Assessing intersectional gender analysis in Nepal’s health management information system:a case study on tuberculosis for inclusive health systems

Background Tuberculosis(TB)remains a major public health problem in Nepal,high in settings marked by prevalent gender and social inequities.Various social stratifiers intersect,either privileging or oppressing individuals based on their characteristics and contexts,thereby increasing risks,vulnerabilities and marganilisation associated with TB.This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System(HMIS)of National Tuberculosis Programme(NTP)by conducting an intersectional analysis of TB cases recorded via HMIS.Methods A desk review of key policies and the NTP’s HMIS was conducted.Retrospective intersectional analysis utilized two secondary data sources:annual NTP report(2017-2021)and records of 628 TB cases via HMIS 6.5 from two TB centres(2017/18-2018/19).Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB,registration category and treatment outcome.Results Gender,social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation.NTP has initiated the collection of age,sex,ethnicity and location data since 2014/15 through the HMIS.However,only age and sex disaggregated data are routinely reported,leaving recorded social stratifiers of TB patients static without analysis and dissemination.Furthermore,findings from the intersectional analysis using TB secondary data,showed that male more than 25 years exhibited higher odds[adjusted odds ratio(a OR)=4.95,95%confidence interval(CI):1.60-19.06,P=0.01]of successful outcome compared to male TB patients less than 25 years.Similarly,sex was significantly associated with types of TB(P<0.05)whereas both age(P<0.05)and sex(P<0.05)were significantly associated with patient registration category(old/new cases).Conclusions The results highlight inadequacy in the availability of social stratifiers in the routine HMIS.This limitation hampers the NTP’s ability to conduct intersectional analyses,crucial for unveiling the roles of other social determinants of TB.Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.

Using intersectional gender analysis to identify challenges in tuberculosis care at four health care facilities in Uganda

Background Tuberculosis(TB)care could be considered as a continuum from symptom recognition,decision to seek care,diagnosis,treatment initiation and treatment completion,with care along the continuum influenced by several factors.Gender dimensions could influence TB care,and indeed,more men than women are diagnosed with TB each year.The study was done to identify social stratifiers that intersect with gender to influence TB care.Methods A cross-sectional qualitative study was done at four health facilities in 3 districts in central Uganda between October 2020 and December 2020.Data was collected from patients seeking a diagnosis or on TB treat-ment through focus group discussions and key informant interviews.Key themes around gender guided by a gender and intersectionality lens were developed and thereafter thematic content analysis was done.Results Women have increased vulnerability to TB due to bio mass exposure through roles like cooking.Women have increased access to health care services as they interface with the health care system frequently given their role as child bearers and child care givers.Men have a duty to provide for their families and this most often is prioritised over healthcare seeking,and together with belief that they are powerful beings leads to poor healthcare seeking hab-its and delays in healthcare seeking.Decisions on when and where to seek care were not straightforward for women,who most often rely on their husbands/partners to make decisions.Conclusions Men and women experience challenges to TB care,and that these challenges are deeply rooted in roles assigned to them and further compounded by masculinity.These challenges need to be addressed through intersec-tional gender responsive interventions if TB control is to be improved.

Understanding gender and its intersection with social stratifiers on prevention and care seeking behavior of lymphatic filariasis in Nepal

BackgroundLymphatic filariasis (LF) is a debilitating and painful neglected tropical disease and is one of the leading causes of permanent disability. In many countries, the intersection of gender with various social stratifiers has influenced exposure to LF and ultimately impacting the disease burden and its elimination. This study aimed to explore the influence of gender and its intersection with other social stratifiers for the prevention and care seeking behavior of LF in Nepal.MethodsThis study employed qualitative research methods: in-depth interviews (IDIs) and focus group discussions (FGDs) for data collection in Bardiya, Nepal. A total of 22 IDIs (11 male, 11 female) and 2 FGDs (1 male and 1 female) were conducted with the community people between January and March 2020. The participants were purposively selected to represent different social stratifiers including age, sex, ethnicity, occupation. The data collected were analyzed using a thematic framework approach with use of intersectional gender analysis matrix.ResultsThe study findings revealed that men spend more time outside their household compared to women while fulfilling their roles and responsibilities, largely determined by societal expectations and gender norms. This resulted in limited access to preventive health services for men, as they often missed annual mass drug administration programme in their community and limited access to preventive methods. Further traditional occupation, specific to particular ethnicity, influenced the vulnerability to LF for certain ethnic groups. The ability to prevent exposure varied among individuals. Although women made decisions regarding the use of protective methods, it was influenced by patriarchal and gender norms. They often felt a responsibility to take care and priorities males and other family members when resources are limited. The intersectionality of gender with other social stratifiers such as marital status, ethnicity, and geographical areas influenced individual’s ability to access information related to LF and care seeking.ConclusionsOverall, the findings emphasized how access to resources, division of work, norms and values and decision-making power alone and its interaction with various social stratifiers shaped peoples’ vulnerability to disease, ability to prevent exposure and response to illness.

Supporting and strengthening research on urban health interventions for the prevention and control of vector-borne and other infectious diseases of poverty:scoping reviews and research gap analysis

Background:More than half of the world’s population currently lives in urban settlements that grow both in size and number.By 2050,approximately 70%of the global population will be living in urban conglomerations,mainly in low-and middle-income countries.Mobility,poverty,different layers of inequalities as well as climate variability and change are some of the social and environmental factors that influence the exposure of human populations in urban settings to vector-borne diseases,which pose eminent public health threats.Accurate,consistent,and evidencebased interventions for prevention and control of vector-borne and other infectious diseases of poverty in urban settings are needed to implement innovative and cost-effective public policy and to promote inclusive and equitable urban health services.Main body:While there is growing awareness of vector-borne diseases epidemiology at the urban level,there is still a paucity of research and action being undertaken in this area,hindering evidence-based public health policy decisions and practice and strategies for active community engagement.This paper describes the collaboration and partnership of the Special Programme for Research and Training in Tropical Diseases(TDR)hosted by the World Health Organization(WHO)and the“VEctor boRne DiseAses Scoping reviews”(VERDAS)Research Consortium as they joined efforts in response to filling this gap in knowledge and evidence by supporting the development of a series of scoping reviews that highlight priority research gaps and policy implications to address vector-borne and other infectious diseases at the urban level.Conclusions:The set of scoping reviews proposed in this special issue presents a critical analysis of the state-of-the-art of research on urban health interventions for the prevention and control of vector-borne and other infectious diseases of poverty.The authors of the 6 reviews highlighted severe gaps in knowledge and identified organizational and theoretical limitations that need to be urgently tackled to improve cities preparedness and vector control response.The more pressing need at present is to ensure that more implementation research on vector-borne diseases in urban settings is conducted,addressing policy and practice implications and calling for more political commitment and social mobilization through adequate citizen engagement strategies.

Establishing research priorities in prevention and control of vector-borne diseases in urban areas:a collaborative process

Background:In 2015,following a call for proposals from the Special Programme for Research and Training in Tropical Diseases(TDR),six scoping reviews on the prevention and control of vector-borne diseases in urban areas were conducted.Those reviews provided a clear picture of the available knowledge and highlighted knowledge gaps,as well as needs and opportunities for future research.Based on the research findings of the scoping reviews,a concept mapping exercise was undertaken to produce a list of priority research needs to be addressed.Methods:Members of the six research teams responsible for the“VEctor boRne DiseAses Scoping reviews”(VERDAS)consortium’s scoping reviews met for 2 days with decision-makers from Colombia,Brazil,Peru,Pan-American Health Organization,and World Health Organization.A total of 11 researchers and seven decision-makers(from ministries of health,city and regional vector control departments,and vector control programs)completed the concept mapping,answering the question:“In view of the knowledge synthesis and your own expertise,what do we still need to know about vector-borne diseases and other infectious diseases of poverty in urban areas?”Participants rated each statement on two scales from 1 to 5,one relative to‘priority’and the other to‘policy relevance’,and grouped statements into clusters based on their own individual criteria and expertise.Results:The final map consisted of 12 clusters.Participants considered those entitled“Equity”,“Technology”,and“Surveillance”to have the highest priority.The cluster considered the most important concerns equity issues,confirming that these issues are rarely addressed in research on vector-borne diseases.On the other hand,the“Population mobility”and“Collaboration”clusters were considered to be the lowest priority but remained identified by participants as research priorities.The average policy relevance scores for each of the 12 clusters were roughly the same as the priority scores for all clusters.Some issues were not addressed during the brain-storming.This is the case for governance and for access and quality of care.Conclusions:Based on this work,and adopting a participatory approach,the concept mapping exercise conducted collaboratively with researchers from these teams and high-level decision-makers identified research themes for which studies should be carried out as a priority.

Research on vector-borne diseases: implementation of research communication strategies

Background:Effective communication of research findings on vector-borne diseases in Africa is challenging for a number of reasons.Following the experiences of a number of researchers over the life of a project,this article looks for lessons that can be shared with the wider research community.Main body:Between 2014 and 2017,a set of five inter-disciplinary teams from seven African countries collaborated on a project focusing on vector-borne diseases in the context of climate change.A central objective of this work was to influence policy and programming with relevant research findings.This article examines how principles of research communication,derived from the literature and current guidelines,can be applied in practice.Several challenges and lessons are highlighted,showing that research communication takes place within difficult constraints and in complex,fluid institutional and political environments.The processes of communication between policymakers and researchers including stakeholder mapping,defining research communication plans and tailoring communication products are discussed.Conclusions:The article concludes that while guidelines and frameworks for research communication are helpful,they should not detract from the ability of local teams to adapt to circumstances.Of key importance are the relationships and networks of local research teams.