Travel has individual, societal and planetary health implications. We explored socioeconomic and gendered differences in travel behaviour in Africa, to develop an understanding of travel-related ...inequity. We conducted a mixed-methods systematic review (PROSPERO CRD42019124802). In 2019, we searched MEDLINE, TRID, SCOPUS, Web of Science, LILACS, SciELO, Global Health, Africa Index Medicus, CINAHL and MediCarib for studies examining travel behaviour by socioeconomic status and gender in Africa. We appraised study quality using Critical Appraisal Skills Programme checklists. We synthesised qualitative data using meta-ethnography, followed by a narrative synthesis of quantitative data, and integrated qualitative and quantitative strands using pattern matching principles. We retrieved 103 studies (20 qualitative, 24 mixed-methods, 59 quantitative). From the meta-ethnography, we observed that travel is: intertwined with social mobility; necessary to access resources; associated with cost and safety barriers; typified by long distances and slow modes; and dictated by gendered social expectations. We also observed that: motorised transport is needed in cities; walking is an unsafe, ‘captive’ mode; and urban and transport planning are uncoordinated. From these observations, we derived hypothesised patterns that were tested using the quantitative data, and found support for these overall. In lower socioeconomic individuals, travel inequity entailed reliance on walking and paratransit (informal public transport), being unable to afford travel, travelling less overall, and travelling long distances in hazardous conditions. In women and girls, travel inequity entailed reliance on walking and lack of access to private vehicles, risk of personal violence, societally-imposed travel constraints, and household duties shaping travel. Limitations included lack of analytical rigour in qualitative studies and a preponderance of cross-sectional quantitative studies (offering a static view of an evolving process). Overall, we found that travel inequity in Africa perpetuates socioeconomic and gendered disadvantage. Proposed solutions focus on improving the safety, efficiency and affordability of public transport and walking.
•Utilised meta-ethnography and pattern-matching principles.•Revealed travel patterns differed by socioeconomic status and gender.•Travel inequity compounded disadvantage.•Females and poor people more likely to rely on walking.•Cost, safety and cultural factors were barriers to travel.
The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style ...diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption ('own livestock') had lower odds of moderate or severe household food insecurity (odds ratio (OR) = 0.29 (95% CI: 0.09, 0.96)) and those that reported buying food from supermarkets had lower odds of moderate or severe household food insecurity (borderline significant, OR = 0.37 (95% CI: 0.14, 1.00)), increased dietary diversity scores (Poisson coefficient = 0.17 (95% CI: 0.10, 0.24)) and higher odds of achieving minimum dietary diversity (OR = 2.84 (95% CI: 1.79, 4.49)). Our findings provide insight into the relationship between food environments, dietary patterns and nutrition in Kenya, and suggest that interventions that influence household food source may impact the malnutrition burden in this context.
At the time of writing, it is unclear how the COVID-19 pandemic will play out in rapidly urbanising regions of the world. In these regions, the realities of large overcrowded informal settlements, a ...high burden of infectious and non-communicable diseases, as well as malnutrition and precarity of livelihoods, have raised added concerns about the potential impact of the COVID-19 pandemic in these contexts. COVID-19 infection control measures have been shown to have some effects in slowing down the progress of the pandemic, effectively buying time to prepare the healthcare system. However, there has been less of a focus on the indirect impacts of these measures on health behaviours and the consequent health risks, particularly in the most vulnerable. In this current debate piece, focusing on two of the four risk factors that contribute to >80% of the NCD burden, we consider the possible ways that the restrictions put in place to control the pandemic, have the potential to impact on dietary and physical activity behaviours and their determinants. By considering mitigation responses implemented by governments in several LMIC cities, we identify key lessons that highlight the potential of economic, political, food and built environment sectors, mobilised during the pandemic, to retain health as a priority beyond the context of pandemic response. Such whole-of society approaches are feasible and necessary to support equitable healthy eating and active living required to address other epidemics and to lower the baseline need for healthcare in the long term.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To synthesize evidence on the impact of context-based interventions on the participation of children with disabilities in the community.
A systematic review was conducted using the American Academy ...for Cerebral Palsy and Developmental Medicine Guidelines for systematic reviews. Seven databases were searched; articles included were on children with developmental disabilities under the age of 19 years, describing systems-level, context-based interventions aimed to improve participation and Participation-related outcomes of the Family of Participation-related Constructs framework. Intervention characteristics were coded using the Community Wellbeing Framework (CWF).
Eleven articles were included for knowledge synthesis. Four studies were level I, II, and III based on the Center for Evidence-Based Medicine hierarchy. All four showed that context-based interventions had a positive effect on participation and participation-related outcomes. All 11 studies had intervention properties that were coded to at least one domain on the CWF.
There is a scarcity of high-quality studies that focus on context-based interventions at the systems-level, as opposed to the individual-level. Albeit low-level quality, existing evidence emphasized the importance of using known facilitators to participation, such as staff training, peer mentorship, awareness-raising, and development of partnerships to change the system and promote participation.
Changed health behaviours can contribute significantly to improved health. Consequently, significant investments have been channelled towards health behaviour change initiatives in Africa. Health ...behaviour change initiatives that address social, economic and environmental levers for behaviour change can create more sustained impact.
Through a scoping study of the literature, we explored the literature on behaviour change initiatives in Africa, to assess their typologies. We explored whether the availability of initiatives reflected country demographic characteristics, namely life expectancy, gross domestic product (GDP), and population sizes. Finally, we assessed topical themes of interventions relative to frequent causes of mortality.
We used the Behaviour Change Wheel intervention categories to categorise each paper into a typology of initiatives. Using Pearson's correlation coefficient, we explored whether there was a correlation between the number of initiatives implemented in a country in the specified period, and socio-demographic indicators, namely, GDP per capita, total GDP, population size, and life expectancy.
Almost 64% of African countries were represented in the identified initiatives. One in five initiatives was implemented in South Africa, while there was a dearth of literature from Central Africa and western parts of North Africa. There was a positive correlation between the number of initiatives and GDP per capita. Most initiatives focused on addressing sexually transmitted infections and were short-term trials and/or pilots. Most initiatives were downstream focused e.g. with education and training components, while upstream intervention types such as the use of incentives were under-explored.
We call for more emphasis on initiatives that address contextual facilitators and barriers, integrate considerations for sustainable development, and consider intra-regional deprivation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Public spaces have the potential to produce equitable improvements in population health. This mixed-methods systematic review aims to understand the components of, determinants, risks, and outcomes ...associated with public space initiatives in African cities. This study will include quantitative and qualitative study designs that describe public space initiatives in African cities with implications for promoting health and wellbeing, particularly through the prevention of noncommunicable diseases. Only studies published after 1990 and that contain primary or secondary data will be included in the review. Literature search strategies will be developed with a medical librarian. We will search PubMed, using both text words and medical subject headings. We will adapt this search to Scopus, Global Health, and Web of Science. This systematic review will adopt a mixed methods analytical approach. Mixing will occur in extracting both qualitative and quantitative findings; in synthesizing findings; and in the analysis where we will integrate the qualitative and quantitative strands. The learnings from this study will contribute to advancing knowledge on noncommunicable disease prevention through public space initiatives in African cities.
Increasing evidence suggests that urban health objectives are best achieved through a multisectoral approach. This approach requires multiple sectors to consider health and well-being as a central ...aspect of their policy development and implementation, recognising that numerous determinants of health lie outside (or beyond the confines of) the health sector. However, collaboration across sectors remains scarce and multisectoral interventions to support health are lacking in Africa. To address this gap in research, we conducted a mixed-method systematic review of multisectoral interventions aimed at enhancing health, with a particular focus on non-communicable diseases in urban African settings. Africa is the world's fastest urbanising region, making it a critical context in which to examine the impact of multisectoral approaches to improve health. This systematic review provides a valuable overview of current knowledge on multisectoral urban health interventions and enables the identification of existing knowledge gaps, and consequently, avenues for future research. We searched four academic databases (PubMed, Scopus, Web of Science, Global Health) for evidence dated 1989-2019 and identified grey literature from expert input. We identified 53 articles (17 quantitative, 20 qualitative, 12 mixed methods) involving collaborations across 22 sectors and 16 African countries. The principle guiding the majority of the multisectoral interventions was community health equity (39.6%), followed by healthy cities and healthy urban governance principles (32.1%). Targeted health outcomes were diverse, spanning behaviour, environmental and active participation from communities. With only 2% of all studies focusing on health equity as an outcome and with 47% of studies published by first authors located outside Africa, this review underlines the need for future research to prioritise equity both in terms of research outcomes and processes. A synthesised framework of seven interconnected components showcases an ecosystem on multisectoral interventions for urban health that can be examined in the future research in African urban settings that can benefit the health of people and the planet.Paper Context
Multisectoral interventions were identified in 27.8% of African countries in the African Union, targeted at major cities with five sectors present at all intervention stages: academia or research, agriculture, government, health, and non-governmental.
We propose a synthesised framework showcasing an ecosystem on multisectoral interventions for urban health that can guide future research in African urban settings.
This study reveals a crucial gap in evidence on evaluating the long-term impact of multisectoral interventions and calls for partnerships involving various sectors and robust community engagement to effectively deliver and sustain health-promoting policies and actions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The Human Mobility Transition model describes shifts in mobility dynamics and transport systems. The aspirational stage, ‘human urbanism’, is characterised by high active travel, universal public ...transport, low private vehicle use and equitable access to transport. We explored factors associated with travel behaviour in Africa and the Caribbean, investigating the potential to realise ‘human urbanism’ in this context. We conducted a mixed-methods systematic review of ten databases and grey literature for articles published between January 2008 and February 2019. We appraised study quality using Critical Appraisal Skills Programme checklists. We narratively synthesized qualitative and quantitative data, using meta-study principles to integrate the findings. We identified 39,404 studies through database searching, mining reviews, reference screening, and topic experts’ consultation. We included 129 studies (78 quantitative, 28 mixed-methods, 23 qualitative) and 33 grey literature documents. In marginalised groups, including the poor, people living rurally or peripheral to cities, women and girls, and the elderly, transport was poorly accessible, travel was characterised by high levels of walking and paratransit (informal public transport) use, and low private vehicle use. Poorly controlled urban growth (density) and sprawl (expansion), with associated informality, was a salient aspect of this context, resulting in long travel distances and the necessity of motorised transportation. There were existing population-level assets in relation to ‘human urbanism’ (high levels of active travel, good paratransit coverage, low private vehicle use) as well as core challenges (urban sprawl and informality, socioeconomic and gendered barriers to travel, poor transport accessibility). Ineffective mobility systems were a product of uncoordinated urban planning, unregulated land use and subsequent land use conflict. To realise ‘human urbanism’, integrated planning policies recognising the linkages between health, transport and equity are needed. A shift in priority from economic growth to a focus on broader population needs and the rights and wellbeing of ordinary people is required. Policymakers should focus attention on transport accessibility for the most vulnerable.
To present the protocol for a systematic review synthesising quantitative and qualitative evidence in academic and grey literature on intersectoral interventions to address non-communicable disease ...risk factors in urban Africa.
This protocol is developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols guidelines. Databases to be searched include PubMed, Global Health, SCOPUS, and Web of Science. Grey literature will be sourced from Google, local, regional, and international agencies, colleagues within the GDAR network, international organisations such as the WHO and UN-Habitat, UNICEF's Child Friendly Cities Initiative, Partnership for Healthy Cities, WHO Alliance for Healthy Cities, the African Centre for Cities, as well as grey literature databases such as Greynet and Opengrey.
We will include all quantitative and qualitative study designs that describe any initiatives to address non-communicable disease risk factors through intersectoral interventions, and those that describe associations between such interventions and behavioural health or wellbeing outcomes. We will also include health service interventions that have an intersectoral component and are focused on non-communicable disease prevention. Studies must have been conducted in African countries, published in the past 30 years, and contain primary or secondary data as well as an analysis of these data.
We will use the qualitative checklist and the cohort study checklist of the Critical Appraisal Skills Programme (CASP), to appraise the quality of each study included in this review. While the specific framework for data synthesis will be concluded after reviewing the extracted data, we anticipate using a parallel convergent method to synthesise the parallel strands of our study, as it involves analysing the qualitative and quantitative papers separately and then integrating them.
This will be the first systematic review to explore intersectoral interventions to address non-communicable disease risk in African cities, thus filling a crucial gap in the literature. The findings of this study will be disseminated across global organisations whose mandates cut across non-communicable diseases prevention, health promotion and healthy urban development. These include but are not limited to the World Health Organization, UN-Habitat, the UN Interagency Task Force on Noncommunicable Diseases Prevention and Control and the NCD Global Coordination Mechanism. We also plan to disseminate our findings to national and provincial stakeholders such as local governments, Ministries of Health and grassroots organisations; intergovernmental organisations such as the African Development Bank, and local and international private foundations such as Dangote Foundation and the Gates Foundation. The pan-African scope of this study makes it eligible to serve as a regional body of work and a resource to inform future interventions, practices, and policies.
Background
The gap between research and its practical application in community settings limits its impact on public health. Closing this gap has the potential to improve the well-being of underserved ...groups, such as children with disabilities. Mobile health has the potential to improve access to community resources and support for underserved populations, thereby encouraging improved health behaviors.
Objective
In this feasibility pilot study, we describe the development of the mobile app Jooay. Jooay was developed in partnership with stakeholders to facilitate access to leisure and physical activity community programs for children and youth with disabilities. We also reflect on the lessons learned throughout the implementation process that are relevant for improving the health behaviors of children with disabilities.
Methods
We used a participatory action research approach to develop the app. We also administered a survey to current Jooay users and analyzed various app usage indicators to explore use patterns, user feedback, and preferences. Finally, we critically appraised the implementation process through a best practices for implementation research framework.
Results
We developed a product that responds to users’ identified need to find information and follows accessibility and user-centered design standards. The analysis of usage data revealed that access to the Jooay app is concentrated in urban areas. Perceptions, attitudes, and information needs varied according to the type of user. The use of the mobile app changed over time, and usage decreased after the app was downloaded, indicating a need for the sustained engagement of app users. Users found value in the ability to identify activities that they would not otherwise know about. However, app use alone was not sufficient to improve participation. Although the app was developed based on users’ active input in multiple iterations, we encountered challenges with survey recruitment and attrition, suggesting the need for more seamless and engaging means for collecting data within this population.
Conclusions
Interactions between users and the app can sustain user engagement and behavior change. We will improve the app’s next iterations by using the information gained from this study to conduct a larger study to assess the relationship among social and material deprivation, urban design, and access to inclusive and adaptive leisure programs. This study will inform the improvement of app listings to improve the use of Jooay by different user groups and promote health through mobile apps for marginalized groups.
PDF
