Qualitative Evaluation of the Africa Malaria Task Force Symposia Effectiveness on African Partner Nations' Malaria Vector Management Capacity.

INTRODUCTION: Creating health alliances to build meaningful networks is critical to combating regional and global burdens of disease. These alliances work by uniting support for elimination efforts through cooperative engagement at the national and international levels. The reduction in malaria-related morbidity and mortality in Africa since 2001 is in part because of investments of international organizations and governments in national level malaria control and prevention-related programs and research. Investment in malaria reduction networks has contributed to this success by strengthening support to overcome the conditions that restrict or prevent change through local laboratory and epidemiological capacity building, thereby resulting in a decrease in burden of disease, increase in economic prosperity, and improvements in stability worldwide.The reformation of local military efforts to combat disease through incorporation into health security alliance networks by the provision of training and financial support is key to reinforcing this success at the national level. One such example of this is the U.S. Africa Command (USAFRICOM) established and partner nation (PN) led Africa Malaria Task Force (AMTF) program. USAFRICOM's mission for AMTF as a health security alliance was to develop sustainable African-led malaria diagnostic, vector surveillance and control capabilities, and to increase collaborations among AMTF military PNs by enabling national and international-level network capacity. MATERIALS AND METHODS: The overall objective of this evaluation of the AMTF program was to assess the implementation effectiveness of two AMTF supported symposia in improving the individual, organizational, and institutional diagnostic capacity of the Ghanaian, Ivorian, and Senegalese armed forces. The specific aims of this process evaluation were to identify procedural, contextual, and capacity-related factors that influence the effect of the symposia events on laboratory capabilities at the individual, organizational, and institutional levels through a two-phased formative evaluation approach utilizing qualitative methodologies. RESULTS AND CONCLUSIONS: Findings indicate that the AMTF program symposia positively encouraged malaria prevention and control efforts in all three countries included in the evaluation. Conclusions suggest that learning about the different types of malaria prevention and control efforts underway in other countries helped to contextualize the burden of malaria-related morbidity and mortality not only within their respective countries, but also across the African continent. Participation in the AMTF Symposia and Key Leader Events helped military leadership clarify the purpose and intention of their military objectives related to systemic malaria prevention and control while purposefully contributing to national land international-level malaria reduction capacity.

Factors That Affect Emergency Responder Wellbeing: Considerations for Public Health Responders.

PURPOSE: The purpose of this study is to identify key risk factors that could negatively affect public health emergency responders' health and wellbeing. We seek to use this information to provide recommendations and strategies to mitigate such risks. DESIGN/METHODOLOGY/APPROACH: A narrative review of the peer-reviewed literature on wellbeing of military personnel and other responders was conducted. Data was grouped and categorized according to overarching domains. FINDINGS: Factors associated with wellbeing were categorized into 5 domains: (1) demographics; (2) mental health concerns; (3) social networks; (4) work environment; and (5) postdeployment life. The strategies identified to promote wellbeing included mental health assessments, preparedness trainings, debriefs in the field, postdeployment debriefs, resources in the field, and further postdeployment decompression strategies. ORIGINALITY/VALUE: This study provides a unique understanding of the risk factors associated with poor health and wellbeing outcomes in public health emergency response work by extending the body of knowledge that focuses on other types of emergency and military response.

Barriers to contraceptive careseeking: the experience of Eritrean asylum-seeking women in Israel.

Objectives: In recent years, there has been a mass migration of Eritreans (many seeking political asylum) into Israel after precarious irregular movement across international borders. This study qualitatively explores the structural barriers to family planning (i.e. contraceptive services) for Eritrean women in Israel that are rooted in their temporary legal status and the patchwork of family planning services.Design/Methods: From December 2012 to September 2013, we interviewed 25 key informants (NGO workers, researchers, Eritrean community activists, International NGO representatives and Ministry of Health officials) and 12 Eritrean asylum seekers. We also conducted 8 focus groups with Eritrean asylum seekers. Data were analyzed using both inductive and deductive coding.Results: We identified 7 main barriers to accessing family planning services: (1) distance to health facilities; (2) limited healthcare resources; (3) fragmentation of the healthcare system; (4) cost of contraceptive services; (5) low standard of care in private clinics; (6) discrimination; and (7) language barriers.Conclusion: The political, economic and social marginalization of Eritrean asylum-seeking women in Israel creates structural barriers to family planning services. Their marginalization complicates providers' efforts (NGO and governmental) to provide them with comprehensive healthcare, and hinders their ability to control their sexual and reproductive health. Failure to act on this evidence may perpetuate the pattern of unwanted pregnancies and social and economic disparities in this population.

Violence en route: Eritrean women asylum-seekers experiences of sexual violence while migrating to Israel.

Migrating irregularly, without access to support, may increase female asylum-seekers' vulnerability to sexual violence. In this study, the authors applied a public health lens to explore the risk for sexual violence experienced by female asylum-seekers en route from Eritrea to Israel. The study team conducted 13 in-depth interviews and 8 focus groups with Eritreans in Israel between April and September of 2013. Participants in the study described their experiences occurring in three segments. The combination of irregular movement through dangerous, difficult and often isolated terrain, dependence on human smugglers, and vulnerability to traffickers led to the systematization and normalization of sexual violence en route. Such factors heighten vulnerability to sexual violence among these Eritrean women asylum-seekers, as well as others who find themselves in similar circumstances.

Life on the margins: the experiences of sexual violence and exploitation among Eritrean asylum-seeking women in Israel.

BACKGROUND: Eritrean migrants in Israel, the majority of whom are seeking asylum, have limited access to institutional support. While the temporary group protection granted to Eritreans by Israel ensures that they are not deported, it does not confer permanent legal status, nor does it allow access to the formal work sector. This study qualitatively explores how political and economic marginalization increases the risk of sexual and other forms of violence as well as the exploitation of Eritrean women asylum seekers living in Israel. METHODS: Twenty-five interviews with key informants, twelve individual interviews (six with men and six with women), and eight focus group discussions (four with men and four with women) were conducted among Eritreans of reproductive age in Tel Aviv, Israel. Qualitative data analysis was conducted using open, focused, and axial coding. RESULTS: Participants reported that Israel's restrictive immigration policies laid the foundation for the political and economic marginalization of asylum seekers. This manifested in limited access to institutional support during and after arrival, and hindered access to formal employment and its associated protections. The Israeli government's decision to grant provisional status with a stipulation banning Eritreans from the formal work sector was perceived to create direct and indirect conditions for a heightened sense of structural vulnerability, particularly for women. Participants reported that this structural vulnerability increased the risk of sexual and domestic violence in addition to the risk for the exploitation of women asylum seekers. CONCLUSIONS: Israel's immigration policies may contribute to women asylum seekers' vulnerability to sexual violence upon arrival in their host country. These policies shape the social realities of women asylum seekers, potentially increasing their risk of violence and exploitation during their time in Israel. This study provides an example of the effects of political and economic marginalization on violence against women, a concept that may apply to other settings globally.

Insights into the Affordable Medicines Facility-malaria in Ghana: the role of caregivers and licensed chemical sellers in four regions.

BACKGROUND: The Affordable Medicine Facility-malaria (AMFm) was an innovative global financing mechanism for the provision of quality-assured artemisinin-based combination therapy (ACT) across both the private and public health sectors in eight countries in sub-Saharan Africa. This study evaluated the effectiveness of AMFm subsidies in increasing access to ACT in Ghana and documented malaria management practices at the household and community levels during the implementation of the AMFm. METHODS: This study, conducted in four regions in Ghana between January, 2011 to December, 2012, employed cross-sectional mixed-methods design that included qualitative and quantitative elements, specifically household surveys, focus group discussions (FGD) and in-depth interviews. RESULTS: The study indicated high ACT availability, adequate provider knowledge and reasonably low quality-assured ACT use in the study areas, all of which are a reflection of a high market share of ACT in these hard-to-reach areas of the country. Adequate recognition of childhood malaria symptoms by licensed chemical seller (LCS) attendants was observed. A preference by caregivers for LCS over health facilities for seeking treatment solutions to childhood malaria was found. CONCLUSIONS: Artemisinin-based combination therapy with the AMFm logo was accessible and affordable for most people seeking treatment from health facilities and LCS shops in rural areas. Caregivers and LCS were seen to play key roles in the health of the community especially with children under 5 years of age.

A qualitative study exploring barriers related to use of footwear in rural highland ethiopia: implications for neglected tropical disease control.

BACKGROUND: The role of footwear in protection against a range of Neglected Tropical Diseases (NTDs) is gaining increasing attention. Better understanding of the behaviors that influence use of footwear will lead to improved ability to measure shoe use and will be important for those implementing footwear programs. METHODOLOGY/PRINCIPAL FINDINGS: Using the PRECEDE-PROCEED model we assessed social, behavioral, environmental, educational and ecological needs influencing whether and when children wear shoes in a rural highland Ethiopian community endemic for podoconiosis. Information was gathered from 242 respondents using focus groups, semi-structured interviews and extended case studies. Shoe-wearing norms were said to be changing, with going barefoot increasingly seen as 'shameful'. Shoes were thought to confer dignity as well as protection against injury and cold. However, many practical and social barriers prevented the desire to wear shoes from being translated into practice. Limited financial resources meant that people were neither able to purchase more than one pair of shoes to ensure their longevity nor afford shoes of the preferred quality. As a result of this limited access, shoes were typically preserved for special occasions and might not be provided for children until they reached a certain age. While some barriers (for example fit of shoe and fear of labeling through use of a certain type of shoe) may be applicable only to certain diseases, underlying structural level barriers related to poverty (for example price, quality, unsuitability for daily activities and low risk perception) are likely to be relevant to a range of NTDs. CONCLUSIONS/SIGNIFICANCE: Using well established conceptual models of health behavior adoption, we identified several barriers to shoe wearing that are amenable to intervention and which we anticipate will be of benefit to those considering NTD prevention through shoe distribution.

The association of beliefs about heredity with preventive and interpersonal behaviors in communities affected by podoconiosis in rural Ethiopia.

Little is known about how beliefs about heredity as a cause of health conditions might influence preventive and interpersonal behaviors among those individuals with low genetic and health literacy. We explored causal beliefs about podoconiosis, a neglected tropical disease (NTD) endemic in Ethiopia. Podoconiosis clusters in families but can be prevented if individuals at genetically high risk wear shoes consistently. Adults (N = 242) from four rural Ethiopian communities participated in qualitative assessments of beliefs about the causes of podoconiosis. Heredity was commonly mentioned, with heredity being perceived as (1) the sole cause of podoconiosis, (2) not a causal factor, or (3) one of multiple causes. These beliefs influenced the perceived controllability of podoconiosis and in turn, whether individuals endorsed preventive and interpersonal stigmatizing behaviors. Culturally informed education programs that increase the perceived controllability of stigmatized hereditary health conditions like podoconiosis have promise for increasing preventive behaviors and reducing interpersonal stigma.