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Gender impacts exposure and vulnerability to tuberculosis (TB) evidenced by a higher prevalence of both TB disease and missed TB diagnoses among men, who significantly contribute to new TB infections. We present the formative research phase of a study, which used participatory methods to identify gender-specific interventions for systematic screening of TB among men in Uganda. Health facility-level data were collected at four Ugandan general hospitals (Kawolo, Gombe, Mityana and Nakaseke) among 70 TB stakeholders, including healthcare workers, TB survivors, policymakers and researchers. Using health-seeking pathways, they delineated and compared men's ideal and actual step-by-step TB health-seeking processes to identify barriers to TB care. The stepping stones method, depicting barriers as a 'river' and each 'steppingstone' as a solution, was employed to identify interventions which would help link men with TB symptoms to care. These insights were then synthesized in a co-analysis meeting with 17 participants, including representatives from each health facility to develop a consensus on proposed interventions. Data across locations revealed the actual TB care pathway diverted from the ideal pathway due to health system, community, health worker and individual-level barriers such as delayed health seeking, unfavourable facility operating hours and long waiting times that conflicted with men's work schedules. Stakeholders proposed to address these barriers through the introduction of male-specific services; integrated TB services that prioritize X-ray screening for men with cough; healthcare worker training modules on integrated male-friendly services; training and supporting TB champions to deliver health education to people seeking care; and engagement of private practitioners to screen for TB. In conclusion, our participatory co-design approach facilitated dialogue, learning and consensus between different health actors on context-specific, person-centred TB interventions for men in Uganda. The acceptability, effectiveness and cost effectiveness of the package will now be evaluated in a pilot study. [ABSTRACT FROM AUTHOR]

Background: Worldwide, health systems have been challenged by the overwhelming demands of the COVID-19 pandemic. In Ethiopia, maintaining essential health services during the COVID-19 pandemic is critical to preventing severe outcomes and protecting the gains made over the past years in the health sector. This project aims to explore the health system's response to maintaining essential healthcare services in Addis Ababa, Ethiopia. Methods: A total of 60 key informant interviews were conducted by purposively selecting key stakeholders from Federal Ministry of Health, Addis Ababa Regional Health Bureau, Sub-city Health Offices, and frontline healthcare providers. Interviews were transcribed verbatim and coded using Open Code. Thematic analysis was employed to analyze the data. Result: COVID-19 affected the delivery of essential health services in several ways, namely: decline in health service utilization, fear of infection among healthcare providers, stigma towards healthcare providers, and perceived decrease in quality-of-service provision. However, the health system actors made efforts to sustain services while responding to the pandemic by enacting changes in the service delivery modality. The most significant service delivery changes included repurposing health centers and prolonged prescriptions (multi-month medication dispensing). The primary challenges encountered were burnout of the health workforce and a shortage of personal protective equipment. Conclusion: COVID-19 has affected the delivery of essential health services in multifaceted ways. System actors have accordingly made efforts to sustain services while responding to the pandemic. [ABSTRACT FROM AUTHOR]

Introduction Historically, malaria has been endemic throughout Papua New Guinea, except in highland areas over 1600 m, where temperatures are low and there is no stable local transmission, though imported [...], Objective To investigate changes in malaria prevalence in Papua New Guinea after the distribution of long-lasting Insecticide-treated nets, starting in 2004, and the introduction of artemisinin-based combination therapy in 2011. Methods Two malaria surveys were conducted in 2010-2011 and 2013-2014. They included 77 and 92 randomly selected villages, respectively. In each village, all members of 30 randomly selected households gave blood samples and were assessed for malaria infection by light microscopy. In addition, data were obtained from a malaria survey performed in 2008-2009. Results The prevalence of malaria below 1600 m in altitude decreased from 11.1% (95% confidence interval, CI: 8.5-14.3) in 2008-2009 to 5.1% (95% CI 3.6-7.4) in 2010-2011 and 0.9% (95% CI 0.6-1.5) in 2013-2014. Prevalence decreased with altitude. Plasmodium falciparum was more common than P. vivax overall, but not everywhere, and initially the prevalence of P. vivax infection decreased more slowly than P. falciparum infection. Malaria infections were clustered in households. In contrast to findings in 2008-2009, no significant association between net use and prevalence was found in the later two surveys. The prevalence of both fever and splenomegaly also decreased but their association with malaria infection became stronger. Conclusion Large-scale insecticide-treated net distribution was associated with an unprecedented decline in malaria prevalence throughout Papua New Guinea, including epidemic-prone highland areas.The decline was accompanied by broader health benefits, such as decreased morbidity. Better clinical management of nonmalarial fever and research into residual malaria transmission are required. Objectif Etudier les changements observes a legard de la prevalence du paludisme en Papouasie-Nouvelle-Gulnee suite a la distribution, depuis 2004, de moustiquaires impregnees d'Insecticides de longue duree et a l'introduction, depuis 2011, d'une combinaison therapeutique a base d'artemisinine. Methodes Deux enquetes portant sur le paludisme ont ete menees en 2010-2011 et 2013-2014. Elles incluaient respectivement 77 et 92 villages, selectionnes d'une maniere aleatoire. Dans chacun de ces villages, tous les membres de 30 foyers selectionnes aleatoirement ont donne des echantillons sanguins et ete soumis a un test de depistage de l'infection palustre par microscopie optique. Des donnees ont par ailleurs ete tirees d'une enquete sur le paludisme realisee en 2008-2009. Resultats La prevalencedu paludisme a moins de 1600 m d'altitude est passee de 11,1 % (intervalle de confiance, IC, a 95%: 8,5-14,3) en 2008-2009 a 5,1 % (IC a 95%: 3,6-7,4) en 2010-2011 et 0,9% (IC a 95%: 0,6-1,5) en 2013-2014. La prevalence diminuait avec l'altitude. Plasmodium falciparum n'etait pas systematiquement plus courant que R vivax, mais l'etait dans l'ensemble et, dans un premier temps, la prevalence de l'infection a R vivax a diminue plus lentement que la prevalence de l'Infection a P. falciparum. Les infections palustres ont ete regroupees par foyers. Contrairement a ce qu'indiquaient les resultats obtenus en 2008-2009, aucune correlation significative entre l'utilisation d'une moustiquaire et la prevalence n'a ete constatee dans le cadre des deux dernieres enquetes. Les prevalences de la fievre et de la splenomegalle ont egalement diminue, mais leur correlation avec l'infection palustre est devenue plus forte. Conclusion La distribution a grande echelle de moustiquaires impregnees d'insecticides a ete associee a un declin sans precedent de la prevalence du paludisme dans l'ensemble de la Papouasie-Nouvelle-Guinee, et notamment dans les reglons montagneuses sujettes aux epidemies. Ce declin s'est accompagne d'autres bienfaits sur la sante, et notamment d'une diminution de la morbidite. Il est necessaire d'ameliorer la prise en charge clinique de la fievre non palustre ainsi que les recherches sur la transmission residuelle du paludisme. Objetivo Investigar los cambios en la prevalencia de la malaria en Papua Nueva Guinea tras la distribucion de mosquiteros tratados con insecticida de larga duracion, a partir de 2004, y la introduccion de terapias combinadas basadas en la artemisinina en 2011. Metodos Se llevaron a cabo dos encuestas sobre la malaria en 2010-2011 y 2013-2014. Incluian 77y 92 aldeas seleccionadas al azar, respectivamente. En cada aldea, todos los miembros de 30 hogares seleccionados al azar dieron muestras de sangre y se evaluaron de infeccion de malaria con microscopio optico. Ademas, se obtuvieron datos de la encuesta sobre la malaria realizada en 2008-2009. Resultados La prevalencia de la malaria por debajo de 1600 m de altitud descendio del 11.1% (intervalo de confidencia (IC) del 95%: 8.5-14.3) en 2008-2009 al 5.1% (95% IC 3.6-7.4) en 2010-2011 y 0.9% (95% IC 0.6-1.5) en 2013-2014. La prevalencia descendia con la altitud. Plasmodium falciparum fue mas comun que P. vivax en general, pero no en todas partes e inicialmente la prevalencia de la infeccion P. vivax descendio mas lentamente que la infeccion P. falciparum. Las infecciones de malaria se agruparon en los hogares. Al contrario que los hallazgos en 2008-2009, no se encontro ninguna asociacion significativa entre el uso del mosquitero y la prevalencia en las dos ultimas encuestas. La prevalencia tanto de la fiebre como de la esplenomegalia tambien descendio, pero su asociacion con la infeccion de malaria se hizo mas fuerte. Conclusion La distribucion de mosquiteros tratados con insecticida a gran escala se asocio con un descenso sin precedentes en la prevalencia de la malaria en toda Papua Nueva Guinea, incluidas las areas altas con propension a causar epidemias. El descenso estuvo acompanado de beneficios saludables mas amplios, como el descenso de la morbilidad. Se requieren una mejor gestion clinica de la fiebre no relacionada con la malaria y la Investigacion de la transmision residual de la malaria.

Electronic gaming machines (EGMs) have been frequently associated with problem gambling. Little research has compared the relative contribution of casino EGMs versus non-casino EGMs on current problem gambling, after controlling for demographic factors and gambling behaviour. Our exploratory study obtained data from questionnaires administered to a convenient, non-representative New Zealand sample of 138 problem gamblers (66 male, 70 female) and 73 non-problem gamblers (41 male, 32 female) categorized by scores on the Problem Gambling Severity Index (PGSI). Age groups ranged from 20 to 60+ years. Of 11 gambling activities, only gambling on EGMs in casinos and EGMs in pubs and clubs distinguished problem gamblers from non-problem gamblers. There were some significant interactions between marital status and types of gambling activities on problem gambling status. From multivariate logistic regression analysis, gambling on EGMs in pubs and clubs was a stronger, unique predictor of current problem gambling than EGMs in casinos, after controlling for demographic factors and total gambling activities. We suggest directions for future large-scale research and interventions for reducing the harm of gambling on non-casino EGMs.

This paper presents findings from a survey that sought the post-treatment support preferences of a group of outpatient alcohol and other drug treatment clients. The client group (n = 83) were presented with six possible models of post-treatment support and were asked to express their level of interest in using or receiving each model and, if interested, by what means they could best be provided. The six models included a range of pro-active (service initiated) and passive (client initiated) support services, variously accessible by telephone, mail, text-message, computer or in-person. Participants were also afforded an opportunity to identify alternative approaches. The results suggest pro-active telephone- and mail-based approaches to post-treatment support are favoured over passive in-person approaches and that computer and text-message approaches (whether passive or pro-active) may be least favourable in the contemporary environment.

This paper examines the post-treatment support practices, attitudes and preferences of outpatient alcohol and other drug (AOD) treatment staff as well as perceived barriers to implementing a post-treatment support service in an outpatient AOD treatment context. Data were collected via semi-structured interview and group discussion (n = 23). Findings suggest that post-treatment support was rarely provided by participating AOD treatment staff or their respective services. However, there was widespread support for implementing such services, and it was generally believed that implementation would be most successful if: multiple post-treatment support options were made available; if one or more of these options were based on the maintenance of an established client/clinician relationship; and if one of the options involved proactive (service-led) telephone support. A number of barriers to possible implementation were identified, although none were considered insurmountable.

Multiple means exist by which gamblers including problem gamblers may be recruited from the general population for research survey purposes. However, there appears to be limited discussion in the published literature about the relative merits of one or other approach. This paper addresses this gap, in part, by reporting the experiences of employing two contrasting approaches to survey recruitment: passive advertisement versus active solicitation outside gambling venues. Fifty participants were recruited by advertisement and 54 by active solicitation. The former group was found to be less ethnically diverse and more likely to be problem gamblers than the latter group which, due to the nature of the recruitment process, showed a more even distribution of ethnicity and PGSI classified risk and problem gambler categories. Results also indicated that recruitment by advertisement was more cost effective for reaching problem gamblers whilst active solicitation was more cost effective for the recruitment of low risk and moderate risk gamblers.

This paper examines the possibility that clinicians working in an alcohol and other drug (AOD) treatment service may lack appreciation of problem improvement in clients who choose to dropout against clinical advice. Underlying this investigation is the belief that if clinicians are indeed unperceptive of problem improvement amongst this population then this may explain why retention based responses to client dropout continue to be promoted, despite evidence to suggest that they are ineffective and/or unnecessary. Outcome data obtained from a sample of 75 AOD treatment clients and their respective clinicians at baseline and 2-month follow-up are reported. Analysis of these data suggest a client/clinician discrepancy in perceived problem improvement was evident in the study setting: clinicians reported significantly less problem improvement in the first 2 months of service attendance as compared to their clients and this discrepancy was most pronounced if the client had dropped out of treatment.