SciCombinator

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Journal: BMC international health and human rights

175

Poor quality housing is an infringement on the rights of all humans to a standard of living adequate for health. Among the many vulnerabilities of those without adequate shelter is the risk of disease spread by rodents and other pests. One such disease is Lassa fever, an acute and sometimes severe viral hemorrhagic illness endemic in West Africa. Lassa virus is maintained in the rodent Mastomys natalensis, commonly known as the “multimammate rat,” which frequently invades the domestic environment, putting humans at risk of Lassa fever. The highest reported incidence of Lassa fever in the world is consistently in the Kenema District of Sierra Leone, a region that was at the center of Sierra Leone’s civil war in which tens of thousands of lives were lost and hundreds of thousands of dwellings destroyed. Despite the end of the war in 2002, most of Kenema’s population still lives in inadequate housing that puts them at risk of rodent invasion and Lassa fever. Furthermore, despite years of health education and village hygiene campaigns, the incidence of Lassa fever in Kenema District appears to be increasing. We focus on Lassa fever as a matter of human rights, proposing a strategy to improve housing quality, and discuss how housing equity has the potential to improve health equity and ultimately economic productivity in Sierra Leone. The manuscript is designed to spur discussion and action towards provision of housing and prevention of disease in one of the world’s most vulnerable populations.

Concepts: Epidemiology, Viral hemorrhagic fever, Lassa fever, Sierra Leone, Freetown, Kenema, Eastern Province, Sierra Leone, Kenema District

170

BACKGROUND: The health and well-being of widows in India is an important but neglected issue of public health and women’s rights. We investigate the lives of Indian women as they become widows, focussing on the causes of their husband’s mortality and the ensuing consequences of these causes on their own lives and identify the opportunities and challenges that widows face in living healthy and fulfilling lives. METHODS: Data were collected in a Gram Panchayat (lowest level territorial decentralised unit) in the south Indian state of Kerala. Interviews were undertaken with key informants in order to gain an understanding of local constructions of ‘widowhood’ and the welfare and social opportunities for widows. Then we conducted semi-structured interviews with widows in the community on issues related to health and vulnerability, enabling us to hear perspectives from widows. Data were analysed for thematic content and emerging patterns. We synthesized our findings with theoretical understandings of vulnerability and Amartya Sen’s entitlements theory to develop a conceptual framework. RESULTS: Two salient findings of the study are: first, becoming a widow can be viewed as a type of ‘shock’ that operates similarly to other ‘economic shocks’ or ‘health shocks’ in poor countries except that the burden falls disproportionately on women. Second, widowhood is not a static phenomenon, but rather can be viewed as a multi-phased process with different public health implications at each stage. CONCLUSION: More research on widows in India and other countries will help to both elucidate the challenges faced by widows and encourage potential solutions. The framework developed in this paper could be used to guide future research on widows.

Concepts: Health, India, Tamil Nadu, South India, Amartya Sen, Kerala, Widow, Widowhood

28

BACKGROUND: As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers' perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. METHODS: A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. RESULTS: Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. CONCLUSIONS: This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq’s Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and policy makers about the main problems affecting this system, though improvements to the health care system must be taken up at the national level and involve other key stakeholders.

Concepts: Health care, Medicine, Fertile Crescent, Iraq, Iraqi Kurdistan, Erbil Governorate, Arbil, Rowanduz

19

The World Health Organisation (WHO) estimates that 100-140 million girls and women have undergone female genital mutilation or cutting (FGM/C). FGM/C is an ancient cultural practice prevalent in 26 countries in Africa, the Middle East and Asia. With increased immigration, health professionals in high income countries including UK, Europe, North America and Australia care for women and girls with FGM/C. FGM/C is relevant to paediatric practice as it is usually performed in children, however, health professionals' knowledge, clinical practice, and attitudes to FGM/C have not been systematically described. We aimed to conduct a systematic review of the literature to address this gap.

Concepts: Medicine, North Africa, Middle East, Europe, Asia, Islam, World War II, Female genital cutting

10

The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services.

Concepts: Health care, LGBT, Sexual orientation, Homosexuality

8

The present Millennium Development Goals are set to expire in 2015 and their next iteration is now being discussed within the international community. With regards to health, the World Health Organization proposes universal health coverage as a ‘single overarching health goal’ for the next iteration of the Millennium Development Goals.The present Millennium Development Goals have been criticised for being ‘duplicative’ or even ‘competing alternatives’ to international human rights law. The question then arises, if universal health coverage would indeed become the single overarching health goal, replacing the present health-related Millennium Development Goals, would that be more consistent with the right to health? The World Health Organization seems to have anticipated the question, as it labels universal health coverage as “by definition, a practical expression of the concern for health equity and the right to health”.Rather than waiting for the negotiations to unfold, we thought it would be useful to verify this contention, using a comparative normative analysis. We found that - to be a practical expression of the right to health - at least one element is missing in present authoritative definitions of universal health coverage: a straightforward confirmation that international assistance is essential, not optional.But universal health coverage is a ‘work in progress’. A recent proposal by the United Nations Sustainable Development Solutions Network proposed universal health coverage with a set of targets, including a target for international assistance, which would turn universal health coverage into a practical expression of the right to health care.

Concepts: Malaria, Human rights, World Health Organization, United Nations, Millennium Development Goals, International development, 2005 World Summit, Sustainable development

6

Persons with psychosocial disabilities face disparate access to healthcare and social services worldwide, along with systemic discrimination, structural inequalities, and widespread human rights abuses. Accordingly, many people have looked to international human rights law to help address mental health challenges. On December 13, 2006, the United Nations formally adopted the Convention on the Rights of Persons with Disabilities (CRPD) - the first human rights treaty of the 21st century and the fastest ever negotiated.

Concepts: Law, Human rights, United Nations, 21st century, Council of Europe, Universal Declaration of Human Rights, International human rights law, Human rights abuses

6

Gender-based violence against women, including intimate partner violence (IPV), is a pervasive health and human rights concern. However, relatively little intervention research has been conducted on how to reduce IPV in settings impacted by conflict. The current study reports on the evaluation of the incremental impact of adding “gender dialogue groups” to an economic empowerment group savings program on levels of IPV. This study took place in north and northwestern rural Cote d'Ivoire.

Concepts: Domestic violence, Gender, Gender role, Violence, Woman, Heteronormativity, Transgender, Violence against women

6

Over the last fifty years, the number of centenarians has dramatically increased. The centenarian rate (CR) is representative of the general longevity prevalent in a nation; it indicates the number of individuals aged 100 years or above at a given date divided by the size of the corresponding cohort of a given age. Two important attributes of the CR (50-54) are that it reflects both unchanged age-specific fertility and the absence of migration in populations. It can generally be used in longevity-based evaluations of the broader concept of successful ageing. As such, this retrospective analysis of the social factors that contribute to the CR (50-54) may help to identify the factors associated with successful ageing.This study estimates the CR (50-54) and elucidates the influence of social factors on successful ageing and the CR (50-54), examining 32 member countries of the Organization for Economic Co-operation and Development (OECD).

Concepts: Age, Demography, Population, Gerontology, Ageing, Organisation for Economic Co-operation and Development, Longevity

6

A third of sub-Saharan Africa’s (SSA) population comprises persons aged 10–24 years. These youth are growing up in a context marked by pervasive poverty, limited educational opportunities, high HIV/AIDS prevalence, widespread conflict, and weak social controls. Published research on the broad issues that affect youth health and wellbeing in SSA is limited and centers heavily on sexual and reproductive health. In this commentary article, we provide a broad overview of sub-Saharan African youth, highlight research gaps with respect to youth health and wellbeing, and describe potential avenues to develop the region’s research capacity on youth health and wellbeing.

Concepts: AIDS, Africa, Sub-Saharan Africa, North Africa, Sahara, Black people, Southern Africa, African people