This study evaluated the program’s effectiveness in mitigating pandemic-related health and economic inequities in Trans-Nzoia County, Kenya, a region with significant pre-existing vulnerabilities. The authors conducted a mixed-methods study using an explanatory sequential design in 2023, collecting data from 609 women in 3 cohorts: continuous participants, discontinued participants and women without exposure. Continuous participants achieved significantly higher rates of postpartum visits and exclusive breastfeeding, with reduced disparities in essential maternal health services, albeit with lower health insurance uptake and minimal improvements in Poverty Probability Index scores. While the pandemic disrupted health services, membership provided continuity of care through adapted community health worker services. Pandemic-related restrictions limited the program’s economic benefits, potentially due to the program’s shift in focus toward health service delivery, intensifying existing economic inequities. The results highlight the need for robust government support and social protection to address underlying economic vulnerabilities for women, integrating community health workers into formal health systems and strengthening their linkages with formal financial systems.
Equitable health services
This study explored the integration of traditional and complementary medicine in health systems and identify the enablers and barriers to the process, with a focus on low- and middle-income countries, with 56% of included papers from African countries. Traditional and complementary medicine was found to have the potential to strengthen various aspects of health systems, particularly in health-service delivery and products. The most commonly mentioned determinants influencing integration of traditional and complementary medicine were policies and finance, resource availability, and efficacy, quality and safety. The findings highlight the role of policies and finance in supporting integration of traditional and complementary medicine, and the need to ensure the quality and safety of traditional products through scientific methods. Reforms in medical education and strategic resource allocation are argued to be needed to create the conditions for successful integration of traditional and complementary medicine.
This study assessed knowledge, attitudes, and practices related to antibiotics among community health workers (CHW) for children with acute respiratory illness in rural Uganda. A total of 63 of 67 CHW completed both baseline and follow-up surveys, and 15 CHW were interviewed. The median age of the full cohort was 40 years with 9.5 years of CHW experience. Almost all CHW identified amoxicillin as an antibiotic at baseline, and most associated antibiotics with treating bacterial diseases. Most perceived antibiotics as harmful to patients when prescribed unnecessarily. At follow-up, more CHW disagreed that antibiotics should be prescribed when in doubt. They welcomed additional education about antimicrobial resistance and diagnostic tools to advance antimicrobial stewardship. CHW were overall familiar with antibiotics and their potential harms. They were eager to gain knowledge regarding advance antimicrobial stewardship and AMR and share it with their communities. CHW are argued to represent an underutilized resource for advance antimicrobial stewardship interventions and should be included in their design and implementation.
This paper assessed the extent and trends of inequalities in full immunization coverage among one-year-olds from the 2007 and 2013 rounds of the DRC Demographic and Health Surveys, and the 2010 and 2017 rounds of the DRC Multiple Indicator Cluster Surveys. The national coverage of full immunization among one-year-olds significantly decreased from 30.7% in 2007 to 21.7% in 2017. Significant disparities in full immunization coverage across the four dimensions of inequality were observed in all study periods. In 2017, for example, the authors recorded substantial economic, maternal education-based, place of residence-based and regional inequalities in full immunization coverage. Economic, urban‒rural, and regional relative inequalities followed a U-shaped trend, while absolute inequalities remained constant or decreased. However, inequality based on maternal education remained constant across all summary measures over time. The decreasing trend of the national full immunization coverage among one-year-olds over the ten-year study period masked substantial and persistent socioeconomic and geographic inequalities. To reduce inequalities in full immunization coverage in the DRC, the authors call for urgent equity-driven interventions to address poverty, illiteracy, and inadequate infrastructure, particularly in rural and underserved regions. Strengthening the health workforce and improving the vaccine supply chain are also seen to be crucial to ensuring equitable access to immunization services.
This systematic review evaluated strategies and interventions implemented in low- and middle-income countries (LMICs) to prevent and manage infectious disease outbreaks during humanitarian crises from 2018 to 2023. Utilizing a comprehensive literature search across Scopus, PubMed, and Web of Science, the authors identified eleven studies from 1,415 unique articles. The research examined diverse interventions including vaccination campaigns, epidemiologic surveillance, and integrated health services across multiple countries. Case studies from Haiti, Mozambique, Thailand, India, the Philippines, Yemen, Uganda, South Sudan, and Nigeria demonstrated the effectiveness of multimodal, targeted, and collaborative responses to complex health emergencies. The findings highlighted the critical importance of adaptable healthcare systems and international collaboration in addressing infectious disease risks during humanitarian crises. Despite successful interventions, the study noted persistent challenges such as infrastructure limitations, insecurity, and logistic constraints that impede comprehensive public health emergency preparedness.
This cross-sectional study examined vaccine acceptance factors among 2,312 participants in Zimbabwe and Sierra Leone using the Health Belief Model and Theory of Planned Behaviour frameworks. Using adjusted logistic regression models accounting for gender, age, education, and location, researchers found high vaccine uptake correlated with heightened perceived COVID-19 threat, recognized vaccination benefits, stronger perceived behaviour control, and fewer barriers to vaccination. Conversely, low uptake was linked to diminished perceived threats, fewer perceived benefits, weaker perceived behaviour control, and heightened perceptions of barriers. Results underscore the importance of theoretical constructs in understanding vaccine uptake variations and suggest public health campaigns should focus on reshaping risk perceptions, addressing obstacles, emphasizing vaccination benefits, and fostering a sense of self-efficacy within target communities.
This qualitative study explored tuberculosis stigma in rural South Africa through interviews with 18 health workers and 15 patients. Using Link and Phelan's theoretical model, researchers found that TB infection prevention and control measures sometimes exacerbated stigma through physical isolation and mask-wearing requirements. Patients and health workers had contrasting perspectives: patients focused on communal benefit while health workers emphasized negative impacts on patient relationships. Recommendations included improving TB education, promoting respectful communication, emphasizing communal safety, and implementing universal precautions rather than targeted measures. The study suggests using ubuntu (an African humanist framework) to guide stigma mitigation interventions and policy changes.
This paper aimed to update a woman hand-held case notes tool reflecting WHO 2016 antenatal care (ANC) guidelines in Malawi. In 2022, the authors applied a co-creative participatory approach in 3 workshops with key stakeholders to compare the current ANC tool contents to the WHO 2016 ANC guidelines, decide on key elements to be changed to improve adherence and change in practice, and to redesign the woman’s health passport tool to reflect the changes. The developed tool was endorsed for implementation within Malawi’s healthcare system by the national safe motherhood technical working group in July 2023. Five themes were identified in the analysis that were missed in the previous tool. Participants further recommended strengthening of already existing policies and investments in health, strengthening public private partnerships, and continued capacity building of healthcare providers to ensure that their skill sets are up to date. The authors' efforts reflect a pioneering attempt in Malawi to improve women’s hand-held case notes to enhance quality of care and improve women’s satisfaction with their healthcare system.
A Case for Integration: A Collection of Lived Experiences of People Living with NCDs and HIV has been published as part of the Non Communicable Disease (NCD) Alliance’s “Our Views, Our Voices” initiative, dedicated to promoting the meaningful involvement of people living with NCDs in the NCD response. Many people living with HIV struggle with mental health, yet most are unaware that their HIV status makes them more vulnerable. A number of people with HIV also reported that their other conditions were not promptly diagnosed by healthcare workers at HIV clinics. The NCD Alliance has developed 15 Transformative Solutions, which are recommendations for contextually appropriate, person-centred information about NCDs and their risk factors for people living with HIV. These include overarching recommendations: that governments – with the support of WHO, UNAIDS, global health donors, and key constituencies, including civil society, communities and people living with HIV and NCDs, and the private sector – must coordinate, fund and drive local context- responsive agendas for HIV-NCD integration to achieve the 90% integrated care target, which emphasises person-centred care and considers the whole care cascade (prevent-find-link-treat- retain). The document proposes that government strategies, national policies, and strategic plans for HIV-NCD integration must: take a phased and context-specific approach to linkages and integration of services and systems; promote the transition to UHC; consider the state of development of different national and local systems for health; and include essential HIV and NCD prevention and care services as key priorities in COVID-19 recovery plans and the ‘building back better’ agenda.
This paper explored the experiences and perceptions of women receiving post-abortal care services in Zambia, within a human-rights framework. A qualitative case study was conducted between August and September 2021 in Lusaka and Copperbelt provinces of Zambia. Fifteen women seeking post-abortion care services were` interviewed using audio recorders; transcribed data was analyzed using thematic analysis. Women who experienced spontaneous abortions delayed seeking health care by viewing symptoms as ‘normal pregnancy symptoms’ and not dangerous. Women also delayed seeking care because they feared the negative attitudes from their communities and the health care providers towards abortion in general, despite it being legal in Zambia. Some services were considered costly, impeding their right to access quality care. Women delayed seeking care compounded by fear of negative attitudes from the community and healthcare providers. To ensure the provision and utilization of quality all abortion-related healthcare services, the authors argue that there is a need to increase awareness of the availability and legality of safe abortion services, the importance of seeking healthcare early for any abortion-related discomfort, and the provision and availability of free services at all levels of care should be emphasized.