A systematic review of recruitment and retention of ethnic minorities and migrants in obesity prevention randomised controlled trials.

BACKGROUND: Participants' recruitment and retention into community-based interventions can be challenging, especially in research involving ethnic minorities and migrants. Despite known challenges, there are limited reviews that probe recruitment and retention strategies involving ethnic minorities and migrants in the Organisation for Economic Cooperation and Development (OECD) countries. This systematic review aimed to measure recruitment and retention rates and identify the barriers and facilitators to effective recruitment and retention of ethnic minorities and migrants in community-based obesity prevention Randomised Control Trials (RCTs) in OECD countries. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases (CINAHL, Cochrane, Embase, Medline and PsychInfo) were searched from January 2000 to March 2022, in addition to Google and Google Scholar. Methodological quality and risk of bias were assessed, and pooled analysis and meta-ethnographic analysis were conducted on the included studies. RESULTS: Twenty-five studies were included in the review. The pooled analysis found a 64% rate of recruitment of ethnic minorities in RCTs, with a retention rate of 71%. Key facilitators identified were-use of multiple communication channels, incentives, recruiting community champions, participant convenience and employing culturally sensitive strategies. Key barriers to participation were limited access to study sites, time constraints, limited trust, perceived fear, and anxiety. CONCLUSION: Findings suggest the importance of undertaking culturally appropriate recruitment and retention strategies to minimise barriers and facilitate effective recruitment and retention of low-income ethnic minorities and migrants in community-based research.

"Dual Pandemics": Intersecting Influences of Anti-Black Racism and the COVID-19 Pandemic on the Mental Health of Black Youth.

BACKGROUND: The intersection of the COVID-19 pandemic with systemic anti-Black racism in the form of police violence and the subsequent Black Lives Matter movement has created an especially critical juncture to examine the mental health of Black youth. PURPOSE: The purpose of this study was to understand the intersecting impacts of anti-Black racism and the COVID-19 pandemic on the mental health of Black youth. METHODS: A youth-engaged research approach and intersectionality framework were utilized. Semi-structured interviews with Black youth across Canada (ages 16 to 30, n = 48) were conducted online via Zoom and analyzed using thematic analysis. Fourteen Black youth were hired to form a Black youth advisory committee, who guided the research process. RESULTS: The "dual pandemics" of the COVID-19 pandemic alongside highly publicized incidents of racism and the subsequent Black Lives Matter movement negatively impacted participants' mental health. Four main themes emerged: (1) ongoing exposure to acts of anti-Black racism (2) compounding effect of racism on mental health; (3) high stress levels and fear; and (4) anger and emotional fatigue from lack of shared, long-term solutions. CONCLUSION: The simultaneous occurrence of the COVID-19 pandemic and instances of systemic anti-Black racism in the form of police violence presented "dual pandemics" for the Black community, profoundly impacting the mental health of Black youth and adding urgency and impetus to its prioritization. Results of this study indicate that it is critical to explore each event individually as well as the combined impact on the mental health of Black youth, particularly from a racial perspective.

COVID-19 among Black people in Canada: a scoping review. / La COVID-19 chez les personnes noires au Canada : un examen de la portée.

INTRODUCTION: The COVID-19 pandemic exacerbated health inequities worldwide. Research conducted in Canada shows that Black populations were disproportionately exposed to COVID-19 and more likely than other ethnoracial groups to be infected and hospitalized. This scoping review sought to map out the nature and extent of current research on COVID-19 among Black people in Canada. METHODS: Following a five-stage methodological framework for conducting scoping reviews, studies exploring the effects of the COVID-19 pandemic on Black people in Canada, published up to May 2023, were retrieved through a systematic search of seven databases. Of 457 identified records, 124 duplicates and 279 additional records were excluded after title and abstract screening. Of the remaining 54 articles, 39 were excluded after full-text screening; 2 articles were manually picked from the reference lists of the included articles. In total, 17 articles were included in this review. RESULTS: Our review found higher rates of COVID-19 infections and lower rates of COVID-19 screening and vaccine uptake among Black Canadians due to pre-COVID-19 experiences of institutional and structural racism, health inequities and a mistrust of health care professionals that further impeded access to health care. Misinformation about COVID-19 exacerbated mental health issues among Black Canadians. CONCLUSIONS: Our findings suggest the need to address social inequities experienced by Black Canadians, particularly those related to unequal access to employment and health care. Collecting race-based data on COVID-19 could inform policy formulation to address racial discrimination in access to health care, quality housing and employment, resolve inequities and improve the health and well-being of Black people in Canada.

Correction: Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis.

[This corrects the article DOI: 10.1371/journal.pone.0218515.].

Mapping of nutrition policies and programs in South Asia towards achieving the Global Nutrition targets.

BACKGROUND: South Asia continues to host the triple burden of child malnutrition with high levels of child undernutrition, hidden hunger (micronutrient deficiencies) and childhood overweight/obesity. To combat malnutrition, the international community along with the National governments have launched initiatives to track the country's progress towards achieving the Global Nutrition targets by 2025. This review captures the country-specific efforts of nutrition-specific and nutrition-sensitive sectoral programs and policies towards achieving these targets for eight South Asian countries. METHODS: A systematic internet search was undertaken to search relevant policies and programs from Government websites and twelve International Organisations working in the region. The authors developed a template to map the policies against the following criteria: (i) enabling supportive environment; (ii) Initiatives targeted at nutrition-specific interventions; and (iii) Initiatives targeted at nutrition-specific interventions that impact child malnutrition. A narrative descriptive approach was used to present findings. RESULTS: All eight countries had relevant policies and programs to address child malnutrition and macronutrient deficiencies with targets for significant reductions in stunting and improved breastfeeding. However, despite the outlined there are major challenges of implementation, monitoring, evaluation and quality that persist with increased dependency on international donors and organisations for funding and/or implementation of nutrition plans. CONCLUSION: There is a need to contextualise efforts designated to donors and governments to improve the tracking of efforts that impact nutrition.

Protocol for integrated solutions for healthy birth, growth and development: a cluster-randomised controlled trial to evaluate the effectiveness of a mixed nutrition intervention package in reducing child undernutrition in Lao People's Democratic Republic.

INTRODUCTION: While Lao People's Democratic Republic has seen economic gains in recent years, one-third of children aged 5 years and under are stunted. There is a need for evidence around clinically effective and cost-effective integrated nutrition-specific and nutrition-sensitive interventions in the local context. METHODS AND ANALYSIS: We aim to conduct a cluster-randomised control trial to test the effectiveness of an integrated package of community-based nutrition-specific and nutrition-sensitive interventions compared with the standard government package of nutrition actions. The trial will be in six districts within the province of Vientiane. We will recruit pregnant women in their third trimester and follow the children born to them every 6 months until 18 months of age. A total of 256 villages (serviced by 34 health centres) will be randomised to a control arm or an intervention arm using a minimisation algorithm. The primary outcome is the prevalence of stunting among children aged 6, 12 and 18 months. The secondary outcomes include prevalence of low birth weight and wasting among children aged 6, 12 and 18 months. Analyses for the primary and secondary outcomes will be conducted at the mother-infant dyad level and adjusted for the cluster randomisation. The difference in prevalence of low birth weight, wasting and stunting between control and intervention groups will be assessed using Pearson's χ2 tests and 95% CIs for the group difference, adjusted for clustering. ETHICS AND DISSEMINATION: The trial protocol was approved by the Alfred Human Research Ethic Committee (Ref: 227/16) and the Lao National Ethics Committee for Health Research (Ref: 81). The trial was registered with the Australian New Zealand Clinical Trials Registry on 28 April 2020 (ACTRN12620000520932). The results will be disseminated at different levels: study participants; the local community; other Lao stakeholders including policymakers; and an international audience. TRIAL REGISTRATION NUMBER: Australia New Zealand Clinical Trials Registry: ACTRN12620000520932.

Community-based lifestyle intervention for diabetes (Co-LID study) management rural Nepal: study protocol for a clustered randomized controlled trial.

BACKGROUND: Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based culturally appropriate lifestyle intervention in improving the management and care of people with T2DM. METHODS: We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bagmati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing support, supervision and monitoring, follow-up from the trained community health workers, and educational materials on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention. DISCUSSION: This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.

Migration-related Factors and Settlement Service Literacy: Findings from the Multi-site Migrants' Settlement Study.

Migrants' access and effective utilisation of settlement services depend on their level of settlement service literacy (SSL). However, SSL is multi-dimensional in nature and has many facets that are influenced by demographic and migration-related factors. Identifying factors that drive various components of SSL, and thus allowing for more focused development of specific dimensions, is critical. The aim of this study was to examine the relationship between components of SSL and migration-related and migrants' demographic factors. Using a snowball sampling approach, trained multilingual research assistants collected data on 653 participants. Data were collected using face-to-face or online (phone and via video platforms such as Zoom and Skype) surveys. Our findings suggest that demographic and migration-related factors explained 32% of the variance in overall SSL; and 17%, 23%, 44%, 8%, 10% of the variance in knowledge, empowerment, competence, community influence, and political components of SSL respectively. SSL was positively associated with pre-migration and post-migration educational attainment, being employed in Australia, being a refugee, coming from the sub-Saharan region but negatively associated with age and coming from the East Asia and Pacific region. Across SSL dimensions, post-migration education was the only factor positively associated with the overall SSL and all SSL dimensions (except the political dimension). Employment status in Australia was also positively associated with competency and empowerment, but not other dimensions. Affiliating with a religion other than Christianity or Islam was negatively associated with knowledge and empowerment whilst being a refugee was positively associated with knowledge. Age was negatively associated with the empowerment and competency dimensions. The study provides evidence of the importance of some pre- and post-migration factors that can assist in developing targeted initiatives to enhance migrants' SSL. Identifying factors that drive various components of SSL will allow for more focused development of specific dimensions and therefore is critical.

A Qualitative Exploration of Sources of Help for Mental Illness in Arabic-, Mandarin-, and Swahili-Speaking Communities in Sydney, Australia.

Despite being disproportionately affected by poor mental health, culturally and linguistically diverse (CaLD) individuals seek help from mental health services at lower rates than others in the Australian population. The preferred sources of help for mental illness amongst CaLD individuals remain poorly understood. The aim of this study was to explore sources of help in Arabic-, Mandarin-, and Swahili-speaking communities in Sydney, Australia. Eight focus-group discussions (n = 51) and twenty-six key informant interviews were undertaken online using Zoom. Two major themes were identified: informal sources of help and formal sources of help. Under the informal sources of help theme, three sub-themes were identified: social, religious, and self-help sources. All three communities strongly recognised the role of social sources of help, with more nuanced roles held by religion and self-help activities. Formal sources of help were described by all communities, although to a lesser extent than informal sources. Our findings suggest that interventions to support help-seeking for all three communities should involve building the capacity of informal sources of help, utilising culturally appropriate environments, and the collaboration between informal and formal sources of help. We also discuss differences between the three communities and offer service providers insights into unique issues that require attention when working with these groups.

Prevalence and factors associated with chronic school absenteeism among 207,107 in-school adolescents: Findings from cross-sectional studies in 71 low-middle and high-income countries.

BACKGROUND: Despite the negative impact of chronic school absenteeism on the psychological and physical health of adolescents, data on the burden of adolescent chronic school absenteeism (ACSA) and interventions and programs to address it are lacking. We estimated the global, regional and national level prevalence of ACSA and its correlation with violence and unintentional injury, psychosocial, protective, lifestyle, and food security-related factors among in-school adolescents across low and middle-income, and high-income countries (LMICs-HICs). OBJECTIVES: This study aimed to estimate the prevalence of chronic school absenteeism (CSA) as well as to determine its associated factors among in-school adolescents across 71 low-middle and high-income countries. METHODS: We used data from the most recent Global School-based Student Health Survey of 207,107 in-school adolescents aged 11-17 years in 71 LMICs-HICs countries across six WHO regions. We estimated the weighted prevalence of ACSA from national, regional and global perspectives. Multiple binary logistic regression analyses were used to estimate the adjusted effect of independent factors on ACSA. RESULTS: The overall population-weighted prevalence of CSA was 11·43% (95% confidence interval, CI: 11·29-11·57). Higher likelihood of CSA was associated with severe food insecurity, peer victimisation, loneliness, high level of anxiety, physically attack, physical fighting, serious injury, poor peer support, not having close friends, lack of parental support, being obese, and high levels of sedentary behaviours. Lower likelihood of CSA was associated with being female (odds ratio, OR = 0·76, 95% CI: 0·74-0·78). CONCLUSION: Our findings indicate that a combination of different socio-economic factors, peer conflict and injury factors, factors exacerbate CSA among adolescents. Interventions should be designed to focus on these risk factors and should consider the diverse cultural and socioeconomic contexts.

The Lack of Race and Ethnicity Data in Australia-A Threat to Achieving Health Equity.

Collecting meaningful race and ethnicity data must be part of the national agenda and must be one of its primary objectives in order to achieve public good and support public interests. Yet, Australia does not collect data on race and ethnicity, and prefers the use of collective cultural groups, whose information is not consistently collected and reported at all levels of government and service delivery. This paper examines the current discrepancies in race and ethnicity data collection in Australia. The paper begins with examining the current practices related to collecting race and ethnicity data and then moves on to examine the various implications and public health significance of not collecting data on race and ethnicity in Australia. The evidence suggests that (1) race and ethnicity data matter, are imperative to ensuring proper advocacy and to reducing inequities in health and social determinant factors; (2) that White privilege is constructed as realized or unrealized personal and systemic racism; and (3) the use of non-committal collective terminologies makes visible minorities invisible, leads to the distorted allocation of governmental support, and legitimises and institutionalises racism and othering, hence perpetuating exclusion and the risk of victimisation. There is an urgent need for the collection of customized, culturally competent racial and ethnicity data that can be consistently integrated into all policy interventions, service delivery and research funding across all levels of governance in Australia. Reducing and eliminating racial and ethnic disparities is not only an ethical, social, and economic imperative, but must also be a critical item on the national agenda. Bridging the racial and ethnic disparities will require concerted whole-of-government efforts to collect consistent and reliable data that depict racial and ethnic characteristics beyond collective cultural groupings.

Exploring the relationships between heritage tourism, sustainable community development and host communities' health and wellbeing: A systematic review.

Previous studies examining the impact of heritage tourism have focused on specific ecological, economic, political, or cultural impacts. Research focused on the extent to which heritage tourism fosters host communities' participation and enhances their capacity to flourish and support long-term health and wellbeing is lacking. This systematic review assessed the impact of heritage tourism on sustainable community development, as well as the health and wellbeing of local communities. Studies were included if they: (i) were conducted in English; (ii) were published between January 2000 and March 2021; (iii) used qualitative and/or quantitative methods; (iv) analysed the impact of heritage tourism on sustainable community development and/or the health and wellbeing of local host communities; and (v) had a full-text copy available. The search identified 5292 articles, of which 102 articles met the inclusion criteria. The included studies covering six WHO regions (Western Pacific, African, Americas, South-East Asia, European, Eastern Mediterranean, and multiple regions). These studies show that heritage tourism had positive and negative impacts on social determinants of health. Positive impacts included economic gains, rejuvenation of culture, infrastructure development, and improved social services. However, heritage tourism also had deleterious effects on health, such as restrictions placed on local community participation and access to land, loss of livelihood, relocation and/or fragmentation of communities, increased outmigration, increases in crime, and erosion of culture. Thus, while heritage tourism may be a poverty-reducing strategy, its success depends on the inclusion of host communities in heritage tourism governance, decision-making processes, and access to resources and programs. Future policymakers are encouraged to adopt a holistic view of benefits along with detriments to sustainable heritage tourism development. Additional research should consider the health and wellbeing of local community groups engaged in heritage tourism. Protocol PROSPERO registration number: CRD42018114681.

The importance of information acquisition to settlement services literacy for humanitarian migrants in Australia.

BACKGROUND: Due to the diversity and range of services provided to humanitarian migrants during the settlement phase of migration, acquiring information across multiple service domains is intrinsic to the effective utilisation of settlement services. There are research gaps investigating how humanitarian migrants experience and navigate unfamiliar, multiple, and often complex information and service systems of host countries. This study seeks to understand the impediments to humanitarian migrants' effective utilisation of information about settlement services and to identify strategies that can be implemented to overcome these barriers. METHODS: Service providers were purposively recruited from organisations funded by the Australian Government to deliver settlement programs. The study applied an inductive thematic analysis approach to identify key themes that emerged from the data. RESULTS: From the perspective of service providers, the themed findings identified how humanitarian migrants gain knowledge about services, their information needs, information seeking practices and skills, and information specific to service domains. The findings illustrate the importance of acquiring information, knowledge, and skills across multiple information platforms and service domains as being integral to the effective utilisation of settlement services for humanitarian migrants. The study identifies systemic barriers to information and service access and suggests different strategies and approaches to improve access to context specific key information. The study identifies factors that inhibit the effectiveness of the Australian settlement service provision model and emphasises the need for targeted training of mainstream referral services. The study highlights the important role that settlement service providers play as mediators of information, adept at tailoring information to humanitarian migrants' individual and community information needs. CONCLUSION: The findings provide important insights that highlight the different roles that policymakers, researchers, and service providers can play to inform new approaches that improve the effectiveness of information and settlement service provision, as part of contributing to optimum settlement outcomes for humanitarian migrants.

Conceptualisations of mental illness and stigma in Congolese, Arabic-speaking and Mandarin-speaking communities: a qualitative study.

BACKGROUND: Australia is an ethnically diverse nation. Research has demonstrated an elevated risk of developing a mental illness in culturally and linguistically diverse (CaLD) communities yet uptake of mental health services is low. To improve mental health treatment seeking and outcomes for CaLD individuals in Australia there is an urgent need to deeply understand barriers to treatment such as stigma. Using an exploratory qualitative approach, the aim of the study was to explore how CaLD communities' conceptualise and interpret mental illness and associated beliefs and experiences of stigma. METHODS: The study focused on three key CaLD groups: the Congolese, Arabic-speaking and Mandarin-speaking communities residing in Sydney, Australia. A series of eight focus group discussions (n = 51) and 26 key informant interviews were undertaken online using Zoom during the period of November to December 2021. Focus group discussions and key informant interviews were digitally recorded, transcribed, and analysed using NVivo software. RESULTS: Three major themes were identified. The first theme related to mental illness terminology used in the three communities. Despite variation in the terms used to refer to 'mental illness' all three communities generally distinguished between 'mental illness', a more severe condition and 'mental health problems', considered to arise due to stressors. The second theme centred on beliefs about mental illness; with all three communities identifying migration-related stressors as contributing to mental illness. Culturally related beliefs were noted for the Congolese participants with the perception of a link between mental illness and supernatural factors, whereas Mandarin-speaking participants highlighted lack of inter and intrapersonal harmony and failure to adhere to values such as filial piety as contributing to mental illness. The final theme related to mental illness related stigma and the various ways it manifested in the three communities including presence of collectivist public stigma felt across all three groups and affiliate (family) stigma reported by the Arabic and Mandarin-speaking groups. CONCLUSIONS: We found rich diversity in how these communities view and respond to mental illness. Our findings provide some possible insights on both service provision and the mental health system with a view to building effective engagement and pathways to care.

Hidden hunger and child undernutrition in South Asia: A meta-ethnographic systematic review.

BACKGROUND AND OBJECTIVES: South Asia hosts the largest proportion of undernourished children in the world. Hidden hunger and undernutrition continue to be a major global health concern in the region. A systematic review looking at factors and drivers for hidden hunger and child undernutrition was undertaken. METHODS AND STUDY DESIGN: This review was conducted using the 2020 Preferred Reporting Items for Systematic reviews and Meta- Analysis guidelines. Five computerized databases were searched: CINAHL, EMBASE, PubMed, PsycINFO and Scopus, in addition to various grey literature sources. RESULTS: A total of 3601 articles were retrieved from databases and 25 studies from grey literature, 98 studies met our inclusion criteria. Included studies were assessed for quality by validated tools. A Meta-ethnographic narrative approach was used to analyse the findings. The most commonly reported factors for child undernutrition were maternal education, poor dietary diversity and rural residence. CONCLUSIONS: Based on findings we propose a model to mainstream context specific nutrition behavioural change along with nutrition specific and sensitive interventions aimed at targeting gender, social and cultural factors and norms. Findings from the review add to the extant literature of child undernutrition to inform policy and program.

Variation in the prevalence of different forms of bullying victimisation among adolescents and their associations with family, peer and school connectedness: a population-based study in 40 lower and middle income to high-income countries (LMIC-HICs).

This study aimed to estimate the prevalence of different forms of bullying victimization experiences and their association with family functioning, peer relationships and school connectedness among adolescents across 40 lower and middle income to high-income countries (LMIC-HICs). Data were drawn from the Health Behaviour in School-Aged Children (HBSC) school-based survey of adolescents aged 11-15 years, between 2013 and 2014. We estimated the weighted prevalence by categorising experiences into traditional bullying victimization only, cyberbullying victimization only, and combined traditional and cyberbullying victimization, at country and country income classification. We used multinominal logistic regression models to estimate the adjusted association with the form of bullying victimization by demographic characteristics, family functioning, peer relationships and school connectedness. Overall, 8.0% reported traditional bullying victimization only (8.8% males, 7.4% females), 2.3% of adolescents reported cyberbullying victimization only (2.1% males, 2.2% females), and 1.7% reported combined traditional and cyber bullying victimization (1.7% males, 1.8% females). All three forms of bullying victimization during adolescence were significantly associated with poor family functioning, poor peer relations and poor school connectedness. A consistent finding is that traditional bullying victimization is considerably more common among adolescents across both LMICs and HICs than cyberbullying victimization. This study also demonstrated that a significant proportion of adolescent's experience victimization in both forms. Positive family functioning, strong peer relationships and greater school connectedness are associated with a lower risk of both forms of bullying victimization. Supplementary information: The online version contains supplementary material available at 10.1007/s40653-022-00451-8.

The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh.

BACKGROUND: Low- and middle-income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. METHODS: The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016-2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service-related factors with patients' preferences for healthcare services. RESULTS: The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56-0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80-9.86) or affordability of healthcare services (RRR = 3.13; 2.25-4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15-1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70-5.04) than the quality of treatment in the health facility, when compared with private service providers. CONCLUSIONS: Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. PATIENT OR PUBLIC CONTRIBUTION: Our research team includes four researchers (co-authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases.

The prevalence of anxiety, depression, and post-traumatic stress disorder among African migrants: A systematic review and meta-analysis.

BACKGROUND: Evidence exists reporting a high mental health burden among migrants globally. However, there is no global estimate of mental ill-health among African migrants despite their adverse pre-migration environments. This systematic review and meta-analysis summarise the current scholarship regarding the prevalence of anxiety, depression and Post-traumatic Stress Disorder (PTSD) in the global African migrant population. METHODS: We searched six databases (Medline (EBSCOHost), PsycINFO (EBSCOHost), Web of Science, PubMed, Scopus and Cumulative Index to Nursing and Allied Health (CINAHL) from 1st January 2000 to 31st August 2021. We screened retrieved articles using strict inclusion and exclusion criteria. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools. Random-effects meta-analyses were employed using DerSimonian and Laird estimator based on inverse variance weights. The I2 statistic was used to measure heterogeneity. RESULTS: Our search retrieved 1091 articles, of which 46 were included representing a total of 28,367 African migrants. The weighted mean age of African migrants was 32.98 years, and nearly half were male (n= 12852, 45.31%). Among the included studies, almost nine out of ten (n=41, 89.1%) were cross-sectional studies. The pooled prevalence of anxiety, depression and PTSD was 34.60%;95%CI (26.30-43.00), 33.20%;95%CI (27.70-38.37) and 37.9%;95%CI (23.5- 52.4) respectively. Significant heterogeneity (I2 >98%) existed in the prevalence estimates for anxiety, depression, and PTSD. Sub-group analyses indicate a significantly higher prevalence of anxiety and depression but PTSD for studies conducted in Africa than outside Africa. Similarly, higher prevalence rates for anxiety, depression, and PTSD were seen in studies that used a screening tool than in those that used a diagnostic tool, although a significant difference was observed for depression only. CONCLUSION: Despite significant heterogeneity among included studies, our systematic review and meta-analysis show a high prevalence of anxiety, depression, and PTSD among African migrants. Our findings underscore the need to develop and implement serious, culturally appropriate mental health interventions that address post-migration stressors that increase their risk of mental ill-health and successful integration into host communities.

Improving COVID-19 Vaccine Uptake among Black Populations: A Systematic Review of Strategies.

Given the growing body of evidence on COVID-19 vaccine hesitancy among Black populations, the aim of this systematic review was to identify the interventions and strategies used to improve COVID-19 vaccine confidence and uptake among Black populations globally. To identify relevant studies, we conducted a systematic review of the literature based on a systematic search of 10 electronic databases: MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Cochrane Library, Web of Science, Sociological Abstracts, Dissertations and Theses Global, and SocINDEX. We screened a total of 1728 records and included 14 peer-reviewed interventional studies that were conducted to address COVID-19 vaccine hesitancy among Black populations. A critical appraisal of the included studies was performed using the Newcastle-Ottawa Quality Assessment Scale. The intervention strategies for increasing COVID-19 vaccine uptake were synthesized into three major categories: communication and information-based interventions, mandate-based interventions, and incentive-based interventions. Interventions that incorporated communication, community engagement, and culturally inclusive resources significantly improved vaccine uptake among Black populations, while incentive- and mandate-based interventions had less impact. Overall, this systematic review revealed that consideration of the sociocultural, historical, and political contexts of Black populations is important, but tailored interventions that integrate culture-affirming strategies are more likely to decrease COVID-19 vaccine hesitancy and increase uptake among Black populations.