scholarly journals Social and Structural Determinants of Household Support for ART Adherence in Low- and Middle-Income Countries: A Systematic Review

2020 ◽  
Vol 17 (11) ◽  
pp. 3808
Author(s):  
Linda Campbell ◽  
Caroline Masquillier ◽  
Estrelle Thunnissen ◽  
Esther Ariyo ◽  
Hanani Tabana ◽  
...  
Keyword(s):  
Low Socioeconomic Status ◽  
Cultural Context ◽  
People Living With Hiv ◽  
Art Adherence ◽  
Structural Factors ◽  
Structural Determinants ◽  
Middle Income ◽  
Middle Income Countries ◽  
Household Members ◽  
Low And Middle Income

Adherence to HIV antiretroviral therapy (ART) is a crucial factor in health outcomes for people living with HIV (PLWH). Interventions to support ART adherence are increasingly focused on the household as a source of social support. This review aims to examine the social and structural determinants of support for ART adherence within households and families in low- and middle-income countries (LMICs). The review methodology followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Seven databases were searched for peer-reviewed literature. The terms searched thematically covered (1) ART adherence, (2) household and family and (3) support and care. Thirty-three studies conducted in 15 LMICs were selected and a mixed methods synthesis was undertaken. Social and structural determinants affected the type, quality and amount of support for PLWH of all ages, which affected PLWH’s ART adherence. Gender norms affected the type of support that household members give to PLWH. Education moderated household support for ART adherence through literacy and language skills. Cultural context, religious beliefs, and social norms reinforced or undermined household support for ART adherence. Stigma affected disclosure, generated secrecy around giving medication and impeded access to support from the community. Supporting PLWH exacerbated economic hardship for household members. Health system dysfunction negatively impacted trust and communication between household members and health professionals. Intersecting social and structural determinants particularly affected the care given by household members who were older, female, with little education and low socioeconomic status. Household members were able to overcome some of these barriers when they received support themselves. Household interventions to support PLWH’s ART adherence should take structural factors into account to have maximum impact.

scholarly journals Evaluating malnutrition management through an intersectional lens: A case study of a community-based child malnutrition program in rural Uganda

2021 ◽  
Author(s):  
Marie-Catherine Gagnon-Dufresne ◽  
Geneviève Fortin ◽  
Kirsten Bunkeddeko ◽  
Charles Kalumuna ◽  
Kate Zinszer
Keyword(s):  
Gender Inequality ◽  
Acute Malnutrition ◽  
List Type ◽  
Structural Factors ◽  
Structural Determinants ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Malnourished Children ◽  
Low And Middle Income

ABSTRACTBackgroundIn Uganda, almost half of children under 5 years old suffer from undernutrition. Community-based management of acute malnutrition (CMAM) is recognized as an effective strategy for tackling this important global health issue. However, evaluations of CMAM programs are inconsistent and largely based on biomedical and behavioral health models, failing to incorporate structural factors influencing malnutrition management. Using an intersectional lens would allow to investigate the complex social processes shaping children’s care in CMAM programs. The aim of this evaluation was to understand and describe factors influencing malnutrition management in a CMAM program in rural Uganda, situating its findings within their social contexts using an intersectional approach.MethodsThis evaluation used qualitative methods to identify determinants linked to caregivers (micro-level), healthcare (meso-level) and societal structures (macro-level) that can influence children’s outpatient care. Data were collected from September to December 2019 at a community clinic through observations and interviews with caregivers of malnourished children. Data were coded in NVivo using thematic analysis. Intersectionality informed the interpretation of findings.ResultsWe observed 14 caregiver-provider encounters and interviewed 15 caregivers to assess factors hindering outpatient malnutrition management. Findings showed that caregivers had limited understanding of malnutrition and its mechanisms. The counselling offered was inconsistent and information given to caregivers about treatment preparation at home was insufficient. Gender inequality and poverty limited caregivers’ access to healthcare and their ability to care of their children. Factors at the micro and meso levels intersected with structural factors to influence malnutrition management.ConclusionResults suggest that CMAM programs would benefit from expanding support to caregivers by providing holistic interventions tackling structural barriers to children’s care. Using an intersectional approach to program evaluation could support improvement efforts by moving beyond individual determinants to address the social dynamics shaping the outpatient management of malnutrition in low- and middle-income countries.KEY MESSAGEMost evaluations of community-based management of acute malnutrition programs adopt biomedical or behavioral health models, while determinants beyond caregivers’ choices, behaviors, and practices can influence the outpatient management of child malnutrition. Managers and evaluators of these programs in low- and middle-income countries should also consider healthcare and structural determinants of care, to offer holistic interventions tackling the multifaceted barriers to programmatic success.KEY MESSAGESKey FindingsPoverty and gender inequality limited caregivers’ access to healthcare and their ability to comply with community-based management of acute malnutrition (CMAM) outpatient protocol.Nutritional counseling provided to caregivers was inconsistent, often including contradictory information about the treatment prescribed to children.Caregivers of malnourished children had a limited understanding of malnutrition and its underlying mechanisms.Key ImplicationsCMAM program evaluators should look beyond individual and behavioral factors and consider how healthcare and structural determinants interact with caregivers’ behaviors in influencing children’s outpatient care.CMAM program managers should expand support offered to caregivers by implementing holistic interventions tackling the multilevel barriers to malnutrition management to maximize programmatic success.Policymakers in Uganda and other low- and middle-income countries should develop national guidelines to fight malnutrition that seek to address the underlying determinants of child undernutrition, such as food insecurity, poverty, and women’s access to education and employment.

scholarly journals Experiences of menstruation in high income countries: a systematic review, qualitative meta-synthesis and comparison to low- and middle-income countries

2021 ◽  
Author(s):  
Dani Jennifer Barrington ◽  
Hannah Robinson ◽  
Emily Wilson ◽  
Julie Hennegan
Keyword(s):  
Cultural Context ◽  
Research Policy ◽  
Integrated Model ◽  
High Income ◽  
Policy And Practice ◽  
Middle Income ◽  
Negative Experiences ◽  
Middle Income Countries ◽  
Protocol Registration ◽  
Low And Middle Income

Background: There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries (HICs) have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can inform intervention approaches. Methods and findings: Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion. Systematic database and hand searching identified 11485 records. Following screening and quality appraisal using the EPPI-Centre checklist, 104 studies (120 publications) detailing the menstrual experiences of over 3800 individuals across sixteen countries were included. We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries (LMICs) as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences. Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials. Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way. Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly designed to inform policy or practice. Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts.Conclusions: We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive and negative menstrual experiences manifestReview protocol registration: The review protocol registration is PROSPERO: CRD42019157618.

Development and Evaluation of a Psychosocial Model for Children Who Experience Trauma from Low and Middle-income Countries

2017 ◽  
Vol 41 (S1) ◽  
pp. S308-S308
Author(s):  
P. Vostanis
Keyword(s):  
Cultural Context ◽  
Good Practice ◽  
Preliminary Evaluation ◽  
Government Schools ◽  
Vulnerable Children ◽  
Middle Income ◽  
Middle Income Countries ◽  
Psychosocial Model ◽  
Competing Interest ◽  
Low And Middle Income

IntroductionDespite fragmented evidence on individual interventions, good practice and child welfare programmes in low and middle-income countries (LMIC), there is no comprehensive model for early interventions, particularly for children who experience complex trauma.ObjectiveThe objective of the World Awareness for Children in Trauma (WACIT: www.wacit.org) is to develop an evidence-based psychosocial model for vulnerable children in low and middle-income countries with limited or no access to specialist resources.MethodsThe aim of the preliminary evaluation was to establish stakeholders’ views on the extent of need, socio-cultural context, service gaps, and recommendations for improvement and creation of working partnerships. This consisted of four studies:– 1. Participatory workshops in six countries (Turkey, Pakistan, Indonesia, Kenya, Rwanda, Brazil) with a total 250 strategic and operational stakeholders;– 2. Quantitative evaluation in two of these countries (Turkey, 32 participants; and Brazil, 80 participants);– 3. Interviews with 17 stakeholders from the six countries;– 4. Focus groups with 7 children, 7 parents, 9 teachers and 11 other professionals in one country (Kenya).ResultsFindings indicated that lack of resources (funding, facilities, training and personnel), poor collaboration (between church, families, government, schools and community), impaired parenting, socio-economic challenges and limited knowledge on child mental health as key factors that impede interventions.ConclusionsThe findings have informed the next phase of the WACIT programme in developing sustainable networks, training, and culturally appropriate interventions in the participating LMIC.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study

2017 ◽  
Vol 2 ◽  
pp. 58 ◽  
Author(s):  
Heiman F.L. Wertheim ◽  
Nguyen Thi Kim Chuc ◽  
Sureeporn Punpuing ◽  
Wasif Ali Khan ◽  
Margaret Gyapong ◽  
...  
Keyword(s):  
Cultural Context ◽  
Qualitative Interviews ◽  
Antibiotic Use ◽  
Community Members ◽  
Multi Centre Study ◽  
Middle Income ◽  
Social Interventions ◽  
Middle Income Countries ◽  
Actual Use ◽  
Low And Middle Income

In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness.

scholarly journals Evaluation of Urban Design Qualities across Five Urban Typologies in Hanoi

Urban Science ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 76
Author(s):  
Thanh Phuong Ho ◽  
Mark Stevenson ◽  
Jason Thompson ◽  
Tuan Quoc Nguyen
Keyword(s):  
Urban Design ◽  
Cultural Context ◽  
Vital Role ◽  
Middle Income Country ◽  
Low Density ◽  
Middle Income ◽  
Urban Forms ◽  
Middle Income Countries ◽  
Health And Wellbeing ◽  
Low And Middle Income

Urban design has been shown to play a vital role in promoting the health and wellbeing of urban citizens. However, studies of microscale urban design are underrepresented in comparison with macroscale urban design, especially from low- and middle-income countries in Asia, where urban forms are traditionally compact, complex and with multiple layers and varied urban typologies. The study evaluated microscale urban design qualities of streets (n = 40) across five urban typologies in Hanoi—a typical city in a low- and middle-income country in Asia. The study found that urban typologies and their characteristics have particular impacts on urban design qualities. Old and high-density urban typologies tend to report higher urban design qualities than modern and low-density typologies. Urban design qualities are also significantly associated with the number of pedestrians on the streets. Compared to Western cities, the urban design qualities in Hanoi are substantially different, especially in terms of imageability and complexity, reflecting the differences in urban design and cultural context between cities from various regions. Overall, the study contributes to our understanding of urban design circumstances in Hanoi, providing policymakers, planners, urban designers and architects with important insights for sustainable urban design policies, strategies and interventions.

scholarly journals Household-focused interventions to enhance the treatment and management of HIV in low- and middle-income countries: a scoping review

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ferdinand C. Mukumbang ◽  
Lucia Knight ◽  
Caroline Masquillier ◽  
Anton Delport ◽  
Neo Sematlane ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Treatment Outcomes ◽  
Self Efficacy ◽  
Perceived Social Support ◽  
World Health ◽  
People Living With Hiv ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background HIV remains a major public health challenge in many low- and middle-income countries (LMICs). The initiation of a greater number of people living with HIV (PLHIV) onto antiretroviral therapy (ART) following the World Health Organization’s ‘universal test and treat’ recommendation has the potential to overstretch already challenged health systems in LMICs. While various mainstream and community-based care models have been implemented to improve the treatment outcomes of PLHIV, little effort has been made to harness the potential of the families or households of PLHIV to enhance their treatment outcomes. To this end, we sought to explore the characteristics and effectiveness of household-focused interventions in LMICs on the management of HIV as measured by levels of adherence, viral suppression and different dimensions of HIV competence. Additionally, we sought to explore the mechanisms of change to explain how the interventions achieved the expected outcomes. Methods We systematically reviewed the literature published from 2003 to 2018, obtained from six electronic databases. We thematically analysed the 11 selected articles guided by the population, intervention, comparison and outcome (PICO) framework. Following the generative causality logic, whereby mechanisms are postulated to mediate an intervention and the outcomes, we applied a mechanism-based inferential reasoning, retroduction, to identify the mechanisms underlying the interventions to understand how these interventions are expected to work. Results The identified HIV-related interventions with a household focus were multi-component and multi-dimensional, incorporating aspects of information sharing on HIV; improving communication; stimulating social support and promoting mental health. Most of the interventions sought to empower and stimulate self-efficacy while strengthening the perceived social support of the PLHIV. Studies reported a significant positive impact on improving various aspects of HIV competent household – positive effects on HIV knowledge, communication between household members, and improved mental health outcomes of youths living in HIV-affected households. Conclusion By aiming to strengthen the perceived social support and self-efficacy of PLHIV, household-focused HIV interventions can address various aspects of household HIV competency. Nevertheless, the role of the household as an enabling resource to improve the outcomes of PLHIV remains largely untapped by public HIV programmes; more research on improving household HIV competency is therefore required. Trial registration PROSPERO registration: CRD42018094383.

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