Lived experiences of persons with disabilities living with HIV in accessing HIV services in Africa: a qualitative systematic review.

PURPOSE: This qualitative review applies an intersectional lens to explore the lived experiences of persons with disabilities (PWDs) living with human immunodeficiency virus (HIV) in accessing HIV services. METHODS: Using thematic analysis, the intersections relating to HIV, disability, gender, stigma, and poverty were explored. RESULTS: Three themes were identified from the analysis: (1) intersection of gender, HIV, and disability - "For a man, it is easier because we women have a lot to take care of at the home and would not have enough time to go get services"; (2) intersection of stigma, HIV, and disability - "…Look at that one. He's disabled, at the same time HIV-positive. He doesn't even feel sorry for himself … to die quietly at home"; (3) intersection of poverty, HIV, and disability - "…maybe you don't even have money to buy food and if you're on medication you need to eat frequently". The findings highlighted how stigma, poverty, and gender collide in a hierarchy of identities to impede accessibility to HIV services. CONCLUSIONS: Researchers and programme implementers should note the intersecting issues of marginalisation that influence inequities in access to HIV services for PWDs living with HIV. National Strategic Plans should address these specific barriers to ensure accessibility for this marginalised population.Implications for rehabilitationGovernments within Africa should commit to including persons with disabilities (PWDs) living with human immunodeficiency virus (HIV) in National Strategic Plans (NSPs), which will support disability-inclusive HIV programming. The development process of NSPs should also include PWDs living with HIV.The inaccessibility of HIV services for PWDs living with HIV is multifaceted and intersectional. Interventions that consider the different social identities such as gender and socioeconomic status of PWDs living with HIV may be more impactful.Understanding the specific dimensions of access that impacted both the demand and supply side will facilitate efficient HIV programming for PWDs living with HIV.

Menstruation practice among school and out-of-school adolescent girls, Lao PDR.

BACKGROUND: The transition from childhood to adolescence is a critical transitional period for girls, and as they experience these changes, having knowledge of, and being able to practice, good menstruation hygiene management is crucial. The objective of this study was to understand in and out of school adolescents' menstrual hygiene management practice, sources of information and attitudes towards menstruation. METHODS: A cross sectional, descriptive study was conducted between November 2018 and May 2019. The sampling included adolescent girls aged 11-19 years in higher secondary schools in Khammouane and Champassak provinces and out-of-school adolescent girls. Out of the total number of 433 participants enrolled in the study, only 343 girls had reached menarche and were included in the study. Factors associated with menstruation hygiene management practice were examined with bivariate and multivariate analyses. RESULTS: Out of 343 subjects who had reached menarche, 44% reported good menstrual hygiene management practice. Over half of the participants, however, were unable to access the tools of good menstruation hygiene management practice, including having somewhere to dispose of used sanitary pads in private. Being older (16-19 years) (AOR:2.4; 95%CI 1.4 to 3.9), and having primary education (AOR 0.4; 95%CI 0.2 to 0.9) were associated with good practice as was fathers' level of education (AOR 2.1; 95%CI 1.0 to 4.1) and mother-girl discussion about menstruation (AOR 2.2; 95%CI 1.0 to 5.0). No significant differences were found between in- and out-of-school adolescents. CONCLUSIONS: In this study, not all participants were able to practice optimal menstruation hygiene management. This is important as good menstrual hygiene management is associated with better health and being able to participate fully in education and work. Further education is needed, but it is also important to ensure that all adolescent girls have access to the necessary tools for effective menstruation hygiene management.

Stillbirth in Lao PDR: a healthcare provider perspective.

BACKGROUND: Stillbirth is a major global concern. However, most research has been conducted in high-income countries. Understanding of the experience and management of stillbirth in low-middle income countries is needed. OBJECTIVE: This qualitative study explored health professionals' experiences of providing stillbirth care in the Lao People's Democratic Republic, a lower-middle-income country in South-East Asia. METHODS: In-depth interviews were conducted with 33 health professionals (doctors, midwives and nurses) and thematic analysis was undertaken. RESULTS: All participants acknowledged stillbirth as a concern, but its incidence and causes were largely undocumented and unknown. A lack of training in managing stillbirth left health professionals often ill-equipped to support mothers and provide responsive care. Social stigma surrounds stillbirth, meaning mothers found limited support or opportunities to openly express their grief. CONCLUSIONS: Better awareness of stillbirth causes could promote more positive experiences for healthcare providers and parents and more responsive healthcare. This requires improved training for healthcare professionals and awareness raising in the wider community.

Identifying inequities in an urban Latin American population: a cross-sectional study in Australian primary health care.

In Australia, people from culturally and linguistically diverse backgrounds often face inequitable health outcomes and access to health care. An important, but under-researched, population is people of Latin American descent. A cross-sectional study obtained clinical data on Latin American Spanish-speaking patients from Brisbane's south-west. Extracted data included demographic characteristics, risk factors, chronic disease and service use. A total of 382 people (60.5% female, 39.5% male), mainly from El Salvador and Chile and predominantly older people (70% over 50 years), were identified. Compared with the general Australian population, the proportion of people with dyslipidaemia, diabetes, arthritis and musculoskeletal, mental health disorders and being obese or overweight was high. There was also a higher use of the 20-40min general medicine consultation than in the general population. The proportion of patients receiving health promotion and chronic disease management activities was higher than in other reports. However, there were gaps in the provision of these services. The study shows an ageing population group with significant risk factors and an important burden of chronic disease and comorbidity. Addressing inequalities in health for culturally and linguistically diverse populations demands improvements in healthcare delivery and targeted actions based on a solid understanding of their complex health needs and their health, social and cultural circumstances.

Perceptions and management of postpartum haemorrhage among remote communities in Lao PDR.

INTRODUCTION: In Lao People's Democratic Republic, despite a policy to provide free maternal health services in healthcare facilities, many rural women continue to deliver at home, without a skilled birth attendant. These women are at high risk of postpartum haemorrhage, the leading cause of maternal mortality in the country. While women in remote areas continue to be unable to access facility-based birthing, interventions to reduce postpartum haemorrhage are a priority. This requires an understanding of how women and their families recognise and manage postpartum haemorrhage in home births. The purpose of this study was to understand community perceptions and management of postpartum bleeding during home births in remote Lao communities. METHODS: Five focus group discussions with a total of 34 women and their support networks were conducted in five remote communities in Oudomxay, a province with high rates of maternal mortality. Villages were selected with district health officials based on (1) known cases of postpartum haemorrhage, (2) travel time from the provincial capital (2-4 hours), (3) distance to the district health service (>4 km), and (4) population (50-150 people), with the five selected villages being the farthest from the district health service. The focus group discussions were complemented by qualitative, community-based key informant interviews (n=9). All interviews were conducted in Lao, English or the ethnic language most suitable for the sample and simultaneously translated by native speakers. All transcripts were translated into English, back translated and checked against interview recordings. The qualitative data were coded into key themes while moving between the data and the coded extracts. Interpretation of the data themes and coding was an ongoing process with codes and themes checked by the research team. RESULTS: Women described postpartum bleeding as a normal, necessary cleansing process. Some women felt it was critical in order to expel 'bad blood' and restore the mother to good health. Participants were able to describe late symptoms of postpartum haemorrhage but did not describe any methods to accurately estimate the amount of blood loss that required intervention. Traditional remedies were the first courses of action, potentially delaying treatment at a healthcare facility. When asked about the acceptability of taking oral medication immediately following home births to prevent postpartum haemorrhage, most women felt it would be acceptable provided it would not stop normal bleeding, and its usage, benefits and side-effects were clearly explained. CONCLUSION: While women continue to home birth in remote communities without skilled birth attendants, an informed understanding of traditional management of postpartum haemorrhage can assist in designing culturally responsive interventions. To support a reduction in morbidity and mortality from postpartum haemorrhage, tailored interventions are needed to raise awareness among women and their families to reduce delays in seeking health care. Women felt it would be acceptable to take oral medication to prevent postpartum haemorrhage. As such, community-based distribution of misoprostol that can be administered by lay people would provide an effective and acceptable prevention strategy. Other strategies should include promoting birthing plans, delivery by skilled birth attendants and early initiation of breastfeeding.

In rural Tibet, the prevalence of lower limb pain, especially knee pain, is high: an observational study.

QUESTION: What is the point prevalence and 12-month prevalence of lower limb musculoskeletal pain in rural Tibet? Does this differ with gender or age? What factors that could contribute to lower limb musculoskeletal pain are commonly present? DESIGN: Observational study using an investigator-administered questionnaire and observation walks through villages. PARTICIPANTS: 499 people aged 15 years and over living in 19 rural villages of Shigatse Municipality, Tibet. RESULTS: The point prevalence of lower limb musculoskeletal pain was 40% (95% CI 34 to 46) while the 12-month prevalence was 48% (95% CI 42 to 54). In particular, the point prevalence of knee pain was 25% (95% CI 20 to 30) and the 12-month prevalence was 29% (95% CI 23 to 35), which was significantly higher than at any other site in the lower limb. On average, being female was not associated with lower limb musculoskeletal pain either currently (OR 1.3, 95% CI 0.9 to 1.9) or over the previous 12 months (OR 1.2, 95% CI 0.9 to 1.8), whereas being older than 50 years was, both for current pain (OR 4.1, 95% CI 2.8 to 6.1) and pain over the previous 12 months (OR 4.0, 95% CI 2.7 to 6.0). Observation walks through the villages revealed people squatting for sustained periods, carrying heavy loads for long distances, wearing poor quality footwear, and with severe bowing of the legs but no obesity. CONCLUSION: Lower limb musculoskeletal pain, particularly knee pain, is common in this rural Tibetan population. They live an extremely arduous life that appears to place considerable pressure on their knees.

Working together to address disability in a culturally-appropriate and sustainable manner.

PURPOSE: Disability has an enormous impact throughout the world. An increasing amount of important disability research and practice is being undertaken in low-income settings; however, success and sustainability of programmes in these contexts can often be challenging. We share lessons from our experiences. METHOD: We reviewed past literature and international consensus statements relating to disability and development practice. We then held several face to face and email discussions to document the key lessons we have learnt from working in this context. We report on these in this paper. RESULTS: The key lessons are to invest adequate time and develop trusting relationships, undertake sufficient consultation and collaboration, include and empower persons with disability, and view capacity building as a two-way process. CONCLUSIONS: Improving the lives of persons with disability in development contexts is likely to be best achieved through processes that are inclusive, owned and driven by local communities.

Effective mine risk education in war-zone areas--a shared responsibility.

The focus of this paper is effective health education and promotion in the field of mine awareness, or what has more recently been re-titled 'mine risk education'. According to the United Nations, mine risk education comprises educational activities that aim to reduce the risk of injury from landmine/unexploded ordnance (UXO) through raising awareness and promoting behavioural change and includes public information dissemination, education and training, and community mine action liaison. Specifically, this paper is an empirical study of mine risk education practices using data collected during the implementation of a mine risk education programme that commenced in Lao PDR in 1996 and is ongoing. In particular, it considers lessons learned from the programme's monitoring and evaluation process. The authors argue that in a country such as Lao PDR, where communities have lived with UXO infestation for over 25 years, more mine risk education is not necessarily needed. This paper concludes that common programmes of mine risk education using top-down educational methods, based on the assumption that ignorance of landmine/UXO risk is the key factor in mine accidents, are inadequate. Evidence from the literature on health promotion and the experience of the programme indicate that there is a need to supplement or replace existing common mine risk education practices with techniques that incorporate an understanding of the economic, social and political circumstances faced by communities at risk.