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Global Public Health

Caitrin M Kelly, Nichole Starr, Nakul P Raykar, Rachel R Yorlets, Charles Liu, Miliard Derbew
With the lowest measured rate of surgery in the world, Ethiopia is faced with a number of challenges in providing surgical care. The aim of this study was to elucidate challenges in providing safe surgical care in Ethiopia, and solutions providers have created to overcome them. Semi-structured interviews were conducted with 10 practicing surgeons in Ethiopia. Following de-identification and immersion into field notes, topical coding was completed with an existing coding manual. Codes were adapted and expanded as necessary, and the primary data analyst confirmed reproducibility with a secondary analyst...
February 15, 2018: Global Public Health
Zhen Ning, Jie Fu, Minghua Zhuang, Jason A Park, Umedjon Ibragimov, Na He, Frank Y Wong
The magnitude of the HIV and syphilis epidemic among Chinese men ages 50 and older is unclear. In this study, we aimed to characterise and compare the prevalence of HIV and syphilis infections; linkage to care among those infected with HIV; and the geographic distribution of the two epidemics among elderly men who have sex with men (MSM) and non-MSM in Shanghai, China. This cross-sectional study involved 12,910 men ages 50 and above who participated in the HIV voluntary and counselling testing programme each year from 2008 to 2014...
February 8, 2018: Global Public Health
Joel Christian Reed
Over the past decade, health systems strengthening (HSS) has become a global health imperative. As an answer to the influence of large-scale initiatives and NGOs, HSS represents a backlash against disease-specific projects and funding. Depicted as a positive evolution, HSS advertises local autonomy, and a turn away from donor-driven agendas. Central to this shift was the hope that 'vertical' funding, especially for HIV/AIDS, could be better used to build up the 'crumbling core' of health infrastructure in sub-Saharan Africa...
February 7, 2018: Global Public Health
Theresa Jones, Lara Ho, Kelvin Koffa Kun, Penelope Milsom, John Shakpeh, Ruwan Ratnayake, Rene Loewenson
During the March 2014-January 2016 Ebola crisis in Liberia, Redemption Hospital lost 12 staff and became a holding facility for suspected cases, prompting violent hostility from the surrounding New Kru Town community, in the capital city Monrovia. Inpatient services were closed for 6 months, leaving the population without maternity care. In January 2015, Redemption reopened, but utilization was low, especially for deliveries. A key barrier was community trust in health workers which worsened during the epidemic...
January 31, 2018: Global Public Health
Megan M Schmidt-Sane
This article examines the social patterning of health, economic uncertainty, hegemonic masculinity, and vulnerability among men who live and work in a low-income sex work community in Kampala, Uganda. This problematises the notion that vulnerable communities are homogenous, in demographics, economic status, and risk. This article draws on ethnographic data collected in 2016, including semi-structured interviews and participant observation. This article uses a stratified risk framework to describe the central finding of this study, which is that men's experience in Kataba is characterised by a struggle to fulfil the provider role that constitutes a core aspect of their socially ascribed gender role...
January 29, 2018: Global Public Health
Matthew Thomann
The global scale-up of AIDS treatment initiatives during the first decade of the twenty-first century has been referred to as a kind of 'pharmaceuticalisation' of public health, a trend that is now building in the area of HIV prevention. This paper traces the emergence and increased uptake of pre-exposure prophylaxis (PrEP), antiretroviral medications that can keep HIV negative individuals from becoming infected, placing it within the broader (re)casting of HIV prevention as a medical and technological problem that has been central to the recent 'end of AIDS' discourse...
January 25, 2018: Global Public Health
Seth Kalichman, Catherine Mathews, Moira Kalichman, Lisa A Eaton, Koena Nkoko
Medical male circumcision (MMC) is a proven method of HIV risk reduction for men in southern Africa. MMC promotion campaigns and scale-up programmes are widely implemented throughout the Republic of South Africa. However, the impact of promoting MMC on women's awareness, beliefs, and behaviours has been understudied. We conducted a self-administered anonymous survey of 279 women receiving health services in an impoverished township located in Cape Town, South Africa. Results showed that two in three women were unaware that male circumcision partially protects men from contracting HIV...
January 25, 2018: Global Public Health
Monica Malta
In 31 August 2016, Brazilian president Dilma Rousseff was impeached and replaced by her vice president Michel Temer. Herein, we examine how the conservative agenda of Mr Temer and his supporters is influencing key decisions in the human rights and public health arena in Brazil. The government's austerity agenda includes severe cuts in critical areas such as health, education and science, jeopardising well-known strategies such as the Brazilian Public Health System (SUS) and nationwide cash transfer program, 'Bolsa Familia' - both benefited millions and were the largest of their kind in the world...
January 25, 2018: Global Public Health
Amets Suess Schwend, Sam Winter, Zhan Chiam, Adam Smiley, Mauro Cabral Grinspan
From 2007 on, the World Health Organisation (WHO) has been revising its diagnostic manual, the International Statistical Classification of Diseases and Related Health Problems (ICD), with approval of ICD-11 due in 2018. The ICD revision has prompted debates on diagnostic classifications related to gender diversity and gender development processes, and specifically on the 'Gender incongruence of childhood' (GIC) code. These debates have taken place at a time an emergent trans depathologisation movement is becoming increasingly international, and regional and international human rights bodies are recognising gender identity as a source of discrimination...
January 24, 2018: Global Public Health
Claudia Susana Caxaj, Kolol Qnan Tx'otx' Parroquia de San Miguel Ixtahuacan
The presence of large-scale mining operations poses many threats to communities. In a rural community in Guatemala, community leaders were motivated to address divisiveness and local conflict that have been exacerbated since the arrival of a mining company in the region. Prior research by our team identified spiritual and cultural strengths as important sources of strength and resilience in the community. We piloted a community-based intervention centred on spiritual and cultural practices in the region, to address divisiveness and build community harmony...
January 24, 2018: Global Public Health
Andrew Gibbs, Rachel Jewkes, Fazal Karim, Frozan Marofi, Julienne Corboz
The processes through which women's economic empowerment interventions are envisaged to improve women's health are strongly embedded in notions of building women's agency and autonomy. Yet despite the ubiquity of such interventions, there remains incredibly little qualitative work exploring how women actually utilise interventions to reshape their lives and wellbeing. Drawing on 9 focus groups discussions among 52 women who participated in the Women for Women International intervention in Afghanistan, an economic strengthening and social empowerment intervention, we explore processes of change...
January 22, 2018: Global Public Health
Rachel Kidman, Jody Heymann
The Sustainable Development Goals set ambitious targets for health. Meeting such will require drastic improvements in the social conditions for women and girls. Understanding which social conditions have the greatest impact on health can help prioritise action, yet there is little comparative data. We use microdata from 338,580 women in 47 low- and middle-income countries to estimate the relative contributions of improved social determinants in bringing about maternal and child health gains over the past 20 years...
January 18, 2018: Global Public Health
Tulsi Patel
Abortion laws in India, like other laws, are premised on the 1861 British Penal Code. The Medical Termination of Pregnancy Act was passed in 1971 to circumvent the criminality clause around abortion. Yet the law continues to render invisible women's right to choose. Legal procedures have often hindered in permitting abortion, resulting in the death of a mother or the foetus. Despite the latest techno-medical advances, the laws have remained stagnant or rather restrictive, complicated further by selective female foetus abortions...
January 17, 2018: Global Public Health
Thurka Sangaramoorthy
In biomedical, public health, and popular discourses, the 'end of AIDS' has emerged as a predominant way to understand the future of HIV research and prevention. This approach is predicated on structuring and responding to HIV in ways that underscore its presumed lifelong nature. In this article, I examine the phenomenon of HIV chronicity that undergirds the 'end of AIDS' discourse. In particular, I explore how the logic of HIV chronicity, induced by technological advances in treatment and global financial and political investments, intensifies long-term uncertainty and prolonged crisis...
January 11, 2018: Global Public Health
Branwyn Poleykett
Transnational Global Health programmes planned and financed in the North and executed in the Global South usually involve some transfer of capacity between sites or capacity building in place. Capacity investment in the form of skills, knowledge, experience and equipment is often assumed to 'flow' between countries, laboratories and institutions, following the trajectories of mobile subjects in the knowledge economy. Drawing on in-depth interviews with Danish and East African scientists, this paper considers the mobilities that underpin scientific capacity building, drawing attention to the paradoxical in ways in which these programmes produce stasis and fixity, as well as mobility and exchange...
January 5, 2018: Global Public Health
Eric D Carter
This paper examines the international networks that influenced ideas and policy in social medicine in the 1930s and 1940s in Latin America, focusing on institutional networks organised by the League of Nations Health Organization, the International Labour Organization, and the Pan-American Sanitary Bureau. After examining the architecture of these networks, this paper traces their influence on social and health policy in two policy domains: social security and nutrition. Closer scrutiny of a series of international conferences and local media accounts of them reveals that international networks were not just 'conveyor belts' for policy ideas from the industrialised countries of the US and Europe into Latin America; rather, there was often contentious debate over the relevance and appropriateness of health and social policy models in the Latin American context...
January 3, 2018: Global Public Health
Srinivasan Kannan, Margret Frenz
Movement for healthcare, mostly termed 'medical tourism', has been a sector of enormous potential in South Asia over the past years attracting many international clients. Kerala, a state in southern India, advertises 'Kerala Ayurveda' as one of its particular attractions. The objective of this paper is to study and understand the public health view on movements for healthcare and/or wellness across borders with a particular focus on the quality of treatments offered and on issues of ethics that concern patients from across different countries, but also the providers of Ayurveda treatments...
December 22, 2017: Global Public Health
Lauren M Hill, Ann Gottert, Catherine MacPhail, Dumisani Rebombo, Rhian Twine, Kathleen Kahn, Audrey Pettifor, Sheri A Lippman, Suzanne Maman
Understanding informal leadership in high HIV prevalence settings is important for the success of popular opinion leader (POL) and other HIV testing and treatment promotion strategies which aim to leverage the influence of these leaders. We conducted a study in Mpumalanga province, South Africa, in which we aimed to: (1) describe men's personal networks and key social relationships; and (2) describe the types of individuals men identify as leaders. We administered a structured questionnaire with 45 men (15 HIV-positive and 30 HIV-negative) in which men enumerated and described characteristics of individuals they share personal matters with, and people they considered as leaders...
December 22, 2017: Global Public Health
Hansjörg Dilger, Dominik Mattes
The interdisciplinary, politically contested field of Global Health has often been described as a consequence of, and response to, an intensification of the mobilities of, and connectivities between, people, pathogens, ideas, and infrastructure across national borders and large distances. However, such global mobilities and connectivities are not as omnidirectional and unpatterned as the rhetoric of many Global Health actors suggests. Instead, we argue that they are suffused by a plethora of institutional, national, and global political agendas, and substantially shaped by transnational and postcolonial power relations...
December 22, 2017: Global Public Health
René Umlauf, Sung-Joon Park
This paper examines the stock-outs of medicines and diagnostic devices in Uganda. Our aim is to trace and compare interruptions in the supply of antiretrovirals and Rapid Diagnostic Tests in order to provide an ethnographic account of the complex role that improvisations play within global health infrastructures. We will argue that the fragmented and mobile infrastructures of these key global health technologies require and necessitate improvisations by the different actors involved as well as on almost all levels of the Ugandan health-care system...
December 15, 2017: Global Public Health
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