Restricted participation: Drivers, experiences and implications of disability stigma in Ethiopia

Background: Community-based inclusive development (CBID) acknowledges society's critical role in supporting the active participation of persons with disabilities. However, research on how this approach relates to the context-sensitive socially situated barriers of disability stigma is underexplored. Objectives: This study aimed to understand the drivers and experiences of disability stigma in Ethiopia, from the perspective of persons with disabilities engaged in CBID programmes, and to establish how disability stigma acts as a barrier to participation. Methods: An inductive methodological approach guided the research design. Mixed methods were used including a narrative review of disabilities studies literature, 16 semi-structured interviews with persons with disabilities, and a quantitative survey of 970 persons with disabilities across three communities in Ethiopia. Results: Informed by theories of epistemic justice, this study identified specific indicators of meaningful participation and examined how these relate to experiences of disability stigma. The study found that the participation of adults with disabilities in society is restricted across different areas of life. Misconceptions about the causes of disability and social perceptions regarding the capacities of persons with disabilities are found to exacerbate stigma and act as a barrier to participation. Conclusion: Targeted efforts to challenge internalised norms and harmful beliefs within CBID approaches are required to address disadvantages arising from embedded disability stigma. Contribution: This study makes conceptual, empirical and practical contributions that advance insights into the relationship between disability stigma and participation in Ethiopia and the dimensions of epistemic justice relevant to understanding the nature and drivers of disability stigma.

Perception and practice of social distancing among Egyptians in COVID-19 pandemic

Introduction: Social distancing is principally intended to reduce infectious disease transmission by decreasing interactions among people in a broader community. Keeping social distancing is an essential public health measure to resist the COVID-19 pandemic.Methodology: a cross sectional study was conducted among 1,036 Egyptians using an online questionnaire between 5 and 10 May 2020.Results: There was significant association between the practice of social distancing and some sociodemographic factors as sex, age, education, working status, and place of residence at p value < 0.001 and with community of residence at pvalue 0.021.Conclusions: Egyptians had good perception for social distancing to prevent transmission of COVID 19, but they were not strictly practicing it

Quarantine alone or in combination with other public health measures to control COVID-19: A rapid Cochrane review

In March 2020, the South African government implemented various non-pharmacological prevention and control measures (e.g. isolation, social distancing and quarantine) in response to the COVID-19 pandemic. We summarise evidence from a rapid Cochrane review on the effect of quarantine alone v. quarantine plus combination measures to prevent transmission of and mortality caused by COVID-19. The findings show that when started earlier, quarantine combined with other prevention and control measures can be more effective than quarantine alone, and cost less

Isolation and quarantine in South Africa during COVID-19: Draconian measures or proportional response?

In the midst of an unprecedented public health crisis, extraordinary containment measures must be implemented. These include both isolation and quarantine, either on a voluntary basis or enforced. In the transition from voluntary to mandatory isolation, conflicts arise at the intersection of ethics, human rights and the law. The Siracusa Principles adopted by the United Nations Economic and Social Council in 1985 and enshrined in international human rights legislation and guidelines specify conditions under which civil liberties may be infringed. In order for isolation processes in South Africa to claim legitimacy, it is important that these principles as well as national laws and constitutional rights are embedded in state action

COVID-19: The role of artificial intelligence in empowering the healthcare sector and enhancing social distancing measures during a pandemic

Indiscriminatory in its spread, COVID-19 has engulfed communities from all social backgrounds throughout the world. While healthcare professionals work tirelessly testing for the virus and caring for patients, they too have become casualties of the pandemic. Currently the best way to attempt to curb the spread of the virus, echoed by almost all nation leaders, is to distance ourselves from one another socially or physically. However ideal this may seem, social distancing is not always practical in densely populated lower-income countries with many citizens below the breadline. With the majority of South Africans living in poverty, communities in overcrowded households are unable to distance themselves from one another appropriately. In addition, as a nation we struggle with high HIV and tuberculosis rates, malnutrition and an already overburdened healthcare system, emphasising the extreme vulnerability of our people. These factors, coupled with the fact that many of our healthcare professionals lack the necessary personal protective equipment to prevent them from contracting the virus themselves, highlight the gravity of the damaging repercussions that we may face in the coming months, after the complete national lockdown in force at the time of writing is lifted and we move towards a partial lockdown state. Nationally, there needs to be a shift in mindset towards exploring alternative technology-based preventive measures that may empower the healthcare sector in the long term and enhance social distancing

Factors that impact the timely treatment of obstetric fistulas in Malawi: The perspective of health care providers

Background: In sub-Saharan African countries, women face a high risk of obstetric fistulas. In Malawi, the prevalence rate is 1 per 1000 women. Studies suggest that several obstacles exist that prevent obstetric fistula patients from getting timely treatment for their condition. Aim: The aim of this article was to find out the factors that delay the timely treatment of obstetric fistula patients at Malawian hospitals. Setting: The study was conducted at the Queen Elizabeth Central Hospital, a referral hospital, situated in Blantyre, Malawi, and the findings have been generalised to all the hospitals in Malawi. Methods: An exploratory case study, employing key interview questions, was used to provide insights into why there are delays in providing treatment and care for fistula patients. Purposive sampling technique was used to identify study respondents. Key informant interviews were conducted with 16 health care personnel at a hospital in Malawi. Results: The presence of numerous cases of complicated obstetric fistula cases overwhelms the health care system in Malawi. In addition, the severe shortage of staff, lack of obstetric fistula surgery training, low staff morale, inadequate infrastructure or equipment and water scarcity in the city of Blantyre contribute towards delayed treatment of fistulas at the hospitals. Conclusion: The presence of numerous cases of obstetric fistulas is overwhelming health services, and hence there is a need for devising and implementing health policies that will motivate Malawian health personnel to undertake obstetric fistula surgery and care

COVID-19 related knowledge, attitudes, practices and needs of households in informal settlements in Nairobi, Kenya

Objective: Urban slums are at high risk of COVID-19 transmission due to the lack of basic housing, water, and sanitation, and overcrowding. No systematic surveys of slum households' experiences exist to date. Methods: A mobile phone knowledge, attitudes, and practices survey was conducted March 30- 31, 2020. Participants were sampled from two study cohorts across five urban slums in Nairobi, Kenya. Findings: 2,009 individuals (63% female) participated. Knowledge of fever and cough as COVID-19 symptoms was high, but only 42% listed difficulty breathing. Most (83%) knew anyone could be infected; younger participants had lower perceived risk. High risk groups were correctly identified (the elderly - 64%; those with weak immune systems - 40%) however, 20% incorrectly stated children.Handwashing and using hand sanitizer were known prevention methods, though not having a personal water source (37%) and hand sanitizer being too expensive (53%) were barriers.Social distancing measures were challenging as 61% said this would risk income.A third worried about losing income, only 26% were concerned about infecting others if themselves sick. Government TV ads and short message service (SMS) were the most common sources of COVID-19 information and considered trustworthy (by >95%) but were less likely to reach less educated households. Conclusion: Knowledge of COVID-19 is high; significant challenges for behavior change campaigns to reach everyone with contextually appropriate guidance remain. Government communication channels should continue with additional efforts to reach less educated households.A strategy is necessary to facilitate social distancing, handwashing and targeted distributions of cash and food

'Here, we cannot practice what is preached': early qualitative learning from community perspectives on Zimbabwe's response to COVID-19

The ramifications of the COVID-19 pandemic extend beyond the direct health consequences to negative social, economic and wider health impacts. Integrating community engagement should be an integral pillar of national responses to strengthen countries' ability to mitigate these negative consequences. We present lessons from rapid qualitative research early in the COVID-19 pandemic in Zimbabwe, aimed at understanding community and health worker perspectives on COVID-19 and policy responses. We conducted phone interviews with community-based organisations (n=4) and healthcare workers (n=16), and collected information from social media and news outlets related to COVID-19. We conducted thematic analysis and present results around four themes. 1) Individuals are overloaded with information, but lack trusted sources, with consequences of widespread fear and unanswered questions. 2) Policies of social distancing are disconnected to communities' ability to follow such measures, without access at home to water, long-term food supplies, or a daily income. 3) Healthcare workers perceived themselves to be vulnerable, due to a shortage of personal protective equipment, contributing to ongoing strikes. 4) Health implications beyond COVID-19 are expected to be wide-reaching and severe, as resources are redirected. Our research emphasises the importance of listening to community perspectives and accounting for context-specific realities to design locally appropriate and effective responses to COVID-19. Communities require support with basic needs and reliable information to enable them to follow prevention measures. Healthcare workers urgently need personal 3 protective equipment. Lastly, continued provision of essential services and medication is essential in reducing excess mortality and morbidity from conditions other than COVID-19