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Showing papers in "Global Health Action in 2011"


Journal ArticleDOI
Malin Eriksson1
TL;DR: Social capital, conceptualized as characterizing whole communities, provides a useful framework for what constitutes health-supporting environments and guidance on how to achieve them and can provide new ideas on the processes that influence human interactions, cooperation, and community action for health promotion in various contexts.
Abstract: This article is a review of the PhD Thesis of Malin Eriksson, entitled 'Social capital, health and community action - implications for health promotion.' The article presents a theoretical overview of social capital and its relation to health, reviews empirical findings of the links between social capital and (self-rated) health, and discusses the usefulness of social capital in health promotion interventions at individual and community levels. Social capital, conceptualized as an individual characteristic, can contribute to the field of health promotion by adding new knowledge on how social network interventions may best be designed to meet the needs of the target group. The distinction of different forms of social capital, i.e. bonding, bridging, and linking, can be useful in mapping the kinds of networks that are available and health-enhancing (or damaging) and for whom. Further, social capital can advance social network interventions by acknowledging the risk for unequal distribution of investments and returns from social network involvement. Social capital, conceptualized as characterizing whole communities, provides a useful framework for what constitutes health-supporting environments and guidance on how to achieve them. Mapping and mobilization of social capital in local communities may be one way of achieving community action for health promotion. Social capital is context-bound by necessity. Thus, from a global perspective, it cannot be used as a 'cookbook' on how to achieve supportive environments and community action smoothly. However, social capital can provide new ideas on the processes that influence human interactions, cooperation, and community action for health promotion in various contexts.

211 citations


Journal ArticleDOI
TL;DR: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.
Abstract: Background: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women’s and men’s life prospects. Objective: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men’s and women’s life circumstances. Design: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. Findings: Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve women’s subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. Conclusions: This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women’s empowerment. Keywords: gender roles; gender inequality; women’s health; intimate partner violence; focus group discussions; Pakistan (Published: 2 November 2011) Citation: Global Health Action 2011, 4 : 7448 - DOI: 10.3402/gha.v4i0.7448

152 citations


Journal ArticleDOI
TL;DR: The profiles and outcome of traditional healing practices for severe mental illnesses in Jinja and Iganga districts in the Busoga region of Eastern Uganda are described to show that traditional healers shoulder a large burden of care of patients with mental health problems.
Abstract: Background: The WHO estimates that more than 80% of African populations attend traditional healers for health reasons and that 40%-60% of these have some kind of mental illness. However, little is known about the profiles and outcome of this traditional approach to treatment. Objective: The purpose of this study was to describe the profiles and outcome of traditional healing practices for severe mental illnesses in Jinja and Iganga districts in the Busoga region of Eastern Uganda. Methods: Four studies were conducted. Study I used focus group discussions (FGDs) with case vignettes with local community members and traditional healers to explore the lay concepts of psychosis. Studies II and III concerned a cross-sectional survey of patients above 18 years at the traditional healer’s shrines and study IV was made on a prospective cohort of patients diagnosed with psychosis in study III. Manual content analysis was used in study I; quantitative data in studies II, III, and IV were analyzed at univariate, bivariate, and multivariate levels to determine the association between psychological distress and socio-demographic factors; for study IV, factors associated with outcome were analyzed. One-way ANOVA for independent samples was the analysis used in Study IV. Results: The community gave indigenous names to psychoses (mania, schizophrenia, and psychotic depression) and had multiple explanatory models for them. Thus multiple solutions for these problems were sought. Of the 387 respondents, the prevalence of psychological distress was 65.1%, where 60.2% had diagnosable current mental illness, and 16.3% had had one disorder in their lifetime. Over 80% of patients with psychosis used both biomedical and traditional healing systems. Those who combined these two systems seemed to have a better outcome. All the symptom scales showed a percentage reduction of more than 20% at the 3- and 6-month follow-ups. Conclusion: Traditional healers shoulder a large burden of care of patients with mental health problems. This calls for all those who share the goal of improving the mental health of individuals to engage with traditional healers. Keywords: mental illness; traditional healers; outcome; Western medicine (Published: 2 August 2011) Citation: Global Health Action 2011, 4 : 7117 - DOI: 10.3402/gha.v4i0.7117 This article has been commented on by Vikram Patel. Please follow this link http://www.globalhealthaction.net/index.php/gha/article/view/7956 - to read his commentary.

124 citations


Journal ArticleDOI
TL;DR: Findings indicate that affected people may especially benefit from a combination of individual stress reducing interventions and psychosocial interventions that foster cognitive social capital.
Abstract: Background: Despite national and international policies to develop social capital in disaster-affected communities, empiric evidence on the association between social capital and disaster mental health is limited and ambiguous. Objective: The study explores the relationship between social capital and disaster mental health outcomes (PTSD, anxiety, and depression) in combination with individual factors (appraisal, coping behavior, and social support). Design: This is a community-based cross-sectional study in a flood-affected town in northern England. The study is part of the MICRODIS multi-country research project that examines the impact of natural disasters. It included 232 flood-affected respondents. Results: The findings showed that a considerable part of the association between cognitive and structural social capital and mental health is exerted through individual appraisal processes (i.e. property loss, primary and secondary appraisal), social support, and coping behavior. These individual factors were contingent on social capital. After the inclusion of individual characteristics, cognitive social capital was negatively related to lower mental health problems and structural social capital was positively associated to experiencing anxiety but not to PTSD or depression. Depression and anxiety showed a different pattern of association with both components of social capital. Conclusions: Individual oriented stress reducing interventions that use appraisal processes, social support, and coping as starting points could be more effective by taking into account the subjective experience of the social context in terms of trust and feelings of mutual support and reciprocity in a community. Findings indicate that affected people may especially benefit from a combination of individual stress reducing interventions and psychosocial interventions that foster cognitive social capital. Keywords: social capital; PTSD; depression; anxiety; disaster; social support; coping (Published: 15 June 2011) Citation: Global Health Action 2011, 4 : 6351 - DOI: 10.3402/gha.v4i0.6351 This paper is part of the cluster Health and health systems impact of natural disasters - more papers from this cluster can be found here .

109 citations


Journal ArticleDOI
TL;DR: Climate change contributed much to the TBE incidence increase in AO and the increase both in mean annual air temperatures and temperatures during tick active season resulted in the northward expansion of Ixodid ticks, main TBE virus vector.
Abstract: Background: The increase in tick-borne encephalitis (TBE) incidence is observed in recent decades in a number of subarctic countries. The reasons of it are widely discussed in scientific publications. The objective of this study was to understand if the climate change in Arkhangelsk Oblast (AO) situated in the north of European subarctic zone of Russia has real impact on the northward expansion of Ixodid ticks and stipulates the increase in TBE incidence. Methods: This study analyzes: TBE incidence in AO and throughout Russia, the results of Ixodid ticks collecting in a number of sites in AO, and TBE virus prevalence in those ticks, the data on tick bite incidence in AO, and meteorological data on AO mean annual air temperatures and precipitations. Results: It is established that in recent years TBE incidence in AO tended to increase contrary to its apparent decrease nationwide. In last 10 years, there was nearly 50-fold rise in TBE incidence in AO when compared with 1980-1989. Probably, the increase both in mean annual air temperatures and temperatures during tick active season resulted in the northward expansion of Ixodes Persulcatus, main TBE virus vector. The Ixodid ticks expansion is confirmed both by the results of ticks flagging from the surface vegetation and by the tick bite incidence in the population of AO locations earlier free from ticks. Our mathematical (correlation and regression) analysis of available data revealed a distinct correlation between TBE incidence and the growth of mean annual air temperatures in AO in 1990-2009. Conclusion: Not ruling out other factors, we conclude that climate change contributed much to the TBE incidence increase in AO. Keywords: climate change; tick-borne encephalitis; Ixodes persulcatus; subarctic zone (Published: 21 October 2011) Citation: Global Health Action 2011, 4 : 8448 - DOI: 10.3402/gha.v4i0.8448

102 citations


Journal ArticleDOI
TL;DR: The Injury epidemiology reported in this study is in general agreement with most other studies reporting injury epidemiology except higher incidence of distal orthopedic injuries particularly to the lower extremities, and it is found that young males were more prone to sustaining injuries.
Abstract: Background: The number of injured far exceeds those dead and the average injury to mortality ratio in earthquakes stands at 3:1. Immediate effective medical response significantly influences injury outcomes and thus the overall health impact of earthquakes. Inadequate or mismanagement of injuries may lead to disabilities. The lack of precise data from immediate aftermath is seen as a remarkable weak point in disaster epidemiology and warrants evidence generation. Objective: To analyze the epidemiology of injuries and the treatment imparted at a secondary rural hospital in the Kutch district, Gujarat, India following the January 26, 2001 earthquake. Design/Methods: Discharge reports of patients admitted to the hospital over 10 weeks were analyzed retrospectively for earthquake-related injuries. Results: Orthopedic injuries, (particularly fractures of the lower limbs) were predominant and serious injuries like head, chest, abdominal, and crush syndrome were minimal. Wound infections were reported in almost 20% of the admitted cases. Surgical procedures were more common than conservative treatment. The most frequently performed surgical procedures were open reduction with internal fixation and cleaning and debridement of contaminated wounds. Four secondary deaths and 102 transfers to tertiary care due to complications were reported. Conclusion: The injury epidemiology reported in this study is in general agreement with most other studies reporting injury epidemiology except higher incidence of distal orthopedic injuries particularly to the lower extremities. We also found that young males were more prone to sustaining injuries. These results warrant further research. Inconsistent data reporting procedures against the backdrop of inherent disaster data incompleteness calls for urgent standardization of reporting earthquake injuries for evidence-based response policy planning. Keywords: disaster; earthquake; injury; epidemiology; data; standardization (Published: 25 July 2011) Citation: Global Health Action 2011, 4 : 7196 - DOI: 10.3402/gha.v4i0.7196 This paper is part of the Cluster Health and health systems impact of natural disasters - more papers from this cluster can be found here .

102 citations


Journal ArticleDOI
TL;DR: This work provides an overview of important available information on exposures and health effects related to household solid fuel use in India, with a view to inform health research priorities for household air pollution and facilitate being able to address air pollution within an integrated rural–urban framework in the future.
Abstract: Environmental and occupational risk factors contribute to nearly 40% of the national burden of disease in India, with air pollution in the indoor and outdoor environment ranking amongst leading risk factors. It is now recognized that the health burden from air pollution exposures that primarily occur in the rural indoors, from pollutants released during the incomplete combustion of solid fuels in households, may rival or even exceed the burden attributable to urban outdoor exposures. Few environmental epidemiological efforts have been devoted to this setting, however. We provide an overview of important available information on exposures and health effects related to household solid fuel use in India, with a view to inform health research priorities for household air pollution and facilitate being able to address air pollution within an integrated rural–urban framework in the future.

87 citations


Journal ArticleDOI
TL;DR: Examples of adverse health effects, including weather-related injury, food insecurity, mental health issues, and water infrastructure damage, and the responses to these effects that are currently being applied in two Northwest Alaska communities are provided.
Abstract: This article provides examples of adverse health effects, including weather-related injury, food insecurity, mental health issues, and water infrastructure damage, and the responses to these effects that are currently being applied in two Northwest Alaska communities. Background: In Northwest Alaska, warming is resulting in a broad range of unusual weather and environmental conditions, including delayed freeze-up, earlier breakup, storm surge, coastal erosion, and thawing permafrost. These are just some of the climate impacts that are driving concerns about weatherrelated injury, the spread of disease, mental health issues, infrastructure damage, and food and water security. Local leaders are challenged to identify appropriate adaptation strategies to address climate impacts and related health effects. Implementation process: The tribal health system is combining local observations, traditional knowledge, and western science to perform community-specific climate change health impact assessments. Local leaders are applying this information to develop adaptation responses. Objective: The Alaska Native Tribal Health Consortium will describe relationships between climate impacts and health effects and provide examples of community-scaled adaptation actions currently being applied in Northwest Alaska. Findings: Climate change is increasing vulnerability to injury, disease, mental stress, food insecurity, and water insecurity. Northwest communities are applying adaptation approaches that are both specific and appropriate. Conclusion: The health impact assessment process is effective in raising awareness, encouraging discussion, engaging partners, and implementing adaptation planning. With community-specific information, local leaders are applying health protective adaptation measures. Keywords: climate change; health impact assessment; health effects; Arctic health (Published: 18 October 2011) Citation: Global Health Action 2011, 4 : 8445 - DOI: 10.3402/gha.v4i0.8445

84 citations


Journal ArticleDOI
TL;DR: With concomitant indoor air pollution measurements, it may be possible to increase the resolution of the association between biomass use and COPD prevalence and refine available attributable burden of disease estimates.
Abstract: Background: Chronic obstructive pulmonary disease (COPD) is the 13th leading cause of burden of disease worldwide and is expected to become 5th by 2020. Biomass fuel combustion significantly contributes to COPD, although smoking is recognized as the most important risk factor. Rural women in developing countries bear the largest share of this burden resulting from chronic exposures to biomass fuel smoke. Although there is considerable strength of evidence for the association between COPD and biomass smoke exposure, limited information is available on the background prevalence of COPD in these populations. Objective: This study was conducted to estimate the prevalence of COPD and its associated factors among non-smoking rural women in Tiruvallur district of Tamilnadu in Southern India. Design: This cross-sectional study was conducted among 900 non-smoking women aged above 30 years, from 45 rural villages of Tiruvallur district of Tamilnadu in Southern India in the period between January and May 2007. COPD assessments were done using a combination of clinical examination and spirometry. Logistic regression analysis was performed to examine the association between COPD and use of biomass for cooking. R software was used for statistical analysis. Results: The overall prevalence of COPD in this study was found to be 2.44% (95% CI: 1.43-3.45). COPD prevalence was higher in biomass fuel users than the clean fuel users 2.5 vs. 2%, (OR: 1.24; 95% CI: 0.36-6.64) and it was two times higher (3%) in women who spend >2 hours/day in the kitchen involved in cooking. Use of solid fuel was associated with higher risk for COPD, although no statistically significant results were obtained in this study. Conclusion: The estimates generated in this study will contribute significantly to the growing database of available information on COPD prevalence in rural women. Moreover, with concomitant indoor air pollution measurements, it may be possible to increase the resolution of the association between biomass use and COPD prevalence and refine available attributable burden of disease estimates. Keywords: chronic obstructive pulmonary disease; prevalence; biomass fuel users; rural women; disease burden (Published: 3 November 2011) Citation: Global Health Action 2011, 4 : 7226 - DOI: 10.3402/gha.v4i0.7226

82 citations


Journal ArticleDOI
TL;DR: The findings showed higher incidences of dengue fever, pink eye, dermatitis, and psychological problems in communes severely affected by flood as compared to that of the controlled communes.
Abstract: Background: Vietnam is one of the most disaster-prone countries in the world. The country suffers from many kinds of natural disasters, of which the most common and serious one is flooding. Long and heavy rainfall during the last days of October and the first week of November 2008 resulted in a devastating flood unseen for over three decades in the capital city of Hanoi. It caused a substantial health impact on residents in and around the city and compromised the capacity of local health services. Objective: The aim of this study is to ascertain the vulnerability and health impacts of the devastating flood in Hanoi by identifying the differences in mortality, injuries, and morbidity patterns (dengue, pink eye, dermatitis, psychological problems, and hypertension) between flood affected and non-affected households. Design: A cross-sectional study was carried out involving 871 households in four selected communes (two heavily flood affected and two comparatively less affected) from two severely flooded districts of Hanoi. Participants were interviewed and information collected on the social, economic, and health impacts of the devastation within 1 month after the flood. Results: The self-reported number of deaths and injuries reported in this study within 1 month after the heavy rainfall were a bit higher in severely affected communes as compared to that of the less affected communes of our study. The findings showed higher incidences of dengue fever, pink eye, dermatitis, and psychological problems in communes severely affected by flood as compared to that of the controlled communes. Conclusions: For people in flood prone areas (at risk for flooding), flood prevention and mitigation strategies need to be seriously thought through and acted upon, as these people are exposed to greater health problems such as psychological issues and communicable diseases such as pink eye or dermatitis. Keywords: food; flooding; natural disaster; health impacts (Published: 23 August 2011) Citation: Global Health Action 2011, 4 : 6356 - DOI: 10.3402/gha.v4i0.6356 This paper is part of the Cluster Health and health systems impact of natural disasters - more papers from this cluster can be found here .

82 citations


Journal Article
TL;DR: In this paper, a cross-sectional study was carried out involving 871 households in four selected communes (two heavily flood affected and two comparatively less affected) from two severely flooded districts of Hanoi, and information collected on the social, economic, and health impacts of the devastation within 1 month after the flood.
Abstract: Background: Vietnam is one of the most disaster-prone countries in the world. The country suffers from many kinds of natural disasters, of which the most common and serious one is flooding. Long and heavy rainfall during the last days of October and the first week of November 2008 resulted in a devastating flood unseen for over three decades in the capital city of Hanoi. It caused a substantial health impact on residents in and around the city and compromised the capacity of local health services. Objective: The aim of this study is to ascertain the vulnerability and health impacts of the devastating flood in Hanoi by identifying the differences in mortality, injuries, and morbidity atterns (dengue, pink eye, dermatitis, psychological problems, and hypertension) between flood affected and non-affected households. Design: A cross-sectional study was carried out involving 871 households in four selected communes (two heavily flood affected and two comparatively less affected) from two severely flooded districts of Hanoi. Participants were interviewed and information collected on the social, economic, and health impacts of the devastation within 1 month after the flood. Results: The self-reported number of deaths and injuries reported in this study within 1 month after the heavy rainfall were a bit higher in severely affected communes as compared to that of the less affected communes of our study. The findings showed higher incidences of dengue fever, pink eye, dermatitis, and psychological problems in communes severely affected by flood as compared to that of the controlled communes. Conclusions: For people in flood prone areas (at risk for flooding), flood prevention and mitigation strategies need to be seriously thought through and acted upon, as these people are exposed to greater health problems such as psychological issues and communicable diseases such as pink eye or dermatitis

Journal ArticleDOI
TL;DR: The role of health-related rehabilitation in natural disaster relief is examined along three lines of inquiry: epidemiology of injury and disability, impact on health and rehabilitation systems, and the assessment and measurement of disability.
Abstract: Background: Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives: To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design: Qualitative literature review and secondary data analysis. Results: Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion: Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health-related rehabilitation following natural disaster is urgently required. Keywords: Natural disaster, health-related rehabilitation, community, health systems, population health (Published: 16 August 2011) Citation: Global Health Action 2011, 4 : 7191 - DOI: 10.3402/gha.v4i0.7191 This paper is part of the Cluster Health and health systems impact of natural disasters - more papers from this cluster can be found here .

Journal ArticleDOI
TL;DR: The study illustrates the vulnerable situation of the reindeer herders and that climate change impact may have serious consequences for the trade and their overall way of life.
Abstract: Background: The Arctic area is a part of the globe where the increase in global temperature has had the earliest noticeable effect and indigenous peoples, including the Swedish reindeer herding Sami, are amongst the first to be affected by these changes. Objective: To explore the experiences and perceptions of climate change among Swedish reindeer herding Sami. Study design: In-depth interviews with 14 Swedish reindeer herding Sami were performed, with purposive sampling. The interviews focused on the herders experiences of climate change, observed consequences and thoughts about this. The interviews were analysed using content analysis. Results: One core theme emerged from the interviews: facing the limit of resilience. Swedish reindeer-herding Sami perceive climate change as yet another stressor in their daily struggle. They have experienced severe and more rapidly shifting, unstable weather with associated changes in vegetation and alterations in the freeze- thaw cycle, all of which affect reindeer herding. The forecasts about climate change from authorities and scientists have contributed to stress and anxiety. Other societal developments have lead to decreased flexibility that obstructs adaptation. Some adaptive strategies are discordant with the traditional life of reindeer herding, and there is a fear among the Sami of being the last generation practising traditional reindeer herding. Conclusions: The study illustrates the vulnerable situation of the reindeer herders and that climate change impact may have serious consequences for the trade and their overall way of life. Decision makers on all levels, both in Sweden and internationally, need improved insights into these complex issues to be able to make adequate decisions about adaptive climate change strategies. Keywords: climate change; indigenous peoples; Sami, reindeer herding; perception; resilience (Published: 28 October 2011) Citation: Global Health Action 2011, 4 : 8417 - DOI: 10.3402/gha.v4i0.8417

Journal ArticleDOI
TL;DR: It is suggested that it would be prudent to undertake careful monitoring of permafrost conditions in all areas where an anthrax outbreak had occurred in the past, as climate warming in the Arctic may increase the risk of zoonoses due to expansion of vector habitats, improved chances of vector survival during winter, andpermafrost degradation.
Abstract: Climate warming in the Arctic may increase the risk of zoonoses due to expansion of vector habitats, improved chances of vector survival during winter, and permafrost degradation. Monitoring of soil temperatures at Siberian cryology control stations since 1970 showed correlations between air temperatures and the depth of permafrost layer that thawed during summer season. Between 1900s and 1980s, the temperature of surface layer of permafrost increased by 2–4°C; and a further increase of 3°C is expected. Frequent outbreaks of anthrax caused death of 1.5 million deer in Russian North between 1897 and 1925. Anthrax among people or cattle has been reported in 29,000 settlements of the Russian North, including more than 200 Yakutia settlements, which are located near the burial grounds of cattle that died from anthrax. Statistically significant positive trends in annual average temperatures were established in 8 out of 17 administrative districts of Yakutia for which sufficient meteorological data were available. At present, it is not known whether further warming of the permafrost will lead to the release of viable anthrax organisms. Nevertheless, we suggest that it would be prudent to undertake careful monitoring of permafrost conditions in all areas where an anthrax outbreak had occurred in the past.

Journal ArticleDOI
TL;DR: Although the health condition of the Sami population appears to be rather similar to that of the general Swedish population, a number of specific health problems have been identified, especially among the reindeer-herding Sami.
Abstract: Background: The Sami are the indigenous ethnic population of northern Scandinavia. Their health condition is poorly known, although the knowledge has improved over the last decade. Objectives: The aim was to review the current information on mortality, diseases, and risk factor exposure in the Swedish Sami population. Design: Health-related research on Sami cohorts published in scientific journals and anthologies was used to compare the health condition among the Sami and the majority non-Sami population.When relevant, data from the Sami populations in Swedish were compared with corresponding data from Norwegian and Finnish Sami populations. Results: Life expectancy and mortality patterns of the Sami are similar to those of the majority population. Small differences in incidences of cancer and cardiovascular diseases have been reported. The traditional Sami lifestyle seems to contain elements that reduce the risk to develop cancer and cardiovascular diseases, e.g. physical activity, diet rich in antioxidants and unsaturated fatty acids, and a strong cultural identity. Reindeer herding is an important cultural activity among the Sami and is associated with high risks for accidents. Pain in the lower back, neck, shoulders, elbows, and hands are frequent among both men and women in reindeer-herding families. For men, these symptoms are related to high exposure to terrain vehicles, particularly snowmobile, whereas for women psychosocial risk factors seem to more important, e.g. poor social support, high effort, low reward, and high economical responsibilities. Conclusions: Although the health condition of the Sami population appears to be rather similar to that of the general Swedish population, a number of specific health problems have been identified, especially among the reindeer-herding Sami. Most of these problems have their origin in marginalization and poor knowledge of the reindeer husbandry and the Sami culture in the majority population. It is suggested that the most sustainable measure to improve the health among the reindeer-herding Sami would be to improve the conditions of the reindeer husbandry and the Sami culture. Keywords: review; Sami; reindeer herding; health; mortality; cancer; cardiovascular diseases; physical and psychosocial risk factors; dietary habits; marginalization (Published: 14 October 2011) Citation: Global Health Action 2011, 4 : 8457 - DOI: 10.3402/gha.v4i0.8457

Journal ArticleDOI
TL;DR: There are increasing differences in tobacco use between educational groups, and higher smoking and snus use prevalence are found among those with basic education, and this is most pronounced in the younger group of this middle-aged population.
Abstract: Background: In Sweden, the smoking prevalence has declined In 2007, it was among the lowest in the industrialized world A steady increase in the use of Swedish oral moist snuff, snus, has occurred in parallel This development is neither solicited by authorities nor the medical establishment, but rather has occurred along with increased awareness of the dangers of smoking, and has been promoted by product development and marketing of snus Objective: To evaluate time trends in patterns of tobacco use in northern Sweden during 1990-2007 Design: Cross-sectional (99,381 subjects) and longitudinal (26,867 subjects) data from the Vasterbotten Intervention Programme (VIP) 1990-2007 were analyzed All adults in Va¨sterbotten County are invited to a VIP health examination at ages 40, 50, and 60 years, and until 1995 also 30 years Smoking and use of snus were evaluated by gender, age and educational groups Intermittent smoking was categorized as smoking Results: From the period 1990-1995 to the period 2002-2007, smoking prevalence decreased from 26 to 16% among men and from 27 to 18% among women The differences in prevalence increased between educational groups The decline in smoking was less and the increase of snus use was greater among those with basic education The use of snus among basic-educated 40-year-olds reached 35% among men and 14% among women during 2002-2007 Dual smoking and snus use increased among men and women with basic education Smoking without snus use was more prevalent among women Gender differences in total smoking prevalence (smoking only plus dual use) were small in all age groups, but increased among those with basic education reaching 73% during 2002-2007, with women being more frequent smokers Smoking prevalences were similar among never, former and current snus users Among the 30,000 former smokers, 38% of men and 64% of women had never used snus Longitudinal data showed a decline in total tobacco use from baseline until follow-up and this was mainly due to a smoking cessation rate of<1% a year Snus use was started by 62% of the 30-year-old women (age at baseline), and this contributed to a stable prevalence of total tobacco use in this group Seventy percent of baseline snus users still used snus at follow-up Among smokers, 55% continued smoking, 12% of men and 7% of women switched to snus Among those with dual tobacco use at baseline, a third of men and a fourth of women remained dual users 10 years later Conclusion: There are increasing differences in tobacco use between educational groups Higher smoking and snus use prevalence are found among those with basic education, and this is most pronounced in the younger group of this middle-aged population In spite of a higher prevalence of smoking without snus use among women, total smoking prevalence is similar in men and women due to a higher prevalence of dual tobacco use, ie snus and cigarettes, among men The increase in snus use is being paralleled by a slight increase in dual use and the smoking prevalence does not seem to be influenced by snus This should be the subject of further studies and also have implications for tobacco control policies Keywords: tobacco; prevalence; smoking; smokeless tobacco; Swedish moist snuff; snus; socioeconomic factors/education (Published: 3 June 2011) Citation: Global Health Action 2011, 4 : 5613 - DOI: 103402/ghav4i05613

Journal ArticleDOI
TL;DR: The study found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging and underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions.
Abstract: Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R) approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting decisions. A broader and more detailed analysis of health system elements, and socio-cultural context is imperative in fostering sustainability. Additionally, the study stresses the need to deal with power asymmetries among various actors in priority-setting contexts.

Journal ArticleDOI
TL;DR: There is a need to understand and acknowledge women's reluctance to involve others during childbirth, however, the healthcare system should provide acceptable care and a functional referral system closer to the community, thus supporting the community's ability to seek timely care as a response to obstructed labour.
Abstract: Background: Obstructed labour is still a major cause of maternal and perinatal morbidity and mortality in Uganda, where many women give birth at home alone or assisted by non-skilled birth attendants. Little is known of how the community view obstructed labour, and what actions they take in cases where this complication occurs. Objective: The objective of the study was to explore community members’ understanding of and actions taken in cases of obstructed labour in south-western Uganda. Design: Grounded theory (GT) was used to analyse data from 20 focus group discussions (FGDs), 10 with women and 10 with men, which were conducted in eight rural and two urban communities. Results: A conceptual model based on the community members’ understanding of obstructed labour and actions taken in response is presented as a pathway initiated by women’s desire to ‘protecting own integrity’ (core category). The pathway consisted of six other categories closely linked to the core category, namely: (1) ‘taking control of own birth process’; (2) ‘reaching the limit - failing to give birth’ (individual level); (3) ‘exhausting traditional options’; (4) ‘partner taking charge’; (5) ‘facing challenging referral conditions’ (community level); and finally (6) ‘enduring a non-responsive healthcare system’ (healthcare system level). Conclusions: There is a need to understand and acknowledge women’s reluctance to involve others during childbirth. However, the healthcare system should provide acceptable care and a functional referral system closer to the community, thus supporting the community’s ability to seek timely care as a response to obstructed labour. Easy access to mobile phones may improve referral systems. Upgrading of infrastructure in the region requires a multi-sectoral approach. Testing of the conceptual model through a quantitative questionnaire is recommended. Keywords: obstructed labour; community members; understanding; actions; protecting own integrity; Uganda; Africa; maternal mortality; childbirth; delivery care; mobile phones; transport (Published: 27 December 2011) Citation: Global Health Action 2011, 4 : 8529 - DOI: 10.3402/gha.v4i0.8529

Journal ArticleDOI
TL;DR: There was a strong association of mental illness with indicators suggestive of poverty, such as lack of food or indebtedness and, amongst those patients who had a psychotic disorder, being in debt was associated with poorer outcomes.
Abstract: Global mental health is primarily concerned with reducing inequalities in the access to health care and health outcomes for people with mental illness within and between countries (1). Reducing the vast treatment gap and promoting the rights of people with mental illness to live with dignity are major goals of adherents of the field such as the Movement for Global Mental Health (www.globalmentalhealth.org). In this context, the thesis by Abbo summarised in her PhD Review paper in Global Health Action (2) is a timely reminder of the role of a key player in the mental health care system in African countries where the biomedical treatment gap is notably large - the traditional healer. Her series of studies in Uganda show that a variety of indigenous labels are used by traditional healers to describe what biomedical psychiatry categorises as psychotic disorders and that these are associated with a range of explanatory models, from supernatural/spiritual causes to somatic causes such as HIV. The prevalence of any mental illness amongst patients seeking help from traditional healers is very high and, notably, the vast majority of persons with psychotic disorders were also concurrently seeking help from the biomedical sector. There was a strong association of mental illness with indicators suggestive of poverty, such as lack of food or indebtedness and, amongst those patients who had a psychotic disorder, being in debt was associated with poorer outcomes. These findings serve to replicate a rich record of evidence from several countries in the region, going back several decades that testify to three major findings: severe mental illness is clearly recognised as causes of illness and suffering by indigenous communities, poverty and mental illness frequently co-exist, and traditional healers plays a prominent role in mental health care. Each of these findings has important implications for global mental health. (Published: 2 August 2011) Citation: Global Health Action 2011, 4 : 7956 - DOI: 10.3402/gha.v4i0.7956

Journal ArticleDOI
Sara Bennett1, Suneeta Singh, Sachiko Ozawa1, Nhan Tran1, JS Kang 
TL;DR: The evaluation design for the Avahan transition strategy is described, designed so as to both inform decision making throughout the transition process and answer larger questions about the transition and sustainability of donor programs.
Abstract: Background: Sustainability is the holy grail of many development projects, yet there is limited evidence about strategies that effectively support transition of programs from donor funding to national governments. The first phase of Avahan, the India AIDS Initiative supported by the Bill and Melinda Gates Foundation (2003-2009), aimed to demonstrate an HIV/AIDS prevention program at scale, primarily targeted at highrisk groups. During the second phase (2009-2013), this large-scale program will be transitioned to its natural owners: the Government of India and local communities. This paper describes the evaluation design for the Avahan transition strategy. Methods/Design: A detailed logic model for the transition was developed. The Avahan transition strategy focuses on three activities: (1) enhancing capacities among communities, non-governmental organizations (NGOs), and government entities, in line with India’s national AIDS control strategy; (2) aligning technical and managerial aspects of Avahan programs with government norms and standards; and (3) promoting and sustaining commitment to services for most-at-risk populations. It is anticipated that programs will then transfer smoothly to government and community ownership, become institutionalized within the government system, and support a sustained HIV/AIDS response. The research design evaluates the implementation and effectiveness of (1) activities undertaken by the program; (2) intermediate effects including the process of institutionalization and the extent to which key Avahan organizational procedures and behaviors are integrated into government systems; and (3) overarching effects namely the impact of the transition process on the sustained delivery of HIV/AIDS prevention services to high-risk groups. Both qualitative and quantitative research approaches are employed so that the evaluation will both assess outcomes and explain why they have occurred. Conclusions: It is unusual for donor-supported projects in low- and middle-income countries to carefully plan transition processes, and prospectively evaluate these. This evaluation is designed so as to both inform decision making throughout the transition process and answer larger questions about the transition and sustainability of donor programs. Keywords: sustainability; evaluation; HIV/AIDS (Published: 14 December 2011) Citation: Global Health Action 2011, 4 : 7360 - DOI: 10.3402/gha.v4i0.7360

Journal ArticleDOI
TL;DR: Frostbite is a freezing injury where localized damage affects the skin and other tissues and occurs during occupational or leisure-time activities and is common in the general population among men and women of various ages as mentioned in this paper.
Abstract: Circumpolar areas are associated with prolonged cold exposure where wind, precipitation, and darkness further aggravate the environmental conditions and the associated risks. Despite the climate warming, cold climatic conditions will prevail in circumpolar areas and contribute to adverse health effects. Frostbite is a freezing injury where localized damage affects the skin and other tissues. It occurs during occupational or leisure-time activities and is common in the general population among men and women of various ages. Industries of the circumpolar areas where frostbite occurs frequently include transportation, mining, oil, and gas industry, construction, agriculture, and military operations. Cold injuries may also occur during leisuretime activities involving substantial cold exposure, such as mountaineering, skiing, and snowmobiling. Accidental situations (occupational, leisure time) often contribute to adverse cooling and cold injuries. Several environmental (temperature, wind, wetness, cold objects, and altitude) and individual (behavior, health, and physiology) predisposing factors are connected with frostbite injuries. Vulnerable populations include those having a chronic disease (cardiovascular, diabetes, and depression), children and the elderly, or homeless people. Frostbite results in sequelae causing different types of discomfort and functional limitations that may persist for years. A frostbite injury is preventable, and hence, unacceptable from a public health perspective. Appropriate cold risk management includes awareness of the adverse effects of cold, individual adjustment of cold exposure and clothing, or in occupational context different organizational and technical measures. In addition, vulnerable population groups need customized information and care for proper prevention of frostbites. Keywords: cold; frostbite; injury; circumpolar; vulnerable; population (Published: 10 October 2011) Citation: Global Health Action 2011, 4 : 8456 - DOI: 10.3402/gha.v4i0.8456

Journal ArticleDOI
TL;DR: Having a say in the selection of a spouse was significantly associated with agreement with spouse over number of children to have, intention to use contraceptives, and the time between marriage and first contraceptive use.
Abstract: Background: Married young women’s reproductive needs are a challenge in traditional Pakistani society. The decisions regarding family planning and pregnancy are controlled by the family, often involving complex negotiations. The current study was undertaken to explore how young married women’s involvement in the arrangements surrounding their marriage is associated with their ability to negotiate sexual and reproductive health decisions in marriage. Objective: The study explores the associations between young women’s involvement in their marriage arrangements and their ability to negotiate for contraceptive use and fertility decisions. Methodology: A subset of 1,803 married young women aged 15-24 years was drawn from a nationally representative adolescent and youth survey conducted in Pakistan in 2001-2002 by the Population Council. Regression models were fitted to outcomes: reported agreement with spouse on the number of children to have, current use of contraceptives, intention to use contraceptives in the future, and the time elapsed between marriage and first contraceptive use. Key covariates of interest were variables that measure the involvement of young women in their marriage: (a) having a say in selection of spouse, (b) having met him prior to marriage, and (c) whether he was related to respondent’s family. Other factors explored were respondents’ mobility outside of household, social role, and decision making in their homes. Results: Having a say in the selection of a spouse was significantly associated with agreement with spouse over number of children to have, intention to use contraceptives, and the time between marriage and first contraceptive use. These relationships existed after controlling for education, socioeconomic status, mobility outside of house, and decision making in the home. Discussion: Women who had decision-making freedom in their parental home carried this ability with them into marriage in their new home and were better able to negotiate about their fertility. Keywords: youth; married women; agency; Pakistan (Published: 11 January 2011) Citation: Global Health Action 2011, 4 : 5079 - DOI: 10.3402/gha.v4i0.5079

Journal ArticleDOI
TL;DR: A severe under-reporting of neonatal deaths in the official health statistics in Quang Ninh province in northern Vietnam is revealed, revealing an inequity in survival chances based on ethnicity of the mother and highlighting the invisibility of this vulnerable group.
Abstract: Neonatal mortality is a major health problem in low and middle income countries and the rate of improvement of newborn survival is slow. This article is a review of the PhD thesis by Mats Ma°lqvist, titled ‘Who can save the unseen - Studies on neonatal mortality in Quang Ninh province, Vietnam’, from Uppsala University. The thesis aims to investigate structural barriers to newborn health improvements and determinants of neonatal death. The findings reveal a severe under-reporting of neonatal deaths in the official health statistics in Quang Ninh province in northern Vietnam. The neonatal mortality rate (NMR) found was four times higher than what was reported to the Ministry of Health. This underestimation of the problem inhibits adequate interventions and efforts to improve the survival of newborns and highlights the invisibility of this vulnerable group. The findings of the thesis also point at an inequity in survival chances based on ethnicity of the mother. Newborns of ethnic minority mothers were at a twofold risk of dying within the first 4 weeks of life compared to their peers belonging to the hegemonic group of Kinh (OR 2.08, 95% CI: 1.39-3.10). This increased risk was independent of maternal education and household economic status. Neonatal mortality was also associated with home deliveries, non-attendance to antenatal care and distance to the health care facilities. However, ethnic minority mothers still had an increased risk of experiencing a neonatal death even if they attended antenatal care, delivered at, or lived close to a health facility. This example of ethnic inequity highlights the importance to target those most in need. Keywords: neonatal mortality; inequity; ethnic minorities; care seeking; delivery care utilisation; under-reporting; Vietnam (Published: 16 March 2009) Citation: Global Health Action 2011, 4 : 5724 - DOI: 10.3402/gha.v4i0.5724 This article has been commented on by Zulfiqar A Bhutta. Please follow this link http://www.globalhealthaction.net/index.php/gha/article/view/6360 - to read his Commentary.

Journal ArticleDOI
TL;DR: Despite the promising evidence of increasing physical activity levels among the population in Västerbotten County, challenges remain for how to reduce the stable levels of sedentary behaviours in some subgroups.
Abstract: Background: Physical activity is identified as one important protective factor for chronic diseases. Physical activity surveillance is important in assessing healthy population behaviour over time. Many countries lack population trends on physical activity. Objective: To present trends in physical activity levels in Va¨sterbotten County, Sweden and to evaluate physical activity among women and men with various educational levels. Methods: Population-based cross-sectional and panel data from the Vasterbotten Intervention Programme (VIP) during 1990-2007 were used. All individuals in Va¨sterbotten County who turned 40, 50, or 60 years old were invited to their local primary health care for a health screening. Physical activity during commuting, recreational activities, physical exercise, and socio-demographic data were collected using a self-administered questionnaire. Respondents were categorised as sedentary, moderate physically active, or physically active. Results: The prevalences of physically active behaviours increased from 16 to 24.2% among men and from 12.6 to 30.4% among women. Increases are observed in all educational groups, but gaps between educational groups widened recently. The level of sedentary behaviour was stable over the time period studied. The 10- year follow-up data show that the prevalences of physically active behaviours increased from 15.8 to 21.4% among men and 12.7 to 23.3% among women. However, 10.2% of men and 3.8% of women remained sedentary. Conclusion: Despite the promising evidence of increasing physical activity levels among the population in Va¨sterbotten County, challenges remain for how to reduce the stable levels of sedentary behaviours in some subgroups. Persisting social gaps in physical activity levels should be addressed further. An exploration of people’s views on engaging in physical activity and barriers to doing so will allow better formulation of targeted interventions within this population. Keywords: physical activity; sedentary lifestyle; health promotion; educational status; longitudinal studies; Sweden (Published: 21 July 2011) Citation: Global Health Action 2011, 4 : 6347 - DOI: 10.3402/gha.v4i0.6347

Journal ArticleDOI
TL;DR: Community-based distribution of oral misoprostol by lay community health workers appeared to be effective, safe, acceptable, and feasible in reducing the incidence of PPH in rural areas of Bangladesh.
Abstract: Aims: Evidence exists about prevention of postpartum haemorrhage (PPH) by oral administration of misoprostol in low-income countries, but effectiveness of prevention by lay community health workers (CHW) is not sufficient. This study aimed to investigate whether a single dose (400 µg) of oral misoprostol could prevent PPH in a community home-birth setting and to assess its acceptability and feasibility among rural Bangladeshi women. Methods: This quasi-experimental trial was conducted among 2,017 rural women who had home deliveries between November 2009 and February 2010 in two rural districts of northern Bangladesh. In the intervention district 1,009 women received 400 µg of misoprostol immediately after giving birth by the lay CHWs, and in the control district 1,008 women were followed after giving birth with no specific intervention against PPH. Primary PPH (within 24 hours) was measured by women’s self-reported subjective measures of the normality of blood loss using the ‘cultural consensus model.’ Baseline data provided socio-economic, reproductive, obstetric, and bleeding disorder information. Findings: The incidence of primary PPH was found to be lower in the intervention group (1.6%) than the control group (6.2%) ( p<0.001). Misoprostol provided 81% protection (RR: 0.19; 95% CI: 0.08-0.48) against developing primary PPH. The proportion of retained and manually removed placentae was found to be higher in the control group compared to the intervention group. Women in the control group were more likely to need an emergency referral to a higher level facility and blood transfusion than the intervention group. Unexpectedly few women experienced transient side effects of misoprostol. Eighty-seven percent of the women were willing to use the drug in future pregnancy and would recommend to other pregnant women. Conclusion: Community-based distribution of oral misoprostol (400 µg) by CHW appeared to be effective, safe, acceptable, and feasible in reducing the incidence of PPH in rural areas of Bangladesh. This strategy should be scaled up across the country where access to skilled attendance is limited. Keywords: prevention of postpartum haemorrhage; misoprostol; BRAC; rural Bangladesh (Published: 10 August 2011) Citation: Global Health Action 2011, 4 : 7017 - DOI: 10.3402/gha.v4i0.7017

Journal ArticleDOI
TL;DR: This article will focus on effects of climate-change on water security with an Arctic perspective giving some examples from different countries how arising problems are being addressed.
Abstract: Water is of fundamental importance for human life; access to water of good quality is of vital concern for mankind. Currently however, the situation is under severe pressure due to several stressors that have a clear impact on access to water. In the Arctic, climate change is having an impact on water availability by melting glaciers, decreasing seasonal rates of precipitation, increasing evapotranspiration, and drying lakes and rivers existing in permafrost grounds. Water quality is also being impacted as manmade pollutants stored in the environment are released, lowland areas are flooded with salty ocean water during storms, turbidity from permafrost-driven thaw and erosion is increased, and the growth or emergence of natural pollutants are increased. By 2030 it is estimated that the world will need to produce 50% more food and energy which means a continuous increase in demand for water. Decisionmakers will have to very clearly include life quality aspects of future generations in the work as impact of ongoing changes will be noticeable, in many cases, in the future. This article will focus on effects of climate-change on water security with an Arctic perspective giving some examples from different countries how arising problems are being addressed.

Journal ArticleDOI
TL;DR: The report does not address a single planned study but rather a compilation of data from a number of ad-hoc investigations in response to the outbreak plus observations and findings made by the authors.
Abstract: Human cutaneous leishmaniasis (CL) has previously been reported in West Africa, but more recently, sporadic reports of CL have increased. Leishmania major has been identified from Mauritania, Senegal, Mali, and Burkina Faso. Three zymodemes (MON-26, MON-117, and MON-74, the most frequent) have been found. The geographic range of leishmaniasis is limited by the sand fly vector, its feeding preferences, and its capacity to support internal development of specific species of Leishmania. The risk of acquiring CL has been reported to increase considerably with human activity and epidemics of CL have been associated with deforestation, road construction, wars, or other activities where humans intrude the habitat of the vector. In the Ho Municipality in the Volta Region of Ghana, a localised outbreak of skin ulcers, possibly CL, was noted in 2003 without any such documented activity. This outbreak was consistent with CL as evidenced using various methods including parasite identification, albeit, in a small number of patients with ulcers. This paper reports the outbreak in Ghana. The report does not address a single planned study but rather a compilation of data from a number of ad-hoc investigations in response to the outbreak plus observations and findings made by the authors. It acknowledges that a number of the observations need to be further clarified. What is the detailed epidemiology of the disease? What sparked the epidemic? Can it happen again? What was the causative agent of the disease, L. major or some other Leishmania spp.? What were the main vectors and animal reservoirs?What are the consequences for surveillance of the disease and the prevention of its reoccurrence when the communities see a self-healing disease and may not think it is important? Keywords: cutaneous leishmaniasis; Ghana; Volta Region; West Africa; outbreak; follow-up (Published: 13 July 2011) Citation: Global Health Action 2011, 4 : 5527 - DOI: 10.3402/gha.v4i0.5527

Journal ArticleDOI
TL;DR: This article is a review of the PhD thesis undertaken by Joanna Vearey that explores local government responses to the urban health challenges of migration, informal settlements, and HIV in Johannesburg, South Africa and suggests a revised, participatory approach to urban health – ‘concept mapping’.
Abstract: This article is a review of the PhD thesis undertaken by Joanna Vearey that explores local government responses to the urban health challenges of migration, informal settlements, and HIV in Johannesburg, South Africa. Urbanisation in South Africa is a result of natural urban growth and (to a lesser extent) in-migration from within the country and across borders. This has led to the development of informal settlements within and on the periphery of urban areas. The highest HIV prevalence nationally is found within urban informal settlements. South African local government has a ‘developmental mandate’ that calls for government to work with citizens to develop sustainable interventions to address their social, economic, and material needs. Through a mixed-methods approach, four studies were undertaken within inner-city Johannesburg and a peripheral urban informal settlement. Two cross-sectional surveys - one at a household level and one with migrant antiretroviral clients - were supplemented with semi-structured interviews with multiple stakeholders involved with urban health and HIV in Johannesburg, and participatory photography and film projects undertaken with urban migrant communities. The findings show that local government requires support in developing and implementing appropriate intersectoral responses to address urban health. Existing urban health frameworks do not deal adequately with the complex health and development challenges identified; it is essential that urban public health practitioners and other development professionals in South Africa engage with the complexities of the urban environment. A revised, participatory approach to urban health - ‘concept mapping’ - is suggested which requires a recommitment to intersectoral action, ‘healthy urban governance’ and public health advocacy. Keywords: urban health; migration; informal settlement; HIV; local government; South Africa (Published: 9 June 2011) Citation: Global Health Action 2011, 4 : 5898 - DOI: 10.3402/gha.v4i0.5898 This article has been commented on by Francoise Barten. Please follow this link http:// www.globalhealthaction.net/index.php/gha/article/view/7290 - to read her Commentary.

Journal ArticleDOI
TL;DR: The proposed performance measurement framework was applied to three mature telemedicine networks that provide services to doctors in low-resource settings and which employ the same basic design and is a practical tool that will permit organisations to assess the performance of their own networks and to improve them by comparison with others.
Abstract: Background: Telemedicine has been used for many years to support doctors in the developing world. Several networks provide services in different settings and in different ways. However, to draw conclusions about which telemedicine networks are successful requires a method of evaluating them. No general consensus or validated framework exists for this purpose. Objective: To define a basic method of performance measurement that can be used to improve and compare teleconsultation networks; to employ the proposed framework in an evaluation of three existing networks; to make recommendations about the future implementation and follow-up of such networks. Methods: Analysis based on the experience of three telemedicine networks (in operation for 7-10 years) that provide services to doctors in low-resource settings and which employ the same basic design. Findings: Although there are many possible indicators and metrics that might be relevant, five measures for each of the three user groups appear to be sufficient for the proposed framework. In addition, from the societal perspective, information about clinical- and cost-effectiveness is also required. The proposed performance measurement framework was applied to three mature telemedicine networks. Despite their differences in terms of activity, size and objectives, their performance in certain respects is very similar. For example, the time to first reply from an expert is about 24 hours for each network. Although all three networks had systems in place to collect data from the user perspective, none of them collected information about the coordinator’s time required or about ease of system usage. They had only limited information about quality and cost. Conclusion: Measuring the performance of a telemedicine network is essential in understanding whether the network is working as intended and what effect it is having. Based on long-term field experience, the suggested framework is a practical tool that will permit organisations to assess the performance of their own networks and to improve them by comparison with others. All telemedicine systems should provide information about setup and running costs because cost-effectiveness is crucial for sustainability. Keywords: Africa; telemedicine; telehealth; developing countries; performance evaluation; Ukraine; HIV/AIDS (Published: 6 December 2011) Citation: Global Health Action 2011, 4 : 7214 - DOI: 10.3402/gha.v4i0.7214

Journal ArticleDOI
TL;DR: Community Health Environment Scan Survey (CHESS) is an empirical assessment tool that measures the availability and accessibility, of healthy lifestyle options lifestyle options, and is the first tool of its kind that systematically and simultaneously examines how built environments encourage/discourage healthy eating, physical activity, and tobacco use.
Abstract: Background: Novel efforts and accompanying tools are needed to tackle the global burden of chronic disease. This paper presents an approach to describe the environments in which people live, work, and play. Community Health Environment Scan Survey (CHESS) is an empirical assessment tool that measures the availability and accessibility, of healthy lifestyle options. CHESS reveals existing community assets as well as opportunities for change, shaping community intervention planning efforts by focusing on communityrelevant opportunities to address the three key risk factors for chronic disease (i.e. unhealthy diet, physical inactivity, and tobacco use). Methods: The CHESS tool was developed following a review of existing auditing tools and in consultation with experts. It is based on the social-ecological model and is adaptable to diverse settings in developed and developing countries throughout the world. Results: For illustrative purposes, baseline results from the Community Interventions for Health (CIH) Mexico site are used, where the CHESS tool assessed 583 food stores and 168 restaurants. Comparisons between individual-level survey data from schools and community-level CHESS data are made to demonstrate the utility of the tool in strategically guiding intervention activities. Conclusion: The environments where people live, work, and play are key factors in determining their diet, levels of physical activity, and tobacco use. CHESS is the first tool of its kind that systematically and simultaneously examines how built environments encourage/discourage healthy eating, physical activity, and tobacco use. CHESS can help to design community interventions to prevent chronic disease and guide healthy urban planning. Keywords: physical activity; nutrition; tobacco use; chronic disease; environmental assessment; built environment (Published: 7 March 2011) Citation: Global Health Action 2011, 4 : 5276 - DOI: 10.3402/gha.v4i0.5276