Browsing by Subject "Low and middle-income countries"

Intimate partner violence (IPV) is a global health challenge characterized by a high prevalence rate; detrimental outcomes across physical, emotional, and sexual health domains; and heavy financial burden. International efforts that actively involve health sectors are needed to address this urgent issue. As IPV differs depending on its specific cultural and socio-environmental context, careful evaluation is required to ensure that relevant practices and policies are contextually appropriate and effective. This dissertation aims to develop knowledge that contributes to a rich and nuanced understanding of how differences in cultural and socio-economic context shape risks and experiences of IPV among populations in low-resource settings globally by focusing on two underrepresented populations in IPV literature: Chinese women in Mainland China and Latinx immigrants in the US. Specifically, the aims of this dissertation are to (a) synthesize current evidence on risk and protective factors associated with IPV against Chinese women, (b) describe the effects of risk factors for IPV victimization and perpetration among Latinx immigrants with a focus on cultural and socio-environmental factors, and (c) describe the experiences of Chinese women who have experienced IPV. This dissertation addresses its aims by means of the following: (a) synthesis of existing literature on risk and protective factors associated with IPV against Chinese women via a systematic review; (b) analysis of a cross-sectional, descriptive, correlational study on IPV against Latinx immigrants in the US; and (c) analysis of posts from a Chinese forum on domestic violence to describe women’s experiences of IPV using a qualitative descriptive design. This dissertation reveals several major findings. First, IPV risk factors for Chinese women that are consistently supported by evidence include factors at the individual level (e.g., demographics, socioeconomic status, attitudinal factors, behavioral factors, adverse childhood experiences [ACEs], and other personal characteristics); factors at the relationship level (e.g., conflicts, power in intimate relationships, and social capital); and factors at the community level (i.e., geographic locations). However, factors at the societal level and intersections of factors within the same level or across different levels are not examined by existing evidence. Second, acculturative stress, rather than acculturation itself, is associated with a higher risk for IPV victimization for Latinx immigrants, and ACEs are associated with an elevated risk of IPV perpetration. Specifically, family stress emerged as a factor that increases risk for IPV victimization. Although further research is warranted, the profiles of risk factors for IPV perpetration were different for women than for men. Third, Chinese women revealed experiences of IPV that are captured by the following five themes: being trapped in my roles; no power in the relationship; the struggles are real, but I need to tolerate; I want to leave, but have no help; and hope for the future. This dissertation addresses critical gaps in the literature on risk and experiences of IPV among populations in low-resource settings and serves as an empirical foundation to address this global health challenge. Further, this dissertation has significant implications as the nursing discipline is well-positioned to prevent IPV, promote health, and eliminate health disparities through future research, practice, and policy based on its findings.

Background Globally, it is estimated that 11% of all disability adjusted life years lost result from conditions requiring surgical intervention. Efforts to estimate burden at country-specific levels have been recommended to plan surgical delivery platforms. However, existing analyses of hospital records are not representative of population-level needs. Therefore, we piloted a population-level epidemiologic survey in a large, peri-urban District of Uganda. The exercise would inform implementation of the eventual nation-wide survey of Uganda.

Methods A 2-stage cluster sampling design was used to sample fifty five (55) households. In each household, up to 2 individual respondents were recruited. Village Health Team (VHT) members served as enumerators and used the Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument to acquire self-reported data on existing surgical conditions and surgical history. A head/representative of household was asked about household deaths within the previous 12-months. Descriptive statistics, weighted adjustments, and regression modeling were used to analyze results.

Results Six of 96 individual respondents (6.25%) reported an existing surgical condition. The lifetime prevalence of surgical conditions was 26.0% (25 of 96 individuals), reporting 33 total surgical conditions. The most commonly reported problems were wound related (54.5% - 18 of 33). The most common anatomic regions affected were face/head/neck, extremities, and abdomen. Injuries were responsible for 51.5% of reported surgical conditions. Two of three household deaths involved proximate causes that were surgically treatable. For all met and unmet need, 80% (20 of 25 individuals) were treated or need treatment at a District Hospital or lower level facility.

Prevalence of existing surgical conditions was used in this pilot to compute a nation-wide study sample size of 4,750. The pilot study cost USD 25/respondent and averaged 36 minutes per household. Major revisions in deployment of the nation-wide survey included: hiring enumerators who lived in the EAs, random household sampling, shift in data collection equipment, and improving breath and depth of data acquired by the SOSAS instrument.

Conclusion The prevalence of existing surgical conditions in Wakiso District was within range of previous pilot studies deploying the same SOSAS instrument, albeit not from Uganda. A large proportion of individuals have surgical problems that can be treated at District Hospital or lower level facilities. The pilot study was feasible and necessary to inform deployment of the nation-wide survey.

This project provides recommendations for how the Global Alliance for Improved Nutrition (GAIN) can assist urban governments and stakeholders to implement institutional healthy food procurement in low- and middle-income countries (LMIC). Public food procurement refers to when governments purchase and provide food to defined populations. Institutional food procurement refers to food purchasing and provision by organizations like schools, hospitals, care homes, youth clubs, prisons, and workplaces. Urban governments often manage public food procurement at these institutions, serving food to students, patients, employees, and their families. Institutional food provision can benefit an individual’s experience at that institution while improving their health and nutritional status. For instance, a student’s nutrition status affects school performance. A hospital patient’s food access may affect their recovery. Healthy food procurement refers to designing food procurement to prioritize the purchase and provision of nutritious food. Since food procurement programmes serve a high volume of people, healthy food procurement represents an opportunity for institutions to promote nutrition, whilst also reshaping the broader food system to be healthier and more sustainable. Many countries face the double burden of malnutrition, with high rates of undernourishment and obesity, especially in urban areas. Urban policymakers are increasingly recognizing institutional healthy food procurement as an opportunity to address malnutrition. However, there is a need to share more experiences and best practices on healthy food procurement among urban stakeholders in LMIC. This report presents a synthesis of literature analysis and key stakeholder interviews on urban public food procurement. This report discusses:

1. Why urban public food procurement is an important tool to improve food and nutrition security

2. A proposed implementation framework / menu of actions for healthy food procurement, with key themes on design and implementation of healthy food procurement policies taken from literature analysis and interviews on successful examples such as New York City and Brazil

3. Two urban public food procurement case studies to explore enabling factors and barriers for healthy food procurement: A city government-led school feeding programme in Addis Ababa, Ethiopia and a hospital feeding programme at Sassoon General Hospital in Pune, India. This section discusses the two case studies through the lens of the proposed implementation framework. These two case studies were selected because they demonstrate success stories in LMIC and illustrate key policy considerations around healthy food procurement.

Key Messages

1. GAIN can support urban healthy food procurement with a nutrition-sensitive approach.

2. Best practices in healthy food procurement include dedicated food procurement governance, use of dietary guidelines in menu-planning, universal coverage and inclusivity, and private sector participation.

3. Invest in institutional food safety; water, sanitation, and hygiene (WASH); and cold chain infrastructure for fresh foods.

4. Create political buy-in for healthy food procurement by highlighting win-win opportunities from perspectives of “customers” and non-nutrition sectors.