Sexual Health and HIV/STI Risk in Gay Refugee Men in Nairobi, Kenya: A Qualitative Study

Refugees are often without financial support and some resort to survival sex. Some of these men are gay or bisexual who fled their countries because of actual or fear of death and other persecution, exacerbated by the criminalization of consensual same-sex practices by life imprisonment or death in extreme cases. We conducted qualitative interviews with 12 gay and bisexual men within a larger sample in Nairobi, Kenya, who engaged in survival sex. Thematic analysis indicated eight main themes: Physical dangers, sexual assault, lack of rights and recourse to justice; Emotional difficulties of sex work; Seeing treatable STIs as “normal”, but others like Hepatitis B and C as abnormal, and HIV as the most feared; Recognition of penile symptoms but concerns about sexual health including anal symptoms, such as fistulas and bleeding; good knowledge about HIV but confusions over PEP and PrEP, self-testing, health access to NGO clinics and some hospital clinics but concerns about stigma and discrimination in public clinics generally; and as a result of concerns about public healthcare settings, use of pharmacies for treatment. The data indicate that male refugees from gay repression, as found for refugees from other repressions, face many of the same issues with local variations.

LEVERAGING DATA MINING TECHNIQUES IN ENHANCING THE EFFICACY OF HEALTHCARE IN THIRD WORLD COUNTRIES: SPOTLIGHT ON TURKISH CASE STUDY

This paper presents a utilization of the information mining technique to decide the financial profiles of the public clinics in Turkey. The review depends on the information accumulated in 2004, covering 645 public clinics run by the Ministry of Health (MoH) as the fundamental supplier of essential and optional wellbeing administrations in Turkey. The public medical clinics, as of now financed by a combination of assets allotted from the overall spending plan and separately worked rotating reserves, need critical answers for their financial issues as a piece of a continuous public change exertion. The examination takes on the Chi-Square Automatic Interaction Detector (CHAID) choice tree calculation, as one of the most efficient and cutting-edge information digging technique utilized for division. The investigation has discovered that the public clinics could be sorted by the CHAID into 12 unique profiles as far as their financial execution. These profiles have directed us in deciding the key financial markers to be engaged upon in the public emergency clinics and present accepted procedures to work on their individual financial exhibitions. The findings have likewise permitted strategy ideas regarding the financial techniques that might be considered in working on the financial execution of the public medical clinics toward an effective wellbeing area change in Turkey.

Parental reporting of adverse drug reactions in South Africa: An online survey

Background: The high incidence of adverse drug reactions (ADRs) in children is of global concern. Enhancing the reporting of ADRs could contribute to making safer medicines available to children.Aim: To assess parents’ awareness of reporting ADRs and their knowledge on the reporting procedures in South Africa.Setting: South African parents with online access.Method: A quantitative descriptive study was conducted based on an anonymous voluntarily web-based self-administered questionnaire that was distributed through Facebook® and LinkedIn™ to parents in South Africa.Results: The questionnaire was completed voluntarily by 206 respondents. The majority of participants (70.9%) were aware of the term ADR. Significant associations between not being aware of the term ADR and single marital status, lower education level, not having private medical aid and accessing public clinics for medical services were found. The majority (66.5%) of participants did report an ADR to a healthcare professional whilst only 15% reported it to a product manufacturer. More than half of the participants (58.7%) knew how to report ADRs whilst 72.8% knew what type of ADRs to report. Almost a third (32.5%) did not know where more information on ADR reporting could be found or how ADRs could be reported (31.5%).Conclusion: The majority of the respondents were aware of the term ADR, indicative of a good knowledge basis on which ADRs to report and the importance of reporting ADRs. However, gaps in the respondents’ knowledge were identified which highlighted specific groups of individuals to be targeted to increase ADR awareness and improve the knowledge on the reporting process.

Health-Seeking Behaviour Among COVID-19 Cases In Singapore: Does Single or Multiple Physicians Make A Difference?

Background: COVID-19 is a novel pandemic affecting almost all countries leading to lockdowns worldwide. In Singapore, locally-acquired cases emerged after the first wave of imported cases, and these two groups may have different health-seeking behaviour affecting disease transmission. Objective: We investigated differences in health-seeking behaviour between locally-acquired cases and imported cases, and within the locally-acquired cases, those who saw single versus multiple healthcare providers.Methods: We conducted a retrospective study of 258 patients who were diagnosed with COVID-19 from 23 January to 17 March 2020. Variables related to health-seeking behaviour included number of visits prior to hospitalisation, timing of the first visit, duration from symptom onset to admission, and places where the cases had at least one visit.Results: Locally-acquired cases had longer duration from symptoms onset to hospital admission (median 6 days, range 1-30) than imported cases (median 4 days, range 1-13) (p<0.0005). Singapore residents were more likely to have at least one visit to private clinics and/or government-subsidised public clinics than non-residents (84.0% vs. 58.7%, p<0.0005). Among locally-acquired cases, those who sought care from a single provider had fewer visits before their hospital admissions compared with those who went to multiple care providers (median 2 vs. 3, p=0.001).Conclusion: Our study indicates the need to encourage individuals to seek medical attention early on in their patient journey, particularly from their family physician or the same doctor. This in turn, would facilitate early detection and isolation, hence limiting local transmission and enabling better control of the pandemic.

Assisted reproduction in Spain, outcome and socioeconomic determinants of access

Research question We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. Design We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. Results The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. Conclusions Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.

A Dynamic Analysis of the Demand for Health Care in Post-Apartheid South Africa

The study aimed to investigate the drivers of demand for healthcare in South Africa 26 years after democracy. The pattern healthcare demand by households in South Africa is that most households use public healthcare services particularly public clinics compared to private and traditional healthcare facilities. Using conditional probability models, the logit model to be more specific, the results revealed that households head who is unemployed, households who do not have a business, households who were not receiving pension money, had a greater probability of demand for public healthcare institutions. On the other hand, being male, being White, Indian and Coloured, being a property owner and being not a grant beneficiary, reduces the probability of demand for public healthcare facilities in South Africa. As a result, the study recommends more investment in public healthcare but more in public clinics in South Africa due to the high percentage of households using these services. Also, the government must consider investing more in the maintenance and improvement of the welfare of nurses in the country considering the huge role they play in the delivery of healthcare to the citizens.

Outcomes of retained and disengaged pregnant women living with HIV in Uganda

Introduction Loss-to-follow-up among women living with HIV (WLWHIV) may lead to unfavorable outcomes for both mother and exposed infant. This study traced WLWHIV disengaged from care and their infants and compared their outcomes with those retained in care. Methods The study included WLWHIV who initiated ART during pregnancy at six public clinics in Uganda. A woman was defined as disengaged (DW) if she had not attended her 6-week post-partum visit by 10 weeks after her estimated date of delivery. DW were matched with retained women (RW) by age and duration on ART. Nurse counselors traced all selected DW via telephone and community visits to assess vital status, infant HIV sero-status and maternal HIV viral load through blood draws. Results Between July 2017 and July 2018, 734 women (359 DW and 375 RW) were identified for the study. Tracing was attempted on 349 DW and 160 (44.6%) were successfully located and enrolled in the study. They were matched with 162 RW. Among DW, 52 (32.5%) transferred to another health facility. Very few DW, 39.0% were HIV virally suppressed (<1000 copies/ml) compared to RW 89.5%, P<0.001). Among 138 babies born to DW, 4.3% tested positive for HIV compared to 1.4% among babies born to RW (P = 0.163). Conclusion Pregnant and breastfeeding WLWHIV who disengage from care are difficult to find in urban environments. Many have detectable viral loads, leading to the potential for an increased risk of MTCT. Efforts to reduce disengagement from care are critical for the successful elimination of MTCT in resource-limited settings.

Assisted Reproduction in Spain, Outcome and Socioeconomic Determinants of Access

Research Question: We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. Design: We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. Results: The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. Conclusions: Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.