Relevant bibliographies by topics / Medical care – Africa, Sub-Saharan

Academic literature on the topic 'Medical care – Africa, Sub-Saharan'

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Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Medical care – Africa, Sub-Saharan"

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Gisselquist, D. "Denialism undermines AIDS prevention in sub-Saharan Africa." International Journal of STD & AIDS 19, no. 10 (October 2008): 649–55. http://dx.doi.org/10.1258/ijsa.2008.008180.

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Some denialists, widely reviled, contend that HIV does not cause AIDS. Other denialists, widely respected, contend that HIV transmits so poorly through trace blood exposures that iatrogenic infections are rare. This second group of denialists has had a corrosive effect on public health and HIV programmes in sub-Saharan Africa. Guided by this second group of denialists, no African government has investigated unexplained HIV infections. Denialists have withheld and ignored research findings showing that non-sexual risks account for substantial proportions of HIV infections in Africa. Denialists have promoted invasive procedures for HIV prevention in Africa – injections for sexually transmitted infections, and adult male circumcision – without addressing unreliable sterilization of reused instruments. By denying that health care causes more than rare infections, denialists blame (stigmatize) HIV-positive African adults for causing their own infections through sexual behaviour. Denialism must be overcome to ensure safe health care and to combat HIV-related stigma in Africa.
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Faruk, Nasir, N. T. Surajudeen-Bakinde, Abubakar Abdulkarim, Abdulkarim Ayopo Oloyede, Lukman Olawoyin, Olayiwola W. Bello, Segun I. Popoola, and Thierry O. C. Edoh. "Rural Healthcare Delivery in Sub-Saharan Africa." International Journal of Healthcare Information Systems and Informatics 15, no. 3 (July 2020): 1–21. http://dx.doi.org/10.4018/ijhisi.2020070101.

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Access to quality healthcare is a major problem in Sub-Saharan Africa with a doctor-to-patient ratio as high as 1:50,000, which is far above the recommended ratio by the World Health Organization (WHO) which is 1:600. This has been aggravated by the lack of access to critical infrastructures such as the health care facilities, roads, electricity, and many other factors. Even if these infrastructures are provided, the number of medical practitioners to cater for the growing population of these countries is not sufficient. In this article, how information and communication technology (ICT) can be used to drive a sustainable health care delivery system through the introduction and promotion of Virtual Clinics and various health information systems such as mobile health and electronic health record systems into the healthcare industry in Sub-Saharan Africa is presented. Furthermore, the article suggests ways of attaining successful implementation of telemedicine applications /services and remote health care facilities in Africa.
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Gisselquist, David, Richard Rothenberg, John Potterat, and Ernest Drucker. "HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission." International Journal of STD & AIDS 13, no. 10 (October 1, 2002): 657–66. http://dx.doi.org/10.1258/095646202760326390.

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An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behaviour. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%–40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. More research is warranted to clarify risks for HIV transmission through health care.
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Ekenze, Sebastian O., Okechukwu O. Onumaegbu, and Okechukwu E. Nwankwo. "The Current Status of International Partnerships for Child Surgery in Sub-Saharan Africa." International Surgery 99, no. 5 (September 1, 2014): 616–22. http://dx.doi.org/10.9738/intsurg-d-13-00244.1.

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Abstract Disparity still exists in the surgical care between sub-Saharan Africa and developed countries. Several international initiatives have been undertaken in the past decades to address the disparity. This study looks at the impact of these programs in child surgery in Sub-Saharan Africa. Review of electronic databases Medline and African Index Medicus on international partnerships for child surgery in Sub-Saharan Africa was undertaken. Four types of international initiatives were identified and consist of periodic medical missions; partnerships between foreign medical institutions or charities and local institutions; international health electives by surgical residents; and training of individual surgeons from developing countries in foreign institutions. The results of these efforts were variable, but sustainability and self-reliance of host nations were limited. Sociocultural factors, dearth of facilities, and lack of local governments' commitment were main impediments to effective local development or transfer of modern protocols of surgical management and improvement of pediatric surgical care at the host community level. Current initiatives may need improvements with better understanding of the sociocultural dynamics and local politics of the host nation, and improved host nation involvement and commitment. This may engender development of locally controlled viable services and sustainable high level of care.
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Limbole Bakilo, Emmanuel. "Natural Evolution of a Marfan’s Syndrome in a Medical Desert in Sub-Saharan Africa: Case Report." Journal of Quality in Health Care & Economics 5, no. 3 (2022): 1–3. http://dx.doi.org/10.23880/jqhe-16000275.

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Marfan syndrome is an autosomal dominant connective tissue disorder associated with a mutation in the Fibrillin-1 (FBN1) gene on chromosome 15. It is a rare disease that affects one in 3,000 to 5,000 people. We describe here the case of a 35-year-old young man suffering from this syndrome and whose diagnosis was made at the terminal stage of the evolution in an environment lacking any means of diagnosis and care in sub-Saharan Africa.
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Groups, African Pathologists' Summit Working. "Proceedings of the African Pathologists Summit; March 22–23, 2013; Dakar, Senegal: A Summary." Archives of Pathology & Laboratory Medicine 139, no. 1 (June 25, 2014): 126–32. http://dx.doi.org/10.5858/arpa.2013-0732-cc.

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Context This report presents the proceedings of the African Pathologists Summit, held under the auspices of the African Organization for Research and Training in Cancer. Objectives To deliberate on the challenges and constraints of the practice of pathology in Sub-Saharan Africa and the avenues for addressing them. Participants Collaborating organizations included the American Society for Clinical Pathology; Association of Pathologists of Nigeria; British Division of the International Academy of Pathology; College of Pathologists of East, Central and Southern Africa; East African Division of the International Academy of Pathology; Friends of Africa–United States and Canadian Academy of Pathology Initiative; International Academy of Pathology; International Network for Cancer Treatment and Research; National Cancer Institute; National Health and Laboratory Service of South Africa; Nigerian Postgraduate Medical College; Royal College of Pathologists; West African Division of the International Academy of Pathology; and Faculty of Laboratory Medicine of the West African College of Physicians. Evidence Information on the status of the practice of pathology was based on the experience of the participants, who are current or past practitioners of pathology or are involved in pathology education and research in Sub-Saharan Africa. Consensus Process The deliberations were carried out through presentations and working discussion groups. Conclusions The significant lack of professional and technical personnel, inadequate infrastructure, limited training opportunities, poor funding of pathology services in Sub-Saharan Africa, and their significant impact on patient care were noted. The urgency of addressing these issues was recognized, and the recommendations that were made are contained in this report.
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Ahinkorah, Bright Opoku, Eugene Budu, Abdul-Aziz Seidu, Ebenezer Agbaglo, Collins Adu, Edward Kwabena Ameyaw, Irene Gyamfuah Ampomah, Anita Gracious Archer, Kwaku Kissah-Korsah, and Sanni Yaya. "Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in sub-Saharan Africa: A multilevel modelling of Demographic and Health Surveys." PLOS ONE 16, no. 2 (February 8, 2021): e0244395. http://dx.doi.org/10.1371/journal.pone.0244395.

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Introduction The success of current policies and interventions on providing effective access to treatment for childhood illnesses hinges on families’ decisions relating to healthcare access. In sub-Saharan Africa (SSA), there is an uneven distribution of child healthcare services. We investigated the role played by barriers to healthcare accessibility in healthcare seeking for childhood illnesses among childbearing women in SSA. Materials and methods Data on 223,184 children under five were extracted from Demographic and Health Surveys of 29 sub-Saharan African countries, conducted between 2010 and 2018. The outcome variable for the study was healthcare seeking for childhood illnesses. The data were analyzed using Stata version 14.2 for windows. Chi-square test of independence and a two-level multivariable multilevel modelling were carried out to generate the results. Statistical significance was pegged at p<0.05. We relied on ‘Strengthening the Reporting of Observational Studies in Epidemiology’ (STROBE) statement in writing the manuscript. Results Eighty-five percent (85.5%) of women in SSA sought healthcare for childhood illnesses, with the highest and lowest prevalence in Gabon (75.0%) and Zambia (92.6%) respectively. In terms of the barriers to healthcare access, we found that women who perceived getting money for medical care for self as a big problem [AOR = 0.81 CI = 0.78–0.83] and considered going for medical care alone as a big problem [AOR = 0.94, CI = 0.91–0.97] had lower odds of seeking healthcare for their children, compared to those who considered these as not a big problem. Other factors that predicted healthcare seeking for childhood illnesses were size of the child at birth, birth order, age, level of community literacy, community socio-economic status, place of residence, household head, and decision-maker for healthcare. Conclusion The study revealed a relationship between barriers to healthcare access and healthcare seeking for childhood illnesses in sub-Saharan Africa. Other individual and community level factors also predicted healthcare seeking for childhood illnesses in sub-Saharan Africa. This suggests that interventions aimed at improving child healthcare in sub-Saharan Africa need to focus on these factors.
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Mbonu, Ngozi C., Bart van den Borne, and Nanne K. De Vries. "Stigma of People with HIV/AIDS in Sub-Saharan Africa: A Literature Review." Journal of Tropical Medicine 2009 (2009): 1–14. http://dx.doi.org/10.1155/2009/145891.

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The aim of this literature review is to elucidate what is known about HIV/AIDS and stigma in Sub-Saharan Africa. Literature about HIV/AIDS and stigma in Sub-Saharan Africa was systematically searched in Pubmed, Medscape, and Psycinfo up to March 31, 2009. No starting date limit was specified. The material was analyzed using Gilmore and Somerville's (1994) four processes of stigmatizing responses: the definition of the problem HIV/AIDS, identification of people living with HIV/AIDS (PLWHA), linking HIV/AIDS to immorality and other negative characteristics, and finally behavioural consequences of stigma (distancing, isolation, discrimination in care). It was found that the cultural construction of HIV/AIDS, based on beliefs about contamination, sexuality, and religion, plays a crucial role and contributes to the strength of distancing reactions and discrimination in society. Stigma prevents the delivery of effective social and medical care (including taking antiretroviral therapy) and also enhances the number of HIV infections. More qualitative studies on HIV/AIDS stigma including stigma in health care institutions in Sub-Saharan Africa are recommended.
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Reid, S. "Increase in clinical prevalence of AIDS implies increase in unsafe medical injections." International Journal of STD & AIDS 20, no. 5 (May 2009): 295–99. http://dx.doi.org/10.1258/ijsa.2008.008441.

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A mass action model developed by the World Health Organization (WHO) estimates that the re-use of contaminated syringes for medical care accounted for 2.5% of HIV infections in sub-Saharan Africa in 2000. The WHO's model applies the population prevalence of HIV infection rather than the clinical prevalence to calculate patients' frequency of exposure to contaminated injections. This approach underestimates iatrogenic exposure risks when progression to advanced HIV disease is widespread. This sensitivity analysis applies the clinical prevalence of HIV to the model and re-evaluates the transmission efficiency of HIV in injections. These adjustments show that no less than 12–17%, and up to 34–47%, of new HIV infections in sub-Saharan Africa may be attributed to medical injections. The present estimates undermine persistent claims that injection safety improvements would have only a minor impact on HIV incidence in Africa.
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Bagayoko, C. O., A. Geissbuhler, and G. Bediang. "Medical Decision Support Systems in Africa." Yearbook of Medical Informatics 19, no. 01 (August 2010): 47–54. http://dx.doi.org/10.1055/s-0038-1638688.

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Summary Objective: To present an overview of the current state of computerbased medical decision support systems in Africa in the areas of public health, patient care, and consumer support. Methods: Scientific and gray literature reviews complemented by expert interviews. Results: Various domains of decision support are developed and deployed in Sub-Saharan Africa: public health information systems, clinical decision-support systems, and patient-centred decisionsupport systems. Conclusions: Until recently, most of these systems have been deployed by international organizations without a real ownership policy entrusted to the African stakeholders. Many of these endeavours have remained or ceased at the experimentation stage. The multiplicity of organizations has led to the deployment of fragmented systems causing serious interoperability problems. In addition to basic infrastructures, these studies also highlight the importance of good organization, training and support, as key to the success and sustainability of these decision support systems.
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Dissertations / Theses on the topic "Medical care – Africa, Sub-Saharan"

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Pumipunta, Surachai Quackenbush Stephen L. "Can money buy health? foreign aid, changes in aid, and the impact of human health in sub-Saharan Africa /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2009. http://hdl.handle.net/10355/6721.

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The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file. Title from PDF of title page (University of Missouri--Columbia, viewed on March 23, 2010). Thesis advisor: Dr. Stephen Quackenbush. Includes bibliographical references.
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Mwingira, Betty. "Development and assessment of medicines information for antiretroviral therapy in Sub-Saharan Africa." Thesis, Rhodes University, 2005. http://hdl.handle.net/10962/d1003257.

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Laokri, Samia. "Assessing cost-of-illness in a user's perspective: two bottom-up micro-costing studies towards evidence informed policy-making for tuberculosis control in Sub-saharan Africa." Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209273.

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Health economists, national decision-makers and global health specialists have been interested in calculating the cost of a disease for many years. Only more recently they started to generate more comprehensive frameworks and tools to estimate the full range of healthcare related costs of illness in a user’s perspective in resource-poor settings. There is now an ongoing trend to guide health policy, and identify the most effective ways to achieve universal health coverage. The user fee exemptions health financing schemes, which grounded the tuberculosis control strategy, have been designed to improve access to essential care for ill individuals with a low capacity to pay. After decades of functioning and substantial progress in tuberculosis detection rate and treatment success, this thesis analyses the extent of the coverage (financial and social protection) of two disease control programs in West Africa. Learning from the concept of the medical poverty trap (Whitehead, Dahlgren, et Evans 2001) and available framework related to the economic consequences of illness (McIntyre et al. 2006), a conceptual framework and a data collection tool have been developed to incorporate the direct, indirect and intangible costs and consequences of illness incurred by chronic patients. In several ways, we have sought to provide baseline for comprehensive analysis and standardized methodology to allow comparison across settings, and to contribute to the development of evidence-based knowledge.

To begin, filling a knowledge gap (Russell 2004), we have performed microeconomic research on the households’ costs-and-consequences-of-tuberculosis in Burkina Faso and Benin. The two case studies have been conducted both in rural and urban resource-poor settings between 2007 and 2009. This thesis provides new empirical findings on the remaining financial, social and ‘healthcare delivery related organizational’ barriers to access diagnosis and treatment services that are delivered free-of-charge to the population. The direct costs associated with illness incurred by the tuberculosis pulmonary smear-positive patients have constituted a severe economic burden for these households living in permanent budget constraints. Most of these people have spent catastrophic health expenditure to cure tuberculosis and, at the same time, have faced income loss caused by the care-seeking. To cope with the substantial direct and indirect costs of tuberculosis, the patients have shipped their families in impoverishing strategies to mobilize funds for health such as depleting savings, being indebted and even selling livestock and property. Damaging asset portfolios of the disease-affected households on the long run, the coping strategies result in a public health threat. In resource-poor settings, the lack of financial protection for health may impose inability to meet basic needs such as the rights to education, housing, food, social capital and access to primary healthcare. Special feature of our work lies in the breakdown of the information gathered. We have been able to demonstrate significant differences in the volume and nature of the amounts spent across the successive stages of the care-seeking pathway. Notably, pre-diagnosis spending has been proved critical both in the rural and urban contexts. Moreover, disaggregated cost data across income quintiles have highlighted inequities in relation to the direct costs and to the risk of incurring catastrophic health expenditure because of tuberculosis. As part of the case studies, the tuberculosis control strategies have failed to protect the most vulnerable care users from delayed diagnosis and treatment, from important spending even during treatment – including significant medical costs, and from hidden costs that might have been exacerbated by poor health systems. To such devastating situations, the tuberculosis patients have had to endure other difficulties; we mean intangible costs such as pain and suffering including stigmatization and social exclusion as a result of being ill or attending tuberculosis care facilities. The analysis of all the social and economic consequences for tuberculosis-affected households over the entire care-seeking pathway has been identified as an essential element of future cost-of-illness evaluations, as well as the need to conduct benefit incidence assessment to measure equity.

This work has allowed identifying a series of policy weaknesses related to the three dimensions of the universal health coverage for tuberculosis (healthcare services, population and financial protection coverage). The findings have highlighted a gap between the standard costs foreseen by the national programs and the costs in real life. This has suggested that the current strategies lack of patient-centered care, context-oriented approaches and systemic vision resulting in a quality issue in healthcare delivery system (e.g. hidden healthcare related costs). Besides, various adverse effects on households have been raised as potential consequences of illness; such as illness poverty trap, social stigma, possible exclusion from services and participation, and overburdened individuals. These effects have disclosed the lack of social protection at the country level and call for the inclusion of tuberculosis patients in national social schemes. A last policy gap refers to the lack of financial protection and remaining inequities with regards to catastrophic health expenditure still occurring under use fee exemptions strategies. Thereby, one year before 2015 – the deadline set for the Millennium Development Goals – it is a matter of priority for Benin and Burkina Faso and many other countries to tackle adverse effects of the remaining social, economic and health policy and system related barriers to tuberculosis control. These factors have led us to emphasize the need for countries to develop sustainable knowledge.

National decision-makers urgently need to document the failures and bottlenecks. Drawing on the findings, we have considered different ways to strengthen local capacity and generate bottom-up decision-making. To get there, we have shaped a decision framework intended to produce local evidence on the root causes of the lack of policy responsiveness, synthesize available evidence, develop data-driven policies, and translate them into actions.

Beyond this, we have demonstrated that controlling tuberculosis was much more complex than providing free services. The socio-economic context in which people affected by this disease live cannot be dissociated from health policy. The implications of microeconomic research on the households’ costs and responses to tuberculosis may have a larger scope than informing implementation and adaptation of national disease-specific strategies. They can be of great interest to support the definition of guiding principles for further research on social protection schemes, and to produce evidence-based targets and indicators for the reduction and the monitoring of economic burden of illness. In this thesis, we have build on prevailing debates in the field and formulated different assumptions and proposals to inform the WHO Global Strategy and Targets for Tuberculosis Prevention, Care and Control After 2015. For us, to reflect poor populations’ needs and experiences, global stakeholders should endorse bottom-up and systemic policy-making approaches towards sustainable people-centered health systems.

The findings of the thesis and the various global and national challenges that have emerged from case studies are crucial as the problems we have seen for tuberculosis in West Africa are not limited to this illness, and far outweigh the geographical context of developing countries.

Keywords: Catastrophic health expenditure, Coping strategies, Cost-of-illness studies, Direct, indirect and intangible costs, Evidence-based Public health, Financial and Social protection for health, Health Economics, Health Policy and Systems, Informed Decision-making, Knowledge translation, People-centered policy-making, Systemic approach, Universal Health Coverage


Doctorat en Sciences de la santé publique
info:eu-repo/semantics/nonPublished

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Sadler, K. "Community-based therapeutic care : treating severe acute malnutrition in sub-Saharan Africa." Thesis, University College London (University of London), 2009. http://discovery.ucl.ac.uk/16480/.

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Severe acute malnutrition (SAM) affects approximately 13 million children under-five and is associated with over 1.5 million preventable child deaths each year. Case fatality rates in hospitals treating SAM remain at 20-30%, and coverage of those affected remains low. Training and support to improve centre-based management can reduce case fatality rates. However, an exclusive inpatient approach does not consider the many barriers to accessing treatment that exist for poor people in the developing world. Community-based therapeutic care (CTC) is a new approach for the management of SAM that uses Ready-to-Use Therapeutic Foods (RUTF) and triage to refer cases without complications to outpatient care and those with complications to inpatient treatment. This thesis aims to test the hypotheses that a CTC strategy can treat children with SAM effectively and can achieve better population treatment coverage than a centre-based approach. Five studies, using primary data, are presented. The first 3 studies evaluate the clinical effectiveness of CTC through examination of individual outcome data from research programmes in Ethiopia and Malawi. The fourth study examines the coverage of a CTC programme for SAM in Malawi and compares this with coverage of a centre- based programme. The final study is a multi-country evaluation of 17 CTC programmes implemented across Africa. Results from all studies that use the CTC treatment model show that outcomes can meet the international Sphere standard indicators of < 10% mortality and > 50% coverage. Coverage of a CTC programme in Malawi was three times that of a centre-based programme in the same region (73.64% (95% C.I. 66.0%, 81.3%) vs. 24.5% (95% C.I. 17.8%, 31.4%)). A number of factors were vital to achieving low mortality and high coverage in these programmes. These included decentralisation of outpatient treatment services and community mobilisation techniques to encourage early presentation, and the use of appropriate triage criteria, to identify children suffering from SAM with no complications that could be treated safely as outpatients. The use of triage did not appear to increase mortality (OR 0.51 95% CI 0.28, 0.94). This thesis suggests that CTC does not increase case fatality rates associated with SAM and could reduce them, and that it could increase the number of children receiving treatment.
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Toska, Elona. "Sex in the shadow of HIV : factors associated with sexual risk among adolescents in a community-traced sample in South Africa." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:e50ba696-e744-457b-a595-dfa55064b968.

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Background: Sub-Saharan Africa is home to 85% of the world's HIV-positive adolescents: an estimated 1.3-2.2 million 10-19 year olds. Adolescents living with HIV face multiple sexual and reproductive health risks: unwanted pregnancies and the risk of mother-to-child-transmission, risk of infecting partners, co-infection with other STIs, and the rising but undocumented risk of re-infection by potentially resistant HI-virus strains. Using contraception, especially condoms, is particularly challenging for all adolescents. It is even more difficult for HIV-positive adolescents due to HIV-related factors such as learning their HIV-positive status, withholding or disclosing their HIV-status to sexual partners, and accessing services in the home, clinics, and schools. This thesis aims to understand which factors shape sexual risk-taking among HIV-positive adolescents to inform the development of interventions that promote safe sexual practices in this population. Methodology: This thesis applies a socio-ecological model to investigate factors associated with sexual risk-taking among HIV-positive adolescents. It consists of three stand-alone papers: a systematic review and two quantitative papers based on a cross-sectional epidemiological and aetiological study of unprotected sex among HIV-positive adolescents and community controls in South Africa. Paper 1 is a systematic review of rates, correlates, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Paper 2 looks at associations between HIV-status knowledge and disclosure and protective sexual practices in the cross-sectional study sample. Paper 3 explores the relationship between various social protection provisions and unprotected sex among HIV-positive adolescents. The candidate co-developed and conducted a community-traced study of adolescents in the Eastern Cape, in South Africa: 1,060 HIV-positive adolescents and 467 community controls. HIV-positive 10-19 year old adolescents were recruited from 53 government facilities in a health sub-district with antenatal HIV prevalence of over 30%. 90.1% of the eligible sample was traced, with only 4.1% refusing to take part. Community controls were neighbouring or co-habiting 10-19 year old adolescents, 92% of whom agreed to take part. Voluntary informed consent was obtained from adolescents and caregivers in the language of their choice: English or Xhosa. Questionnaires were administered by trained research assistants using mobile devices (tablets) with adolescent-friendly graphic content to ensure participant interest and reduce participant burden through skip-patterns. The systematic review (Paper 1) included studies located through electronic databases and grey literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies reporting on HIV-positive participants (10-24 year old) included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older sexual partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy). Only studies conducted in sub-Saharan Africa were included. The candidate and a second author independently piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and correlates, no meta-analyses was conducted. The systematic review informed the analyses conducted for the two quantitative papers. Analyses for Papers 2 and 3 used condom use at last sexual encounter (dichotomised either as safe sex/abstinence or unprotected sex) as the outcome, controlling for a series of covariates. Analyses used SPSS 22 and STATA 11. For each paper, the hypothesised factors were entered as independent variables in multivariate logistic regressions controlling for potential confounders. Based on the findings of the systematic review, gender moderation analyses was run entering a 2-way interaction term of gender*correlate in multivariate logistic regressions, controlling for covariates. Marginal effect models explored the effect of combinations of risk/ protective factors. Predicted probabilities for safe sex/ unprotected sex were computed for different two- and three-way combinations of the independent variables, controlling for covariates significantly associated with the outcome. Paper 2 tested the effect of three types of disclosure on protective sexual practices: (i) knowledge of one's own HIV-positive status, (ii) disclosing one's HIV-status to a partner, and (iii) knowing a partner's HIV-status. It compared HIV-positive status aware adolescents (n=794) with the rest of the sample (n=733). Paper 3 investigated associations between nine types of social protection provisions and unprotected sex. In line with UNICEF's definition, social protection was defined as any provision aimed at preventing, reducing and eliminating economic and social vulnerabilities to poverty and deprivation among HIV-positive adolescents. The nine social protection provisions tested by the analyses included ‘cash' and ‘care' factors accessed in the home, school, and community. Results: Paper 1 – ‘Sexual Risk-Taking among HIV-Positive Adolescents and Youth in Sub-Saharan Africa: A systematic review of prevalence rates, risk factors, and interventions.' The systematic review (Chapter 4) found that, despite their heightened vulnerabilities and high rates of sexual risk-taking, there is a dearth of evidence on interventions which may help HIV-positive adolescents engage in safe sexual practices. The review included 35 studies, four of which were interventions aiming to reduce sexual risk-taking. The quality of the included studies was low with most studies (k=31) reporting findings from cross-sectional data. HIV-positive adolescents and youth reported high rates of sexual risk-taking, however findings were inconsistent about potential factors associated with sexual risk-taking. Factors consistently associated with sexual risk-taking in multivariate analyses included: food insecurity, living alone, living with a partner, and gender-based violence. No significant associations were reported for: rural residence, informal housing, anxiety, religious guidance, STI prevention knowledge, poor birth outcomes, orphanhood, parental monitoring, having a supportive family, social support, maternal education level, poverty, disclosing one's HIV-status to a partner, time on ART, ART adherence, receiving care at a hospital, opportunistic infections. However, most of the above associations were reported by only one study, therefore further analyses is needed to build the evidence base on potential determinants of sexual risk-taking among HIV-positive adolescents and youth. The included interventions consist of three individual- and group-based psychosocial interventions evaluated in three small-scale trials (n<150) and one large trial of combination interventions for HIV-positive orphaned adolescent girls (n=710). Three of these interventions had positive effects in reducing sexual risk-taking: an individual based 18-session counselling intervention in Uganda, a support group intervention in South Africa, and a combination intervention in Zimbabwe. Quantitative data analyses of cross-sectional study data: Overall, adolescents in the full sample (n=1,527) reported high rates of sexual activity (34.9%) and high rates of unprotected sex (22%), with adolescent girls reporting higher rates of unprotected sex than boys (33% vs. 7%).
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Chireshe, Jaison. "Financial development, health care system financing and health outcomes: Evidence from sub-Saharan Africa." University of the Western Cape, 2018. http://hdl.handle.net/11394/6691.

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Philosophiae Doctor - PhD
This thesis purposes to examine the impact of financial development on health outcomes, health care expenditure and financial protection in health in 46 selected sub-Saharan African (SSA) countries from 1995 to 2014. It also estimates the impact of health care expenditure on health outcomes. The thesis is premised on the hypothesis that health care expenditure is a critical transmission mechanism through which financial development leads to better health outcomes. The health care expenditure channel is conspicuously absent in the literature on financial development and health outcomes; hence the need for this study to fill the gap in the literature. The thesis explores the effects of both depth and access dimensions of financial development on health outcomes, expenditure and financial protection. Throughout the study, financial access is measured by the number of automated teller machines (ATMs) and commercial bank branches per 100 000 people, while financial depth is measured by the proportion of broad money and bank credit to the private sector, to Gross Domestic Product (GDP). The study uses fixed and random effects and the Two-Stage Least Squares estimation approaches. The Generalised Method of Moments (GMM) is also used to estimate the impact of health care expenditure and health outcomes given the absence of valid instrumental variables. The results of the regression analyses show that financial development leads to increased health care expenditure and health outcomes. The analysis also shows that health care expenditure leads to better health outcomes. Additionally, the study indicates that financial development leads to financial protection in health care by reducing out-of-pocket health care expenditure. Well-developed financial systems provide financial protection from the risk of catastrophic health care expenditure and impoverishment resulting from illness. The study shows that health care systems financed through prepaid mechanisms reduce neonatal, infant and under-five mortality rates and increase life expectancy, while those relying on out-of-pocket expenditure have adverse effects on health outcomes.
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Gibson, Christine Concetta. "Neoliberalism and Dependence: A Case Study of The Orphan Care Crisis in Sub-Saharan Africa." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0003248.

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Nsengiyumva, Ladislas. "Supporting a Human Rights Agenda: A Three-Pillar Virtue-Based Personal and Social Anthropology of Public Health Policy for Sub-Saharan Africa." Thesis, Boston College, 2016. http://hdl.handle.net/2345/bc-ir:107471.

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Thesis advisor: James F. Keenan
Thesis advisor: Andrea Vicini
Sub-Saharan Africa has one of the worst health care systems in the world. Besides, underdeveloped economies paired with political instability do not offer much hope for improvement. In fact, despite many efforts by local, international organizations and governments to help in this field, the majority of the populations in this region do not have access to basic health care. With this in mind, the aim of this research project is to develop a personal and social anthropology of the human rights language read through the lens of the common good in order to contribute to creating and developing sustainable healthcare systems. While agreeing that many efforts have been made using different frameworks in the sphere of public health ethics in the past two decades and aware of the possibility that other underlying causes may have contributed to the failure of health systems in Sub-Saharan Africa, we will choose to address the human rights language as the main interlocutor for future contribution. This choice is motivated by the influence of human rights on public health policies that affect the lives of people in general
Thesis (STL) — Boston College, 2016
Submitted to: Boston College. School of Theology and Ministry
Discipline: Sacred Theology
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Agulanna, Christopher. "Informed Consent in Sub-Saharan African Communal Culture: The." Thesis, Linköping University, Centre for Applied Ethics, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-11963.

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Some scholars argue that the principle of voluntary informed consent is rooted in the Western ethos of liberal individualism; that it would be difficult to implement this requirement in societies where the norms of decision-making emphasize collective rather than individual decision-making (for example, Sub-Saharan Africa); that it would amount to “cultural imperialism” to seek to implement the principle of voluntary informed consent in non-Western societies. This thesis rejects this skepticism about the possibility of implementing the informed consent requirement in non-Western environments and argues that applying the principle of voluntary informed consent in human subjects’ research in Sub-Saharan African communal culture could serve as an effective measure to protect vulnerable subjects from possible abuses or exploitations. The thesis proposes the “multi-step” approach to informed consent as the best approach to the implementation of the principle in the African communal setting. The thesis argues that the importance of the “multi-step” approach lies in the fact that it is one that is sensitive to local culture and customs. On the question of whether the principle of voluntary informed consent should be made compulsory in research, the thesis answers that we have no choice in the matter.

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Sinnott, Colleen M. "Evaluating the Causal Impact of Medical Brain Drain in sub-Saharan Africa: An Instrumental Variables Approach." Thesis, Boston College, 2013. http://hdl.handle.net/2345/3067.

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Thesis advisor: Donald Cox
I investigate the effect of the medical brain drain on health in sub-Saharan Africa. Such information would be invaluable to policymakers; if doctors are likely to emigrate, there is little benefit in investing in their training. Previous work has mostly been limited to measuring correlations, which fail to illuminate causal pathways; countries with weakly structured healthcare systems may have both poor health and high physician emigration. I address the problem with an instrumental variable. For African countries with historic colonial ties to the United Kingdom or France, I used immigration policy changes in these European nations to instrument for the medical brain drain. Higher rates of medical brain drain cause decreased physician density, decreased rates of measles immunizations among children, and increased rates of HIV prevalence in sub-Saharan Africa. Therefore, I conclude that targeting physician emigration would help improve health in the region
Thesis (BA) — Boston College, 2013
Submitted to: Boston College. College of Arts and Sciences
Discipline: College Honors Program
Discipline: Economics Honors Program
Discipline: Economics
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Books on the topic "Medical care – Africa, Sub-Saharan"

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Financing health care in Sub-Saharan Africa. Westport, Conn: Greenwood Press, 1993.

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DeJong, Jocelyn. Nongovernmental organizations and health delivery in sub-Saharan Africa. Washington, DC (1818 H St., NW, Washington 20433): Population and Human Resources Dept., World Bank, 1991.

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Balancing public and private health care systems: The sub-Saharan African experience. Lanham, Md: University Press of America, 2010.

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Vogel, Ronald J. Health insurance in Sub-Saharan Africa: A survey and analysis. Washington, DC (1818 H St. NW, Washington 20433): Africa Technical Dept., World Bank, 1990.

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Shaw, R. Paul. Financing health care in sub-Saharan Africa through user fees and insurance. Washington, D.C: World Bank, 1995.

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Fox, C. William. Military medical operations in sub-Saharan Africa: The DoD "point of the spear" for a new century. [Carlisle Barracks, Pa.]: Strategic Studies Institute, U.S. Army War College, 1997.

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Reducing geographical imbalances of the distribution of health workers in Sub-Saharan Africa: A labor market angle on what works, what does not, and why. Washington, D.C: World Bank, 2011.

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1946-, Akhtar Rais, ed. Health and disease in tropical Africa: Geographical and medical viewpoints. Chur [Switzerland]: Harwood Academic Publishers, 1987.

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M, Altevogt Bruce, Institute of Medicine (U.S.). Forum on Neuroscience and Nervous System Disorders, Uganda National Academy of Sciences. Forum on Health and Nutrition, and National Academies Press (U.S.), eds. Mental, neurological, and substance use disorders in Sub-Saharan Africa: Reducing the treatment gap, improving quality of care : summary of a joint workshop by the Institute of Medicine and the Uganda National Academy of Sciences. Washington, D.C: National Academies Press, 2010.

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Zere, Eyob. Hospital efficiency in Sub-Saharan Africa: Evidence from South Africa. Helsinki: United Nations University, World Institute for Development Economics Research, 2000.

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Book chapters on the topic "Medical care – Africa, Sub-Saharan"

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Jaiyesimi, Rotimi A. K., and Ayo Oshowo. "Delivering Safe and Affordable Cancer Surgical Care." In Cancer in Sub-Saharan Africa, 155–63. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-52554-9_11.

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Carr-Hill, Roy A. "Adult health and health care." In Social Conditions in Sub-Saharan Africa, 81–96. London: Palgrave Macmillan UK, 1990. http://dx.doi.org/10.1057/9780230377172_8.

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Nkoala, Sisanda. "A Comparative Discourse Analysis of African Newspaper Reports on Global Epidemics: A Case Study of Ebola and Coronavirus." In Health Crises and Media Discourses in Sub-Saharan Africa, 163–81. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-95100-9_10.

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AbstractThis qualitative multi-case study analyses how two African newspapers engaged in self-presentation of African countries and other-presentation of Western countries when reporting on the outbreak of diseases. Using van Dijk’s ideological square as a framework, the study undertakes a discourse analysis of news reports on the 2014 Ebola outbreak and the 2020 Coronavirus outbreak reported by the South African daily broadsheet, the Sowetan, and the Nigerian daily broadsheet, the Daily Trust. The analysis shows that in their reports on European countries and the United States of America, the discourse’s macro- and microstructures emphasised the positive features of Western nations and de-emphasised the negative ones. Conversely, concerning African countries, there was a tendency to de-emphasise the positive while emphasising the negative ones. As a result, the newspaper reports were found to engage in negative self-presentation of African countries and positive other-presentation of Western countries, perpetuating the “us vs them” ideology that newspapers from Europe and America employ when reporting on the outbreak of diseases in Africa.
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Abdulkareem, Fatimah B., Olatokunboh M. Odubanjo, and Awodele N. Awolola. "Pathological Services in Sub-Saharan Africa, a Barrier to Effective Cancer Care." In Cancer in Sub-Saharan Africa, 53–64. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-52554-9_4.

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Dancaster, Lisa. "State Measures Towards Work–Care Integration in South Africa." In Work–Family Interface in Sub-Saharan Africa, 177–94. Cham: Springer International Publishing, 2013. http://dx.doi.org/10.1007/978-3-319-01237-7_11.

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Mahomed-Asmail, Faheema, and De Wet Swanepoel. "mHealth Solutions in Hearing Care for Sub-Saharan Africa." In Advances in Audiology and Hearing Science, 349–64. Includes bibliographical references and indexes. | Contents: Volume 2. Otoprotection, regeneration, and telemedicine.: Apple Academic Press, 2020. http://dx.doi.org/10.1201/9780429292620-16.

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Tshuma, Bhekizulu Bethaphi, Lungile Augustine Tshuma, and Nonhlanhla Ndlovu. "Media Discourses on Gender in the Time of COVID-19 Pandemic in Zimbabwe." In Health Crises and Media Discourses in Sub-Saharan Africa, 267–83. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-95100-9_16.

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AbstractMedia institutions always have a public obligation to disseminate news that is fair, balanced and gender sensitive, more so in times of crisis. Within the context of the Coronavirus (COVID-19) global pandemic, it is important that media provide a diverse, balanced and gender sensitive coverage that reflects existing inequalities in a society rather than merely prioritising statistics of the infection and its death rates. Informed by poststructuralist feminist theory and normative roles of the media, this chapter investigates the discursive parameters of gendered media discourses within the context of COVID-19. This chapter presents results from a case study of two main daily newspapers—the Chronicle and NewsDay—circulating in the country by investigating their representation of gender. Findings indicate that while there was generally more coverage of issues affecting women, both newspapers reinforced deeply rooted biases in their reporting. The findings further show that the emphasis was on gender-based violence with statistics indicating that it was on the rise during lockdown. We argue that newspapers must always strive for sensitive reporting that challenges hierarchical gender relations if the transformative potential of the media is to be realised.
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Finkelstein, Ruth K., Gregg S. Gonsalves, and Mark Brennan-Ing. "Beyond Policy Fixes to a New Politics of Care: The Case of Older People Living with HIV in Sub-Saharan Africa." In Aging with HIV in Sub-Saharan Africa, 195–210. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-96368-2_10.

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Hapunda, Given, and Frans Pouwer. "Diabetes in Sub-Saharan African Children: Risks, Care, and Challenges." In Handbook of Applied Developmental Science in Sub-Saharan Africa, 157–72. New York, NY: Springer New York, 2017. http://dx.doi.org/10.1007/978-1-4939-7328-6_9.

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Michael, Obaro S. "Medical Biotechnology and Biomimetics: Prospects and Challenges in Sub-Saharan Africa." In Series in BioEngineering, 19–27. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-319-53214-1_2.

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Conference papers on the topic "Medical care – Africa, Sub-Saharan"

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Sigu, Lamech, Emmah Achieng, Chite Asirwa, and Gloria Kitur. "Abstract 25: End User Support for Telemedicine Oncology Care in Sub Saharan Africa." In Abstracts: 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; March 10-11, 2021. American Association for Cancer Research, 2021. http://dx.doi.org/10.1158/1538-7755.asgcr21-25.

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Patel, Megha, Emily Dugo, Nicole Tchiakpe, Lehila Tossa-Bagnan, Noe Akonde, Maroufou J. Alao, Genetics, Marcelline D'Almeida, and Nicole G. Rouvinez Bouali. "Breaking Barriers and Improving Newborn Survival through Kangaroo Mother Care in Benin, Sub-Saharan Africa." In AAP National Conference & Exhibition Meeting Abstracts. American Academy of Pediatrics, 2021. http://dx.doi.org/10.1542/peds.147.3_meetingabstract.231.

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Griesel, M., J. Feuchtner, T. Seraphin, L. Hämmerl, N. Mezger, A. Korir, H. Wabinga, et al. "Cervical cancer in Sub-Saharan Africa: a multinational population-based study on patterns of care." In 62. Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe – DGGG'18. Georg Thieme Verlag KG, 2018. http://dx.doi.org/10.1055/s-0038-1671060.

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Frehywot, Seble, and Abdel Karim Koumare. "Retention of Graduates and Faculty in Medical Schools in Sub-Saharan Africa: Case Study." In Annual Global Healthcare Conference. Global Science & Technology Forum (GSTF), 2015. http://dx.doi.org/10.5176/2251-3833_ghc15.49.

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Rompalo, Anne, Ruth Kikonyogo, Yu-Hsiang Hsieh, Yukari Manabe, Charlotte Gaydos, and Rosalind Parkes-Ratanshi. "P1.05 Current use and perceived obstacles to use of point-of-care tests in sub-saharan africa." In STI and HIV World Congress Abstracts, July 9–12 2017, Rio de Janeiro, Brazil. BMJ Publishing Group Ltd, 2017. http://dx.doi.org/10.1136/sextrans-2017-053264.113.

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Crow, Jeff, Ramona Broussard, Lorrie Dong, Jeanine Finn, Brandon Wiley, and Gary Geisler. "A synthesis of research on ICT adoption and use by medical professionals in Sub-Saharan Africa." In the 2nd ACM SIGHIT symposium. New York, New York, USA: ACM Press, 2012. http://dx.doi.org/10.1145/2110363.2110384.

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Beisl Ramos, J., M. Laires, P. Godinho, and S. Amaro. "LB17 Neuraxial anaesthesia for acute abdomen surgery in a medical-humanitarian mission in sub-Saharan Africa." In ESRA Abstracts, 39th Annual ESRA Congress, 22–25 June 2022. BMJ Publishing Group Ltd, 2022. http://dx.doi.org/10.1136/rapm-2022-esra.536.

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Beisl Ramos, J., M. Laires, P. Godinho, and S. Amaro. "B266 Neuraxial anaesthesia for acute abdomen surgery in a medical-humanitarian mission in sub-Saharan Africa." In ESRA Abstracts, 39th Annual ESRA Congress, 22–25 June 2022. BMJ Publishing Group Ltd, 2022. http://dx.doi.org/10.1136/rapm-2022-esra.340.

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Lawrence, D., A. Ssali, K. Tsholo, J. Jarvis, and J. Seeley. "19 The dynamics of trust and structural coercion within a meningitis trial in sub-Saharan Africa." In Negotiating trust: exploring power, belief, truth and knowledge in health and care. Qualitative Health Research Network (QHRN) 2021 conference book of abstracts. British Medical Journal Publishing Group, 2021. http://dx.doi.org/10.1136/bmjopen-2021-qhrn.19.

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Faruk, Nasir, Nazmat T. Surajudeen-Bakinde, Abdulkarim A. Oloyede, Olayiwola O. Bello, Segun I. Popoola, A. Abdulkarim, and Lukman A. Olawoyin. "On green virtual clinics: A framework for extending health care services to rural communities in Sub-Saharan Africa." In 2017 International Rural and Elderly Health Informatics Conference (IREHI). IEEE, 2017. http://dx.doi.org/10.1109/ireehi.2017.8350380.

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Reports on the topic "Medical care – Africa, Sub-Saharan"

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Fox, William, and Jr. Military Medical Operations in Sub-Saharan Africa: The DOD 'Point of the Spear' for Engagement and Enlargement. Fort Belvoir, VA: Defense Technical Information Center, January 1997. http://dx.doi.org/10.21236/ada326903.

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Quak, Evert-jan. The Link Between Demography and Labour Markets in sub-Saharan Africa. Institute of Development Studies (IDS), January 2020. http://dx.doi.org/10.19088/k4d.2021.011.

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This rapid review synthesises the literature from academic, policy, and knowledge institution sources on how demography affects labour markets (e.g. entrants, including youth and women) and labour market outcomes (e.g. capital-per-worker, life-cycle labour supply, human capital investments) in the context of sub-Saharan Africa. One of the key findings is that the fast-growing population in sub-Saharan Africa is likely to affect the ability to get productive jobs and in turn economic growth. This normally happens when workers move from traditional (low productivity agriculture and household businesses) sectors into higher productivity sectors in manufacturing and services. In theory the literature shows that lower dependency ratios (share of the non-working age population) should increase output per capita if labour force participation rates among the working age population remain unchanged. If output per worker stays constant, then a decline in dependency ratio would lead to a rise in income per capita. Macro simulation models for sub-Saharan Africa estimate that capital per worker will remain low due to consistently low savings for at least the next decades, even in the low fertility scenario. Sub-Saharan African countries seem too poor for a quick rise in savings. As such, it is unlikely that a lower dependency ratio will initiate a dramatic increase in labour productivity. The literature notes the gender implications on labour markets. Most women combine unpaid care for children with informal and low productive work in agriculture or family enterprises. Large family sizes reduce their productive labour years significantly, estimated at a reduction of 1.9 years of productive participation per woman for each child, that complicates their move into more productive work (if available). If the transition from high fertility to low fertility is permanent and can be established in a relatively short-term period, there are long-run effects on female labour participation, and the gains in income per capita will be permanent. As such from the literature it is clear that the effect of higher female wages on female labour participation works to a large extent through reductions in fertility.
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Bankole, Akinrinola, Lisa Remez, Onikepe Owolabi, Jesse Philbin, and Patrice Williams. From Unsafe to Safe Abortion in Sub-Saharan Africa: Slow but Steady Progress. Guttmacher Institute, December 2020. http://dx.doi.org/10.1363/2020.32446.

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This report represents the first comprehensive compilation of information about abortion in Sub-Saharan Africa and its four subregions. It offers a panorama of this hard-to-measure practice by assembling data on the incidence and safety of abortion, the extent to which the region’s laws restrict abortion, and how these laws have changed between 2000 and 2019. Many countries in this region have incrementally broadened the legal grounds for abortion, improved the safety of abortions, and increased the quality and reach of postabortion care. There is still much progress to be made, however, including enabling the region’s women to avoid unintended pregnancies and unsafe abortions. The report concludes with recommendations for a broad range of actors to improve the sexual and reproductive health and autonomy of the region’s 255 million women of reproductive age.
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Denison, Julie, Audrey Pettifor, Lynne Mofenson, and Deanna Kerrigan. Developing an implementation science research agenda to improve the treatment and care outcomes among adolescents living with HIV in sub-Saharan Africa. Population Council, 2016. http://dx.doi.org/10.31899/hiv7.1010.

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Eschen, Andrea. Community-based AIDS prevention and care in Africa: Workshop report. Population Council, 1993. http://dx.doi.org/10.31899/hiv1993.1000.

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Representatives from community-based AIDS prevention and care programs in five sub-Saharan African countries spoke about their programs’ strengths, shortcomings, and hopes for the future at a meeting organized by the Population Council that took place on June 5, 1993, in Berlin just prior to the IXth International Conference on AIDS. Participants’ experiences and insights demonstrated the ingenuity and imagination that communities have generated to prevent the spread of HIV and AIDS and how they have taken action where government activities have fallen short. The workshop brought representatives of these programs together with staff of governmental and nongovernmental organizations, funding institutions, technical assistance agencies, and national and international AIDS-prevention programs to present their experiences. Discussion focused on strategies to strengthen community-based AIDS prevention and care in Africa. The meeting was the culmination of the first year of a three-year project established by the Population Council as part of the Positive Action Program’s Developing Country Initiative. This report notes that the aim was to identify successful elements of community-based AIDS prevention and care programs and promote a global exchange of expertise.
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Hall, Sarah, Mark Vincent Aranas, and Amber Parkes. Making Care Count: An Overview of the Women’s Economic Empowerment and Care Initiative. Oxfam, November 2020. http://dx.doi.org/10.21201/2020.6881.

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Across the globe, unpaid care and domestic work (UCDW) sustains communities and economies, provides essential care for children, sick and elderly people and those living with disabilities, and keeps households clean and families fed. Without unpaid care, the global economy as we know it would grind to a halt. Yet this work falls disproportionately on women and girls, limiting their opportunities to participate in decent paid employment, education, leisure and political life. Heavy and unequal UCDW traps women and girls in cycles of poverty and stops them from being part of solutions. To help address this, Oxfam, together with a number of partners, has been working in over 25 countries to deliver the Women’s Economic Empowerment and Care (WE-Care) programme since 2013. WE-Care aims to reignite progress on gender equality by addressing heavy and unequal UCDW. By recognizing, reducing and redistributing UCDW, WE-Care is promoting a just and inclusive society where women and girls have more choice at every stage of their lives, more opportunities to take part in economic, social and political activities, and where carers’ voices are heard in decision making about policies and budgets at all levels. This overview document aims to highlight the approaches taken and lessons learned on unpaid care that Oxfam has implemented in collaboration with partners in sub-Saharan Africa and Asia.
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Expanding the evidence base on comprehensive care for survivors of sexual violence in sub-Saharan Africa. Population Council, 2014. http://dx.doi.org/10.31899/rh10.1001.

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Best practices in CBD programs in sub-Saharan Africa: Lessons learned from research and evaluation. Population Council, 2002. http://dx.doi.org/10.31899/rh2002.1006.

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Community-based distribution (CBD) is the use of nonprofessional local distributors or agents to provide family planning (FP) methods—typically condoms, pills, and spermicides—and referral for other services. FP programs in Africa, Asia, and Latin America have implemented CBD programs for the past 30 years. There is a large body of evidence on the effectiveness, cost, and sustainability of CBD models. Most evidence supports using CBD where appropriate conditions exist. However, major changes have taken place in the context in which programs operate, including the onset of the HIV/AIDS pandemic, enhanced access to FP services, and increased demand for related reproductive health care. These changes call for a review of CBD’s relevance—particularly in sub-Saharan Africa. This seminar was organized by the Population Council’s Frontiers in Reproductive Health Program, Family Health International, and Advance Africa and attended by participants of the U.S. Agency for International Development and collaborating agencies. Key issues reviewed are detailed in this document.
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Strengthening reproductive health services in Africa through Operations Research. Population Council, 1999. http://dx.doi.org/10.31899/rh1999.1016.

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The health status of women, men, and children in sub-Saharan Africa remains the poorest in the world. Moreover, virtually every country in the region is suffering mediocre economic growth or economic decline, thereby reducing the ability of their health care systems to respond adequately, and increasing dependence on external donor assistance. In terms of reproductive health (RH), the region is faced with high levels of unwanted fertility; high levels of maternal, child, and infant morbidity and mortality; and an almost exponential growth in HIV prevalence. Access to and quality of RH services remains poor in most countries, thereby maintaining unmet need for even the most basic RH services. Despite this situation, RH services in Africa are receiving tremendous attention from governments, NGOs, donors, and technical assistance organizations. This report states that the objective of the Africa OR/TA Project II was to broaden understanding of how to improve family planning (FP) and other RH services in sub-Saharan Africa through applying operations research (OR) and technical assistance. The project supported activities in 13 countries and 47 OR studies that contributed to strengthening FP and other RH services.
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Integrating STI/HIV management strategies into existing MCH/FP programs: Lessons from case studies in East and Southern Africa. Population Council, 1997. http://dx.doi.org/10.31899/rh1997.1002.

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Sub-Saharan Africa is confronting an HIV/AIDS epidemic and virtually all health programs in the region are seeking ways of preventing and reducing the spread of this virus. To compound the problem, the presence of certain sexually transmitted infections (STIs) is known to increase risk of the sexual transmission of HIV. The sub-Saharan region is believed to have some of the highest levels of STIs in the world, thus controlling STIs is not only an important reproductive health care strategy in itself but also a key strategy in reducing the spread of HIV. The strongest evidence to support this has come from the Mwanza Intervention Trial in Tanzania, which demonstrated that improved early detection and treatment of STIs can significantly reduce the incidence of HIV. Putting these principles into practice through health care programs in sub-Saharan Africa remains a challenge. This paper describes the results of a few, selected case studies of efforts that have already been made to address this challenge in east and southern Africa. The case studies document the application of these principles in the context of female clients attending MCH/FP clinics.
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