Condom use and risk factors of inconsistent or low use of the condoms during heterosexual anal intercourse in sub-Saharan Africa: a scoping review.

Background: Anal intercourse (AI) has been reported to be the riskiest among other sexual intercourses in spreading human immunodeficiency virus (HIV) and the risk could be minimized by the use of condoms. Whilst AI is believed to be practised mainly by men who have sex with men, AI has also been reported to occur in heterosexual relationships. However, data on condom use during heterosexual AI are inadequate in sub-Saharan Africa. Method: A scoping review of English language published articles on condom use during heterosexual anal sex, whose studies were conducted in Sub-Saharan Africa from January 2010 to May 2020 was conducted. Articles were searched systematically on PubMed and Google Scholar electronic databases. Heterosexual AI was defined as penile penetrative anal sex between a man and a woman regardless of the sexual orientation of the 2 parties involved in the act of heterosexual AI. Findings: A total of 21 studies were eligible for analysis. Most of the studies (17 out of 21) reported females to be involved in heterosexual AI whilst 9 out of 21 studies reported males to be involved in heterosexual AI. The lifetime prevalence estimate of condom use during heterosexual AI ranged from 29%-97.5%. Other prevalence estimates of condom use during heterosexual anal intercourse were reported over various recall periods which were: 12 months' recall period with prevalence estimates ranging from 2.9%-59%; prevalence estimates for the past 3 months which ranged from 50%-94.4%; 1 month's recall period with prevalence estimates ranging from 5%-96% and prevalence estimates for the last intercourse experienced ranging from 1%-55%. Condom use during heterosexual AI was generally low and/or inconsistent among female sex workers (FSWs), men who have sex with men and women (MSMW) and some women in the general population. There were no risk factors identified in the study for the inconsistent or low use of condoms during heterosexual AI. Conclusion: Evidence from this study suggests condom use during heterosexual AI could be fairly low especially among groups such as FSWs, MSMW and some women in the general population. Risk factors for using condoms inconsistently or using condoms less during heterosexual AI are not clear. Heterosexual anal intercourse and condom use during the AI practice is generally an under-studied subject in Sub-Saharan Africa. Future studies need to explore on heterosexual AI and condom use practices during AI comprehensively so that there can be concrete evidence on the subject which will inform targeted interventions aimed at reducing HIV among heterosexual populations in SSA.

Increasing Health Insurance Enrollment in Low- and Middle-Income Countries: What Works, What Does Not, and Research Gaps: A Scoping Review.

Health insurance programs have the potential to shield individuals in low- and middle-income countries from catastrophic health expenses and reduce their vulnerability to poverty. However, the uptake of insurance programs remains low in these countries. We reviewed existing evidence from experimental studies on approaches that researchers have tested in order to raise the uptake. In the 12 studies we synthesized, educational programs and subsidies were the dominant interventions. Consistent with findings from previous studies on other health products, subsidies were effective in raising the uptake of insurance programs in many contexts. Conversely, education interventions-in their current forms-were largely ineffective, although they bolstered the effect of subsidies. Other strategies, such as the use of microfinance institutions and social networks for outreach and enrollment, showed mixed results. Additional research is needed on effective approaches to raise the uptake of insurance programs, including tools from behavioral economics that have shown promise in other areas of health behavior.

Condom use and risk factors of inconsistent or low use of the condoms during heterosexual anal intercourse in sub-Saharan Africa: a scoping review

Anal intercourse (AI) has been reported to be the riskiest among other sexual intercourses in spreading human immunodeficiency virus (HIV) and the risk could be minimized by the use of condoms. Whilst AI is believed to be practiced mainly by men who have sex with men, AI has also been reported to occur in heterosexual relationships. However, data on condom use during heterosexual AI are inadequate in sub-Saharan Africa. Method: A scoping review of English language published articles on condom use during heterosexual anal sex, whose studies were conducted in Sub-Saharan Africa from January 2010 to May 2020 was conducted. Articles were searched systematically on PubMed and Google Scholar electronic databases. Heterosexual AI was defined as penile penetrative anal sex between a man and a woman regardless of the sexual orientation of the 2 parties involved in the act of heterosexual AI. Findings: A total of 21 studies were eligible for analysis. Most of the studies (17 out of 21) reported females to be involved in heterosexual AI whilst 9 out of 21 studies reported males to be involved in heterosexual AI. The lifetime prevalence estimates of condom use during heterosexual AI ranged from 29%-97.5%. Other prevalence estimates of condom use during heterosexual anal intercourse were reported over various recall periods which were: 12 months' recall period with prevalence estimates ranging from 2.9%-59%; prevalence estimates for the past 3 months which ranged from 50%-94.4%; 1 month's recall period with prevalence estimates ranging from 5%-96% and prevalence estimates for the last intercourse experienced ranging from 1%-55%. Condom use during heterosexual AI was generally low and/or inconsistent among female sex workers (FSWs), men who have sex with men and women (MSMW) and some women in the general population. There were no risk factors identified in the study for the inconsistent or low use of condoms during heterosexual AI. Conclusion: Evidence from this study suggests condom use during heterosexual AI could be fairly low especially among groups such as FSWs, MSMW and some women in the general population. Risk factors for using condoms inconsistently or using condoms less during heterosexual AI are not clear. Heterosexual anal intercourse and condom use during the AI practice is generally an under-studied subject in Sub-Saharan Africa. Future studies need to explore on heterosexual AI and condom use practices during AI comprehensively so that there can be concrete evidence on the subject which will inform targeted interventions aimed at reducing HIV among heterosexual populations in SSA

A preliminary study of skin bleaching and factors associated with skin bleaching among women living in Zimbabwe.

BACKGROUND: Skin bleaching was reported to be commonly practiced among women and Africa was reported to be one of the most affected yet the subject is not given much attention in public health research in Zimbabwe despite the adverse effects of skin bleaching on health. METHOD: This study was an exploratory cross-sectional survey to explore skin bleaching, skin bleaching patterns and factors associated with skin bleaching among women living in Zimbabwe. An online self-administered questionnaire was sent out to women on social network i.e. WhatsApp, Facebook, LinkedIn and Twitter. FINDINGS: A total number of 260 respondents, mean age 31.69 (SD, 8.12) years participated in the survey. The prevalence of skin bleaching among the participants was 31.15%. The major reason reported for skin bleaching was to have smooth and healthy skin alongside other factors such as beauty, gaining social favours for example getting married and good jobs. Occupation, complexion and marital status were associated with skin bleaching. The odds of skin bleaching for participants who were employed was 1.45(95% confidence interval [CI],0.32-1.91);p-value 0.02, dark skinned participants 2.56(95% CI, 0.76-2.87);p-value 0.01 and unmarried participants 2.87(95% CI,0.29-3.58);p-value 0.03. CONCLUSION: Evidence from the research suggests skin bleaching might be common among women living in Zimbabwe and possibly poses serious health threats to the women. Skin bleaching seems to be deep rooted in colourism. The colourism seems to be taken advantage of by the cosmetic industry which produce the potentially hazardous products which promise the revered light skin to women but which comes with a price. However, the study provides a base for future studies to explore more on skin bleaching practices among women living in Zimbabwe.

Rethinking and strengthening the Global Health Diplomacy through triangulated nexus between policy makers, scientists and the community in light of COVID-19 global crisis.

The COVID-19 pandemic is considerably the biggest global health challenge of this modern era. Spreading across all regions of the world, this corona virus disease has disrupted even some of the most advanced economies and healthcare systems. With an increasing global death toll and no near end in sight, questions on the efficacy of global response mechanisms, including the role and relevancy of global health institutions, have emerged. Using a reflexive content analytic approach, this study sheds light on some of these questions, underscoring the disconnect between science, policymaking, and society. Global health funding approaches; politicization of the pandemic, including political blame gaming; mistrust of government and other institutions; and a lack of robust accountability measures are some of the pandemic response obstacles. However, COVID-19 has also presented an opportunity for a collaboration that may potentially solidify global solidarity. A pandemic response built on strategic global health diplomacy, vaccine diplomacy, and science diplomacy can spur both political and economic benefits, advancing development, health security, and justice. The virus thrives and flourishes in face of political divisions and lack of cooperation. While the current global crisis has exacerbated the existing social injustices in societies, national unity and global solidarity is essential to winning the fight against the COVID-19 pandemic.

Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study.

BACKGROUND: Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients' socio-economic gradient. METHODS: We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users' characteristics. In the qualitative component, we synthesized users' and providers' narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. RESULTS: Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. CONCLUSION: The quality of ANC in Nepal's primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

Integrated management of neonatal and childhood illness strategy in Zimbabwe: An evaluation.

More than five million children under the age of five die each year worldwide, primarily from preventable and treatable causes. In response, the World Health Organization's Integrated Management of Childhood Illnesses (IMNCI) strategy has been adopted in more than 95 low- and middle-income countries, 41 of them from Africa. Despite IMNCI's widespread implementation, evidence on its impact on child mortality and institutional deliveries is limited. This study examined the effect of IMNCI strategy in the context of Zimbabwe, where neonatal and infant mortality rates are among the highest in the world. We used binary logistic regression to analyze cross-sectional data from the 2015 Zimbabwe Demographic and Health Survey. Zimbabwe implemented the IMNCI strategy in 2012. Our empirical strategy involved comparing neonatal and infant mortality and institutional deliveries within the same geographic area before and after IMNCI implementation in a nationally representative sample of children born between 2010 and 2015. Exposure to IMNCI was significantly associated with a reduction in neonatal mortality (adjusted odds ratio (95% CI): 0.70 (0.50, 0.98)) and infant mortality (adjusted odds ratio (95% CI): 0.69 (0.54, 0.91)). The strategy also helped increase institutional deliveries significantly (adjusted odds ratio (95% CI): 1.95 (1.67, 2.28)). Further analyses revealed that these associations were concentrated among educated women and in rural areas.The IMNCI strategy in Zimbabwe seems to be successful in delivering its intended goals. Future programmatic and policy efforts should target women with low education and those residing in urban areas. Furthermore, sustaining the positive impact and achieving the child health-related Sustainable Development Goals will require continued political will in raising domestic financial investments to ensure the sustainability of maternal and child health programs.

Evidence on result-based financing in maternal and child health in low- and middle-income countries: a systematic review.

Introduction: Result-Based Financing (RBF) is an umbrella term for financial mechanisms that link incentives to outputs or outcomes. International development agencies are promoting RBF as a viable financing approach for the realization of universal health coverage, with numerous pilot trials, particularly in low- and middle-income countries (LMICs). There is limited synthesized evidence on the performance of these mechanisms and the reasons for the lack of RBF institutionalization. This study aims to review the evidence of RBF schemes that have been scaled or institutionalized at a national level, focusing on maternal, newborn, and child health (MNCH) programming in LMICs. Methods: A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors identified and reviewed country-level RBF evaluation reports for the period between January 2000 and June 2019. Data were extracted from both published and gray literature on RBF application in MNCH using a predesigned matrix. The matrix headers included country of application; program setting; coverage and duration; evaluation design and methods; outcome measures; and key findings. A content thematic analysis approach was used to synthesize the evidence and emerging issues. Results: The review identified 13 reports from 11 countries, predominantly from Sub-Saharan Africa. Performance-based financing was the most common form of RBF initiatives. The majority of evaluation designs were randomized trials. The evaluations focused on outputs, such as coverage and service utilization, rather than outcomes. RBF schemes in all 11 countries expanded their scope, either geographically or accordingly in terms of performance indicators. Furthermore, only three studies conducted a cost-effectiveness analysis, and only two included a discussion on RBF's sustainability. Only three countries have institutionalized RBF into their national policy. On the basis of the experience of these three countries, the common enabling factors for institutionalization seem to be political will, domestic fund mobilization, and the incorporation of demand-side RBF tools. Conclusion: RBF evidence is still growing, partial, and inconclusive. This limited evidence may be one of the reasons why many countries are reluctant to institutionalize RBF. Additional research is needed, particularly regarding cost-effectiveness, affordability, and sustainability of RBF programs.

Climate change and dengue risk in central region of Thailand.

Dengue poses a huge public health threat. It places physical and financial burden on individuals affected, family, and national health systems. This descriptive study aimed for two specific objectives; to investigate the weather effects on dengue incidence and to estimate level of risk in the central region of Thailand. It utilized a 10-year population level dengue morbidity data and meteorological data from 2007 to 2016. Kriging method was used to interpolate a weighted risk factor upon a 5-point risk estimate was developed for estimating area risk on a 5-point scale. The findings showed that 2 out of 16 provinces (12.5%) are strong to very strong risk areas for dengue, including Bangkok and Nonthaburi provinces. The study revealed that the impact of La Niña and El Niño on increased dengue incidence and risk level in Bangkok. We recommend further studies to establish intersections of dengue disease and social determinants of health.

Production and analytic bioinformatics for next-generation DNA sequencing.

The bioinformatics requirements within the clinical environment are very specific, and analytic techniques need to be fit for purpose, robust, and predictable. At the same time, the bewildering amount of information produced during these analyses needs to be carefully managed, used and interpreted correctly. The challenge for clinical laboratories now is to implement production analytical processes that are capable of handling different experimental approaches on current equipment, as well as to incorporate ways for these systems to evolve to take account of developments likely to make impacts in the near future. This is complicated by the many options available at each of the critical processing steps and a clear method needs to be developed to assemble appropriate pipelines. Here, I discuss the issues relevant to the development of an informatics pipeline that meets these criteria that should allow individual laboratories to assess their proposed strategies.

Congenital hereditary endothelial dystrophy caused by SLC4A11 mutations progresses to Harboyan syndrome.

PURPOSE: Homozygous mutations in SLC4A11 cause 2 rare recessive conditions: congenital hereditary endothelial dystrophy (CHED), affecting the cornea alone, and Harboyan syndrome consisting of corneal dystrophy and sensorineural hearing loss. In addition, adult-onset Fuchs endothelial corneal dystrophy (FECD) is associated with dominant mutations in SLC4A11. In this report, we investigate whether patients with CHED go on to develop hearing loss and whether their parents, who are carriers of an SLC4A11 mutation, show signs of having FECD. METHODS: Patients with CHED were screened for mutations in the SLC4A11 gene and underwent audiometric testing. The patients and their parents underwent a clinical examination and specular microscopy. RESULTS: Molecular analyses confirmed SLC4A11 mutations in 4 affected individuals from 3 families. All the patients were found to have varying degrees of sensorineural hearing loss at a higher frequency range. Guttate lesions were seen in 2 of the 4 parents who were available for examination. CONCLUSIONS: Our observations suggest that CHED caused by homozygous SLC4A11 mutations progresses to Harboyan syndrome, but the severity of this may vary considerably. Patients with CHED should therefore be monitored for progressive hearing loss. We could not determine conclusively whether the parents of the patients with CHED were at increased risk of developing late-onset FECD.

Detection and activity assessment of primary coronal caries lesions: a methodologic study.

This study has three main objectives: Study (1) test the reproducibility and accuracy of the ICDAS I and ICDAS II caries detection systems; Study (2) validate a new impression material (Clinpro, 3M ESPE), which is said to detect lactic acid in plaque fermenting sucrose; Study (3) devise and test a scoring system for the assessment of caries activity of coronal lesions. Study (1): 141 extracted teeth were examined by two examiners using the ICDAS I and ICDAS II caries detection systems and validated against a histological classification system. Study (2): The accuracy of the impression material in predicting plaque with pH lower/higher than 5.5 was determined in an in situ study of 45 root dentin specimens by comparing the color change in the impression with the actual pH of the plaque, determined with a pH meter. Study (3): A scoring system to assess lesion activity was devised based on the predictive power of the visual appearance of the lesion (ICDAS II system), location of the lesion in a plaque stagnation area and, finally, the tactile feeling, rough/soft or smooth/hard, when running a perio-probe over the lesion. The accuracy was tested in a clinical study of 35 children with 225 lesions/sound surfaces and was validated using the Clinpro impression material for construct validity. Study (1): Intra- and inter-examiner reproducibility was found to be excellent (Kappa-values > 0.82) and the associations strong (Spearmans correlation coefficients > 0.90). Study (2): The Clinpro impression material was found to be acceptable as compared to the results of a pH meter, the combined sensitivity and specificity was 1.63. Study (3): ROC analysis showed that the devised classification system for determining lesion activity had acceptable accuracy (area under curve = 0.84 and the highest combined sum of specificity and sensitivity was 1.67). Thus, it is possible to predict lesion depth and assess the activity of primary coronal caries lesions accurately by using the combined knowledge obtained from visual appearance, location of the lesion and tactile sensation during probing.

Sporadic inclusion body myositis in Japanese is associated with the MHC ancestral haplotype 52.1.

In Caucasians, sporadic inclusion body myositis has been associated with the MHC ancestral haplotypes; HLA-A1, B8, DR3 (8.1AH) and HLA-B35, DR1 (35.2AH). It is not known whether these haplotypes carry susceptibility for the disease in other ethnic groups. We report here the results of HLA-B and -DRB1 typing using a high-resolution sequence-based technique in a cohort of 31 Japanese patients with definite sIBM. Patient allele frequencies were 40.3% for HLA-B*5201 (10.7% in controls: p<0.001) and 37.1% for HLA-DRB1*1502 (10% in controls: p<0.001). Both alleles were found together as part of a conserved haplotype (52.1AH) at a frequency of 37.1% in patients (8.4% in controls: p<0.001). This is the first description of a haplotypic MHC association with sporadic inclusion body myositis in Japanese patients. These findings indicate that different MHC ancestral haplotypes are associated with sIBM in different ethnic groups and further emphasize the importance of genetic factors in this condition.