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Abstract Persons with mental illness (PWMI) continue to encounter stigma from the public with negative outcomes. Recent stigma discourse points to power differentials as key in shaping stigma related to mental illness within social settings. The perceived social injustice towards PWMI is known to exist both anecdotally and in documented discourses. Stigma constitutes the product of public attitudes and behaviors that characterize labeling, stereotyping, prejudice, cognitive separation, status loss, and discrimination that lead to responses that may include stress and esteem‐related appraisal of experienced, anticipated, perceived, or personal endorsement of societal actions that are anchored by existing power relational differentials. The potential consequence of such societal injustices (unfair treatments) towards PWMI may result in stigma and its sequels, including low socioeconomic status, stress, low self‐esteem, unemployment, homelessness, exclusion, and human rights abuse. This paper proposes an Interprofessional Health Education framework and discusses the implications of such unfair social treatments for Professional knowledge development and practice among healthcare professionals, with the view to improving collaboration and patient care outcomes. A more collaborative model of care, where service users and clinicians regard each other as knowledgeable with shared power to achieve healthy outcomes, empowers patients even more in areas where they fall short.

Abstract With increasing human-induced environmental degradation, women's nature-based livelihood activities are threatened. In semi-arid northern Ghana, shea processing (i.e., shea butter, a derivative of shea nut from the shea tree), a vital women-dominated economic activity, is at risk as naturally occurring shea trees continue to decline in numbers and productivity. The decline of the shea tree's number and productivity and the ensuing biodiversity loss have sparked conservation efforts by governments and local communities. This includes community-led conservation models, which have recently gained traction in the Global South. Ghana implemented the Community Resource Management Areas (CREMA)—a community-led conservation model to improve biodiversity and ecosystem services, including shea trees conservation in response to climate change. Research has not explored the impacts of community-led conservation efforts on women’s nature-based livelihoods in Ghana. Using a mixed-methods approach involving surveys (n = 517) and focus group discussions (n = 8), this study explored shea productivity outcomes under CREMAs. Findings show that women residing in CREMAs had significantly better shea harvesting outcomes than those outside CREMAs (α = −53.725; P

Abstract Background Research indicates that women in polygamous relationships may be exposed to unique sexual and reproductive health challenges. However, there are very few studies that examine whether polygamy is associated with safe sex negotiation among married women in sub-Saharan Africa, including Cameroon. Methods Using the 2018 Cameroon Demographic and Health Survey, we apply logistic regression analysis to compare two indicators of safe sex negotiation (i.e., the ability to ask for condom use and refuse sex against their partner) between polygamous (n = 1,628) and monogamous (n = 5,686) women aged 15–49 years old. Results We find that 67% and 50% of married women can ask for condom use and refuse sex against their partner, respectively. Multivariate analysis further reveals that women in polygamous relationships are less likely to report they can ask for condom use (OR = 0.71, p

The COVID-19 pandemic had a substantial impact on older adults, especially in Sub-Saharan Africa (SSA). To support older adults during this time, non-governmental organizations (NGOs) coordinated programs to help provide for basic needs related to food and water security and healthcare. This research explores the attitudes, perceptions and experiences of NGO staff and volunteers who provided support to older adults in SSA in rural East Africa during the COVID-19 pandemic. In-depth interviews (n = 28) were conducted with NGO staff and volunteers in Uganda and Ethiopia between September and December of 2022. Overall, NGO staff and volunteers reported high levels of knowledge surrounding the COVID-19 pandemic and stated that one positive of the COVID-19 pandemic was the improved hygiene practices. However, the NGO staff and volunteers also reported that the pandemic and the associated public health measures exacerbated pre-existing social inequalities, such as increasing pre-existing levels of food insecurity. The exacerbation of pre-existing social inequalities may be one reason for the increased reliance on NGO services. The learnings from the COVID-19 pandemic and associated public health measures can be utilized to create targeted strategies to mitigate the negative impacts of future public health crises on vulnerable populations.

Food waste is a routine and increasingly growing global concern that has drawn significant attention from policymakers, climate change activists and health practitioners. Amid the plurality of discourses on food waste-health linkages, however, the health risks from food waste induced emissions have remained under explored. This lack of evidence is partly because of the lack of complete understanding of the effects of food waste emissions from household food waste on human health either directly through physiological mechanisms or indirectly through environmental exposure effects. Thus, this systematic review contributes to the literature by synthesizing available evidence to highlight gaps and offers a comprehensive baseline inventory of food waste emissions and their associated impacts on human health to support public health decision-making. Four database searches: Web of Science, OVID(Medline), EMBASE, and Scopus, were searched from inception to 3 May 2023. Pairs of reviewers screened 2189 potentially eligible studies that addressed food waste emissions from consumers and how the emissions related to human health. Following PRISMA guidelines, 26 articles were eligible for data extraction for the systematic review. Findings indicate that emissions from food waste, such as hydrogen sulphide, ammonia, and volatile organic carbons, can affect human endocrine, respiratory, nervous, and olfactory systems. The severity of the human health effects depends on the gaseous concentration, but range from mild lung irritation to cancer and death. This study recommends emission capture technologies, food diversion programs, and biogas technologies to reduce food waste emissions.

Dietary diversity is crucial in ensuring food and nutrition security. In low-middle-income countries, people frequently prioritize the quantity of food they consume over its quality due to a lack of availability and financial limitations. As a result, achieving dietary diversity is often overlooked in favor of ensuring adequate caloric intake. Through a social cognitive theory perspective, our study examines the relationship between food demonstrations and household dietary diversity in Ghana's Upper West Region utilizing cross-sectional survey data from 517 smallholder farmer households. The results from ordered logistic regression presented in odds ratio (OR) show that participating in food demonstrations (OR: 2.585, p

Introduction. Stigma is noted to be one of the greatest barriers to the recovery of persons with mental health problems. Stigma has been acknowledged as both an individual and a social orchestration that has an overpowering impact on the social standing of marginalized persons in a society. This study examined the extant literature to ascertain if any evidence(s) suggested a relationship between perceived public attitudes, religious and cultural beliefs, and structural violence in perpetuating stigma against persons with mental illness. Method. We applied a five-step scoping review framework by Arksey and O’Malley to examine evidence in the literature that suggests relationships between perceptions, religious and cultural beliefs, and structural violence in perpetuating stigma. The researchers systematically conducted a literature search from six databases, including CINAHL, Ovid MEDLINE(R), ProQuest Dissertations & Theses Global, Sociology Collection, PsycINFO, and Sociological Abstracts, using search terms that included stigma, mental illness, perception, religious and cultural beliefs, and structural violence. Results. An initial search in six databases yielded 1223 articles. Checking in the Google Search engine yielded 30 more articles. After removing 25 duplicates, 1198 articles remained for title and abstract screening. After a full-text review, 1143 articles were removed. Overall, 30 articles were selected for data extraction. Thematic analysis of the extracted data resulted in three main themes. These include perceptions about mental illness, perceptions about stigma and discrimination, and forms of stigma perception. Conclusion. This study revealed that individual perceptions of public attitudes contributed to their construction of stigma. It is incumbent on everyone to play their part in mitigating all the negative outcomes that stigma brings, especially to persons with mental illness.

Over the past few years, food insecurity has been increasing globally due to the COVID-19 pandemic, climate change, economic downturns and conflict and a number of other intersecting factors. Older adults residing in low- and middle-income countries are more vulnerable to food insecurity. While the impacts of food insecurity on physical health outcomes have been thoroughly researched, the effect on mental health outcomes remains under-researched, especially among older adults. Hence, this systematic review aims to investigate existing literature to assess how food insecurity impacts the mental health of older persons residing in LMICs. A systematic search of six databases and Google for studies was conducted. The search was limited to studies written in English and published between 2000 to the present. We identified 725 studies, out of which 40 studies were selected for a full-text review and 12 studies were included for a final analysis. The significant finding in all the included studies was that food insecurity is associated with the worsening mental health of older adults. We also found a complex interplay of factors such as gender, age, rural/urban and health conditions associated with the aggravation of several mental health outcomes. The findings of this study illuminate the need for improved food programs to improve food security and, consequently, mental health among older adults.

Climate change and non-communicable diseases (NCDs) are considered the 21st Century's major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases-Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases were automatically removed as duplicates (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular.

BackgroundMalaria is a substantial health burden in Ghana, particularly among children. Despite the availability of malaria vaccines, uptake remains low. Notwithstanding, there is a paucity of nationally representative studies on the factors driving hesitance towards the new malaria vaccine. In response, this study, guided by the Theory of Planned Behaviors (TPB), seeks to understand the determinants of child malaria vaccine uptake in Ghana to inform strategies for improving coverage.Materials and methodsWe employed multiple regression model to examine the association between maternal awareness, socioeconomic status, ethnicity, geographical location, and vaccine uptake using data from the 2019 Ghana Malaria Indicator Survey (MIS).ResultsMaternal awareness of vaccine (OR = 2.200; PConclusionsEnhancing awareness through education campaigns can improve child malaria vaccine coverage. Observing socioeconomic disparities in uptake and ensuring equitable access to vaccines are vital. Tailored strategies considering ethnic background and geographical location, can as well enhance acceptance of the vaccine. This study provides valuable insights for developing effective strategies to reduce the burden of malaria in children and improve coverage of uptake. This study underscores the need to improve parental awareness and the relevance of the vaccine in preventing child mortality.

Abstract Background In Canada, heterosexual African, Caribbean and Black (ACB) men tend to suffer a disproportionate burden of HIV. Consequently, studies have examined the underlying contributors to this disparity through the nexus of behavioral and structural factors. While findings from these studies have been helpful, their use of deficit and risk models only furthers our knowledge of why ACB men are more vulnerable to HIV infection. Thus far, there is a dearth of knowledge on how heterosexual ACB men mobilize protective assets to promote their resilience against HIV infection. Methods As part of a larger Ontario-based project called weSpeak, this study examined how ACB men acquire protective assets to build their resilience to reduce their HIV vulnerability. We analyzed three focus group discussions (n = 17) and 13 in-depth interviews conducted with ACB men using NVivo and a mixed inductive-deductive thematic analyses approach. Results The findings show that ACB men mostly relied on personal coping strategies, including sexual abstinence, to build resilience against HIV. Interpersonal resources such as family, friends, and religious communities also played an important role in constructing ACB men’s resilience. ACB men bemoaned their lack of access to essential institutional resources, such as health services, that are important in managing HIV adversity. Conclusion Based on these findings, there is an urgent need for HIV policy stakeholders, including service providers, to engage the ACB community in the design of intervention programs. Additionally, addressing the socioeconomic disadvantages faced by ACB communities will increase the capacity of ACB men to develop resilience against HIV.

In semi-arid Northern Ghana, smallholder farmers face food insecurity and financial risk due to climate change. In response, the Village Savings and Loan Association (VSLA) model, a community-led microfinance model, has emerged as a promising finance and climate resilience strategy. VSLAs offer savings, loans, and other financial services to help smallholder farmers cope with climate risks. In northern Ghana, where formal financial banking is limited, VSLAs serve as vital financial resources for smallholder farmers. Nevertheless, it remains to be seen how VSLAs can bridge financial inclusion and climate resilience strategies to address food insecurity. From a sustainable livelihoods framework (SLF) perspective, we utilized data from a cross-sectional survey of 517 smallholder farmers in northern Ghana’s Upper West Region to investigate how VSLAs relate to food insecurity. Results from an ordered logistic regression show that households with membership in a VSLA were less likely to experience severe food insecurity (OR = 0.437, p < 0.01). In addition, households that reported good resilience, owned land, had higher wealth, were female-headed, and made financial decisions jointly were less likely to experience severe food insecurity. Also, spending time accessing the market increases the risk of severe food insecurity. Despite the challenges of the VSLA model, these findings highlight VSLAs’ potential to mitigate food insecurity and serve as a financially resilient and climate-resilient strategy in resource-poor contexts like the UWR and similar areas in Sub-Saharan Africa. VSLAs could contribute to achieving SDG2, zero hunger, and SDG13, climate action. However, policy interventions are necessary to support and scale VSLAs as a sustainable development and food security strategy in vulnerable regions.

Abstract Background It is estimated that over 930 million people live in fragile and conflict-affected situations (FCAS) worldwide. These regions, characterized by violence, civil unrest, and war, are often governed by corrupt administrations who are unwilling to provide their citizens with basic human rights. Individuals living in FCAS face health inequities; however, women are disproportionally affected and face additional barriers to accessing sexual and reproductive services, including antenatal care (ANC). This systematic review aims to identify the factors that impact ANC usage in the 37 countries or regions classified as FCAS in 2020 by The World Bank. Methods Using the PRISMA guidelines, a systematic search of five databases (SCOPUS, Web of Science, PubMed, EMBASE, and CINAHL) was conducted. Results were limited to human studies, written in English, and published between January 2002 and January 2022. Studies that identified factors affecting utilization of ANC or maternal health services were included for review and critically appraised using the National Institute of Health’s Quality Assessment Tools. Findings were summarized using a narrative synthesis approach. Results The database search yielded 26,527 studies. After title, abstract and full-text review, and exclusion of duplicate articles, 121 studies remained. Twenty-eight of the 37 FCAS were represented in the included studies. The studies highlighted that women in FCAS’ are still not meeting the World Health Organization’s 2002 recommendation of four ANC visits during pregnancy, a recommendation which has since been increased to eight visits. The most cited factors impacting ANC were socioeconomic status, education, and poor quality of ANC. Despite all studies being conducted in conflict-affected regions, only nine studies explicitly identified conflict as a direct barrier to accessing ANC. Conclusion This review demonstrated that there is a paucity in the literature examining the direct and indirect impacts of conflict on ANC utilization. Specifically, research should be conducted in the nine FCAS that are not currently represented in the literature. To mitigate the barriers that prevent utilization of maternal health services identified in this review, policy makers, women utilizing ANC, and global organizations should attempt to collaborate to enact policy change at the local level.

The impacts of climate change are already pushing beyond the threshold for sustainable agriculture and rural livelihoods. In Sub-Saharan Africa, smallholder farmers are particularly vulnerable due to limited resources and adaptive capacity. Early warnings are critical in mitigating and reducing climate-related dangers and building resiliency. That notwithstanding, there needs to be higher coverage of early warnings in developing countries, and there is even less knowledge of their contribution to rural development. Using a cross-sectional survey involving smallholder farmer households (n = 517), this study investigates the relationship between early warnings and perceived climate preparedness in Ghana’s semi-arid Upper West Region. From ordered logistic regression presented as an odds ratio (OR), factors that influenced climate preparedness in the past 12 months before the study include exposure to early warnings (OR = 2.238; p < 0.001) and experiences of prior climate events such as drought (OR = 9.252; p < 0.001), floods (OR = 6.608; p < 0.001), and erratic rain (OR = 4.411; p < 0.001). The results emphasize the importance of early warning systems and various socioeconomic factors in improving the climate resilience of smallholder farmers in Ghana. In conclusion, the study puts forth policy suggestions worth considering.

BackgroundMaternal near-miss refers to women who survive death from life-threatening obstetric complications and has various social, financial, physical, and psychological impacts on families.ObjectiveTo explore male partners' perceptions of maternal near-miss experienced by their female partners and the associated psychosocial impacts on their families in Rwanda.MethodsThis was a qualitative study involving 27 semi-structured in-depth interviews with male partners whose spouses experienced a maternal near-miss event. Data were analyzed using a thematic coding to generate themes from participants' responses.ResultsSix key themes that emerged were: male partner's support during wife's pregnancy and during maternal near-miss hospitalization, getting the initial information about the spouse's near-miss event, psychosocial impacts of spouse's near-miss, socio-economic impact of spouse's near-miss, post- maternal near-miss family dynamics, and perceived strategies to minimize the impacts of near-miss. Male partners reported emotional, social, and economic impacts as a result of their traumatic experiences.ConclusionsThe impact of maternal near-miss among families in Rwanda remains an area that needs healthcare attention. The residual emotional, financial, and social consequences not only affect females, but also their male partners and their relatives. Male partners should be involved and be well-informed about their partners' conditions and the expected long-term effects of near-miss. Also, medical and psychological follow-up for both spouses is necessary for the enhancement of the health and well-being of affected households.

Globally, there has been tremendous advancement in medicine and child healthcare with increased life expectancy. That notwithstanding, the risk of under-five mortality ─ children dying before their fifth birthday remains relatively high in countries in Sub-Saharan Africa such as Ghana. In Ghana, under-five mortality remains a major public health problem that requires significant policy interventions. Using data from the 2017 Maternal Health Survey (n = 4785), we examined the geographic disparities in the time to under-five mortality in Ghana. The Kaplan Meier estimator showed significant (Log-rank: p< 0.001) rural-urban differences in the time to under-five mortality in Ghana. A disaggregated cox proportional hazards analysis showed that despite wide consensus that children in urban areas have a high survival rate, children in urban areas in northern regions of Ghana, especially the Upper West (HR = 4.40, p < 0.05) and Upper East (HR = 5.37, p < 0.01) Regions were significantly at increased risk of dying before the age of five compared to children in urban areas in the Greater Accra Region. A rural-urban comparison showed that children born in rural areas in all the other regions of Ghana were at a higher risk of dying before the age of five when compared to their counterparts in the rural areas of Greater Accra Region. Other factors such as sex of child, mothers' age and use of the internet, number of household members, ethnicity and household wealth were significantly associated with the timing of under-five mortality in Ghana. Healthcare policies and programs such as immunizations and affordable child healthcare services should be prioritized especially in rural areas of regions with a high risk of child mortality. Also, there is a need to improve healthcare delivery in urban areas, particularly in northern Ghana, where deplorable healthcare service infrastructure and delivery coupled with high poverty rates put children at risk of dying before their fifth birthday.

Abstract Background The shortage of health care providers (HCPs) and inequity in their distribution along with the lack of sufficient and equal professional development opportunities in low-income countries contribute to the high mortality and morbidity of women and newborns. Strengthening skills and building the capacity of all HCPs involved in Maternal and Newborn Health (MNH) is essential to ensuring that mothers and newborns receive the required care in the period around birth. The Training, Support, and Access Model (TSAM) project identified onsite mentorship at primary care Health Centers (HCs) as an approach that could help reduce mortality and morbidity through capacity building of HCPs in Rwanda. This paper presents the results and lessons learnt through the design and implementation of a mentorship model and highlights some implications for future research. Methods The design phase started with an assessment of the status of training in HCs to inform the selection of Hospital-Based Mentors (HBMs). These HBMs took different courses to become mentors. A clear process was established for engaging all stakeholders and to ensure ownership of the model. Then the HBMs conducted monthly visits to all 68 TSAM assigned HCs for 18 months and were extended later in 43 HCs of South. Upon completion of 6 visits, mentees were requested to assist their peers who are not participating in the mentoring programme through a process of peer mentoring to ensure sustainability after the project ends. Results The onsite mentorship in HCs by the HBMs led to equal training of HCPs across all HCs regardless of the location of the HC. Research on this mentorship showed that the training improved the knowledge and self-efficacy of HCPs in managing postpartum haemorrhage (PPH) and newborn resuscitation. The lessons learned include that well trained midwives can conduct successful mentorships at lower levels in the healthcare system. The key challenge was the inconsistency of mentees due to a shortage of HCPs at the HC level. Conclusions The initiation of onsite mentorship in HCs by HBMs with the support of the district health leaders resulted in consistent and equal mentoring at all HCs including those located in remote areas.

Abstract Background In Canada, heterosexual African, Caribbean, and Black (ACB) men’s heightened risk of HIV infection has been linked to behavioral characteristics, including practices of hegemonic masculinity that discourage the use of HIV preventive services. However, this framing is bereft of the role of structural factors that may be contributing to new HIV infections. This paper examined the underlying factors limiting access to health services among heterosexual ACB men in London, Ontario Canada. Methods A convenient sampling technique was used to recruit thirty-seven (n = 37) self-identified heterosexual ACB men and service providers. Four focus groups (FG) were conducted; three with ACB participants of similar age category (i.e., 16–24; 25–38; 39+), and one with service providers. The FGs focused on the barriers to using health services and interrogated the ease of access to HIV intervention programs by ACB men respectively. Recurring themes from the FGs were probed further using in-depth interviews (n = 13). FGs and in-depth interviews complemented each other in reducing uneven power dynamics, fact checking, and allowing for detail discussion of the topic under study. Data analyses were done in NVivo using a mixed inductive-deductive thematic analyses approach. Results Most ACB men lacked information on HIV and were unaware of their increased risk of infection. Contrary to the notion that behavioral characteristics keep ACB men away from health services, we found that most ACB men were unaware of the availability of these services. Those that had some knowledge about the services reported that they were not appropriately tailored to their needs. In addition, stereotypes and stigma about the etiology of HIV among Blacks, and systemic neglect served as significant barriers to ACB men’s use of services. Conclusion The findings suggest that, to enhance preventive health service use among heterosexual ACB men, there is the need to remove structural barriers. Engaging ACB men in the design and implementation of policies may be useful at improving access to HIV information, testing, and treatment services. Increased information dissemination to ACB men would create awareness of the availability of HIV services. Finally, service providers should be conscious of ACB men’s concern about experiences of discrimination and racism at service centers.

Background: Several environmental factors are associated with the risk of acute lower respiratory infections (ALRIs) and upper respiratory infections (URIs) in children under 5 years of age (YOA). Evidence implicating chemical pesticides remains equivocal. There are also no data on this subject in these children in Ghana. This study investigated the association between urinary pesticide residual levels and the risk for ALRIs/URIs in children under 5 YOA. Methods: The participants for this study were from the Offinso North Farm Health Study, a population-based cross-sectional study. Two hundred and fifty four parents/guardians who had answered affirmatively to the question “Has your child ever accompanied you to the farm?” were interviewed on household socio-demographic and environmental factors, being breastfed, child education, age, gender, and respiratory infection. One hundred fifty children were randomly selected to provide the first void urine. Results: The proportion of children with ALRI was 22.1% and those with URI was 35.8%. We observed a statistically significant exposure-response relation of p,p′-DDE (tertile) with ALRI (1.7-3.2 µg/L urine: prevalence ratio [PR] = 1.22 [1.05-1.70], ⩾3.2 µg/L urine: 1.50 [1.07-3.53] [ P -for trend = .0297]). This observation was in children older than two YOA ( P -for trend = .0404). Delta-HCH and beta-HCH (2-levels) were significantly associated with ALRI but not URI. The risk of ALRI increased with deltamethrin levels in an exposure-response manner (2.5-9.5 µg/L urine: 2.10 [1.37-3.24], ⩾9.5 µg/L urine: 4.38 [1.87-10.32] [ P -for trend = .0011]) and this was also observed in children older than two YOA. Similar observation was noted for URI. Bifenthrin (>0.5 µg/L urine) was positively associated with ALRI and URI whereas permethrin (⩾1.2 µg/L urine) was not associated only with URI. Conclusions: The present study supports the hypothesis that exposure to chemical pesticides is associated with respiratory infections in children under 5 YOA.

Abstract Background There are a number of factors that may contribute to high mortality and morbidity of women and newborns in low-income countries. These include a shortage of competent health care providers (HCP) and a lack of sufficient continuous professional development (CPD) opportunities. Strengthening the skills and building the capacity of HCP involved in the provision of maternal, newborn and child health (MNCH) is essential to ensure quality care for mothers, newborns and children. To address this challenge in Rwanda, mentorship of HCPs was identified as an approach that could help build capacity, improve the provision of care and accelerate the reduction in maternal and neonatal mortality and morbidity. In this paper, we describe the development and implementation of a novel mentorship model named Four plus One (4+ 1) for MNCH in Rwanda. Methods The mentorship model built on the basis of inter-professional collaboration (IPC) was developed in early 2017 through consultations with different key actors. The design phase included refresher courses in specific skills and training course on mentoring. Field visits were conducted in 10 hospitals from June 2017 to February 2020. Hospital management teams (MT) were involved in the development and implementation of this mentorship model to ensure ownership of the program. Results Upon completion of planned visits to each hospital, a total of 218 HCPs were involved in the process. Reports prepared by mentors upon each mentorship visit and compiled by Training Support and Access Model (TSAM) for MNCH’CPD team, highlighted the mothers and newborns who were saved by both mentors and mentees. Also, different logbooks of mentees showed how the capacity of staff was strengthened, thereby suggesting effectiveness of the model. Through different mentorship coordination meetings, the model was much appreciated by the MTs of hospitals, especially the IPC component of the model and confirmed the program ‘effectiveness. Conclusion The initiation of a mentorship model built on IPC together with the involvement of the leadership of the hospital may be the cause effect of reduction of specific mortality and improve MNCH in low resource settings even when there are a limited number of specialists in the health facilities.

Abstract Background In Rwanda, maternal community health workers (M-CHWs) are involved in the country’s overall health system. In maternal health, their role includes the provision of preventive and promotional health services at the community level. They provide services such as health education on maternal health wellbeing, advice and information on access and timely utilization of health facilities for prenatal, delivery and postpartum care. The contribution of M-CHWs in the health sector combined with other government initiatives led the country to achieving the fifth Millennium Development Goal (MDG) - target 5A- that aimed to improve maternal health through the reduction of maternal mortality ratio by 75% between 1990 and 2015). The objective of this study was to explore M-CHWs’ perceptions and experiences on access and provision of maternal health services. Methods We used a case study methodology, a qualitative research approach to explore M-CHWs’ experiences and perceptions on access and provision of maternal health services at the community level in Rwanda. For the period of June–August 2014, in-depth interviews were conducted with sixteen M-CHWs who had been providing maternal health services in the Eastern Province of Rwanda. Participants shared their experiences and perceptions on access and provision of maternal health service in their communities. Results The results of this research highlight the role of M-CHWs in promoting the use of health facilities for prenatal care and delivery and the ways they use to reach out to women. Several challenges prohibit M-CHWs to deliver adequate maternal health services and these are related to the poor resources settings in which they operate. Conclusion The results of this study highlight the experiences and perceptions of M-CHWs on the provision and access to maternal health services in their communities. The fact that M-CHWs are volunteers operating in limited resources settings with no formal training in maternal health and with considerable workloads translates into challenges regarding the quality and quantity of services they provide in their communities. Such challenges create an impact on M-CHWs service provision, satisfaction and retention. The voices of M-CHWs and the communities they serve are needed to explore areas that are specific to each community context that would contribute to making the M-CHW program sustainable to achieve equitable access to maternal health services.

Objective: Canada became a preferred destination for many non-European and non-American migrants since the introduction of favorable immigration policies in the late 1960 s. Blackimmigrants from the African and Caribbean regions however are a known vulnerable population to HIV infection in Canada. Even though first-generation immigrants might differ from subsequent generations in terms of culture and beliefs which are important for health outcomes and behaviors, research examining disparities in their use of preventative healthcare is limited. This study aimed to examine generational disparities in the uptake of HIV screening services among a sample of heterosexual Black men in Ontario, Canada. Methods: We used data from a cross-sectional survey sample (n = 829) that was collected from heterosexual Black men in four Ontarian cities (Toronto, Ottawa, London and Windsor) between March 2018 and February 2019. We used the negative log-log link function of the binomial family to examine the independent relationship between immigration status and the uptake of HIV testing and the cumulative effect of other predictor variables on HIV testing in nested models. Results: Findings from multivariate analysis show second-generation immigrants were significantly less likely to test for HIV compared with their first-generation immigrant counterparts. After controlling for theoretically relevant variables, the second-generation immigrants were 53% less likely to test for HIV. We further observed that participants with good knowledge of HIV transmission (OR=1.05; p > 0.05) and those who were older were more likely to test for HIV. Those with masculine tendencies (OR=0.98; p > 0.05) and those who reported not having sexual partner were less likely to test (OR=0.57; p > 0.01). Religion emerged as a significant predictor of HIV testing as Christians (OR=1.62; p > 0.05) and other believers (OR=1.59; p > 0.05) were more likely to test for HIV when compared to their Muslim counterparts. Conclusion: HIV prevention policies may need not only prioritize first-generation immigrants, but the wellbeing of their descendants as well. This could be achieved by implementing programs that will enhance second-generation immigrants’ use of HIV screening services. Additionally, HIV educational programs would be of relevance and especially so as respondents with good knowledge of HIV transmission consistently demonstrated higher likelihood of testing for their HIV status.

Deworming medication utilization is a useful strategy to reduce the burden of anemia among pregnant women. Yet, we know very little about the prevalence and correlates of deworming medication utilization among pregnant women in sub-Saharan Africa, including Benin. To address this void in the literature, we used the 2017–2018 Benin Demographic and Health Survey and applied logistic regression analysis to explore the demographic, socioeconomic, and healthcare factors associated with deworming medication utilization in Benin. We found that deworming medication coverage was 65% at the national level. We observed that women aged 35–49 years were less likely to use deworming medication compared to those aged 15–24 years (OR = 0.79, p < 0.01). Compared to Christian women, Muslim women (OR = 0.70, p < 0.01) and women of other religions (OR = 0.51, p < 0.01) were also less likely to use deworming medication. Moreover, women with lower levels of education and household wealth, as well as unemployed women, were less likely to use deworming medication in comparison to their educated, richer, and employed counterparts. Women who visited ANC fewer than eight times were also less likely to use deworming medication compared to their counterparts who did so eight times or more (OR = 0.65, p < 0.001). Based on these findings, we discussed several implications for policymakers.

Crop yield is related to household food security and community resilience, especially in smallholder agricultural systems. As such, it is crucial to accurately estimate within-season yield in order to provide critical information for farm management and decision making. Therefore, the primary objective of this paper is to assess the most appropriate method, indices, and growth stage for predicting the groundnut yield in smallholder agricultural systems in northern Malawi. We have estimated the yield of groundnut in two smallholder farms using the observed yield and vegetation indices (VIs), which were derived from multitemporal PlanetScope satellite data. Simple linear, multiple linear (MLR), and random forest (RF) regressions were applied for the prediction. The leave-one-out cross-validation method was used to validate the models. The results showed that (i) of the modelling approaches, the RF model using the five most important variables (RF5) was the best approach for predicting the groundnut yield, with a coefficient of determination (R2) of 0.96 and a root mean square error (RMSE) of 0.29 kg/ha, followed by the MLR model (R2 = 0.84, RMSE = 0.84 kg/ha); in addition, (ii) the best within-season stage to accurately predict groundnut yield is during the R5/beginning seed stage. The RF5 model was used to estimate the yield for four different farms. The estimated yields were compared with the total reported yields from the farms. The results revealed that the RF5 model generally accurately estimated the groundnut yields, with the margins of error ranging between 0.85% and 11%. The errors are within the post-harvest loss margins in Malawi. The results indicate that the observed yield and VIs, which were derived from open-source remote sensing data, can be applied to estimate yield in order to facilitate farming and food security planning.

Abstract The African continent is predicted to be home to over half of the expected global population growth between 2015 and 2050, highlighting the importance of addressing population health in Africa for improving public health globally. By 2050, nearly 60% of the population of the continent is expected to be living in urban areas and 35–40% of children and adolescents globally are projected to be living in Africa. Urgent attention is therefore required to respond to this population growth - particularly in the context of an increasingly urban and young population. To this end, the Research Initiative for Cities Health and Equity in Africa (RICHE Africa) Network aims to support the development of evidence to inform policy and programming to improve urban health across the continent. This paper highlights the importance of action in the African continent for achieving global public health targets. Specifically, we argue that a focus on urban health in Africa is urgently required in order to support progress on the Sustainable Development Goals (SDGs) and other global and regional public health targets, including Universal Health Coverage (UHC), the new Urban Agenda, and the African Union’s Agenda 2063. Action on urban public health in Africa is critical for achieving global public health targets. Four key research and training priorities for improving urban health in Africa, are outlined: (1) increase intersectoral urban health literacy; (2) apply a healthy urban governance and systems approach; (3) develop a participatory and collaborative urban health planning process; and, (4) produce a new generation of urban health scholars and practitioners. We argue that acting on key priorities in urban health is critical for improving health for all and ensuring that we ‘leave no-one behind’ when working to achieve these regional and global agendas to improve health and wellbeing.

This paper assessed the transition probabilities between the stages of hypertension severity and the length of time an individual might spend at a particular disease state using the new American College of Cardiology/American Heart Association hypertension blood pressure guidelines. Data for this study were drawn from the Ghana WHO SAGE longitudinal study, with an analytical sample of 1884 across two waves. Using a multistate Markov model, we estimated a seven-year transition probability between normal/elevated blood pressure (systolic ≤ 129 mm Hg & diastolic

African, Caribbean, and Black (ACB) men living in Canada share a heightened risk of HIV infection and the associated risk factors such as suboptimal use of family planning services such as condom use. In this study, we assessed the factors associated with knowledge, attitude, and condom use among ACB men in Ontario. Methods. This was a cross-sectional study that surveyed heterosexual ACB men regardless of their residency status living in Ontario (n = 430). This is a part of a larger mixed methods study informed by critical race theory, intersectionality, and community-based participatory research (CBPR). Outcome variables were knowledge of condom use, attitude towards condom use, and actual use of condom during the last 12 months. Results. Of 430 participants, 77.70% has good knowledge of condom use as a protection against HIV transmission, 31.77% had positive attitude towards condom use, and 62.43% reported using condom regularly with casual partners during the last 12 months. Men who were currently married had more positive attitude towards condom use compared with their unmarried counterparts (odds ratio = 1.46, 95% CI = 1.20, 1.78). Canadian residents were found to have higher odds of having correct knowledge of condom (odds ratio = 1.31, 95% CI = 1.11, 1.55), and positive attitude towards condom use (odds ratio = 1.44, 95%CI = 1.09, 1.92). Men who visited sexual health clinics showed a positive association with having correct knowledge of condom (odds ratio = 1.78, 95% CI = 1.30, 2.44) and reported experiences of difficulty in accessing sexual health. This showed a negative association towards condom use (odds ratio = 0.45, 95% CI = 0.21, 0.97]. Conclusion. A considerable percentage of heterosexual ACB men did not have correct knowledge regarding the protective effect of condom use against HIV and positive attitude towards the use of condom. Several sociodemographic and healthcare-related factors were significantly associated with knowledge, attitude, and use of condom.

Background The association between fine particulate matter and cardiovascular disease has been convincingly demonstrated. The role of traffic‐related air pollutants is less clear. To better understand the role of traffic‐related air pollutants in cardiovascular disease development, we examined associations between NO2, carotid atherosclerotic plaque, and cardiometabolic disorders associated with cardiovascular disease. Methods and Results Cross‐sectional analyses were conducted among 2227 patients (62.9±13.8 years; 49.5% women) from the Stroke Prevention and Atherosclerosis Research Centre (SPARC) in London, Ontario, Canada. Total carotid plaque area measured by ultrasound, cardiometabolic disorders, and residential locations were provided by SPARC medical records. Long‐term outdoor residential NO2 concentrations were generated by a land use regression model. Associations between NO2, total carotid plaque area, and cardiometabolic disorders were examined using multiple regression models adjusted for age, sex, smoking, and socioeconomic status. Mean NO2 was 5.4±1.6 ppb in London, Ontario. NO2 was associated with a significant increase in plaque (3.4 mm2 total carotid plaque area per 1 ppb NO2), exhibiting a linear dose‐response. NO2 was also positively associated with triglycerides, total cholesterol, and the ratio of low‐ to high‐density lipoprotein cholesterol (P

Abstract Background Although use of modern contraception is considered beneficial in lowering maternal and child mortality rates, the prevalence of contraceptive use remains low in the Democratic Republic of Congo. This study examined modern contraceptive use and its linkage to women’s autonomy. Methods Data were drawn from the 2013–2014 Democratic Republic of Congo Demographic and Health Survey. We selected unsterilized and non-pregnant married women who have given birth in the last three years (N = 6680). Logistic regression models were fitted to explore the relationship between women’s autonomy and modern contraceptive use. Results The study found that only 7.1% of married women who had delivered within three years used modern contraceptive methods. After controlling for socioeconomic and demographic factors, the association between women’s autonomy and modern contraceptive use remained positively significant (OR = 1.16; 95% CI = 1.05, 1.29). Conclusion The findings from this study indicate that it is not enough to provide women with educational and employment opportunities to increase the uptake of modern contraception, but also to enhance women’s assertiveness to make their own decisions regardless of their partners’ preferences within household settings. It is critical for government and other stakeholders to roll out programs aimed at reducing gender inequality and improving women’s autonomy in decision-making about reproductive health.

Mapping crop types and land cover in smallholder farming systems in sub-Saharan Africa remains a challenge due to data costs, high cloud cover, and poor temporal resolution of satellite data. With improvement in satellite technology and image processing techniques, there is a potential for integrating data from sensors with different spectral characteristics and temporal resolutions to effectively map crop types and land cover. In our Malawi study area, it is common that there are no cloud-free images available for the entire crop growth season. The goal of this experiment is to produce detailed crop type and land cover maps in agricultural landscapes using the Sentinel-1 (S-1) radar data, Sentinel-2 (S-2) optical data, S-2 and PlanetScope data fusion, and S-1 C2 matrix and S-1 H/α polarimetric decomposition. We evaluated the ability to combine these data to map crop types and land cover in two smallholder farming locations. The random forest algorithm, trained with crop and land cover type data collected in the field, complemented with samples digitized from Google Earth Pro and DigitalGlobe, was used for the classification experiments. The results show that the S-2 and PlanetScope fused image + S-1 covariance (C2) matrix + H/α polarimetric decomposition (an entropy-based decomposition method) fusion outperformed all other image combinations, producing higher overall accuracies (OAs) (>85%) and Kappa coefficients (>0.80). These OAs represent a 13.53% and 11.7% improvement on the Sentinel-2-only (OAs < 80%) experiment for Thimalala and Edundu, respectively. The experiment also provided accurate insights into the distribution of crop and land cover types in the area. The findings suggest that in cloud-dense and resource-poor locations, fusing high temporal resolution radar data with available optical data presents an opportunity for operational mapping of crop types and land cover to support food security and environmental management decision-making.

Abstract Background In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi. Methods A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions. Results Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men’s family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new ‘emergent’ masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on agriculture and food security, alongside involving male leaders were some of the reasons that respondents named for changed gender norms. Conclusions Participatory education that explicitly addresses hegemonic masculinities related to child nutrition, such as women’s roles in child care, can begin to change dominant gender norms. Involving male leaders, participatory methods and integrating agriculture and food security concerns with nutrition appear to be key components in the context of agrarian communities.

Amid climate change, biodiversity loss and food insecurity, there is the growing need to draw synergies between micro-scale environmental processes and practices, and macro-level ecosystem dynamics to facilitate conservation decision-making. Adopting this synergistic approach can improve crop yields and profitability more sustainably, enhance livelihoods and mitigate climate change. Using spatially explicit data generated through a public participatory geographic information system methodology (n = 37), complemented by spatial analysis, interviews (n = 68) and focus group discussions (n = 4), we explored the synergies between participatory farmer-to-farmer agroecology knowledge sharing, farm-level decisions and their links with macro-level prioritization of conservation strategies. We mapped farm conditions and ecosystem services (ES) of two village areas with varying knowledge systems about farming. Results of the farm-level analysis revealed variations in spatial perception among farmers, differences in understanding the dynamics of crop growth and varying priorities for extension services based on agroecological knowledge. The ES use pattern analysis revealed hotspots in the mapped ES indicators with similarities in both village areas. Despite the similarities in ES use, priorities for biodiversity conservation align with farmers’ understanding of farm processes and practices. Farmers with training in agroecology prioritized strategies that are ecologically friendly while farmers with no agroecology training prioritized the use of strict regulations. Importantly, the results show that agroecology can potentially contribute to biodiversity conservation and food security, with climate change mitigation co-benefits. The findings generally contribute to debates on land sparing and land sharing conservation strategies and advance social learning theory as it pertains to acquiring agroecological knowledge for improved yield and a sustainable environment.

This paper focuses on public concerns about real estate value loss in communities in the vicinity of wind turbines. There are some conflicting results in recent academic and non-academic literatures on the issue of property values in general—yet little has been studied about how residents near turbines view the value of their own properties. Using both face-to-face interviews (n = 26) and community survey results (n = 152) from two adjacent communities, this exploratory mixed-method study contextualizes perceived property value loss. Interview results suggest a potential connection between perceived property value loss and actual property value loss, whereby assumed property degradation from turbines seem to lower both asking and selling prices. This idea is reinforced by regression results which suggest that felt property value loss is predicted by health concerns, visual annoyances and community-based variables. Overall, the findings point to the need for greater attention to micro-level local, and interconnected impacts of wind energy development.

Objectives. Although a growing body of evidence demonstrates the public health burden of prostate cancer in SSA, relatively little is known about the underlying factors surrounding the low levels of testing for the disease in the context of this region. Using Namibia Demographic Health Survey dataset (NDHS, 2013), we examined the factors that influence men’s decision to screen for prostate cancer in Namibia. Methods. We use complementary log-log regression models to explore the determinants of screening for prostate cancer. We also corrected for the effect of unobserved heterogeneity that may affect screening behaviours at the cluster level. Results. The results show that health insurance coverage (OR = 2.95, p=0.01) is an important predictor of screening for prostate cancer in Namibia. In addition, higher education and discussing reproductive issues with a health worker (OR = 2.02, p=0.05) were more likely to screening for prostate cancer. Conclusions. A universal health insurance scheme may be necessary to increase uptake of prostate cancer screening. However it needs to be acknowledged that expanded screening can have negative consequences and any allocation of scarce resources towards screening must be guided by evidence obtained from the local context about the costs and benefits of screening.

Objectives. Although research demonstrates the public health burden of prostate cancer among men in the Caribbean, relatively little is known about the factors that underlie the low levels of testing for the disease among this population. Study Design. A cross-sectional study of prostate cancer testing behaviours among men aged 40–60 years in Dominican Republic using the Demographic and Health Survey (2013). Methods. We use hierarchical binary logit regression models and average treatment effects combined with propensity score matching to explore the determinants of prostate screening as well as the average effect of health insurance coverage on screening. The use of hierarchical binary logit regression enabled us to control for the effect of unobserved heterogeneity at the cluster level that may affect prostate cancer testing behaviours. Results. Screening varied significantly with health insurance coverage, knowledge of cholesterol level, education, and wealth. Insured men were more likely to test for prostate cancer (OR = 1.65, p=0.01) compared to the uninsured. Conclusions. The expansion and restructuring of Dominican Republic universal health insurance scheme to ensure equity in access may improve health access that would potentially impact positively on prostate cancer screening among men.

Spatial monitoring campaigns of volatile organic compounds were carried out in two similarly sized urban industrial cities, Windsor and Sarnia, ON, Canada. For Windsor, data were obtained for all four seasons at approximately 50 sites in each season (winter, spring, summer, and fall) over a three-year period (2004, 2005, and 2006) for a total of 12 sampling sessions. Sampling in Sarnia took place at 37 monitoring sites in fall 2005. In both cities, passive sampling was done using 3M 3500 organic vapor samplers. This paper characterizes benzene, toluene, ethylbenzene, o, and (m + p)-xylene (BTEX) concentrations and relationships among BTEX species in the two cities during the fall sampling periods. BTEX concentration levels and rank order among the species were similar between the two cities. In Sarnia, the relationships between the BTEX species varied depending on location. Correlation analysis between land use and concentration ratios showed a strong influence from local industries. Use one of the ratios between the BTEX species to diagnose photochemical age may be biased due to point source emissions, for example, 53 tonnes of benzene and 86 tonnes of toluene in Sarnia. However, considering multiple ratios leads to better conclusions regarding photochemical aging. Ratios obtained in the sampling campaigns showed significant deviation from those obtained at central monitoring stations, with less difference in the (m + p)/E ratio but better overall agreement in Windsor than in Sarnia.

Urban cyclists are exposed to many traffic-related air pollutants including particulate matter (PM) that may increase vulnerability to health effects. This study investigates second-by-second personal exposure to PM2.5 (fine particulate matter that is 2.5 microns in diameter and less) along bicycle commuting paths, and assesses elements of the natural and built environment for the relative importance of these factors in understanding the variability in PM2.5 personal exposure. Urban cyclists were carrying high resolution PM2.5 monitors (placed in a backpack) in combination with portable GPS trackers to provide a spatial identity to each one-second pollutant measurement. The results of this study indicate that daily averages of PM2.5 concentrations from all bicycle routes were weakly correlated with meteorological variables, however, a strong influence of regional levels of PM2.5 was observed. Geospatial analysis of PM2.5 personal exposure concentrations showed a considerable variation within routes, correlated with land use (with lower concentrations in parks and higher in industrial areas) and clustered at four areas: busiest bridge, heavily trafficked road segments, the downtown urban core, and two construction sites. This study has found many incidences of personal exposure to PM2.5 exceeding the provincial guidelines for healthy activity (e.g., very poor (PM2.5 > 91 μg/m3) pollution concentrations are clustered in three regions: approaching the bridge in the west part of the city; the downtown urban core; and two under construction spots), which suggests behavioural and infrastructure modifications in balancing the health benefits of cycling with the environmental exposure to air pollutants.

BACKGROUND:In the past decade, research on neglected tropical diseases (NTDs) has intensified in response to the need to enhance community participation in health delivery, establish monitoring and surveillance systems, and integrate existing disease-specific treatment programs to control overlapping NTD burdens and detrimental effects. In this paper, we evaluated the geographical distribution of NTDs in coastal Tanzania. METHODS AND FINDINGS:We also assessed the collective (compositional and contextual) factors that currently determine risks to multiple NTDs using a cross sectional survey of 1253 individuals in coastal Tanzania. The results show that the effect size in decreasing order of magnitude for non-binary predictors of NTD risks is as follows: NTD comorbidities > poverty > educational attainment > self-reported household quality of life > ethnicity. The multivariate analysis explained 95% of the variance in the relationship between NTD risks and the theoretically-relevant covariates. Compositional (biosocial and sociocultural) factors explained more variance at the neighbourhood level than at the regional level, whereas contextual factors, such as access to health services and household quality, in districts explained a large proportion of variance at the regional level but individually had modest statistical significance, demonstrating the complex interactions between compositional and contextual factors in generating NTD risks. CONCLUSIONS:NTD risks were inequitably distributed over geographic space, which has several important policy implications. First, it suggests that localities of high burden of NTDs are likely to diminish within statistical averages at higher (regional or national) levels. Second, it indicates that curative or preventive interventions will become more efficient provided they can be focused on the localities, particularly as populations in these localities are likely to be burdened by several NTDs simultaneously, further increasing the imperative of multi-disease interventions.