COVID-19 has caused a revelation of change across the world. Higher education leaders faced significant challenges during the unprecedented crisis, particularly in the early stage of the pandemic. We ...examined the University of Sydney's response to the pandemic using key informant interviews with leaders at different levels of the university structure to fill the crisis management gap in Australia's higher education sector. Key themes that emerged from the interviews focused on the importance of communication strategies in crisis, how the level of collaboration affected the pandemic response efforts and that adaptability to change was essential for engagement and communication in a time where face-to-face contact was limited. We applied the thematic analysis results from the interviews to Mitroff and Pearson's crisis management model to reflect on the University's response. We identified several recommendations from the experiences for future public health crisis responses.
Data on the prevalence of chronic conditions, their risk factors, and their associations with disability in older people living with and without HIV are scarce in sub-Saharan Africa.
In older people ...living with and without HIV in sub-Saharan Africa: 1) to describe the prevalence of chronic conditions and their risk factors and 2) to draw attention to associations between chronic conditions and disability.
Cross-sectional individual-level survey data from people aged 50 years and over living with and without HIV were analyzed from three study sites in Uganda. Diagnoses of chronic conditions were made through self-report, and disability was determined using the WHO Disability Assessment Schedule (WHODAS). We used ordered logistic regression and calculated predicted probabilities to show differences in the prevalence of multiple chronic conditions across HIV status, age groups, and locality. We used linear regression to determine associations between chronic conditions and the WHODAS.
In total, 471 participants were surveyed; about half the respondents were living with HIV. The prevalence of chronic obstructive pulmonary disease and eye problems (except for those aged 60-69 years) was higher in the HIV-positive participants and increased with age. The prevalence of diabetes and angina was higher in HIV-negative participants. The odds of having one or more compared with no chronic conditions were higher in women (OR 1.6, 95% CI 1.1-2.3) and in those aged 70 years and above (OR 2.1, 95% CI 1.2-3.6). Sleep problems (coefficient 14.2, 95% CI 7.3-21.0) and depression (coefficient 9.4, 95% CI 1.2-17.0) were strongly associated with higher disability scores.
Chronic conditions are common in older adults and affect their functioning. Many of these conditions are not currently addressed by health services in Uganda. There is a need to revise health care policy and practice in Uganda to consider the health needs of older people, particularly as the numbers of people living into older age with HIV and other chronic conditions are increasing.
Stunting (low height-for-age) remains a global and national health problem because it increases the risk of disturbances in growth and development and mortality. Banjar Margo District, Tulang Bawang ...Regency, has the second-highest prevalence in Lampung Province, Indonesia. This study aimed to analyze the association of exclusive breastfeeding history and stunting in children aged 12–23 months in Banjar Margo District. This study used a cross-sectional design on 193 children aged 12–23 months. It was primary data conducted between April and May 2018 with a questionnaire. Data analysis was performed using the chi-square test and multiple logistic regression. The result showed that of 193 children, 29.5% were stunted. Children who were not exclusively breastfed were 3.1 times (95%CI = 1.5–6.4) more at risk of stunting than those exclusively breastfed, after controlling for mothers with low education and unemployment factors as confounding variables. Health promotion activities in primary/integrated health care should be focused not only on mothers but also on other people involved in child care, such as grandparents, at-home caregivers, and day carers.
BackgroundThe COVID-19 pandemic resulted in extreme strain on health systems including the health workforce, essential health services and vaccination coverage. We examined disruptions to ...immunisation and maternal and child health (MCH) services, concerns of personal well-being and delivery of healthcare during the pandemic as well as factors associated with self-reported trauma or burnout among healthcare providers (HCPs).MethodsIn March–April 2022, we conducted a cross-sectional survey among HCPs in two provinces of Indonesia. HCPs involved in COVID-19 or routine immunisation and MCH services were randomly selected from district/city health office registration lists. We descriptively analysed service disruptions experienced by HCPs as well as trauma, burnout and concerns of personal well-being and delivery of healthcare during the pandemic. Multivariate logistic regression analyses were undertaken to identify factors associated with trauma or burnout.ResultsWe recruited 604 HCPs. Mobilisation of staff from routine health services to COVID-19 response duties was a key reason for service disruptions (87.9%). Strategies such as community outreach and task shifting were implemented to overcome disruptions. Trauma or burnout during the pandemic was reported by 64.1% HCPs, with 23.5% reporting worse mental or emotional health.Factors associated with trauma or burnout included delivery of COVID-19 immunisation (adjusted OR (aOR) 2.54, 95% CI 1.08 to 5.94); and delivery of both COVID-19 immunisation and routine immunisation compared with no involvement in vaccination programmes (aOR 2.42, 95% CI 1.06 to 5.52); poor treatment in the workplace (aOR 2.26, 95% CI 1.51 to 3.38) and lower confidence to respond to patient queries on COVID-19 immunisation (aOR 1.51, 95% CI 1.03 to 2.22).ConclusionHCPs experienced service disruptions, trauma and burnout and implemented strategies to minimise disruptions to service delivery and improve patient experiences. Our study highlights the need to ensure that workforce resilience and strategies to protect and support HCPs are considered for pandemic planning, preparedness and management.
This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and ...strategies for increasing the amount of health research conducted with socially disadvantaged groups.
A systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition.
In total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials.
To tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships.
•Most caregivers had positive beliefs about routine immunisation.•Many children aged 2–24 months were not up-to-date with all vaccines for age.•Uptake was associated with education, income and ease ...of access to immunisation.•Child illness and perceived vaccine unavailability were key reasons for missed/delayed immunisation.•Interventions should focus on strategies that are responsive to the context-specific needs and priorities of districts and communities.
The COVID-19 pandemic contributed to significant health services declines in South-East Asia including Indonesia, which experienced a decline in routine immunisation of children. This study investigated the influence of the pandemic on the beliefs and experiences of caregivers of children related to routine immunisation.
This study involved a cross-sectional survey among 1399 caregivers of children aged 0–24 months in Central Java and West Nusa Tenggara provinces from March–April 2022. Data on beliefs and experiences of childhood immunizations were captured using core items from the WHO/UNICEF Behavioural and Social Drivers of Immunization (BeSD) survey. Bivariate and multivariate logistic regression analyses identified factors associated with uptake of routine immunisations.
While nearly all caregivers (95.7%) reported wanting their child to receive all recommended routine immunisations, only 40.3% of children aged 2–24 months were up-to-date with all vaccines for age. Factors associated with up-to-date included higher parental education (aOR: 1.76, 95% CI 1.02–3.05), higher household income (aOR: 1.54, 95% CI 1.09–2.18), and caregivers who found it moderately or very easy to get immunisations (aOR: 2.26/2.22, 95% CI 1.06–4.83/1.06–4.69).
Recovery efforts should prioritise responding to the factors associated with immunisation status (e.g., perceived ease of access) and on families experiencing disadvantage (e.g., caregivers with lower education and household income) to ensure protections against future outbreaks that are responsive to the context-specific needs and priorities of districts and communities.
The focus of HIV interventions in Botswana, a country with the second highest prevalence of HIV in the world, remains targeted at those aged 15-49 years despite a growing cohort of older people ...living with the disease - driven largely by the successful roll-out of antiretroviral therapy (ART). Primarily utilising the Botswana AIDS Impact Survey IV, we set out to examine HIV related characteristics and behaviours of this often ignored older cohort (50-64 years) relative to younger (25-49 years) adults. Analysis revealed that more than 80% of older people living with HIV were on ART. HIV prevalence among this older cohort was 24.6% in 2013 compared to 35.1% among the younger cohort, p < 0.0001. Prevalence in older adults was higher among older males (27.8%) than females (21.9%), p = 0.02. Furthermore, 58.9% of older adults acknowledged being sexually active, with 59.0% of these admitting to inconsistent condom use during sexual intercourse. In addition to this low condom usage, older men (6.0%) were significantly more likely to be unaware of their HIV-positive status than older women (3.0%), p = 0.002. While HIV prevalence showed a dramatic increase among older men over time (17.2% in 2004, to 23.4% in 2008, to 27.8% in 2013), the trend was flatter among older women (16.3% in 2004, to 22.4% in 2008, to 21.9% in 2013). These trends are likely attributable to a large increase in ART coverage and uptake. Going forward, more targeted interventions acknowledging the ageing epidemic are important to consider.
Community health workers (CHWs)—or ‘cadres’ as they are known in Indonesia—are intermediaries between the health system and the community, providing maternal and child health services at a village ...level. However, systemic and contextual factors inhibit CHWs from realising their potential impact. Training is essential for improving CHW performance; however, there is a need to understand whether and how this affects the care communities receive. This paper explores how communities in Aceh Province, Indonesia, receive care from cadres and the extent to which training interventions of CHWs influence this care. Semi-structured interviews were conducted remotely with 10 cadres in two districts in Aceh between June and July 2021, and five focus group discussions were conducted face-to-face with 21 caregivers of young children in one district in September 2021. Data were iteratively and thematically analysed throughout data collection. Cadres were seen as ‘of’ the community but not ‘of’ the health system. Cadres found training valuable. However, training did not adequately address the contextual challenges cadres face. From the caregivers’ perspective, cadres’ enhanced knowledge did not translate into credible guidance. Their proximity to the community and perceived distance from the health system undermined caregiver perceptions of cadres’ credibility. Infrastructural limitations of
Posyandu
inhibited CHW’s perceived ability to perform their roles effectively. To maximise the potential of their role, there must be more investment in enhancing the credibility of cadres within their communities—and programmatic factors such as training must better account for and adapt to the local context.
Introduction: The burden of HIV is increasing among adults aged over 50, who generally experience increased risk of cormorbid illnesses and poorer financial protection. We compared patterns of health ...utilisation and expenditure among HIV-positive and HIV-negative adults over 50. Methods: Data were drawn from the Study on global AGEing and adult health in South Africa with analysis focusing on individual and household-level data of 147 HIV-positive and 2725 HIV-negative respondents. Results: HIV-positive respondents reported lower utilisation of private health-care facilities (11.8%) than HIV-negative respondents (25.0%) (p = .03) and generally had more negative attitudes towards health system responsiveness than HIV-negative counterparts. Less than 10% of HIV-positive and HIV-negative respondents experienced catastrophic health expenditure (CHE). Women (OR 1.8; p < .001) and respondents from rural settings (OR 2.9; p < .01) had higher odds of CHE than men or respondents in urban settings. Over half the respondents in both groups indicated that they had received free health care. Conclusions: These findings suggest that although HIV-positive and HIV-negative older adults in South Africa are protected to some extent from CHE, inequalities still exist in access to and quality of care available at health-care services - which can inform South Africa's development of a national health insurance scheme.
Background: Child anaemia continues to represent a major public health challenge in lower-and-middle income countries. It has serious long-term consequences for child growth and development. In ...Indonesia, there was a 10% increase in the national prevalence of child anaemia between 2013 and 2018. Aim: This study aims to assess the prevalence of, and factors associated with anaemia among children aged one to three years in eight districts in Aceh Province, Indonesia. Methods: A cross-sectional study was conducted on a sample of 1148 mother-child dyads aged one to three years between November and December 2018. The sampling process involved a three-stage cluster sampling design using the probability proportionate to size methodology. Anaemia status was determined using haemoglobin level (Hb < 11.0 g/dL). Data were analysed using multivariable logistic regression to estimate adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) for associated factors. Results: The overall prevalence of anaemia was 76.1% (869/1142). 44.7% (510/1142) and 28.6% (327/1142) had moderate and mild anaemia, respectively. Child aged 12–24 months (aOR: 2.00, 95% CI: 1.26–3.17), not receiving routine immunisation (aOR: 2.62, 95% CI: 1.34–5.10), and maternal anaemia (aOR: 2.15, 95% CI: 1.59–2.90) were significantly associated with anaemia. Conclusion: The prevalence of anaemia among the children in this study was high, and was associated with child age, immunisation status, and maternal anaemia. These findings provide further insight into anaemia as a public health issue at a sub-national level in Indonesia and for development of targeted programmes to address associated risk factors of child anaemia.
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