Formative research - an essential step in developing and adapting health interventions and policies in low- and lower-middle income countries

Ivanova, Olena (2021): Formative research - an essential step in developing and adapting health interventions and policies in low- and lower-middle income countries. Dissertation, LMU München: Medizinische Fakultät

Abstract

Background: Situation analysis is an important component of designing and developing healthcare interventions and allows us to describe health gaps and needs of different population groups in various settings. The overall objective of both studies was to shed light on the health situation and needs of adolescents and adults living in low- and low-middle income countries in Africa, with a focus on sexual and reproductive health (SRH) and respiratory health. Methods: We employed mixed-methods research. The data collection took place in 2017 and 2018 in Maputo, Mozambique and in the Nakivale refugee settlement in Mbarara, Uganda. Data was collected in healthcare facilities and communities. We used questionnaires, focus group discussions and individual interviews, as well as clinical assessments and lung function testing. Data was analysed using statistical methods: descriptive statistics and logistic regression, and qualitative thematic analysis. Results: In Study I, a total of 212 male and female participants were recruited, from whom 155 participants provided usable spirometry results. The mean age of participants was 35.20 years (SD 10.99) and 59.35% (93 of 155) were female. Spirometric prediction equations were developed based on the studied population. The predicted values for spirometric parameters: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and the FEV1/FVC ratio using Mozambican equations were lower than the GLI- and the South African-based predictions [1]. In Study II, a total of 260 female participants were recruited, with a median age of 15.9 years. The countries of origin for majority of girls were DR Congo and Burundi. A total of 43% of girls, who had experienced menstruation (93%), had ever missed school due to pain, lack of hygiene products or shame. SRH knowledge was poor: a total of 11.7% of the girls were not aware of how HIV is prevented and 13.8% could not name any methods to prevent pregnancy. Thirty girls were sexually active at the time of interview, 11 of them had experienced forced sexual intercourse, which occurred during conflict, in transit or within the camp. A total of 27 participants had reported female genital mutilation (FGM). The most preferred sources for SRH information were parents or guardians, however, some participants mentioned that they were shy or afraid to discuss other sexuality topics apart from menstruation with their parents. A total of 30% of girls had ever visited an SRH service centre, mostly to seek medical aid for menstrual problems or to test for HIV [2]. Conclusions: These studies contribute to knowledge on the health status of vulnerable populations, i.e. adolescents in a refugee camp in Uganda and adults living in poor urban neighbourhoods in Mozambique, and provide valuable data for the design and implementation of future research projects and programs in these settings, addressing specific health issues (SRH and respiratory health).

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 21. Oktober 2021
• 1. Bericht­erstatter:in: Hölscher, Michael