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Gaining ethical approval for qualitative health research and implementing all the planned research processes in a proposed study are not straightforward endeavours. The situation becomes more complex when qualitative research is conducted in a cross-national healthcare and academic context. Also, it is even exhausting when the study is student-based, as student researchers may be considered novices and inexperienced researchers, especially for field-based research. Our aim in this reflective paper is to present, reflect, and discuss the experiences of a doctoral researcher in dealing with two independent institutional review boards in Canada and Ghana during an interdisciplinary Ph.D. project and the ethical dilemmas encountered while collecting data in Ghana. Based on the researcher's experiences, it became apparent that consent and its documentation can have cultural implications in different settings; hence, institutional review boards must exercise reflexivity in their protocol review practice. Also, sharing research data with participants and institutional leaders while maintaining participant confidentiality and privacy in institutional ethnographic research requires sensitivity to bi-lateral ethical values. With the experiences shared in this paper, we advocate for a dialogic ethical review process in qualitative research where researchers and research ethics boards engage in ongoing dialogue rather than the usual prescriptive format research ethics reviews often assume.

Engaging in sexual relationships is part of adulthood, but doing so in a foreign country can be risky because unsafe sexual experiences can have severe consequences for international students. This review explored sexual and reproductive health (SRH) experiences and needs of international university students in Western countries to identify challenges and gaps and to discuss critical SRH interventions. Four databases (Scopus, Embase, Web of Science, and PubMed) were searched for peer-reviewed journal articles published between 2000 and 2023. After screening 1607 articles, 10 met the inclusion criteria. Results of the review showed that many international students lack comprehensive knowledge about sexual health and sexually transmitted infections. They often obtain SRH information from informal sources, face language barriers, and experience difficulties navigating the healthcare systems of their host countries. University sexual wellness programs should examine how cultural orientations impact the sexual health of international students and provide culturally appropriate SRH interventions. [Note: The publication year for v14 n1 (2024) may be incorrect. The correct publication year for this article is 2023.]

Abstract Trust is known to be an important factor in vaccine decisions for parents of young children, but there has been a lack of Canadian data measuring the determinants and impact of trust. Using data from the 2017 Canadian Childhood National Immunization Coverage Survey (cNICS), this study analyzed the relationships between sources that parents trust for vaccine information and demographics, parental knowledge, attitudes, and beliefs (KAB) and vaccine decisions (refusal, delay or reluctance) in parents of 2-year-old children who had accepted at least one vaccine for their child (n = 6125). The findings show that 83% of parents trust doctors for vaccine information; 70–80% trust pharmacists, PMH, nurses and HC/PHAC; 34% trust family and 23% trust friends and CAM HCPs. However, parents found to have poor or moderate KAB were less likely to trust doctors, nurses, pharmacists, PMH and HC/PHAC. Parents were also less likely to trust the PMH or HC/PHAC if they had high school education or less or trade/college education, or were widowed, separated, or divorced. Parents who had never been reluctant to vaccinate their 2-year-old child were over 2 times more likely to trust doctors, nurses, pharmacists, PMH and HC/PHAC while parents who trusted family and friends were less likely to delay or refuse vaccines. There was also significant regional variation within Canada, with parents from Quebec most likely to trust doctors, nurses, pharmacists, friends, PMH and HC/PHAC. Parents from the Territories were less likely to trust doctors, nurses and pharmacists, but more likely to trust family. Parents were less likely to trust doctors if they were from the Prairies, and pharmacists if they were from BC, and parents from the Prairies and BC were less likely to trust HC/PHAC. Parents from Ontario were less likely to trust family or friends, but more likely to trust the PMH. Tailored vaccine campaigns are needed to account for educational, marital, and regional differences across Canada to improve vaccine uptake.

Nicholaus P Mnyambwa,1 Coline Mahende,1 Amani Wilfred,1 Erica Sandi,1 Nicodem Mgina,2 Clara Lubinza,1 Amos Kahwa,1 Pammla Petrucka,3,4 Sayoki Mfinanga,1,3,5 Esther Ngadaya,1 Godfather Kimaro1 1National Institute for Medical Research, Muhimbili Research Centre, Dar es Salaam, Tanzania; 2Central Tuberculosis Reference Laboratory (CTRL), Dar es Salaam, Tanzania; 3School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 4University of Saskatchewan, Saskatoon, Canada; 5Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaCorrespondence: Nicholaus P MnyambwaNational Institute for Medical Research Muhimbili Research Centre, P. O. Box 447, Dar es Salaam, TanzaniaEmail lodnicho@gmail.comIntroduction: Antimicrobial resistance is one of the biggest threats of modern public health. Although sub-Saharan Africa is highly burdened with infectious diseases, current data on antimicrobial resistance are sparse.Methods: A prospective study was conducted between October 2018 and September 2019 to assess the antibiotic susceptibility patterns of clinical bacterial isolates obtained from four referral hospitals in Tanzania. We used standard media and Kirby-Bauer disc diffusion methods as per Clinical and Laboratory Standards Institute (CLSI) standards.Results: We processed a total of 2620 specimens of which 388 (14.8%) were culture-positive from patients with a median (IQR) age of 28 (12– 44) years. Of the positive cultures, 52.3% (203) were from females. Most collected specimens were ear pus 28.6% (111), urine 24.0% (93), wound pus 20.6% (80), stool 14.9% (58), and blood 8.3% (32). Predominant isolates were S. aureus 28.4% (110), E. coli 15.2% (59), P. aeruginosa 10.6% (41), P. mirabilis 7.0% (27), V. cholerae 01 Ogawa 6.2% (24), Klebsiella spp. 5.2% (20) and Streptococcus spp. 4.6% (18). Generally, the isolates exhibited a high level of resistance to commonly used antibiotics such as Ampicillin, Amoxicillin-Clavulanic acid, Erythromycin, Gentamicin, Tetracycline, Trimethoprim, third-generation Cephalosporins (Ceftriaxone and Ceftazidime), and reserved drugs (Clindamycin and Meropenem). S. aureus isolates were resistant to most of the antibiotics tested; 66.7% were classified as MRSA infections.Conclusion: Antibiotic resistance to commonly prescribed antibiotics was alarmingly high. Our findings emphasize the need for comprehensive national control programs to combat antibiotic resistance.Keywords: antibiotics, antimicrobial resistance, AMR, antibiotic susceptibility testing, methicillin-resistant Staphylococcus aureus, MRSA, bacterial isolates

Khairulnissa Ajani,1 Ambreen Gowani,1 Raisa Gul,1,2 Pammla Petrucka3 1School of Nursing, Aga Khan University, Karachi, Pakistan; 2School of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan; 3College of Nursing, University of Saskatchewan, Saskatoon, CanadaCorrespondence: Khairulnissa AjaniAga Khan University School of Nursing, P.O. Box 3500, Stadium Road, Karachi, PakistanEmail khairulnissa.ajani@aku.eduBackground: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan.Methods: This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban cosmopolitan setting within Karachi Pakistan. Four hundred and two patients were screened using the H-SCALE questionnaire, while socio-demographic predictors of self-care and level of knowledge of hypertension were identified using a study-specific checklist. Self-care was assessed against six clinical domains including medication adherence, diet, weight management, physical activity, and abstinence from alcohol.Results: Participants were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. Highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self-care, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors for each self-care behavior in the given population.Conclusion: Overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in Pakistan which is reflected in their behaviors. There is a need to introduce healthcare educational programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications.Keywords: hypertension, self-care management, cross-sectional study, Pakistan

Mekonnen Haftom,1 Pammla Petrucka,2 Kbrom Gemechu,1,3 Haftamu Mamo,3,4 Tesfay Tsegay,1,5 Embay Amare,4 Hayelom Kahsay,5 Alem Gebremariam4 1Department of Nursing, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 2College of Nursing, University of Saskatchewan, Saskatchewan, Canada; 3Department of Psychiatric Nursing, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 4School of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 5School of Medicine, College of Medicine and Health Sciences, Adigrat University, Adigrat, EthiopiaCorrespondence: Mekonnen Haftom Email haftommekonnen@gmail.comBackground: With the onset of any novel condition, it is the “first” case identified that brings attention and sets into motion the machinery to respond – so it began with a first novel pneumonia case of unknown origin in Wuhan, China. Currently, the World Health Organization has declared SARS-CoV-2 (more commonly known as COVID-19) a public health emergency of international concern. It is projected that the path of COVID-19 could kill 50– 80 million people and impacts the world’s economy in its devastating global sweep. The surge is increasing on global and national levels, causing rapid loss of life, joblessness, deterioration of the healthcare systems, and both national and global economies. In Ethiopia, the first COVID-19 case was reported in March. Since then, the government has been taking different measures to prevent its spread. Locking down all schools, declared social distancing and hand hygiene, and restricting large gatherings were some of the Ethiopian government’s actions.Objective: To determine knowledge, attitudes, and practices towards COVID-19 pandemic among quarantined adults in Tigrai region, Ethiopia.Methods: A total of 331 participants selected using a systematic random sampling method were included in the study. We used an interviewer-administered questionnaire. After describing the variables using frequencies, means, and standard deviations, multivariable logistic regression determined factors associated with knowledge and chi-squared tests for attitudes and practices towards COVID-19.Results: The study participants were primarily males (70%) and mean age 30.5 (SD=11) years. The mean knowledge score was 8.73 (SD=2.64), with less than half 42.9% (95% CI: 37.5– 48%) of the study participants were knowledgeable. Regarding the attitude questions, three-fourths of the participants believed that Ethiopia will control and win the battle against the COVID-19 pandemic. Nearly one-third of the participants replied that the Ethiopian government is handling this pandemic health crisis well. About half of the study participants reported that they had gone to crowded places in recent days, did not wear face mask when leaving home, and practiced preventive measures given by local health authorities. Knowledge score was statistically significantly associated with gender, age, and educational status of the study participants, whereas attitude and practices were significantly associated with educational status and knowledge of participants.Keywords: knowledge, attitude, practice, quarantine, COVID-19, Ethiopia

Naelijwa Mshanga,1 Haikael Martin,1 Pammla Petrucka2 1Department of Food Biotechnology and Nutrition Sciences, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 2College of Nursing, University of Saskatchewan, Saskatoon, CanadaCorrespondence: Naelijwa Mshanga Email mshangan@nm-aist.ac.tzBackground: Provision of micronutrients knowledge is important during pregnancy as it informs mothers what to eat and avoid, to ensure sufficient micronutrient absorption by the mothers and fetuses. Most studies focus on general nutrition knowledge and dietary practices, but there is minimal known about micronutrient knowledge especially in pastoral societies. Therefore, the aim of this study was to explain the current micronutrient knowledge and dietary practices of pregnant women in this unique pastoral society.Methods: This is a mixed-method study that involves focus group discussions and questionnaires in assessing the micronutrient knowledge and frequency micronutrients dietary practices of Maasai pregnant women from one week to thirty-six weeks pregnant. Chi-square test and descriptive statistics, such as percentages, frequency distribution and measures of central tendency, were used to assess socio-demographic data, micronutrients knowledge and frequency of micronutrients dietary practices and the comparison between knowledge and dietary practices, while inductive thematic content analysis was used to analyze qualitative data.Results: In total, 140 questionnaires were completed with a response rate of 100% and 32 participants drawn from this group attended one of four focus group discussions. The study found that most participants had good knowledge of dietary iron, while less than a quarter (24.3%) had good knowledge of vitamin A. Moreover, there was a statistical significance difference (P=0.043) between knowledge and dietary practices. Low dietary micronutrient intake was primarily due to cultural restrictions, prohibition in cultivating and unavailability of micronutrients rich foods in this geographical area.Conclusion: The majority of the study participants had good knowledge of iron compared to vitamin A; however, they do not translate the knowledge in dietary practices. Therefore, the Government of Tanzania through Ministry of Education and Health should introduce different interventions to increase micronutrients knowledge and practices in pastoral societies.Keywords: micronutrients, pregnant women, pastoralists, dietary iron, vitamin A, Tanzania

Renatha Pacific,1,2 Haikael D Martin,1 Kissa Kulwa,2 Pammla Petrucka3 1Department of Food Biotechnology and Nutrition Sciences, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 2Department of Food Technology, Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania; 3College of Nursing, University of Saskatchewan, Regina, SK, CanadaCorrespondence: Renatha PacificDepartment of Food Biotechnology and Nutrition Sciences, Nelson Mandela African Institution of Science and Technology, P. O. Box 447, Arusha, TanzaniaTel +255 759 184 316Email pacificr@nm-aist.ac.tzAbstract: This review aimed primarily to investigate the current trends of overweight and obesity in school children in the African context, secondly to explore the contribution of home and school environments on the children’s food choices and lastly suggesting measures for creating a healthier food environment. Despite the increase in overweight and obesity among school children, empirical evidence on their determinants in the African context is scarce, thus calls for consideration of home and school environments. A literature search was conducted between October and December 2018 using Medline (PubMed), Directory of Open Access Journals, Google Scholar, manual search and “grey” literature. This review included articles published between the 1st January 2008 and 30th June 2018. Out of 343 articles, 49 were included for the full text reading after meeting the inclusion criteria. Five reports from grey literature were also included. Results show that the prevalence of overweight and obesity among school children in Africa is increasing and ranges from < 5% to > 40% in the 10-year period in which the review was taken. High socio-economic status, urban residence and female gender predicted higher prevalence of overweight/obesity. Few reviewed articles on the contribution of home and school environments on children’s food choices showed a shred of evidence, thus calls for further research to address this gap. This review found an increasing prevalence of overweight and obesity in school children in Africa. Therefore, further investigation of home and school environment is imperative to curb the increase in the magnitude of overweight and obesity.Keywords: food choice, food environment, prevalence, school-children, strategies, Africa

Haftom Tesfay Gebremedhin,1 Berhanu Boru Bifftu,2 Mikiyas Tulu Lebessa,3 Aemro Zerihun Weldeyes,3 Tesfay Tsegay Gebru,4 Pammla Petrucka5,6 1Department of Psychiatry, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia; 2Department of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia; 3Department of Psychiatry, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia; 4Department of Nursing, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia; 5College of Nursing, University of Saskatchewan, Saskatchewan, Canada; 6Adjunct Nelson Mandela African Institute of Science and Technology, Arusha, TanzaniaCorrespondence: Haftom Tesfay Gebremedhin Tel +251914272630Email haftomtesfay30@gmail.comBackground: Psychological distress is defined as a state of emotional suffering characterized by the combination of symptoms of depression and anxiety. It is more prevalent in school adolescents than in the general population. There are no published studies that reflect the current status of psychological distress among Ethiopian school adolescents. So, this study aimed to determine the prevalence and associated factors of psychological distress among secondary students in Mekelle Town, North Ethiopia.Methods: A school-based cross-sectional study was done among 782 from May 15 to June 15, 2018. Stratified multistage sampling procedure was used to select study subjects. Data were collected using a pretested and structured self-administered questionnaire. Psychological distress was assessed using Kessler Psychological Distress Scale (K10). Binary logistic regression models were fitted to identify associated factors. Adjusted odds ratio with its 95% confidence interval was used to declare the statistical significance between psychological distress and associated factors.Results: A total of 845 students were enrolled in the study, with a response rate of 92.54%. The mean age of the participants was 16.24 years (SD=± 1.17). Prevalence of psychological distress among the study participants was 34.9%. Being female [AOR = 2.30; 95% CI: (1.28, 4.12)], current alcohol use [AOR = 3.08; 95% CI: (1.64, 5.77)], physical fight [AOR = 2.99; 95% CI: (1.69– 5.28)], contact sexual abuse [AOR=2.37; 95% CI: (1.23, 4.55)], non-contact sexual abuse [AOR = 1.91; 95% CI: (1.04, 3.49)], and being bullied [AOR = 1.81; 95% CI: (1.03, 3.29)] were significantly associated with psychological distress.Conclusion: The prevalence of psychological distress in this study was high. Therefore, it is recommended to strengthen the activities that help to reduce or ameliorate the major causes of psychological distress.Keywords: psychological distress, adolescent students, depression, anxiety

Nicholaus Peter Mnyambwa,1,2 Esther S Ngadaya,2 Godfather Kimaro,2 Dong-Jin Kim,1 Rudovick Kazwala,3 Pammla Petrucka,1,4 Sayoki G Mfinanga2 1School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; 2National Institute for Medical Research, Muhimbili Medical Research Center, Dar es Salaam, Tanzania; 3Department of Veterinary Medicine, Sokoine University of Agriculture, Morogoro, Tanzania; 4College of Nursing, University of Saskatchewan, Saskatoon, Canada Abstract: Diagnosis of pulmonary tuberculosis (TB) in technology-limited countries is widely achieved by smear microscopy, which has limited sensitivity and specificity. The frequency and clinical implication of smear-positive but culture-negative among presumptive TB patients remains unclear. A cross-sectional substudy was conducted which aimed to identify the proportion of nontuberculous mycobacteria (NTM) infections among 94 “smear-positive culture-negative” patients diagnosed between January 2013 and June 2016 in selected health facilities in Tanzania. Out of 94 sputa, 25 (26.60%) were GeneXpert® mycobacteria TB positive and 11/94 (11.70%) repeat-culture positive; 5 were Capilia TB-Neo positive and confirmed by GenoType MTBC to be Mycobacterium tuberculosis/Mycobacterium canettii. The remaining 6 Capilia TB-Neo negative samples were genotyped by GenoType® CM/AS, identifying 3 (3.19%) NTM, 2 Gram positive bacteria, and 1 isolate testing negative, together, making a total of 6/94 (6.38%) confirmed false smear-positives. Twenty-eight (29.79%) were confirmed TB cases, while 60 (63.83%) remained unconfirmed cases. Out of 6 (6.38%) patients who were HIV positive, 2 patients were possibly coinfected with mycobacteria. The isolation of NTM and other bacteria among smear-positive culture-negative samples and the presence of over two third of unconfirmed TB cases emphasize the need of both advanced differential TB diagnostic techniques and good clinical laboratory practices to avoid unnecessary administration of anti-TB drugs. Keywords: nontuberculous mycobacteria, pulmonary TB, smear-positive, culture-negative, tuberculosis diagnosis