MSc Global Health 2009-2010
Nasser Cherif Aidara
Background - Development Studies
Research Project: Directly Observed Treatment Short-Course Supervision: An investigation into the knowledge and practices of community DOTS providers in tuberculosis treatment in the prefecture of Telimele, Guinea
Background: TB is and has long been a major public health problem in Guinea. The recent introduction of community DOTS in the treatment of tuberculosis (TB) has made treatment available to many people living in remote areas in Telimele. However, problems such as defaulting, failure, multi-drug resistance TB (MDR), or death can occur for patients under community-based treatment methods, unless a qualitative investigation analysing CDPs awareness, knowledge and practice of DOTS is conducted and acted upon.
Methods: A qualitative approach using non-probability, purposive sampling method was used in conducting this study. A total number of thirty one participants were selected through a list provided by the Programme de Lutte Antituberculose in Conakry, and the Prefectural Health Department in Telimele. Participants were all interviewed using open-ended semi-structure interviews and data were analysed using a thematic content analysis.
Results: The results draw attention to CDPs’ insufficient knowledge and practice with regard to the WHO DOTS treatment guidelines, especially the direct observation component of it, which is a major cause of poor treatment adherence. The findings revealed that CDPs’ non-compliance to the WHO guidelines was associated to socio-cultural, economic, and political factors such as, poverty, lack of financial incentives, insufficient training, inadequate transportation means, and the remoteness of villages. However, it was evident that a comprehensive public policy with a cross-sectoral collaboration within different government department could contribute to TB control in Telimele.
Conclusions: Fighting TB in Guinea requires not only CDPs supervision but, more importantly, community education, and strong government leadership and commitment. This exploratory study provides the basis for further research in enhancing CDPs’ performance in TB treatment.
Key words: TB, DOTS, CDPs, Treatment, Adherence.
Research Project: Comparative Study of Dentists Trained in the European Union and Outside of the European Union Registered and/or Employed in Ireland
Background: The migration of health professionals in Ireland closely follows general migration trends. While Ireland had been a typical source-country it became a very attractive destination country for health professionals, due to its economic development. While the migration of doctors and nurses is very well researched, very little is known about the migration of dentists. Moreover, in comparison with other health professionals, the proportion of foreign-trained dentists, who studied dentistry outside of the UE, is very small. Therefore, the aim of our study was to explore the push and pull factors affecting foreign-trained dentists in Ireland and a comparison of the experiences of EU-trained and non-EU-trained dentists during their registration process and employment. In addition, perception of job satisfaction for these sub-groups of dentists was compared as well.
Method: The study was designed as exploratory and descriptive. It was cross-sectional, using quantities methods, and included all study population of FTDs who had postal addresses in Ireland and obtained registration between 2004 and 2010. Questionnaires were posted to 302 FTDs. A total of 67 were received back: 9 from non-EU-tainted dentists and 58 from EU-tainted dentists.
Results: The main pull factors varied between the EU and non-EU subgroups. FTDs did not have difficulties finding employment after registration, while the registration time for non-EU qualified dentists was considerably longer than for EU-trained. Both sub-groups were unsatisfied with the training opportunities available in Ireland. The main source countries were the UK and Poland. A significant number of participants had an Irish or Northern Irish origin and came back to Ireland after qualifying. Half of the dentists were planning to stay in Ireland permanently.
Conclusion: More information and technical support has to be provided to non-EU trained dentists. English language requirements for dentists from other EU countries would be beneficial for the quality of dental services. Data collection on migrant dentists has to be improved in order to understand migration trends.
Key words: Migration of health workers, dentist, registration, Ireland
[Total words count: 11, 965]
Background - International Geography and Psychological Studies
Research Project: Access and Barriers to Health Services Experienced by the Hijra in Dhaka, Bangladesh
The hijra community are ostracised within Bangladesh society, do not have access to health services like their fellow non-hijra citizens and have specific health needs. This study examined where the hijra access health services and highlighted the barriers they experience. It explored whether health organisations catered for hijra and what services they provided. It also looked at unmet health needs experienced by this community. This research took place with the hijra community in Dhaka, Bangladesh.
In-depth interviews, key-informant interviews and focus group discussions were the methods used to gather data while the sampling technique was heterogeneity sampling. Ten participants took part in in-depth interviews for investigating the access and barriers hijra experience. Key informant interviews were used with five organisations that provide health services. Two focus groups took place with five chelas (junior member of hijra community) and five gurus who had undergone castration or urethral reconstruction (senior members of hijra community). Conventional content analysis was used to analyse the data.
The hijra community have access to very good STI/HIV health services, although this does not include treatment for Hepatitis. The main barriers they experience relate to general and transitioning health services. These barriers include geographical proximity, discrimination, financial constraints and community politics. They choose different healthcare providers on these bases. This can result in the hijra not receiving proper treatment and taking part in risky procedures or treatments for transitioning. There is also room for improvement in relation to the area of mental healthcare provision.
Like transgender communities across the world, the hijra experience discrimination which has a ripple effect on their access to healthcare. However, the hijra also have a very specific culture, hierarchy and community system which needs to be taken into account by those who are working with them. Regardless of the global or local context, the hijra’s right to health is currently being violated.
Word Count: 14990
Key Words: Hijra, transgender, Bangladesh, health services, transitioning
Background: Public Health and Health Promotion
Research Project: An analysis of the inter-relationship between climate, nutrition and agriculture in Ethiopia
Climate change is a global issue, affecting the lives of millions of people annually but more so in developing countries, such as Ethiopia. Changes in climate have been known to affect food security, whereby food accessibility is influenced by changes in agricultural yield, which is dependent upon suitable climate. Market price has also been noted as an influencing factor also. There is a scarcity of published research regarding the impact of climate change on prevalence of malnutrition among vulnerable communities in Ethiopia.
Quantitative and qualitative data were executed in order to explore the presence of an interrelationship between malnutrition and climate change, agricultural yield and the market price of crops in the Woredas of Damot Woyde and Duguna Fango, Wolayita, SNNPR, Ethiopia. Data, on the level of rainfall, agricultural yield and market price of crops were examined and compared to the prevalence of malnutrition in order to observe if a trend existed between the prevalence of malnutrition and the aforementioned factors between 2006 and 2010. Focus group discussions and in-depth interviews were facilitated to examine qualitatively whether an interrelationship existed between the aforementioned factors.
Results from this research demonstrate the presence of an interrelationship between the prevalence of malnutrition and climate change, agricultural yield and market price of crops. 2007 and 2008 were highlighted as the worst years for food insecurity. Rainfall was lowest for the years 2006 to 2010 during Belg season 2008. This coincides with the lowest yield of haricot bean for the years 2006- 2009 at 1.654 kg/hectare during Belg season 2008. The highest market price recorded for haricot bean and maize was during 2007 Sepe and 2008 Sepe seasons. All crops analysed did not show the same trends for yield and market price, however. Results of the qualitative analysis further compounds the magnitude of the impact that climate change is having in the Woredas, with results explaining how the prevalence of malnutrition is influenced by the level and timing of rainfall, agricultural yield and market price.
Results suggest that climate change has influenced the prevalence of malnutrition in these Woredas. The adaptive capacity of the Woredas to climate change needs to be better addressed through combined intervention from NGOs and government. Unless the degree of vulnerability to climate change of the people residing in these Woredas is reduced, climate change will continue to cause widespread devastation.
Key words: Ethiopia, Woredas, malnutrition, climate change, food security, vulnerability, adaptive capacity.
Word Count: 14,998 (excluding in-text references, tables, figures and graphs)
Background - Education
Research Project: Vulnerabilities facing sex workers and their children in Myanmar and Bangladesh: A Qualitative Study
The children of sex workers (SW) are potentially exposed to a range of threats to their psychosocial and physical well-being. The aims of this study were to explore for threats faced by children of sex workers, such as abuse, exploitation, discrimination and violence, and highlight the role of current services responding to them.
Qualitative interviews and focus groups were undertaken with 31 female SW and 29 children of SW, at a number of locations in Myanmar (Yangon) and Bangladesh (Dhaka, Chittagong and Sylhet). Interviews were semi-structured, and on average lasted for between forty-five and sixty minutes (adults) and thirty to forty-five minutes (children, mainly in workshop settings).
Data were analysed inductively, and revealed a number of key themes providing insights into the range of threats perceived by the respondents, and information for guiding specific interventions. A number of themes emerged. For SW, these included: stigma – and especially self-stigma; fear of disclosure to their children; socio-economic challenges; dependence on other carers, and their unease about this; threat of violence from clients; and the desire to ensure their children are safe, healthy and not sex workers. For children, their concerns focused on: loneliness and being apart from their mothers; the importance of school and friendships; stigma from other children and the community.
Findings suggest that high levels of tension and anxiety in this context, with specific issues such as fear of violence, and stigma from the general populace are significant even though in this region (Asia) the number of men purchasing sex is higher than elsewhere (revealing the paradox of high levels of access, with continuing widespread disapproval). Current services, though providing some essential support services, could go further to address the psychosocial and physical needs of respondents.
Further research is required to identify specific levels of health and other risks, and mechanisms for enabling SW and their children to achieve their aspirations.
Background - Biology & Zoology
Research Project: Migration of Sudanese Doctors to Ireland: Push and Pull Factors
Background: A key factor in providing medical care is the availability of qualified and motivated health care professionals. The deficiency of health human resources is one of the main constraints to improve health conditions in developing countries. Sudan currently has approximately 21,000 doctors registered with the Sudanese medical council. However, of these approximately 12,000 are not working in Sudan and instead are working overseas. In terms of annual output, 1,500 doctors graduate each year, but 800 migrate. It is not known whether migration is temporary or permanent. Ireland is an attractive destination country for migrant doctors and there are currently 471 doctors registered in Ireland. The aim of this research is to investigate the motivation of Sudanese doctors to work in Ireland and what are the factors that contribute to their decisions to leave Sudan and come to work in Ireland and their future plans about their returning back to Sudan as doctors.
Methods: A sample of 120 completed survey Sudanese doctors was obtained. Recruited doctors were through online survey. Emails had been collected from doctors using Sudanese Society in Ireland and snowballing approach to recruit more doctor by sending their emails, which create a pool of about 300 emails.
Results: 94% of the participants were male and 6% were females. 90% of the participants were obtained their medical degree from Sudanese Medical College, mainly Khartoum University 52% and AL Gazeera University.
43% of the participants choose lack of training as the main push factor in Sudan. 64% of them rank career development and training opportunities as the main incentive for their working in Ireland. 65% of the participants choose Ireland rather than other countries as recommendation of friend. 79.6% of the participants (86 doctors) stated that Ireland is not their last destination. 89.0% of the participants (97 doctors) mentioned that they are planning to go back to Sudan, 93 of them are going back to work as doctors. Of those who are going to work in Sudan, 67.7% are going back to work as doctors.
Conclusions: Sudanese migration of doctors is contributing hugely to the imbalance health services provision in Sudan. Lack of training and low payment in Sudan the main push factors for Sudanese doctors to work outside Sudan. On the other hand, the career development and continuing education are the main reasons for migrating to work in Ireland. Developed countries such as Ireland will continue to attract doctors from developing countries including Sudanese doctors to fill its shortage in doctors.This will not stop unless Sudan government address the causes of this migration and implement suitable and efficient policies. These policies can improve retention and motivation of Sudanese doctors to work in Sudan. Their planning to go back to Sudan could be good example for brain exchange or wisdom gain rather than brain drain.
Key words: Doctor Migration-Sudanese Doctors-Brain Drain-Push and Pull factors-Ireland
Word Count [10,062]
Nneka Abba Mba Kalu
ABSTRACT: SOCIAL BARRIERS TO BREASTFEEDING IN DUBLIN, IRELAND
Social Barriers to Breastfeeding in Dublin, Ireland
INTRODUCTION: The benefits of breastfeeding for mothers, children and the economy are numerous but to establish it successfully, women, the community and the nation are facing challenges. The goal of this piece of work is to increase our awareness on the social factors that contribute to the low rates of breastfeeding in Dublin, Ireland.
METHODS: A quantitative research strategy was selected as appropriate for the purpose of the research question of this study. A non- experimental, cross-sectional design was used and convenience sampling was used to choose the research participants all over Dublin. A self-administered close-ended questionnaire was used as a research tool to collect sample of one hundred and fifty antenatal and postnatal mothers. SPSS version 17 was used for the data analysis.
RESULTS: The percentage of women that chose to breastfeed their babies for less than 6 months were 46.7 percent. Only 17.3 percent chose to breastfeed their babies for up to 6 months while 24.0 percent chose to combine breastfeeding and formulae feeding and 12.0 percent chose to formulae feed alone. The 30-39 years age group had the highest rate of breastfeeding while the 18-29 years age group had more mixed feeders. The rate of formulae feeding was the same for both age groups at 50 percent. Work was a major social factor that influenced the participants’ choice of infant feeding method. Other social factors were breastfeeding education and family. Some psychosocial factors like being shy to breastfeed in public, the perception of being tied down with breastfeeding, the assumption that formulae is of same value as breast milk, breastfeeding being time consuming and not producing enough milk were also noted as barriers to breastfeeding in this study. All the participants had received breastfeeding education.
CONCLUSION: More focus should be placed on social aspects like work, education and family when reviewing and implementing policies regarding breastfeeding.
Keywords: Breastfeeding, social factor, women.
Research Project: Older People's Participation in the Decision-making process before moving from hospital to a Nursing home in Dublin
Objectives: The aim of this thesis is to establish how older people participate in the decision to be admitted to a nursing home; to determine the circumstances surrounding the time of admission to a nursing home; and to identify the main causes influencing their decision to move to a nursing home.
Methods: Purposive sampling techniques were utilised to recruit participants who were residents in a nursing home in Dublin. Qualitative, in-depth interviews were conducted with eight older people who were living in a private nursing home for more than three months and less than 12 months. Narrative analysis was used to analyse their stories.
Results: Findings indicated that respondents had a variety of views, which were rooted in individual experiences of the process of planning their discharge from hospital to nursing home in the discharge planning. Some respondents were involved in the process and they negotiated or were consulted in the decision-making, meaning that they had a say in the process, whereas others felt they were compelled to move to the nursing home and felt excluded from the discussions. The lack of options was mentioned in many cases. It was rare for a respondent to have made independent choices but, on the other hand, interdependence in making decisions appeared to offer a way of being involved in the decision for those respondents who had a say in discussions. Reasons to move to the nursing home included a decision made by the family or by health staff, along with poor health, loneliness and financial constraints. Six major themes emerged from the analysis of the data: passivity/ lack of control, options/ choice, physical well-being, emotional well-being, financial resources/ difficulties, and ineffective communication.
Conclusion: As the number of Irish older people living in nursing homes is increasing rapidly and little is known about their participation in the decision-making process, they should be at the heart of discharge process to make sure that their voice is heard. The process of moving older people to residential care needs to be smooth in order to achieve better outcomes in nursing homes and to provide a setting where older people’s potential can be realised – rather than making them feel unimportant and unwanted.
Older people, decision-making process, participation, residential care, qualitative
Dissertation Word Count: 15,874
Background - Nutritional Science
Research Project: Diet Diversity in Orphans and Vulnerable Children in an Urban Area of KwaZulu-Natal, South Africa
Background: Adequate nutrition is known to be essential for the physical and psychological health of children as well as contributing to economic development. Increasing diversity in the diet has been found to be effective in improving the nutritional status of children. Child malnutrition is a persistent problem in the KwaZulu-Natal province of South Africa. Stunting affects approximately 20% of children and it has been estimated that 10% of children are underweight in South Africa. Given South Africa’s context of HIV and AIDS and its associated numbers of orphans and vulnerable children (OVCs), it is important to understand the nutritional status of OVCs and determine the factors that influence it. In describing their nutrition status, appropriate and proven interventions can be targeted to this population. This study aims to describe the diet diversity of OVCs in an urban area and the association between diet diversity and various demographic, household and child specific characteristics. This study aims to provide baseline data in order to measure achievements from future interventions and to recommend appropriate interventions to improve diet diversity.
Methods: This was an observational, descriptive, cross-sectional study. A mixed method that combined both quantitative and qualitative techniques was utilised. A structured questionnaire was administered to 100 carers of OVCs aged 2-10 years in urban townships within the Municipality of Kokstad in the KwaZulu-Natal province of the Sisonke District of South Africa. This questionnaire included information regarding basic demographic information of the care-giver and child, the child’s diet, water and sanitation in the household and illness in the child. A 24-hour dietary recall was then conducted. This information was used later to calculate the diet diversity score (DDS) and the food variety score (FVS). Anthropometric measurements of the OVC were taken. Key informant semi-structured interviews were then conducted with 7 community careworkers, 2 community nurses, 1 paediatric doctor from the public hospital and 1 dietician from the public hospital. These were used to further describe the nutrition situation of OVCs in the area.
Results: Results showed that 59% of the subjects had a low DDS (i.e. ≤ 4). The mean DDS found was 4.2 (Standard deviation (SD) = 1.2). FVS was used to validate the results. The mean FVS found was also considered low at 7.3. No statistically significant associations (p < 0.05) were found between DDS and variables such as income, relation to child, care-givers education status or anthropometric status. DDS was found to be significantly higher in houses with indoor plumbing as opposed to houses retrieving their water from a source outside their yard. Prevalence of illness in the sample was low and therefore could not be correlated with DDS. Hand-washing practices were found to be poor as respondents reported washing their hands on 2.1 (SD = 0.7) occasions out of a total of 8 responses.
Conclusions: From the results it is clear that diet diversity needs to be improved amongst OVCs in the area. Future interventions that encompass a comprehensive education programme involving diet diversity, behavioural change and sanitation practices are recommended. Such an intervention could be evaluated after an appropriate period of time through a similar study that compares data to the baseline data obtained in this study. Future research is required to determine the best interventions to increase diet diversity and address other underlying determinants of nutritional status to ensure a productive and healthy future for OVCs.
Key words: Diet Diversity, Food Variety, Orphans and Vulnerable Children
Word Count: 14,995
Background - Production Management
Research Project: The Role of HIV/AIDS Support Groups in Reducing Stigma and Discrimination in Choma District, Zambia
Background: The HIV and AIDS epidemic remains one of the serious health challenges in the world today, especially in the Sub-Saharan Africa. In Zambia where it is estimated that one in every seven (14.3% prevalence) people is HIV positive, it has resulted into an over burdened, already struggling health care system. Despite the numerous interventions put in place to try and address it, the major barrier has been the stigma and discrimination associated with the problem.
Methods: This study employed in-depth interviews and focus group discussions to explore the role HIV and AIDS support groups are playing towards reducing stigma and discrimination against people living with HIV and AIDS. It comprised of seven SGs from six purposively selected sites within Choma district while non SG members were conveniently sampled from ART clinics within the research sites. Using a descriptive qualitative methodology, 57 PLHIV (51 SG members and 6 non SG members) and 4 personnel from organisations dealing with SGs for PLHIV were interviewed to; (i) examine the nature of HIV-related S&D that exist, (ii) investigate how national policies are addressing S&D, and (iii) evaluate the interventions of SGs in reducing the S&D towards PLHIV of Choma district in the Southern Province of Zambia.
Results: It was found that S&D against PLHIV exists in Choma district and manifests in different forms ranging from simple actions such as gossip to abandonment. Self stigma (internal) was found to be higher in urban areas while rural settings suffered from community (external) stigma. Furthermore, a comparison of feelings of S&D between members and non members of SGs indicated a freer attitude among members than non members of SGs, suggesting the usefulness and effectiveness of SGs in helping PLHIV cope with S&D. The government of Zambia’s policy of providing ART free of charge was found to be helping reduce S&D, especially that which emanated from family members who fear medical expenses. These results were identified around seven thematic areas: (1) understanding of S&D; (2) experience of S&D; (3) Coping mechanisms; (4) SGs’ response to S&D; (5) Effect of public policies on S&D; (6) Support to SGs and (7) Stigmatising terms.
Conclusions: This study demonstrated that S&D in various forms exist and that SGs have been a very effective intervention in reducing S&D against PLHIV in Choma district. Furthermore, the government of Zambia’s policy of providing ART free of charge was found not only to prolong life through enhancing access to treatment, but also helps reduce S&D against PLHIV. Therefore, it should be born in mind that in as much as SGs have shown effectiveness in addressing S&D, there are other factors at play such as the government policy in question, which have also helped address the associated S&D.
Dissertation Word Count: 14, 774
Background - Law
Research Project: Knowledge and Awareness of tobacco-related health effects amongst selected groups in Dares Salaam and Arusha, Tanzania
In the face of epidemiological research showing the devastating health effects of tobacco and tobacco-related disease, the tobacco industry has repeatedly insisted that fully informed adults should have the right to smoke if they so choose. However, a definition of “fully informed” has not been established. In fact, the tobacco industry has a history of skewing the health message, and a consequence in the developing world is to exploit a people with an already low level of health knowledge. This denies entire populations their right to health-relevant information, and violates their right to health, and ultimately, right to life. This study takes an exploratory approach to tobacco-related health knowledge and health literacy in Tanzania, one of Africa’s biggest tobacco producers. Focus group discussions with diverse populations, both smokers and non-smokers, in Dar es Salaam and Arusha provide insights into their tobacco-related knowledge and perceptions of knowledge, and attempt to categorize this knowledge into four levels. Themes emerge from the discussions to show that there is a general lack of knowledge about the dangerous direct and indirect effects of tobacco, demonstrating that participants interviewed do not have full knowledge about tobacco and health.
Key words - Tobacco, knowledge, qualitative, rights, Tanzania.
Final Word Count: 13, 571
Background - Bachelor of Arts
Research Project: HPV and Cervical Cancer Screening: A Survey of Knowledge, Attitudes and Practices among Female University Students (aged 18-29) in Mwanza, Tanzania
Objectives: To assess knowledge, attitudes, and practices of sexual and reproductive health relating to HPV and Cervical Cancer among female university students (ages 18-29) attending Weill Bugando University College of Health Sciences (WBUCHS) in Mwanza, Tanzania.
Methods: Stratified random sampling techniques were utilised to recruit participants from Weill Bugando University College of Health Sciences (WBUCHS). Quantitative questionnaires were completed by 98 female students between the ages of 18 and 29 years old. Questionnaires were self administered and took approximately 30 minutes to complete.
Results: Findings of this study suggest an overall low level of knowledge surrounding cervical cancer, HPV, their risk factors and screening methods amongst the students attending WBUCHS. While many students knew what cervical cancer was and that it is a serious disease, very few had knowledge of what HPV was, the role HPV played in the development of cervical cancer, and the risk factors associated with HPV infection. Knowledge surrounding Pap smear tests was limited and very few students had ever had a Pap smear test preformed. Findings surrounding risky sexual behaviours revealed that while the students did participate in risky behaviours that would likely place them at higher risk for contracting HPV, they did so at a lower rate when compare to different populations from similar studies.
Conclusions: AsHPV and cervical cancer continues to influence the lives and health of thousands of Tanzanian women each year, a number of interventions are required to address the issues encompassing screening services, risky sexual behaviours and knowledge of HPV and cervical cancer amongst university women. By breaking down the barriers that limit knowledge and access to services surrounding HPV and cervical cancer, progression towards reducing the risk of infection and the incidence of cervical cancer may be achieved.
HPV, sexual health, cervical cancer, KAP, university students
Word Count: 10,431
Background - Bachelor of Science
Research Project: The Prevalence of Depression and Anxiety in People Living with HIV in an Infectious Disease Clinic
Objectives: The general objective of this study was to systematically show the prevalence of depression and anxiety present in people living with HIV as a call for the proper integration of mental health services towards their care. The specific objectives were, to determine the prevalence of depression and anxiety in people living with HIV in an Infectious Disease Clinic in North Dublin, and to determine the additional benefits for patients of the systematic use of a depression and anxiety screening tool to identify cases of depression and anxiety.
Methods: This was a quantitative cross-sectional study, where non-probabilistic purposive sampling technique was employed to recruit participants from an Infectious Disease Out-patients’ Clinic, on St. John’s ward, in Beaumont hospital, North Dublin. One 14-item mood screening self-rated questionnaire called hospital anxiety and depression rating scale (HADS), and another 17-item semi-structured questionnaire were administered to 100 people living with HIV attending this clinic, which both took 15 minutes to complete in total. Quantitative data was collected and analysed using the Statistical Package for Social Sciences (SPSS) windows version 16.0.
Results: Up to 31.3% of males and 46.1% of females who took part in the study were screened to be depressed; and 52% of males as well as 55.7% of females were screened to have anxiety disorder. There were also interesting association between depression and/or anxiety, and some sociodemographic and/or health-related factors.
Conclusion: As the prevalence of depression and anxiety is significant enough in people living with HIV, the need to improve the service provided for this cohort, by referring on to mental health specialists to confirm diagnosis and treat as appropriate becomes essential. Co-morbid depression and anxiety will; reduce compliance to treatment, increase the rate of progression, cause impairment of insight, and completed suicide in people living with HIV if not treated. Hence the need for proper integration of mental health service in the management of people living with HIV.
Keywords: Prevalence, depression, anxiety, HADS, HIV, Ireland
Total Word Count: 12,142 (Only body of thesis was counted)
Background - International Development Studies
Research Project: Innovations in Emergency Food Security Interventions: Lessons Learned from Concern Worldwide’s Mitigation Programme in Niger
BACKGROUND: Conventional food aid is undergoing a transition towards market-based alternatives. Cash transfers have gained prominence as an alternative food security delivery mechanism. The impacts of such interventions have been difficult to assess, given the precarious nature of crisis contexts. Furthermore, “cash transfers” has become a generalised term; its incorporation into a wide variety of programmes has caused some confusion in the literature. This research qualifies the use of unconditional targeted cash transfers1 in conjunction with a targeted Blanket Feeding programme (BF) in a context of slow-onset food insecurity resulting from drought among high rates of malnutrition approaching emergency levels.
METHODS: This is an observational, descriptive, cross-sectional study using mixed quantitative methods. Structured interviews were conducted with beneficiaries of supplementary food aid and targeted cash transfer programmes in Tahoua District, Niger during the hunger period in 2010, which began earlier than in most years due to a poor harvest (May to August). The questionnaire investigated the usage of both types of transfer, household livelihood strategies, and the impact each transfer had on household food security. Focus Group Discussions were conducted with beneficiaries from communes demonstrating the best and worst food deficits to draw comparisons of household food security and coping strategies.
RESULTS: 378 respondents (95% response rate). 24.1% were BF and cash beneficiaries and 75.9% were BF only beneficiaries. 100% of respondents were women. The results reveal that the majority of food aid was eaten by members of the household additional to the registered beneficiary. Almost 80% of food aid was consumed in less than one week. All cash beneficiaries reported spending most or all of the transfer on cereals for the household (100%). These findings were reinforced by the FGDs conducted among 30 women which found that food aid was shared in the household and that the majority of monetary expenditures were dedicated to food.
CONCLUSIONS: The results demonstrate the appropriateness of both the BF and cash transfer programme in a context of slow-onset and prolonged food security. These findings were complemented by a recent nutrition survey demonstrating remarkable differences between non-beneficiaries, food beneficiaries, and food plus cash transfer beneficiaries.
Background - Bachelor of Science
Research Project: A multi-agency perspective on emergency preparedness and response from the 2004 Asian Tsunami in Aceh, Indonesia
Introduction: With an increase in the number of natural disasters occurring worldwide, and an increase in the number of acting agencies in disaster relief, an integrated and coordinated response is now more important than ever. Whether agencies can provide relief while “doing no harm” is dependant on their ability to adapt to the local situation, revise their interventions from previous experience and adapt their relief programmes and procedures accordingly. The Asian Tsunami that hit the Asia-Pacific region on December 26th 2004 shook the world and became a major turning point for reforming disaster relief and management.
Research Objectives: This case study examines emergency preparedness and response in the context of local disease control from the perspective of aid workers in Aceh Indonesia following the tsunami disaster of 2004. Through looking at the broader organisational issues from the lens of healthcare as well as more specific health related issues, how well these lessons have been incorporated into current programmatic procedures and processes was studied and potential strategies to improve disaster preparedness and relief efforts were then sought.
Design: Qualitative study using key informant interviews.
Methods: Key informants from various international medical aid agencies were sampled purposively. Once several participants had been recruited snowball sampling was initiated. Interviews were recorded for clarity and data collected was later analysed using thematic analysis.
Results: The study found that where preparedness plans were available their usefulness was questionable. Agencies have made some changes to their programmes by ensuring that capacity building is now included as early on in the response as possible and that medical teams sent into the field are multi-disciplinary. Barriers identified were similar to those in the immediate post-tsunami reports such and included a misallocation of medical personnel, inappropriate aid and difficulty adapting their programmes to the local context. Reactions concerning the cluster approach and how well it has improved response effectiveness were mixed.
Conclusion: Though strides have been made in attempting to solve some of the recurrent issues, as seen by the health response to the tsunami and similar disasters in the five years that have passed there are still many changes yet to be made. Some issues addressed in post-disaster reports five years ago are still being identified as problems in current relief efforts. In particular, the question of the why the cluster approach has done little to manage inappropriate aid in the past several years was raised. Though this study looked at the experiences of a limited number of representatives, future relief efforts could be improved by ensuring preparedness measures are integrated into programmes themselves rather than imposed onto them, and by better preparing medical personnel to deal with the local environment. On a broader international level, humanitarian relief could be improved by the use of a coordinating body implemented through the cluster approach or by national governments to filter inappropriate aid.
Keywords: Aid, humanitarian; Primary health care; local disease control; disaster preparedness and response; Aceh; Indonesia; preparedness
(Word Count: 12, 456 including citations)
Background - Political Science
Research Project: Explaining the Gap in Sustainable Development Programmes in Bogota, Colombia: A Qualitative Study
Background: Colombia has one of the largest populations of internally displaced persons in the world and Bogotá, its capital city, is one of the main towns of reception. Many IDPs living in Bogotá are from rural areas and, upon arrival in the urban centre, do not possess the necessary skill set to incorporate themselves into the formal economy. Service provision for IDPs is focused on emergency aid and humanitarian assistance, typically lasting the first three months of registered displacement. Because there is a substantial lack of sustainable development projects, such as income generation, job skills training, and housing programmes, when the emergency assistance has ended, many IDPs are not self-sufficient and become more vulnerable to the corresponding conditions and diseases of urban slum-dwelling and poverty, creating a cycle that is very difficult to break.
Methods: Using qualitative methods, NGO and FBO workers and government officials participated in semi-structured key-informant interviews to explore existing resources and perceptions on the focus of programmes and policy for internally displaced persons in Bogotá, Colombia.
Results: There were found to be three main challenges to implementing sustainable development programmes in Bogotá or other urban centres. The Colombian government and the Constitutional Court have created progressive and inclusive laws, but there is very little done to ensure execution. Secondly, the harmful orchestrated image to the international community, often down-playing the situation of displacement and the refusal to admit there is an ongoing conflict, is preventing appropriate allocation of funding as well as limiting worldwide attention on a very serious crisis. And thirdly, Colombia has proven itself a unique case study: a conflict country with one of the highest displaced populations in the world, yet maintaining a stable government and relatively thriving economy. Because of the comprehensive laws and the structural security of the government, the weaknesses that should be addressed when trying to effect change are unclear. Finally, groups were found to be underutilising potentially beneficial interdisciplinary partnerships, and thus neglecting existing available resources.
Conclusions: The existing resources in Bogotá are extensive, particularly the dedication of the Catholic Church and its integral position in Colombian culture, rehabilitation centres’ focus on beneficiaries regaining a productive role in society, the academic and legal experts working toward a solution, and the resilience of the displaced population. There are cultural issues to overcome such as the structural racism, classism, gender inequality, and prejudice against IDPs that permeate the country and contribute to the current situation of displacement. Specifically, this affects the focus of programmes because many do not acknowledge or accept the reality that the majority of IDPs are staying and not returning. But with the formation of more interdisciplinary networks, these issues can be overcome and more effective sustainable development programmes can be implemented.
Internally displaced persons, income generation, sustainable development programmes, armed conflict, qualitative
Research Project: Reintegration Initiatives and Needs for Formerly abducted Child Soldiers and Child Mothers in Northern Uganda
Background: For two decades, the Lord’s Resistance Army (LRA) fought a dirty war, terrorizing civilians and abducting an estimated 30,000 children in Northern Uganda. These children were subjected to starvation, rape, beatings, killings, and were forced to commit unspeakable atrocities. Now that the LRA has fled Uganda and most of the child soldiers have been released, a new challenge presents itself: how to rehabilitate and reintegrate the formerly abducted child soldiers into society.
Many of the abducted girls suffered even more than their male counterparts; in addition to forced labor and involvement in battle, they were frequently given to rebel leaders as “wives” and repeatedly raped for months or years. Numerous girls returned home with children they had given birth to in captivity, presenting unique challenges to reintegration.
Methods: A total of 49 child mothers participated in five focus group discussions held in the Kitgum and Lamwo districts of Northern Uganda. They discussed the interventions that were the most beneficial and detrimental to their reintegration in the community, and made suggestions for future initiatives based on their needs. Participants were mobilized by a gatekeeper from the Kitgum Concerned Women’s Association (KICWA), which runs a welcome and rehabilitation center for former child soldiers in Northern Uganda. Selection criteria included female gender, current age of at least 18 years, and status of either formerly abducted child soldier or child mother.
Focus group discussions were supplemented by eight key informant interviews with government and NGO staff who worked closely with the population. These interviews, taking place in Kitgum and Gulu, offered expert insights on the same problems from a different perspective.
Findings: Current reintegration strategies can be summarized in four categories: psychosocial, physical health, education, and economic. While the existing activities seem to be having a positive impact, resource constraints were consistently rated among the biggest frustrations by both groups involved in the study. A pattern also emerged of factors which interacted to determine the success of girls’ reintegration in the community. The most influential of these were: presence of a child born in captivity, utilization of reception centers and other rehabilitation services, behavior of the child before abduction and since return, and awareness and sensitivity on the part of the community.
Interpretation: If adequate funding can be obtained, additional programs should be implemented to address the unique and overwhelming needs of formerly abducted child soldiers and child mothers in Northern Uganda. As the country moves away from conflict and towards development, livelihood issues, including education, vocational training, and income-generating activities, take precedence. In order to reduce stigma, many of these projects can include both the aforementioned population and other vulnerable youth in the community.
Key Words: child soldier, child mother, reintegration, rehabilitation, Northern Uganda, LRA
Word Count: 14,638
Research Project: STI Risk and Prevention among Refugees in Long Term Post-|Emergency Phase Refugee Camps in Africa - A Systematic Review
Distinct factors associated with refugee status are believed to fuel an increase in sexually transmitted infection (STI) prevalence among this population. The control of STIs in long term refugee camps is a difficult and poorly researched area. There are approximately 2.5 million refugees living in long term camps in sub-Saharan Africa at present. The emergency phase of interventions for these displaced populations is prioritised by the needs of food, shelter and water. The control of STIs is not considered a necessity in these resource constrained settings. In long term post-emergency phase camps however STI control becomes an issue. This review aimed to analyse the published data on specific risk factors and the prevalence of STIs in refugee camps in Africa. A literature search was conducted using PubMed, SCIRUS and the Cochrane databases. 1322 articles were assessed for their relevance and from these 21 articles specific to the context of long term refugee camps were chosen for analysis.
The results highlighted a distinct lack of published data in the area of STI prevention and control in refugee camps. There were however some good studies identifying the specific risk factors faced by refugees, these include rates of transactional sex, low status of women, lack of education, low employment levels and stigma. Community-based interventions were the most successful programmes targeting behavioural changes, education and the provision of condoms.
As each situation is unique there is a need for a standardised framework of prevention and control practises that are based on well researched, published studies which can be adapted and directed towards each situation as necessary.
Key words: Refugee, STI prevention and control, camps, Africa.
Word count: 10,053
Background - Molecular Biology
Research Project: The Influence of Maternal Knowledge, Attitudes and Practices on Urban Child Health: A Mixed Methods Study in Mumbai, India
Objectives: A mixed-methods approach was used to assess factors determining healthcare for childhood illnesses among mothers living in urban slums in Mumbai, India. Maternal health seeking behaviour and practices, their perceptions of illness and utilization of health services, complemented by the insights and experience of health care providers, were investigated to yield a holistic understanding of the challenges faced in improving child health.
Methods: Questionnaires were conducted in four cluster areas of an eastern urban slum, Ghatkoper in the state of Maharashtra, via random probability based sampling techniques. These were enhanced by incorporating focus group discussions to further explore and ascertain maternal health seeking behaviour, hygiene practices, and perceptions of available health interventions. Semi-structured key informant interviews were utilized with health providers and NGO workers for further insights about the current health interventions aimed at prevalent under 5 illness, as well as improvements for the future of child health.
Results: A total of 112 households were surveyed, 4 focus group discussions facilitated and 8 key informant interviews conducted. The findings from these quantitative and qualitative data methods uncovered factors that affect urban child health in light of linkages between maternal health seeking behaviour and accessibility to current public health interventions. Findings described maternal knowledge, attitude and practice patterns relating to recognition, management and treatment of childhood illnesses. The results also provided details on the perceptions and experiences of the public health system from the supply and demand standpoint of the mother and healthcare provider relationship. Maternal educational levels were shown to play a major role in preventative and curative health measures for children under 5.
Discussion: The acquiescence of maternal knowledge and perspectives provided shape understanding the dynamics behind the underutilization of public health services as well as captured potential avenues for improvements in proper child care. This has lead to an opportunity to further probe into the dynamics behind maternal health seeking behaviour. Research findings also lead to speculation on the type of efforts needed to enhance child health, such as effective health promotion, increased maternal knowledge with respect to recognizing illness severity and engagement strategies for health facility staff to enhance quality of care.
Keywords: urban child health, maternal health seeking behaviour, underutilization, research, engagement
Background - BSc Psychology
Research Project: A Community based Participatory Analysis of Orphans and Vulnerable Children in Rongai Constituency, Rift Valley Province, Kenya
There exists a need to build reliable and consistent data within and across countries in order to improve policy planning, inform decision making and provide better support to the increasing number of orphans and vulnerable children (OVC) in sub-Saharan Africa. Community definitions of OVC however, tend to vary from the definitions employed by both national government and international agencies, putting children at an increased risk of being left out of government initiatives and policies aiming to improve the lives of OVC. One solution to this problem is to scale-up the capacity of already existing community-based interventions and allow them to define their own definition of OVC according to the needs of children under their care. By collaborating with a local community group in Rongai, we aimed to identify the needs of OVC in this particular environment in order to provide evidence-based feedback on how to best allocate resources and improve training of future community based OVC caregivers in this area. A community based participatory analysis of orphans and vulnerable children was employed to conduct 173 questionnaires and 2 focus group discussions with OVC in Rongai. Children were found to lack material resources as well as support programmes and counselling. Results also discuss a need to increase capacity building and advocacy training for community based care workers. A series of recommendations are made in order to better train community based care workers and efficiently direct care for the needs of OVC in Rongai.
Keywords: OVC, Kenya, Community-based interventions, Situational-Analysis
Word Count: 13,876