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Background: The importance of management capacity in the health sector has been increasingly recognized. After decades of conflict one of the main obstacles facing the Afghan health system was the limited ‘management/leadership capacity.’ To effectively build capacity it is important to understand the underlying issues. Methods: A mixed-methods study, conducted in 2017/18, before the Taliban takeover, was carried out in all directorates of the Ministry of Public Health (MoPH) to explore the management/leadership capacity. Interviews were conducted with 12 staff; data were analyzed thematically. A quantitative survey was also conducted covering directors of 30 departments, it was analyzed using descriptive statistics. Results: Our research identified four main factors in the MoPH affecting management and leadership capacity; insufficient support, uncoordinated capacity building, political and socio-cultural issues, and lack of transparency/accountability. This paper focuses on one aspect - the perceptions of the MoPH employees about the impact of political/socio-cultural issues on capacity. Overall, management capacity was weak. Key appointments including directors were subject to political interference and many directors appointed by politicians lacked the required management skills. Consequently, those directors were not able to support employees appropriately or to create a healthy work environment. Overall, there were strong socio-cultural influences such as nepotism and favoritism. Due to these problems employees believed they were not treated consistently or fairly. This was compounded by overly complex administrative systems. Conclusion: Being able to strengthen management and leadership capacity in the Afghan health system depends largely on the implementation of (existing) anti-corruption strategies.

Introduction: Prenatal mental health problems are associated with morbidity for the pregnant person, and their infants are at long-term risk for poor health outcomes. We aim to explore how the SARS-CoV-2 pandemic affected the mental health of pregnant people in the United Kingdom (UK), and to further identify resilience factors which may have contributed to varying mental health outcomes. We also aim to examine the quality of antenatal care provided during the pandemic in the UK and to identify potential inadequacies to enhance preparedness for future events. Methods: During June-November 2020, we recruited 3666 individuals in the UK for the EPPOCH pregnancy cohort (Maternal mental health during the COVID-19 pandemic: Effect of the Pandemic on Pregnancy Outcomes and Childhood Health). Participants were assessed for depression, anxiety, anger and pregnancy-related anxiety using validated scales. Additionally, physical activity, social support, individualized support and personal coping ability of the respondents were assessed as potential resilience factors. Results: Participants reported high levels of depression (57.05%), anxiety (58.04%) and anger (58.05%). Higher levels of social and individualized support and personal coping ability were associated with lower mental health challenges. Additionally, pregnant individuals in the UK experienced higher depression during the pandemic than that reported in Canada. Finally, qualitative analysis revealed that restrictions for partners and support persons during medical appointments as well as poor public health communication led to increased mental health adversities and hindered ability to make medical decisions. Discussion: This study revealed increased mental health challenges among pregnant individuals in the UK during the SARS-CoV-2 pandemic. These results highlight the need for reassessing the mental health support measures available to pregnant people in the UK, both during times of crisis and in general. [ABSTRACT FROM AUTHOR]

Introduction: Prenatal mental health problems are associated with morbidity for the pregnant person, and their infants are at long-term risk for poor health outcomes. We aim to explore how the SARS-CoV-2 pandemic affected the mental health of pregnant people in the United Kingdom (UK), and to further identify resilience factors which may have contributed to varying mental health outcomes. We also aim to examine the quality of antenatal care provided during the pandemic in the UK and to identify potential inadequacies to enhance preparedness for future events. Methods: During June-November 2020, we recruited 3666 individuals in the UK for the EPPOCH pregnancy cohort (Maternal mental health during the COVID-19 pandemic: Effect of the Pandemic on Pregnancy Outcomes and Childhood Health). Participants were assessed for depression, anxiety, anger and pregnancy-related anxiety using validated scales. Additionally, physical activity, social support, individualized support and personal coping ability of the respondents were assessed as potential resilience factors. Results: Participants reported high levels of depression (57.05%), anxiety (58.04%) and anger (58.05%). Higher levels of social and individualized support and personal coping ability were associated with lower mental health challenges. Additionally, pregnant individuals in the UK experienced higher depression during the pandemic than that reported in Canada. Finally, qualitative analysis revealed that restrictions for partners and support persons during medical appointments as well as poor public health communication led to increased mental health adversities and hindered ability to make medical decisions. Discussion: This study revealed increased mental health challenges among pregnant individuals in the UK during the SARS-CoV-2 pandemic. These results highlight the need for reassessing the mental health support measures available to pregnant people in the UK, both during times of crisis and in general. [ABSTRACT FROM AUTHOR]

In recent years, international media and the scientific community have expressed concerns regarding rising kidney health-related risks among Nepalese labour migrants in Gulf countries and Malaysia. Previous studies have highlighted poor lifestyles and work conditions among Nepalese migrants, which could potentially impact their kidney health. This qualitative study aims to explore the lifestyles and work environment of returnee Nepalese migrants who were diagnosed with kidney health problems. In-depth interviews were carried out with twelve returnee migrants, all males, with half having worked abroad for at least a decade. Our analysis yielded seven themes: (a) living and lifestyles; (b) work environment; (c) exposure to pollutants; (d) Chronic Kidney Disease (CKD) experience; (e) use of painkillers and healthcare; (f) medical expenses for CKD patients; and (g) pre-departure training. This study indicates that Nepalese migrants face numerous challenges, including limited access to clean water and sanitation facilities, poor diets, exposure to occupational hazards, and overuse of pain medication, all of which may contribute to an increased risk of kidney disease. An enhanced pre-departure and on-arrival orientation programme focusing on kidney health-related topics, including the necessary advocacy at the country of destination to provide access to basic services, may encourage migrants to adopt healthy lifestyles and safe working environments, as well as help sensitise migrants to their kidney health risks. [ABSTRACT FROM AUTHOR]

There are many different methods or approaches that can be applied to the evaluation of complex programmes. This paper describes the use of the Most Significant Change (MSC) participatory technique to monitor and evaluate programmatic effects. The MSC is a form of monitoring because it occurs throughout the programme cycle and provides information to manage it. Further, MSC is an evaluation because it provides stories from which programmes' overall impact can be assessed. However, MSC, a participatory evaluation technique using qualitative approaches, is neglected by many researchers. We hope this study will convince relevant funders and evaluators of the value of the MSC technique and application. This paper offered step-by-step guidelines on how to use the MSC technique when evaluating a large-scale intervention covering perspectives of different beneficiaries within a limited period. The MSC process involves purposively selecting the beneficiaries, collecting the Most Significant (MS) stories, which are then systematically analysed by designated stakeholders and or implemented partners, selected through internal vetting, and external process by involving beneficiaries and stakeholders. The central question focuses on changes in the form of stories such as 'Who did what?'; 'When did the change occur?'; and 'What was the process?' Additionally, it seeks feedback to explain why particular a story was selected as MS and how the selection process was organised. The MSC technique further attempts to verify the validity, significant, relevant, sustainability of the change, and impact on marginalized or Gender Equality and Social Inclusion (GESI) groups brought by the programme. Furthermore, the technique seeks verification of the MS story by triangulating comprehensive notes and recordings. [ABSTRACT FROM AUTHOR]

Background and Aims: Access to safe and sufficient drinking Water, Sanitation, and good Hygiene (WASH) facilities in schools play a crucial role in preventing students from numerous Neglected Tropical Diseases, improving the learning environment in schools, and creating resilient communities living in a healthy environment. This study aims to explore the impact of combining WASH facilities on students' health status, school attendance, and educational achievements. Methods: Four schools, two with improved and two without improved WASH facilities, were selected purposively from Dhanusha and Chitwan districts of Nepal. A total of 24 participants, 16 students, and eight teachers were also purposively selected based on the Theory of Data Saturation. The participants were interviewed face‐to‐face using study guidelines; Key Informants Interview for teachers and In‐depth Interview for students. The data were audio recorded and analyzed thematically using Dedoose 9.0.17 qualitative data management and analysis software. Results: School WASH facilities have a significant impact on students' health and well‐being. Poor school‐WASH facilities hindered students' school attendance, particularly for menstruating girls. School without separate toilets for girls, including menstruation hygiene facilities, lack of water and soap, sanitary pad, and secure toilet's door often have higher rates of absenteeism among girls. Poor teacher and students' relationships, students' low interest in education, household chores, and participation in social customs also contribute to students' absence from school and low educational performance. It is important to note that inadequate WASH facilities affect not only students, but also teachers in the same school. Conclusion: The lack of safe and sufficient drinking water, unimproved sanitation, and poor hygiene facilities were seen by students and teachers as reducing their health and well‐being, school attendance, and academic performance. Thus, schools need prioritize and promote the provision of improved WASH facilities for the betterment of students' health, attendance, and educational proficiency. [ABSTRACT FROM AUTHOR]

Objective The purpose of this health system's study is to assess the availability of Emergency Obstetric Care (EmOC) services in birthing centres in Taplejung District of eastern Nepal. Methods A cross-sectional survey was conducted in 2018 in all 16 public health facilities providing delivery services in the district. Data collection comprised: (1) quantitative data collected from health workers; (2) observation of key items; and (3) record data extracted from the health facility register. Descriptive statistics were used to calculate readiness scores using unweighted averages. Results Although key health personnel were available, EmOC services at the health facilities assessed were below the minimum coverage level recommended by the World Health Organisation. Only the district hospital provided the nine signal functions of Comprehensive EmOC. The other fifteen had only partially functioning Basic EmOC facilities, as they did not provide all of the seven signal functions. The essential equipment for performing certain EmOC functions was either missing or not functional in these health facilities. Conclusions for Practice The Ministry of Health and Population and the federal government need to ensure that the full range of signal functions are available for safe deliveries in partially functioning EmOC health facilities by addressing the issues related to training, equipment, medicine, commodities and policy., Author(s): Amrit Banstola [sup.1] , Padam Simkhada [sup.2] , Edwin van Teijlingen [sup.3] , Surya Bhatta [sup.4] , Susma Lama [sup.5] , Abisha Adhikari [sup.4] , Ashik Banstola [sup.1] [sup.6] [...]

Online communication tools are increasingly being used by qualitative researchers; hence it is timely to reflect on the differences when using a broad range of data collection methods. Using a case study with a potentially hard-to-reach substance-using population who are often distrustful of researchers, this article explores the use of a variety of different platforms for interviews. It highlights both the advantages and disadvantages of each method. Face-to-face interviews and online videos offer more opportunity to build rapport, but lack anonymity. Live Webchat and audio-only interviews offer a high level of anonymity, but both may incur a loss of non-verbal communication, and in the Webchat a potential loss of personal narrative. This article is intended for sociologists who wish to broaden their methods for conducting research interviews. [ABSTRACT FROM AUTHOR]

This article explores the presence and impact of microplastics and nanoplastic particles (MNPs) on cardiovascular health. MNPs have been found in various environments, including oceans and food, posing a threat to human health. Studies have shown that MNPs have negative effects on the cardiovascular system, but the exact mechanisms are not fully understood. The article emphasizes the need to reduce the production and spread of MNPs through campaigns, eco-friendly organizations, and stricter legislation. It suggests minimizing the use of plastics and opting for biodegradable products, while also acknowledging the potential of clean-up programs and new technologies to remove MNPs from the environment. [Extracted from the article]