Knowledge, perception and utilization of cervical cancer screening and Human Papillomavirus (HPV) vaccination among immigrants and refugees in Central Ohio

Background: Immigrants in the US are at higher risk of Human Papilloma Virus (HPV) infection and cervical cancer compared to the general US population. Low awareness surrounding cervical cancer inhibits associated preventive practices. Purpose: This cross-sectional study examined the association between knowledge, attitude, and utilization of health services for cervical cancer screening and HPV vaccine among immigrant and refugee women in Ohio. Method: Preliminary analyses were conducted on a total of 70 participants recruited from immigrant and refugee organizations and community centers, using a validated paper survey. Results: There was a statistically significant association between cervical cancer screening and general knowledge on cervical cancer (p = 0.038). The study also revealed association between screening age (p < 0.001) and insurance status (p = 0.033). Majority of the participants perceived HPV vaccine to be ineffective at preventing cervical cancer, and 40.8% participants had never heard of the vaccine and consequently had not been vaccinated. 94% participants did not receive the HPV vaccine, however, 65.3% participants indicated willingness to be vaccinated against HPV for free or at reduced cost. Conclusion: Culturally appropriate interventions are warranted to develop effective strategies that will influence HPV screening behavior and vaccine uptake in this target population.

Letter From The Editors

This past year has been characterized by great uncertainty, turmoil, and profound loss due to the COVID-19 pandemic. No matter where in the world you are, there is no doubt in our minds that some aspect of your life has been altered. However, in some ways, the pandemic has also provided opportunities to showcase our human adaptability, resilience, and scientific innovation. The pandemic has also renewed focus on the vital roles that public health research and advocacy play in ensuring our collective wellbeing in society. Therefore, it has never been more important for our journal to continue our mission of relaying innovative solutions to interdisciplinary global health issues from a variety of academic, cultural, and geographic perspectives.

Place, People & Diseases: The Association Between Geography & Diseases in Ghana

The nexus between geography and the health of humans is of interest to many scholars globally. However, this nexus is not fully examined in developing nations like Ghana as compared to developed nations. Therefore, this study examines this nexus in the Ledzokuku-Krowor municipality, a suburb of the Greater Accra region of Ghana using a means comparison approach. Malaria, diarrhea, and intestinal worm related disease are common in the municipality and strongly supported by previous studies. However, hypertension and rheumatism are two diseases that are on the rise in the municipality which are not on the list of the diseases common in Ghana.

COVID-19 in Senegal

While many academics and popular journalists have recently addressed historical epidemics in the context of COVID-19, much of this literature concerns the history of former colonial powers rather than the history of formerly colonized states. This review finds that the French colonial regime frequently used disease as a means to exert increased political power over the people of the Senegal. Primary sources, analyses of colonialism and disease in Senegal, and current popular media reveal that post-colonial successes in managing epidemic disease, when contrasted with colonial-era racialization of rampant disease, is likely shaping the Senegalese government’s response to the COVID-19 pandemic.

Utilization of Individual Birth Plan Among Women Attending Postnatal Clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu Kenya

Background: Kenya has a maternal mortality rate (MMR) of 362 women per 100,000, partly attributed to inadequate or lack of birth and emergency preparedness, including the individual birth plan. Moreover, a paucity of data on determinants of individual birth plan use hampers its promotion and utility against MMR. This study assessed the determinants of individual birth plan use among women attending the postnatal clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya. Methods: Hospital-based survey was conducted among 354 expectant women between November 2018 and February 2019. Data were collected using questionnaires and a Focus Group Discussion guide. A Logistic regression model was also used to determine factors associated with IBP utilization, where only p-value's <0.05 were considered significant. Textual data were analyzed thematically using NVIVO. Results: Most mothers (68.6%) had an individual birth plan. Determinants for having birth plans included client factors such as education, OR 8.93, p<0.001, occupation, OR=2.40, p=0.020, and parity, AOR=3.29, p=<0.034; knowledge of danger signs, AOR 8.1, p=0.001. Health facility factors included birth plan counseling, OR=3.45, p=0.013, emergency preparedness, OR=2.06, p=0.034, access to motorized transport such as a car, OR=3.8, p=0.035 or motorcycle, OR=2.7, p=0.006 and attending a clinic in a referral hospital, OR=5.8, p=0.003 Conclusion: This study has demonstrated most women utilize individual birth plans. However, they were ill-prepared for an emergency. Determinants of IBP use included client factors such as education level, employment status, parity, knowledge of danger signs, maternal attitude; and facility factors including counseling, attending a clinic in a referral hospital, the use of an automobile to reach the hospital, and hostility by the health care providers. Therefore, we recommend that prenatal counseling should emphasize emergency preparedness among pregnant women. There is a need to empower women through education and employment to enhance IBP utilization.

Mental Health Literacy, Stigma, and Access to Services among Young Adults in Tunisia

Background: There is limited research on mental health literacy and stigmatization attitudes towards mental illness in Tunisia, despite the increasing need for such research to better understand its complexity in a specific country context. Using an exploratory mixed-method approach this study attempted to assess the needs and perceptions about mental health within a population of Tunis-based young adults. Methods: A sample of 80 participants completed an online survey on different aspects of mental health attitudes, mental illness literacy and stigma, with a subset of survey participants participating in one-on-one interviews. Results: Survey results show that 77% of respondents completely agreed or somewhat agreed that they would like to learn more about mental health. This study also found that 68% of the sample reported a lack of accessibility to mental healthcare services resulting in 49% reporting their preference to search their symptoms on the internet instead of informing someone. Throughout the interviews phase, the main factors identified to have a crucial impact on young adults' choice to openly communicate feelings and thoughts with each other and to seek professional help are: culture, gender roles, sexual orientation, and family approval. Conclusion: This study suggests a great desire among young adults to learn more about mental health, and highlights the cultural complexities regarding mental health stigmatization in Tunisia. It also highlights the need for culturally relevant approaches raising awareness about mental health.

Workplace Violence Experienced by Nursing Staff at a Tertiary Hospital in Urban Nepal

Background: Healthcare workplaces are prone to the occurrence of violence of varying types and degrees. This study assessed the prevalence of violence experienced by nursing staff at a tertiary hospital in urban Nepal. Methods: A self-administered, cross-sectional survey was distributed to the entire nursing staff (N=146) currently working at a large teaching hospital in Kathmandu. The types of violence ascertained included verbal abuse, general harassment, physical assault, and sexual violence. Descriptive and logistic regression were applied to the data analysis. Results: General harassment was the second most commonly experienced; 44% reported having experienced it any time in the past; and 28% reported to have experienced it in the last 12 months. Overall, 68% of all the respondents reported having experienced any type of violence, and 47% reported having experienced it any time in the last 12 months. Compared to single nurses/respondents, married nurses were particularly more likely to experience violence. Conclusion: Development of workplace standards, orientation for all staff members, and the establishment of an effective monitoring and enforcement system are needed to minimize workplace violence at the study site, and most likely elsewhere in Nepal as well.

Exploration of introducing a chlamydia screening programme to the Democratic People's Republic of Korea

Chlamydia trachomatis is a common STI that is often asymptomatic, and can only be diagnosed through a screening test. Despite acute infection being asymtpoamtic, long term consequences of untreated CT infection can lead to infertility in men and women, increased risk of ectopic preganancy, and the economic burden of the long-term impacts far outweigh the cost of testing and treatment. Despite this, there is currently no concentrated CT screening programme in the DPRK, a region that is indicated to have high STI rates, including CT. Taking into account prevalency, the geopolitical situation of the DPRK, and the cost per positive test, this paper explores whether or not a CT screening programme would be cost-effective in the DPRK.

Pediatric Resuscitation Education in the Age of COVID-19

Despite improving medical care worldwide, vast healthcare disparities remain in low- and middle-income countries (LMIC). In Haiti, the under-5 mortality rate is more than double the rate of the Dominican Republic on the other side of the island. Through a partnership with St. Damien and Hospital Bernard Mevs in Port-Au-Prince, Haiti, and the Department of Emergency Medicine, University of Minnesota Medical School, healthcare providers have collaborated to improve pediatric emergency care and outcomes by teaching American Heart Association (AHA) courses in Haiti. Due to COVID-19, many global health initiatives, including through the University of Minnesota, have been postponed indefinitely. In efforts to continue working toward improved delivery of care, we sought to pilot a remote AHA Pediatric Advanced Life Support (PALS) course in Haiti. We delivered a complete AHA PALS course through videoconferencing, with participants engaging in hands-on procedures and simulations. We surveyed participants’ confidence in relevant skills and knowledge pre- and post-course. Results showed significantly improved ratings in 12 of the 18 surveyed items (p<0.05). Participant satisfaction in the video-based delivery of the course indicated that videoconferencing may be an effective method of course delivery. Videoconferencing shows promise as a successful tool to continue global health education.

Promoting a More Inclusive Definition of Global Health in U.S. Medical Schools

Due to increased funding opportunities, faculty recruitment, and growing interest among medical students, global health has evolved into a mainstay in American medical education. However, medical schools continue to engage with global health through fundamentally different definitions of the term itself.1,2,3 These interpretations range widely, from emphasis on neglected tropical diseases, to health systems strengthening. This essay offers a more concise and inclusive definition of global health for academic inquiry undertaken by medical schools in this field - to interpret the word global as global in scope, rather than global in geography alone. Clarifying the definition of global health in this manner offers three distinct advantages. First, it would better align American medical schools’ global health interests to the Sustainable Development Goals passed in 2015 by the United Nations, and other consensus documents shaping the current global health agenda.4 Second, this definition would encourage researchers from non-traditional disciplines in academic medicine to collaborate with medical schools on global health projects. Finally, it would facilitate smoother translation of global health practices between developed and developing countries. Reforming the definition of global health in this nature would ultimately preserve the problem-solving ethos of this field, while streamlining its commendable efforts to improve society.