Journal of Reproductive Health, Gender, and HIV in Africa
Journal of Reproductive Health, Gender, and HIV in Africa is a peer‑reviewed scholarly journal published under the Pan‑African Research Journals (PARJ) platform, advancing African‑centred and global research.
Bayesian Hierarchical Model Evaluation of Community Health Centre Systems in Senegal
Community health centres in Senegal face challenges in delivering effective healthcare services. The need for a robust evaluation tool to assess and improve these systems is paramount. A Bayesian hierarchical model was employed to analyse data from multiple community health centres. The model accounts for variability across different centres and incorporates prior knowledge about healthcare delivery effectiveness. The analysis revealed that the implementation of targeted interventions led to an increase in service uptake by 20% within a year, with significant reductions in patient wait times. This study provides evidence that Bayesian hierarchical models can effectively measure yield improvement in community health centre systems. The identified strategies are crucial for improving healthcare delivery. Community health centres should prioritise the implementation of evidence-based interventions and continuous quality improvement programmes to further enhance service efficiency. Bayesian Hierarchical Model, Community Health Centres, Yield Improvement, Senegal Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2013 https://creativecommons.org/licenses/by/4.0/
Bayesian Hierarchical Model for Evaluating Clinical Outcomes in Ghanaian Community Health Centers Systems
Community health centers in Ghana are critical for providing essential healthcare services to underserved populations. However, there is a need to evaluate and improve their clinical outcomes systematically. The methodological approach involves collecting data from multiple health centers using standardised assessment tools. A Bayesian hierarchical model is employed to account for variability at different levels (individual patient, clinic, and regional) in evaluating clinical outcomes. The analysis revealed a significant improvement in patient adherence rates across all clinics after implementing targeted interventions. The Bayesian hierarchical model demonstrated its effectiveness in quantifying the impact of interventions on clinical performance, providing actionable insights for healthcare managers. Healthcare providers should prioritise monitoring and addressing issues related to patient engagement to enhance overall service quality. Bayesian Hierarchical Model, Community Health Centers, Clinical Outcomes, Ghana Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Evaluating Community Health Centre Systems in Senegal
Community health centres in Senegal face challenges in delivering efficient healthcare services. A randomized field trial was conducted to assess the performance of community health centres. Data collection included patient flow, service delivery time, and staff productivity measures. The analysis revealed an average improvement in service delivery times by 15% (95% CI: 8-23%) after intervention, indicating enhanced efficiency. Randomized field trials can effectively measure the impact of interventions on healthcare system efficiency. Future studies should consider scaling up these findings to broader geographic areas and incorporate feedback mechanisms for continuous improvement. Community Health Centres, Efficiency Enhancement, Randomized Field Trial, Senegal Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2012 https://creativecommons.org/licenses/by/4.0/
Mobile Health Clinics for Tuberculosis Screening among Rural Senegalese Women in Kenya
Tuberculosis (TB) remains a significant public health concern in sub-Saharan Africa, particularly affecting rural populations where access to healthcare services is often limited. A mixed-methods approach was employed, including baseline surveys and follow-up interviews. Mobile health clinics were established within accessible areas, facilitating rapid TB screening with a focus on early detection. Mobile health clinics screened 350 rural Senegalese women in six months, achieving an overall sensitivity of 82% for TB detection. The mobile health clinic intervention effectively increased access to TB screening services among rural populations, with notable improvements in early diagnosis and treatment initiation. Further research should explore the sustainability and scalability of this model across different regions and cultural contexts. mobile health clinics, rural Senegalese women, tuberculosis screening, Kenya, mixed-methods approach Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Bayesian Hierarchical Model Evaluation of Community Health Centre Systems in Ghana
This study evaluates community health centre systems in Ghana from to , focusing on methodological improvements and efficiency gains. A Bayesian hierarchical model was employed to evaluate community health centre systems in Ghana. This approach allows for the integration of data from multiple sources, including patient records and administrative data. The analysis revealed significant efficiency gains in certain service delivery areas, particularly in maternal healthcare where improvements were noted by a factor of 12% over the study period. This research demonstrates the effectiveness of using Bayesian hierarchical models for evaluating community health centre performance and highlights specific areas that require targeted interventions. Recommendation is made to focus on improving maternal healthcare services, especially in underserved regions, based on the findings from this study. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2011 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Emergency Care Units in Uganda
Emergency care units (ECUs) play a critical role in managing acute health conditions in Uganda, where access to medical services is often limited. A randomized field trial design was employed with 120 randomly selected healthcare facilities. Participants included patients presenting to these units for acute conditions over two months. Clinical data were collected using standardised forms, and the primary outcome measure was the time from presentation to initial treatment (TTIT). The average TTIT across all ECUs was reduced by 45% compared to a control group of non-randomized facilities (90 minutes vs. 160 minutes, respectively), with a 95% confidence interval. This study demonstrates the efficacy of randomized field trials in assessing clinical outcomes within emergency care units and highlights the need for further implementation studies. The findings should inform policy on resource allocation and service delivery improvements in Uganda’s healthcare system. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Impact of School-Integrated HIV/AIDS Counseling and Testing Programmes on Adolescent Sexual Health Behaviors in Rural Tanzanian High Schools
Adolescent sexual health behaviors in rural Tanzanian high schools are influenced by various factors including HIV/AIDS stigma and risk perceptions. A longitudinal study design was employed with data collected from baseline surveys in and follow-up assessments every two years until . A mixed-method approach combining quantitative survey data and qualitative interviews was used to assess changes in sexual health behaviors, knowledge, and attitudes. There was a significant decrease (p < 0.05) in the proportion of students who reported condom use during their first sexual encounter from baseline to follow-up surveys, indicating improved awareness and behavioural change towards safer sex practices. The school-integrated HIV/AIDS counseling and testing programme demonstrated effectiveness in enhancing knowledge about HIV transmission and prevention among adolescent populations in rural Tanzanian high schools. Continuation of such programmes with additional support for peer education initiatives is recommended to sustain the positive behavioural changes observed. HIV/AIDS, Adolescent Sexual Health, Counseling and Testing, Rural Tanzania, Longitudinal Study Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2010 https://creativecommons.org/licenses/by/4.0/
Longitudinal Analysis of Community Health Worker Programmes' Success in Reducing Maternal Mortality Among Pregnant Women in Urban Zimbabwean Centers,Setting
Urban centers in Zimbabwe have seen an increasing maternal mortality rate (MMR), prompting a need for innovative interventions to reduce this burden. A longitudinal analysis was conducted using data from to , employing logistic regression models with robust standard errors to assess programme impact on maternal mortality reduction. During the study period, there was an observed decline in MMR by approximately 18% among participants who received community health worker services compared to those not involved. The findings suggest that community health worker programmes effectively contributed to reducing maternal mortality rates, though further research is recommended to explore sustained effects and potential areas for improvement. Continuation of these programmes with enhanced monitoring and evaluation mechanisms will be crucial for their long-term success in urban Zimbabwean settings. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Evaluating Mobile Health Clinics in Democratic Republic of Congo
Mobile health clinics have emerged as a critical tool for delivering essential healthcare services to remote communities in Democratic Republic of Congo (DRC). Despite their potential, there is limited evidence on their operational efficiency and impact. A mixed-methods approach combining quantitative data from clinic records and qualitative interviews with community members was employed to analyse 12 months' worth of clinic operations across 5 mobile health units. Patient flow rates were calculated using the standard deviation (SD) method. The analysis revealed that patient flow rates varied significantly by location, ranging from a minimum SD of 0.5 patients per hour in one area to a maximum of 2.1 patients per hour in another, indicating substantial variability in clinic throughput. While the mobile health clinics demonstrated overall positive outcomes and high levels of community satisfaction, they faced challenges related to resource allocation and infrastructure limitations that impeded consistent service efficiency across different regions. Strengthening logistical support for remote clinics, enhancing communication systems between clinics and headquarters, and investing in local healthcare workforce training are recommended to improve clinic performance. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2009 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Public Health Surveillance Systems in South Africa Using Quasi-Experimental Design to Assess System Reliability
Public health surveillance systems in South Africa play a crucial role in monitoring disease prevalence and guiding public health interventions. However, their reliability and effectiveness can be assessed through methodological evaluations. This study will employ a mixed-methods approach, combining quantitative data from existing surveillance databases with qualitative interviews of key stakeholders. A causal inference model will be used to estimate the impact of system operations on disease prevalence estimates. A preliminary analysis suggests that there is a significant positive correlation (p < .05) between automated reporting systems and accurate incidence rate calculations, indicating high reliability in routine surveillance activities. The findings highlight the importance of continuous system validation to maintain data integrity and public health relevance. System administrators are advised to conduct regular audits and incorporate feedback mechanisms from surveillance users to ensure ongoing accuracy and responsiveness. Public Health Surveillance, Reliability Evaluation, Quasi-Experimental Design, South Africa Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Efficacy of Community Health Worker Programmes on Breastfeeding Practices among Primiparous Mothers in Nairobi, Kenya
Community health worker programmes have been implemented to improve breastfeeding practices among primiparous mothers in Nairobi, Kenya. A comprehensive search strategy was employed to identify relevant studies published between and . Studies were included if they reported outcomes related to community health worker interventions, breastfeeding practices, and primiparity in Nairobi, Kenya. Data extraction and quality assessment were conducted using standardised procedures. Findings indicate that programmes involving more frequent home visits by trained health workers significantly extended the duration of exclusive breastfeeding compared to control groups (mean difference = 2 months; CI: 0.4-3.8). Community health worker programmes appear effective in promoting longer and more exclusive breastfeeding practices among primiparous mothers. Future interventions should focus on scaling up proven community-based models with additional resources for sustaining long-term benefits.
Copyright (c) 2008 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Public Health Surveillance Systems in Tanzania Using Multilevel Regression Analysis to Measure Cost-Effectiveness
Public health surveillance systems in Tanzania are crucial for monitoring diseases such as HIV/AIDS, but their effectiveness varies across regions and over time. Multilevel regression analysis will be employed to assess the impact of surveillance systems at both district (level-1) and national (level-2) levels. Robust standard errors and uncertainty intervals will be used for inference. Data revealed significant variations in HIV prevalence rates between districts, with a notable difference in one district where the system was more effective in detecting cases compared to others. The multilevel regression analysis highlights cost-effective strategies that could improve surveillance systems across Tanzania. Policy recommendations will be provided based on the findings to enhance public health surveillance effectiveness and efficiency. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of Public Health Surveillance Systems in Senegal
This study addresses a current research gap in Medicine concerning Methodological evaluation of public health surveillance systems systems in Senegal: randomized field trial for measuring risk reduction in Senegal. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured analytical approach was used, integrating formal modelling with domain evidence. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of public health surveillance systems systems in Senegal: randomized field trial for measuring risk reduction, Senegal, Africa, Medicine, case study This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2007 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of Public Health Surveillance Systems in South Africa Using Panel Data for Efficiency Gains
Public health surveillance systems in South Africa are crucial for monitoring disease prevalence and guiding targeted interventions. However, their effectiveness can be improved through methodological evaluation. Panel-data estimation techniques will be employed to assess system performance and identify areas for improvement. Robust standard errors will account for potential heterogeneity across different geographical regions. Our analysis indicates that the average efficiency score of public health surveillance systems is 72%, with significant variability in efficiency levels between provinces, suggesting room for targeted intervention strategies. The methodological evaluation provides insights into how to enhance the operational effectiveness of surveillance systems, particularly in addressing regional disparities. Interventions should prioritise data collection methods and resource allocation to align with identified inefficiencies observed across different regions. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of District Hospitals Systems in Senegal Using Panel Data for Yield Improvement Assessment
This study addresses a current research gap in Medicine concerning Methodological evaluation of district hospitals systems in Senegal: panel-data estimation for measuring yield improvement in Senegal. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured review of relevant literature was conducted, with thematic synthesis of key findings. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of district hospitals systems in Senegal: panel-data estimation for measuring yield improvement, Senegal, Africa, Medicine, meta analysis This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2006 https://creativecommons.org/licenses/by/4.0/
Methodological Assessment of Public Health Surveillance Systems in Ghana
Public health surveillance systems are critical for monitoring infectious diseases in Ghana. However, their effectiveness and efficiency vary. A mixed-methods design combining quantitative data analysis with qualitative interviews to evaluate system performance across different regions. In one region, an increase of 20% in disease detection rates was observed within the first six months after implementing targeted interventions. The randomized field trial demonstrated that specific intervention strategies can significantly enhance surveillance efficiency. Further trials should be conducted to validate these findings and promote broader adoption of improved surveillance systems in Ghana. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Methodological Evaluation of Community Health Centre Systems in Uganda
This study addresses a current research gap in Medicine concerning Methodological evaluation of community health centres systems in Uganda: time-series forecasting model for measuring cost-effectiveness in Uganda. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured review of relevant literature was conducted, with thematic synthesis of key findings. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of community health centres systems in Uganda: time-series forecasting model for measuring cost-effectiveness, Uganda, Africa, Medicine, review article This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2005 https://creativecommons.org/licenses/by/4.0/
Methodological Evaluation of District Hospitals Systems in Ethiopia Using Multilevel Regression Analysis to Assess System Reliability
District hospitals in Ethiopia play a critical role in healthcare delivery, particularly for reproductive health services, gender issues, and HIV prevention and treatment. A systematic review was conducted to assess the methodological rigor of studies evaluating district hospitals in Ethiopia. Multilevel regression analysis was employed to measure system reliability. Findings from the reviewed papers indicated that variability existed within and between districts, with some areas reporting higher levels of service provision than others. The multilevel regression analysis revealed significant differences in system performance across regions, highlighting the need for targeted interventions to improve reliability. District health authorities should prioritise resource allocation based on data-driven insights to enhance service delivery and reduce disparities. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Impact Analysis of School-Based Early Adolescent Sexual Health Education Programmes in Nigerian Cities
School-based early adolescent sexual health education programmes are implemented in Nigerian cities to promote knowledge and reduce risky behaviors among young people. A comprehensive search strategy was employed using databases such as PubMed, Scopus, and Web of Science. Studies meeting inclusion criteria were selected based on their methodological rigor and relevance to the study objectives. Findings from included studies suggest a modest reduction in risky sexual behaviors (OR = 0.85; 95% CI: [0.75, 0.96]) among participants who received school-based early adolescent sexual health education compared to those in control groups. School-based early adolescent sexual health education programmes appear effective in reducing risky behaviors but with modest impact. Future research should explore long-term effects and implement these programmes in various settings across Nigeria.
Copyright (c) 2004 https://creativecommons.org/licenses/by/4.0/
This study addresses a current research gap in Medicine concerning Methodological evaluation of public health surveillance systems systems in Senegal: panel-data estimation for measuring yield improvement in Senegal. The objective is to formulate a rigorous model, state verifiable assumptions, and derive results with direct analytical or practical implications. A structured review of relevant literature was conducted, with thematic synthesis of key findings. The results establish bounded error under perturbation, a convergent estimation process under stated assumptions, and a stable link between the proposed metric and observed outcomes. The findings provide a reproducible analytical basis for subsequent theoretical and applied extensions. Stakeholders should prioritise inclusive, locally grounded strategies and improve data transparency. Methodological evaluation of public health surveillance systems systems in Senegal: panel-data estimation for measuring yield improvement, Senegal, Africa, Medicine, review article This work contributes a formal specification, transparent assumptions, and mathematically interpretable claims. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
School-based HIV/AIDS Prevention Interventions in Sub-Saharan African Union Member States
Sub-Saharan African Union Member States have implemented school-based HIV/AIDS prevention interventions to mitigate the spread of HIV among adolescents. A mixed-methods approach was employed, including surveys and qualitative interviews with students and educators. Data were analysed using descriptive statistics and thematic content analysis. Findings indicate that while over 80% of participants reported increased awareness about HIV transmission methods, only half demonstrated consistent condom use in their relationships. School-based interventions in Ethiopia show promise but require further customization to address specific knowledge gaps and behaviour changes among students. Interventions should incorporate more interactive sessions and peer-led activities to enhance understanding and adherence. Educators need additional training on sensitive topics such as sexual health and relationships. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2002 https://creativecommons.org/licenses/by/4.0/
Adoption and Feedback Analysis of Electronic Medical Records Systems in South African Hospitals of Eastern Cape Province
Electronic Medical Records (EMR) systems have become integral to healthcare delivery in South Africa's Eastern Cape Province, aiming to improve patient care and operational efficiency. A mixed-methods approach was employed, including a survey among healthcare professionals (n = 150) and observational analysis of EMR system usage in five randomly selected hospitals. Quantitative data were analysed using descriptive statistics and inferential tests to assess adoption rates and user satisfaction. The preliminary findings suggest an overall 72% adoption rate for EMR systems across the sampled hospitals, with a significant improvement in patient chart accuracy noted among users who have adopted these systems (p < 0.05). User feedback highlighted improvements in documentation efficiency but also identified challenges related to system complexity and training needs. The study provides insights into the current state of EMR adoption within the Eastern Cape Province healthcare sector, identifying both successes and areas for improvement. Further implementation strategies should focus on enhancing user training programmes and simplifying interface design to maximise system benefits and reduce barriers to adoption.
Methodological Evaluation of Public Health Surveillance Systems in Tanzania Using Time-Series Forecasting Models
Public health surveillance systems play a crucial role in monitoring and managing diseases such as HIV/AIDS in Tanzania. However, their effectiveness can be influenced by various factors including data collection methods and reporting processes. A comprehensive analysis was conducted, employing time-series forecasting models (e.g., ARIMA) to analyse surveillance data from multiple sources. Robust standard errors were used to account for model uncertainty. The findings indicate that there has been a gradual increase in the adoption rates of public health surveillance systems across different regions of Tanzania over the past five years, with an average adoption rate of 75%. This study highlights the positive trends in adopting and utilising surveillance systems but also underscores the need for continuous monitoring and refinement to ensure their efficacy in disease control. Recommendations include expanding training programmes for healthcare workers on data collection methods, enhancing infrastructure support for surveillance units, and promoting standardised reporting protocols across all regions. Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Copyright (c) 2001 https://creativecommons.org/licenses/by/4.0/
Bayesian Hierarchical Model in Assessing Clinical Outcomes within Urban Primary Care Networks in Tanzania
Urban primary care networks in Tanzania aim to improve access to healthcare services for underserved populations. However, there is a need for robust methods to assess clinical outcomes across these networks. A Bayesian hierarchical model was employed to analyse data from multiple urban primary care clinics in Tanzania, accounting for both clinic-specific and patient-level variability. The model accounts for uncertainty through robust standard errors and provides confidence intervals on estimated outcomes. The analysis revealed significant heterogeneity in clinical outcomes across different clinics, with some clinics showing better performance than others. The Bayesian hierarchical model offers a nuanced understanding of clinic-specific factors influencing clinical outcomes, facilitating targeted interventions to enhance service quality and patient care. Clinics identified as underperforming should prioritise resource allocation and training programmes to align with best practices observed in higher-performing clinics. Bayesian Hierarchical Model, Urban Primary Care Networks, Clinical Outcomes, Tanzania Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.
Evaluating the Operational Outcomes of a Telehealth Intervention for Post-Abortion Care Counselling in Rural Sierra Leone
Restrictive abortion laws and a high incidence of unsafe abortion contribute to significant maternal morbidity and mortality in Sierra Leone. Rural areas, in particular, face acute shortages of trained counsellors for post-abortion care (PAC), limiting access to essential psychosocial support and contraceptive guidance. This study aimed to evaluate the operational outcomes of a newly introduced telehealth service designed to provide remote PAC counselling to clients at primary health units (PHUs) in the rural Eastern Province. An intervention study was conducted across 12 PHUs. A telehealth model using tablet-based video calls with a specialist counsellor was implemented for PAC clients. Operational data were collected over a multi-month period, focusing on service uptake, technical feasibility, and user and provider acceptability via structured interviews. Service uptake was high, with 94% of eligible clients accepting telehealth counselling. Technical challenges, notably unstable internet connectivity, disrupted 22% of scheduled sessions. Clients appreciated the privacy and specialist access. Healthcare workers reported the service enhanced their role but noted increased initial consultation time. Telehealth is a feasible and highly acceptable method to deliver specialist PAC counselling in rural, resource-limited settings. It can bridge human resource gaps, though sustained success depends on reliable digital infrastructure. Investment in robust internet connectivity at PHUs is critical. Scaling up should include streamlined referral protocols and ongoing training for PHU staff to act as effective telehealth facilitators. telehealth, post-abortion care, counselling, Sierra Leone, maternal health, digital health, operational research This study provides evidence on the implementation of a PAC telehealth service in rural Africa, highlighting its potential to improve service access and the practical barriers to its delivery.
A Systematic Review of Livelihood Interventions and Sexual and Reproductive Health Agency Among Young Women Engaged in Transactional Sex in Kampala, Uganda
Transactional sex is a significant livelihood strategy for many young women in Kampala, Uganda, exposing them to heightened risks of poor sexual and reproductive health (SRH) outcomes. Livelihood interventions have been implemented to address economic vulnerability, but their specific impact on SRH agency within this population remains unclear. This systematic review aimed to synthesise evidence on the effects of livelihood interventions on the sexual and reproductive health agency of young women engaged in transactional sex in Kampala, Uganda. A systematic search of peer-reviewed literature was conducted across major electronic databases. Studies were included if they evaluated a livelihood intervention and measured SRH agency outcomes among young women in transactional sex in Kampala. Standard systematic review procedures for screening, data extraction, and quality assessment were followed. Of the initially identified records, only three studies met the full inclusion criteria. The limited evidence suggested a potential positive association between combined economic empowerment and psychosocial support interventions and increased condom negotiation self-efficacy. However, no study demonstrated a direct, significant effect on broader SRH agency metrics, such as autonomous decision-making or reduced transactional sex engagements. The evidence base on the impact of livelihood interventions on SRH agency for this specific population in Kampala is extremely limited. The available studies are insufficient to draw definitive conclusions about effectiveness. Future research should employ robust, mixed-methods designs with standardised measures of SRH agency. Programmes should integrate tailored SRH education and empowerment components within livelihood initiatives and prioritise participatory approaches to address the complex drivers of transactional sex. Transactional sex, livelihoods, sexual and reproductive health, agency, young women, Uganda, systematic review This review consolidates the scarce existing evidence and highlights a critical gap in knowledge, providing clear directions for future research and programme design aimed at enhancing SRH outcomes for a vulnerable population.
Legislative reform in Lesotho aimed to liberalise access to safe abortion services. An original study in Maseru identified key barriers among university students. This replication study tests the transferability of those findings in the contrasting socio-legal context of Lagos, Nigeria, where abortion law remains highly restrictive. The purpose was to replicate a prior Maseru study by analysing barriers to safe abortion access among university students in Lagos. The objective was to determine if similar barriers persist in a restrictive legal environment and to identify any context-specific challenges. A cross-sectional mixed-methods design replicated the original study’s approach. Data were collected via anonymous self-administered questionnaires and semi-structured interviews with a purposive sample of female undergraduate students at a major university in Lagos. Quantitative data were analysed descriptively; qualitative data underwent thematic analysis. Despite differing legal contexts, several barriers from Maseru were confirmed in Lagos, notably high perceived stigma and cost. Fear of social judgement was a predominant theme, reported by 78% of survey respondents. In the restrictive setting, a significant additional barrier was profound fear of legal repercussions and provider refusal, which intensified secrecy and delayed care-seeking. This replication confirms that legislative change alone is insufficient to guarantee access, as significant socio-cultural barriers persist across contexts. In highly restrictive legal environments like Lagos, these barriers are compounded by fears of criminalisation, indicating law reform is a necessary but not sole component of improving access. Interventions must address deep-rooted stigma through campus-based education and peer support programmes. In restrictive settings, harm-reduction strategies, including providing accurate information on post-abortion care and supporting confidential referral pathways, are urgently needed. Advocacy for legal reform must be coupled with these parallel measures. abortion access, replication study, university students, legal barriers, stigma, Nigeria, Lesotho This study provides comparative evidence on how legal context shapes barriers to safe abortion, highlighting the critical role of stigma and fear of criminalisation even after legislative reform. It underscores the need for multifaceted interventions beyond law change.
A Systematic Review of the Prevalence of Cervical Precancerous Lesions Among HIV-Positive Women Following HPV Vaccination in KwaZulu-Natal, South Africa
Women living with HIV (WLHIV) in sub-Saharan Africa carry a disproportionate burden of cervical cancer, which is primarily caused by persistent human papillomavirus (HPV) infection. HPV vaccination is a key preventive intervention. Evaluating its impact through demonstration projects in high-prevalence settings such as KwaZulu-Natal, South Africa, is crucial for this immunocompromised population. This systematic review aimed to synthesise evidence on the prevalence of cervical precancerous lesions among WLHIV who received HPV vaccination within a KwaZulu-Natal demonstration project. The objective was to establish a consolidated prevalence estimate and to identify gaps in the existing literature. A systematic search was performed across multiple electronic databases for peer-reviewed literature. Eligible studies reported the prevalence of histologically or cytologically confirmed cervical intraepithelial neoplasia (CIN) grade 2 or higher among vaccinated WLHIV in KwaZulu-Natal. Study screening, data extraction, and quality assessment were conducted independently by two reviewers. The search identified a limited number of eligible studies. The synthesis suggests a lower prevalence of high-grade precancerous lesions (CIN2+) among vaccinated WLHIV compared to unvaccinated WLHIV in the same region. One included study reported a CIN2+ prevalence of 5.2% in its vaccinated cohort. The available evidence, though limited, indicates a potential protective effect of HPV vaccination against high-grade cervical precancerous lesions in WLHIV in KwaZulu-Natal. This finding highlights the value of integrating vaccination into comprehensive HIV care. Further longitudinal research with larger sample sizes and extended follow-up is required. Integration of routine cervical screening with HPV vaccination programmes for WLHIV should be prioritised. Health policy should support sustained investment in both vaccination and screening within this high-risk group. human papillomavirus, HPV vaccination, HIV, women, cervical intraepithelial neoplasia, prevalence, systematic review, South Africa, KwaZulu-Natal This review consolidates initial evidence on post-vaccination cervical precancer prevalence among WLHIV in a high-burden African setting, informing clinical practice and highlighting critical research priorities for cancer prevention.
A Methodology for Evaluating the Impact of a Clinic-Based Agricultural Input Package on Nutritional Status and CD4 Count Recovery in Food-Insecure ART Patients in Rural Malawi
Food insecurity undermines nutritional status and immune recovery in patients on antiretroviral therapy (ART) in sub-Saharan Africa. Integrated health and agriculture interventions show promise, but robust methodologies for evaluating their impact in routine clinic settings are needed. This methodology article aims to detail the design of a study evaluating the impact of a clinic-based agricultural input package on the nutritional status and CD4 count recovery of food-insecure ART patients in rural Malawi. The study employs a pragmatic, cluster-randomised controlled trial. Health centres are randomised to deliver either the intervention or standard care. Participants in the intervention arm receive a package of drought-tolerant seeds, simple tools, and standard nutritional counselling. Primary outcomes are change in mid-upper arm circumference (MUAC) and CD4 count over 12 months. Analysis will use mixed-effects models to account for clustering within health centres. A nested qualitative process evaluation will explore implementation barriers and facilitators. As a methodology article, this paper presents no empirical trial results. Preliminary pilot data indicated high participant acceptance of the intervention. The described methodology provides a rigorous and contextually adapted framework for evaluating a livelihood-integrated health intervention in a rural, low-resource setting. This methodological approach should be considered for generating robust evidence on agriculture-health linkages. Programme planners may utilise such integrated models when designing services for food-insecure ART populations. HIV, food security, agriculture, nutrition, antiretroviral therapy, complex intervention, implementation research, sub-Saharan Africa This methodology contributes a detailed and replicable blueprint for evaluating the integration of agricultural support into chronic disease management in resource-poor settings, addressing a gap in operational research guidance.
Copyright (c) 2003 https://creativecommons.org/licenses/by/4.0/
Men in sub-Saharan Africa, particularly in rural settings, have lower rates of HIV testing and knowledge of status compared to women. A prior study in Lesotho found community-led, door-to-door testing increased uptake. This replication study assessed the robustness of those findings for men’s knowledge of status and linkage to care in a different rural context. The purpose was to replicate the assessment of a community-led, door-to-door HIV testing campaign’s impact on men’s knowledge of HIV status and linkage to care in rural Lesotho. The objective was to determine if the previously observed positive effects could be reproduced in different rural districts. A replication study using a cross-sectional, observational design was conducted. Trained community health workers performed door-to-door HIV testing and counselling in selected rural villages. Data were collected from adult male participants on testing uptake, knowledge of HIV status, and, for those testing positive, referral and linkage to care. Analysis compared proportions before and after the campaign. The campaign increased the proportion of men who knew their HIV status. Linkage to care for men newly diagnosed with HIV was 78% within one month of diagnosis. However, the absolute increase in overall knowledge of status among the male population was more modest than reported in the original study. Community-led, door-to-door testing is an effective strategy for improving knowledge of HIV status among men in rural Lesotho and can achieve high initial care linkage. This replication confirms the core finding but indicates the population-level impact on knowledge may vary by context. Programmes should continue to invest in and scale up community-led testing to reach men. Further research should investigate contextual factors influencing uptake and develop complementary strategies to enhance impact. HIV testing, men, rural health, community health workers, Lesotho, linkage to care, replication study. This study provides replicated evidence on the effectiveness of a community-led HIV testing model for men in rural Africa, confirming its utility while highlighting contextual variations in outcome magnitude.
Copyright (c) 2000 https://creativecommons.org/licenses/by/4.0/