage (4% versus 1% reported a behaviour change). Within the target audience, high-usage consumers were significantly more likely than lower-usage consumers to recall the message and report a behaviour change. Across respondents who reported a decrease in saiga horn usage, they cited the intervention message as a specific reason for their behaviour change significantly more than other reasons. Additionally, across all respondents, the belief that saiga is a common species in the wild decreased significantly from pre- to post-intervention. TCM shopkeepers, however, cited factors such as price and availability as the strongest influences on saiga horn sales. In sum, the intervention did significantly influence some consumers but the reduction of high-usage consumer frequency was not significant at the population level. We explore reasons for these findings, including competing consumer influences, characteristics of the intervention, and evaluation timing. This work suggests our intervention approach has potential, and exemplifies a multi-pronged in-person evaluation of an online wildlife trade consumer intervention. Published version This research was funded by Oxford University through the Oxford Martin Programme on the Illegal Wildlife Trade (grant held by author EJMG). The funder provided support in the form of salaries for authors (EJMG, DV) and fieldwork costs but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section of the manuscript.