Background We examined the evidence derived from healthcare professionals’ interfacing with women... more Background We examined the evidence derived from healthcare professionals’ interfacing with women with female genital mutilation (FGM) to comprehend the referral pathways available to these women in Australia. Main body Clinicians encountered FGM-related complications that included ruptured bladder and total urinary incontinence. Midwives and paediatricians indicated a lack of referral pathways for FGM, but used their discretion to refer such cases to social work departments, obstetric/gynaecological units, child protection service providers, psychological counsellors and surgeons. The continuum of care for women with FGM is characterised by inadequate and lack of clear referral pathways. This underscores the need to develop and strengthen referral pathways in response to physical, birthing and psychological complications of women with FGM to improve their care experiences in Australia. Short conclusion Capacity building initiatives on FGM-prevention and care for trainees and practi...
Background People from racial minority groups in western countries experience disproportionate so... more Background People from racial minority groups in western countries experience disproportionate socioeconomic and structural determinants of health disadvantages. These disadvantages have led to inequalities and inequities in health care access and poorer health outcomes. We report disproportionate disparities in prevalence, hospitalisation, and deaths from COVID-19 by racial minority populations. Methods We conducted a systematic literature search of relevant databases to identify studies reporting on prevalence, hospitalisations, and deaths from COVID-19 by race groups between 01 January 2020-15 April 2021. We grouped race categories into Blacks, Hispanics, Whites and Others. Random effects model using the method of DerSimonian and Laird were fitted, and forest plot with respective ratio estimates and 95% confidence interval (CI) for each race category, and subgroup meta-regression analyses and the overall pooled ratio estimates for prevalence, hospitalisation and mortality rate were presented. Results Blacks experienced significantly higher burden of COVID-19: prevalence ratio 1.79 (95% confidence interval (CI) = 1.59-1.99), hospitalisation ratio 1.87 (95% CI = 1.69-2.04), mortality ratio 1.68 (95% CI = 1.52-1.83), compared to Whites: prevalence ratio 0.70 (95% CI = 0.0.64-0.77), hospitalisation ratio 0.74 (95% CI = 0.65-0.82), mortality ratio 0.82 (95% CI = 0.78-0.87). Also, Hispanics experienced a higher burden: prevalence ratio 1.78 (95% CI = 1.63-1.94), hospitalisation ratio 1.32 (95% CI = 1.08-1.55), mortality ratio 0.94 (95% CI = 0.84-1.04) compared to Whites. A higher burden was also observed for Other race groups: prevalence ratio 1.43 (95% CI = 1.19-1.67), hospitalisation ratio 1.12 (95% CI = 0.89-1.35), mortality ratio 1.06 (95% CI = 0.89-1.23) compared to Whites. The disproportionate burden among Blacks and Hispanics remained following correction for publication bias. Conclusions Blacks and Hispanics have been disproportionately affected by COVID-19. This is deeply concerning and highlights the systemically entrenched disadvantages (social, economic, and political) experienced by racial minorities in western countries; and this study underscores the need to address inequities in these communities to improve overall health outcomes.
Background Access to and delivery of comprehensive emergency obstetric and neonatal care (CEmONC)... more Background Access to and delivery of comprehensive emergency obstetric and neonatal care (CEmONC) services are often weak in low and middle-income countries affecting maternal and infant health outcomes. There are no studies on resources for maternal healthcare in the Northern region of Ghana. This knowledge is vital for health service planning and mobilising funding to address identified gaps. We investigated the available resources for managing CEmONC and referral services in the region. Methods This study involved a cross-sectional survey of maternity facilities in ten hospitals in the Northern region of Ghana, serving a population of 2,479,461, including 582,897 women aged 15–49. Public and faith-based hospitals were included in the study. We used the Service Provision Assessment tool to gather data for this study between October and December 2019. Given the small sample size, we used descriptive statistics to summarise the data using SPSS version 25 and Excel 2016. Results A to...
Background: sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highe... more Background: sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women.Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent health...
Introduction Female genital mutilation/cutting (FGM/C) comprises all procedures that involve the ... more Introduction Female genital mutilation/cutting (FGM/C) comprises all procedures that involve the total or partial elimination of the external genitalia or any injury to the female genital organ for non-medical purposes. More than 200 million females have undergone the procedure globally, with a prevalence of 89.6% in Sierra Leone. Education is acknowledged as a fundamental strategy to end FGM/C. This study aims to assess women's educational attainment and how this impacts their views on whether FGM/C should be discontinued in Sierra Leone. Methods We used data from the 2013 Sierra Leone Demographic and Health Survey. A total of 15,228 women were included in the study. We carried out a descriptive analysis, followed by Binary Logistic Regression analyses. We presented the results of the Binary Logistic Regression as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with 95% confidence intervals (CIs). Results Most of the women with formal education (65.5%) and 15.6% of those...
IntroductionThere is a paucity of research examining models of maternal and child health (MCH) ca... more IntroductionThere is a paucity of research examining models of maternal and child health (MCH) care for refugees in high-income countries. Attention has focused on tailoring existing healthcare services to meet the needs of this population and ensure accessible high-quality patient-centred care. This protocol reports the methodology of a study designed to identify models of care for African refugees in New South Wales (NSW), Australia, to determine the evidence for these models and the improvements necessary to best meet service needs that can be delivered in line with available resources, organisational readiness and capacity to implement.Methods and analysisThis multiphased, participatory research project will employ an exploratory, mixed-methods design. Preparatory activities involve a situational analysis of current MCH services for African refugees and associated policies and guidelines in NSW. We will consult key health service providers and analyse Australian census and settl...
Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highes... more Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highest burden of maternal and neonatal morbidity and mortality in the world. Timely and appropriate obstetric referral to a suitable health facility is a sign of effective health system. This paper presents the findings of a systematic review that aimed to identify what referral practices are delivered according to accepted standards for pregnant women and newborns in SSA LLMICs by competent healthcare providers and in line with the need and wishes of women. Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and effectiveness. We conducted a content analysis of data in the findings of each paper guided by a framework for assessing the quality of maternal referral. Results: Seventeen articles were included in the study. Most studies were quantitative (n=11). Quality maternal referral was define...
Background: Female genital mutilation (FGM) is prevalent in communities of migration. Given the h... more Background: Female genital mutilation (FGM) is prevalent in communities of migration. Given the harmful effects of the practice and its illegal status in many countries, there have been concerted primary, secondary and tertiary prevention efforts to protect girls from FGM. However, there is paucity of evidence concerning useful strategies and approaches to prevent FGM and improve the health and social outcomes of affected women and girls. Methods: We analysed peer-reviewed and grey literature to extract the evidence for FGM prevention interventions from a public health perspective in high income countries by a systematic search of bibliographic databases and websites using appropriate keywords. Identified publications were screened against selection criteria, following the PRISMA guidelines. We examined the characteristics of prevention interventions, including their programmatic approaches and strategies, target audiences and evaluation findings using an apriori template. Findings: Eleven documents included in this review described primary and secondary prevention activities. High income countries have given attention to legislative action, bureaucratic interventions to address social injustice and protect those at risk of FGM, alongside prevention activities that favour health persuasion, foster engagement with the local community through outreach and the involvement of community champions, healthcare professional training and capacity strengthening. Study types are largely process evaluations that include measures of short-term outcomes (pre-and post-changes in attitude, knowledge and confidence or audits of practices). There is a dearth of evaluative research focused on empowerment-oriented preventative activities that involve individual women and girls who are affected by FGM. Beattie's framework provides a useful way of articulating negotiated and authoritative prevention actions required to address FGM at national and local levels. Conclusion: FGM is a complex and deeply rooted sociocultural issue that requires a multifaceted response that encompasses socio-economic, physical and environmental factors, education and learning, health services and facilities, and community mobilisation activities. Investment in the rigorous longitudinal evaluation of FGM health prevention efforts are needed to provide strong evidence of impact to guide future decision making. A national evidence-based framework would bring logic, clarity, comprehension, evidence and economically more effective response for current and future prevention interventions addressing FGM in high income countries.
We are deeply grateful to everyone who participated in the study. Special thanks also go to Ms. H... more We are deeply grateful to everyone who participated in the study. Special thanks also go to Ms. Habiba of Habiba International, who played a great role of mobilizing the community influentials and who made arrangements for the interviews, to Hassan Mohamed and Mohamed Ibrahim who were the rapporteurs during the study, and to all the research assistants for their dedication and commitment.
This thesis explores three topics concerning youth in Kenya: their knowledge and information need... more This thesis explores three topics concerning youth in Kenya: their knowledge and information needs regarding sexual and reproductive health including HIV/AIDS; their sexual risk behaviour; and HIV prevention efforts targeted at them. The data on which these studies are based were collected in Kenya during 1999-2004. The studies were conducted in collaboration with several institutions including the Population Council in Nairobi, Institute of Tropical Medicine in Antwerp, SOMA-Net in Nairobi, Erasmus MC in Rotterdam, and NUFFIC in The Hague. The studies that are described in this thesis fill gaps in knowledge concerning risk factors that are crucial in the spread of STI/HIV, but have received little attention in the literature. Despite a growing interest in adolescent health, much remains unknown about the factors that enhance sexual risk among young people. For example, why are HIV rates in Kenya so high among young people and especially young women? Few studies have focussed on the...
Background We examined the evidence derived from healthcare professionals’ interfacing with women... more Background We examined the evidence derived from healthcare professionals’ interfacing with women with female genital mutilation (FGM) to comprehend the referral pathways available to these women in Australia. Main body Clinicians encountered FGM-related complications that included ruptured bladder and total urinary incontinence. Midwives and paediatricians indicated a lack of referral pathways for FGM, but used their discretion to refer such cases to social work departments, obstetric/gynaecological units, child protection service providers, psychological counsellors and surgeons. The continuum of care for women with FGM is characterised by inadequate and lack of clear referral pathways. This underscores the need to develop and strengthen referral pathways in response to physical, birthing and psychological complications of women with FGM to improve their care experiences in Australia. Short conclusion Capacity building initiatives on FGM-prevention and care for trainees and practi...
Background People from racial minority groups in western countries experience disproportionate so... more Background People from racial minority groups in western countries experience disproportionate socioeconomic and structural determinants of health disadvantages. These disadvantages have led to inequalities and inequities in health care access and poorer health outcomes. We report disproportionate disparities in prevalence, hospitalisation, and deaths from COVID-19 by racial minority populations. Methods We conducted a systematic literature search of relevant databases to identify studies reporting on prevalence, hospitalisations, and deaths from COVID-19 by race groups between 01 January 2020-15 April 2021. We grouped race categories into Blacks, Hispanics, Whites and Others. Random effects model using the method of DerSimonian and Laird were fitted, and forest plot with respective ratio estimates and 95% confidence interval (CI) for each race category, and subgroup meta-regression analyses and the overall pooled ratio estimates for prevalence, hospitalisation and mortality rate were presented. Results Blacks experienced significantly higher burden of COVID-19: prevalence ratio 1.79 (95% confidence interval (CI) = 1.59-1.99), hospitalisation ratio 1.87 (95% CI = 1.69-2.04), mortality ratio 1.68 (95% CI = 1.52-1.83), compared to Whites: prevalence ratio 0.70 (95% CI = 0.0.64-0.77), hospitalisation ratio 0.74 (95% CI = 0.65-0.82), mortality ratio 0.82 (95% CI = 0.78-0.87). Also, Hispanics experienced a higher burden: prevalence ratio 1.78 (95% CI = 1.63-1.94), hospitalisation ratio 1.32 (95% CI = 1.08-1.55), mortality ratio 0.94 (95% CI = 0.84-1.04) compared to Whites. A higher burden was also observed for Other race groups: prevalence ratio 1.43 (95% CI = 1.19-1.67), hospitalisation ratio 1.12 (95% CI = 0.89-1.35), mortality ratio 1.06 (95% CI = 0.89-1.23) compared to Whites. The disproportionate burden among Blacks and Hispanics remained following correction for publication bias. Conclusions Blacks and Hispanics have been disproportionately affected by COVID-19. This is deeply concerning and highlights the systemically entrenched disadvantages (social, economic, and political) experienced by racial minorities in western countries; and this study underscores the need to address inequities in these communities to improve overall health outcomes.
Background Access to and delivery of comprehensive emergency obstetric and neonatal care (CEmONC)... more Background Access to and delivery of comprehensive emergency obstetric and neonatal care (CEmONC) services are often weak in low and middle-income countries affecting maternal and infant health outcomes. There are no studies on resources for maternal healthcare in the Northern region of Ghana. This knowledge is vital for health service planning and mobilising funding to address identified gaps. We investigated the available resources for managing CEmONC and referral services in the region. Methods This study involved a cross-sectional survey of maternity facilities in ten hospitals in the Northern region of Ghana, serving a population of 2,479,461, including 582,897 women aged 15–49. Public and faith-based hospitals were included in the study. We used the Service Provision Assessment tool to gather data for this study between October and December 2019. Given the small sample size, we used descriptive statistics to summarise the data using SPSS version 25 and Excel 2016. Results A to...
Background: sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highe... more Background: sub-Saharan African Low and Lower-Middle Income Countries (sSA LLMICs) have the highest burden of maternal and perinatal morbidity and mortality in the world. Timely and appropriate maternal referral to a suitable health facility is an indicator of effective health systems. In this systematic review we aimed to identify which referral practices are delivered according to accepted standards for pregnant women and newborns in sSA LLMICs by competent healthcare providers in line with the needs of pregnant women.Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. Quality referral was defined as: timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent health...
Introduction Female genital mutilation/cutting (FGM/C) comprises all procedures that involve the ... more Introduction Female genital mutilation/cutting (FGM/C) comprises all procedures that involve the total or partial elimination of the external genitalia or any injury to the female genital organ for non-medical purposes. More than 200 million females have undergone the procedure globally, with a prevalence of 89.6% in Sierra Leone. Education is acknowledged as a fundamental strategy to end FGM/C. This study aims to assess women's educational attainment and how this impacts their views on whether FGM/C should be discontinued in Sierra Leone. Methods We used data from the 2013 Sierra Leone Demographic and Health Survey. A total of 15,228 women were included in the study. We carried out a descriptive analysis, followed by Binary Logistic Regression analyses. We presented the results of the Binary Logistic Regression as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with 95% confidence intervals (CIs). Results Most of the women with formal education (65.5%) and 15.6% of those...
IntroductionThere is a paucity of research examining models of maternal and child health (MCH) ca... more IntroductionThere is a paucity of research examining models of maternal and child health (MCH) care for refugees in high-income countries. Attention has focused on tailoring existing healthcare services to meet the needs of this population and ensure accessible high-quality patient-centred care. This protocol reports the methodology of a study designed to identify models of care for African refugees in New South Wales (NSW), Australia, to determine the evidence for these models and the improvements necessary to best meet service needs that can be delivered in line with available resources, organisational readiness and capacity to implement.Methods and analysisThis multiphased, participatory research project will employ an exploratory, mixed-methods design. Preparatory activities involve a situational analysis of current MCH services for African refugees and associated policies and guidelines in NSW. We will consult key health service providers and analyse Australian census and settl...
Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highes... more Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highest burden of maternal and neonatal morbidity and mortality in the world. Timely and appropriate obstetric referral to a suitable health facility is a sign of effective health system. This paper presents the findings of a systematic review that aimed to identify what referral practices are delivered according to accepted standards for pregnant women and newborns in SSA LLMICs by competent healthcare providers and in line with the need and wishes of women. Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and effectiveness. We conducted a content analysis of data in the findings of each paper guided by a framework for assessing the quality of maternal referral. Results: Seventeen articles were included in the study. Most studies were quantitative (n=11). Quality maternal referral was define...
Background: Female genital mutilation (FGM) is prevalent in communities of migration. Given the h... more Background: Female genital mutilation (FGM) is prevalent in communities of migration. Given the harmful effects of the practice and its illegal status in many countries, there have been concerted primary, secondary and tertiary prevention efforts to protect girls from FGM. However, there is paucity of evidence concerning useful strategies and approaches to prevent FGM and improve the health and social outcomes of affected women and girls. Methods: We analysed peer-reviewed and grey literature to extract the evidence for FGM prevention interventions from a public health perspective in high income countries by a systematic search of bibliographic databases and websites using appropriate keywords. Identified publications were screened against selection criteria, following the PRISMA guidelines. We examined the characteristics of prevention interventions, including their programmatic approaches and strategies, target audiences and evaluation findings using an apriori template. Findings: Eleven documents included in this review described primary and secondary prevention activities. High income countries have given attention to legislative action, bureaucratic interventions to address social injustice and protect those at risk of FGM, alongside prevention activities that favour health persuasion, foster engagement with the local community through outreach and the involvement of community champions, healthcare professional training and capacity strengthening. Study types are largely process evaluations that include measures of short-term outcomes (pre-and post-changes in attitude, knowledge and confidence or audits of practices). There is a dearth of evaluative research focused on empowerment-oriented preventative activities that involve individual women and girls who are affected by FGM. Beattie's framework provides a useful way of articulating negotiated and authoritative prevention actions required to address FGM at national and local levels. Conclusion: FGM is a complex and deeply rooted sociocultural issue that requires a multifaceted response that encompasses socio-economic, physical and environmental factors, education and learning, health services and facilities, and community mobilisation activities. Investment in the rigorous longitudinal evaluation of FGM health prevention efforts are needed to provide strong evidence of impact to guide future decision making. A national evidence-based framework would bring logic, clarity, comprehension, evidence and economically more effective response for current and future prevention interventions addressing FGM in high income countries.
We are deeply grateful to everyone who participated in the study. Special thanks also go to Ms. H... more We are deeply grateful to everyone who participated in the study. Special thanks also go to Ms. Habiba of Habiba International, who played a great role of mobilizing the community influentials and who made arrangements for the interviews, to Hassan Mohamed and Mohamed Ibrahim who were the rapporteurs during the study, and to all the research assistants for their dedication and commitment.
This thesis explores three topics concerning youth in Kenya: their knowledge and information need... more This thesis explores three topics concerning youth in Kenya: their knowledge and information needs regarding sexual and reproductive health including HIV/AIDS; their sexual risk behaviour; and HIV prevention efforts targeted at them. The data on which these studies are based were collected in Kenya during 1999-2004. The studies were conducted in collaboration with several institutions including the Population Council in Nairobi, Institute of Tropical Medicine in Antwerp, SOMA-Net in Nairobi, Erasmus MC in Rotterdam, and NUFFIC in The Hague. The studies that are described in this thesis fill gaps in knowledge concerning risk factors that are crucial in the spread of STI/HIV, but have received little attention in the literature. Despite a growing interest in adolescent health, much remains unknown about the factors that enhance sexual risk among young people. For example, why are HIV rates in Kenya so high among young people and especially young women? Few studies have focussed on the...
Uploads
Papers by C Njue