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Postpartum care is a critical element for ensuring survival and health of mothers and newborns but is often inadequate in low- and middle-income countries due to barriers to access and resource constraints. Newly delivered mothers and their families often rely on traditional forms of postnatal care rooted in social and cultural customs or may blend modern and traditional forms of care. This ethnographic study sought to explore use of biomedical and traditional forms of postnatal care. Data were collected through unstructured observation and in-depth interviews with 15 mothers. Participants reported embracing traditional understandings of health and illness in the post-partum period centered on heating the body through diet, steaming, and other applications of heat, yet also seeking injections from private health care providers. Thematic analysis explored concepts related to transitioning forms of postnatal care, valuing of care through different lenses, and diverse sources of advice on postnatal care. Mothers also described concurrent use of both traditional medicine and biomedical postnatal care, and the importance of adhering to cultural traditions of postnatal care for future health. Maternal and newborn health are closely associated with postnatal care, so ensuring culturally appropriate and high-quality care must be an important priority for stakeholders including understand health practices that are evolving to include injections.

As health professionals develop health communication for coronavirus disease 2019 (COVID-19), we implore that these communication approaches do not include fear appeals. Fear appeals, also known as scare tactics, have been widely used to promote recommended preventive behaviors. We contend that unintended negative outcomes can result from fear appeals that intensify the already complex pandemic and efforts to contain it. We encourage public health professionals to reevaluate their desire to use fear appeals in COVID-19 health communication and recommend that evidence-based health communication be utilized to address the needs of a specific community, help people understand what they are being asked to do, explain step-by-step how to complete preventative behaviors, and consider external factors needed to support the uptake of behaviors. To aid health professionals in redirecting away from the use of fear appeals, we offer a phased approach to creating health communication messages during the COVID-19 crisis.

In March 2020, most institutions of higher education (IHEs) closed their campuses and transitioned to online learning in the wake of the coronavirus disease 2019 (COVID-19) pandemic. With the COVID-19 pandemic continuing for the foreseeable future, IHEs had the difficult task of determining their plans for the fall semester and the remainder of the 2020-2021 academic year. As of January 4, 2021, more than 20.5 million COVID-19 cases had been confirmed and more than 350 000 deaths were directly attributed to COVID-19 in the United States,1 and universities were considered one of the highest-risk settings for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.2 As of December 11, 2020, more than 397 000 cases of COVID-19 had been confirmed on college campuses nationally,3 and COVID-19 cases on college campuses have been associated with community spread.4 Young adults who do not have comorbidities have been found to have prolonged illness after COVID-19 diagnosis.5 With 20 million enrolled students and an additional 4 million faculty and staff members in more than 6000 postsecondary institutions across the United States,6,7 IHEs have made and continue to make decisions about COVID-19 prevention that will have widespread implications for both people affiliated with IHEs and communities at large.

Maternal and under five-year-old mortality rates have reduced in the last two decades globally due to concerted effort, yet newborn deaths remain unacceptably prevalent. Behavior change is an important component of interventions to address newborn health problems in low-income countries. In Cambodia, maternal and newborn mortality has markedly decreased, and continued improvements will allow the country to achieve further reduction in newborn morbidity. The results of an implementation study of the Newborn Care and Infection Control Initiative using process evaluation are presented to provide insight into the trial implementation and context of the program that may have contributed to intervention results. The study utilized a mixed method process to explore the context, mechanisms, and implementation of intervention components: training of village health support group volunteers to provide home visits, training of midwives on infection prevention and control around the perinatal period, counseling on newborn care, and provision of training materials for counseling and intervention. Implementation was evaluated through quantitative and qualitative data collection including surveys, observation, semi-structured interviews, focus groups, and visual media. Descriptive statistics summarized the quantitative data and thematic analysis was used to explore the qualitative data. The evaluation identified several factors that might have influenced the outcomes of the trial: continuity of health center staff communication, timing and ability to complete home visits, and training quality. Additional support for parents in the perinatal period, preferably provided at the community level, will contribute to further improvement in health outcomes for newborns in this area. Researchers in this context should consider mechanisms to improve the coordination of health facility staff counseling while providing support and resources to ensure home visits to families with newborns are made on time. Attention to staffing, training, and quality of newborn health interventions is critical in planning for the scaling-up of newborn health programming.

Objective: Tulane University School of Public Health and Tropical Medicine created a program planning course required for all master of public health (MPH) students to address the revised 2016 Council on Education for Public Health (CEPH) foundational competencies. The objective of this study was to examine students’ feedback on this new class based on their reflective writing. Methods: Students across 3 class sections during 3 semesters (fall 2018, spring 2019, and fall 2019) wrote a reflection paper as a final assignment about their course experience (N = 102). We conducted a conventional qualitative content analysis of deidentified student responses to systematically examine themes in the overarching areas of what students found valuable about the course and what they would want to be improved. We calculated frequency counts of themes to further contextualize the findings. Results: Students found the following aspects of the course valuable: a positive perception shift toward program planning (93.1%), new transferable career skills (87.3%), the course format (77.5%), course content (69.6%), working in teams (52.0%), course assignments (47.1%), and the instructional team (31.4%). Critiques included the following: more support for course assignments (39.2%), challenges of working in teams (27.5%), aspects of the course format (25.5%), gaps in course content (19.6%), and wanting more consultations with the instructional team (5.9%). About 14% of students stated there was nothing or little they would change about the course. Conclusion: Overall, the course received positive feedback from students. They identified several valuable course components and areas that could be enhanced, which we have worked to improve. We offer the course as a potential model for how schools and programs of public health can meet the 2016 CEPH competencies.

Infectious disease outbreaks are associated with substantial stigma, which can have negative effects on affected persons and communities and on outbreak control. Thus, measuring stigma in a standardized and validated manner early in an outbreak is critical to disease control. We reviewed existing scales used to assess stigma during outbreaks. Our findings show that many different scales have been developed, but few have been used more than once, have been adequately validated, or have been tested in different disease and geographic contexts. We found that scales were usually developed too slowly to be informative early during an outbreak and were published a median of 2 years after the first case of an outbreak. A rigorously developed, transferable stigma scale is needed to assess and direct responses to stigma during infectious disease outbreaks.

Stigma is widely observed during (re)emerging infectious disease outbreaks, contributing to psychological distress, social isolation, and care-seeking hesitancy. Despite this, it is often inadequately addressed in public health responses, partly due to the lack of a fit-for-purpose approach. The objective of this study was to develop a conceptual model to facilitate structured consideration of stigma during (re)emerging disease outbreaks. We conducted 34 in-depth interviews with international stakeholders across 25 outbreak-prone diseases, including emergency response leaders, frontline responders, researchers, and community advocates. We analysed transcripts using thematic analysis, integrating insights from social and behavioural theories to refine the model. We introduce the hourglass stigma model, a theory-informed conceptualisation of stigma in outbreaks. The model consists of five domains (major themes): context, thoughts, emotions, manifestations, and impact. Within each domain there are key considerations, such as the influence of response measures on concealability (context), the association of certain diseases with ‘dirtiness’ due to hygiene-dominant messaging (thoughts), the negative effects of fear-based appeals (emotions), the enactment of stigma due to unconscious bias (manifestations), and the enduring consequences of (mis)trust in institutions (impact). The hourglass model can be used to inform operational tools, ensuring stigma is adequately addressed in outbreak preparedness and response activities.

Background A manual approach to case investigation and contact tracing can introduce delays in response and challenges for field teams. Go.Data, an outbreak response tool developed by the World Health Organization (WHO) in collaboration with the Global Outbreak Alert and Response Network, streamlines data collection and analysis during outbreaks. This study aimed to characterize Go.Data use during COVID-19, elicit shared benefits and challenges, and highlight key opportunities for enhancement. Methods This study utilized mixed methods through qualitative interviews and a quantitative survey with Go.Data implementors on their experiences during COVID-19. Survey data was analyzed for basic univariate statistics. Interview data were coded using deductive and inductive reasoning and thematic analysis of categories. Overarching themes were triangulated with survey data to clarify key findings. Results From April to June 2022, the research team conducted 33 interviews and collected 41 survey responses. Participants were distributed across all six WHO regions and 28 countries. While most implementations represented government actors at national or subnational levels, additional inputs were collected from United Nations agencies and universities. Results highlighted WHO endorsement, accessibility, adaptability, and flexible support modalities as main enabling factors. Formalization and standardization of data systems and people processes to prepare for future outbreaks were a welcomed byproduct of implementation, as 76% used paper-based reporting prior and benefited from increased coordination around a shared platform. Several challenges surfaced, including shortage of the appropriate personnel and skill-mix within teams to ensure smooth implementation. Among opportunities for enhancements were improved product documentation and features to improve usability with large data volumes. Conclusions This study was the first to provide a comprehensive picture of Go.Data implementations during COVID-19 and what joint lessons could be learned. It ultimately demonstrated that Go.Data was a useful complement to responses across diverse contexts, and helped set a reproducible foundation for future outbreaks. Concerted preparedness efforts across the domains of workforce composition, data architecture and political sensitization should be prioritized as key ingredients for future Go.Data implementations. While major developments in Go.Data functionality have addressed some key gaps highlighted during the pandemic, continued dialogue between WHO and implementors, including cross-country experience sharing, is needed ensure the tool is reactive to evolving user needs.

Background Stigma emerged as a prominent public health challenge in the global mpox outbreak that began in 2022, impeding outbreak control efforts and the well-being of affected individuals. Addressing stigma is important for improving infection prevention and control. Despite frequent mention in public and policy discourse, robust assessment of mpox stigma is lacking. This study investigated the causes, manifestations, and impacts of mpox-related stigma in the UK, focusing on anticipated stigma among directly and indirectly affected communities. Methods We conducted an online, mixed-methods cross-sectional survey to assess mpox stigma. We developed and content validated a new tool, the Stigma Survey and Community-based Assessment for New and Re-emerging outbreaks (Stigma-SCANR) for this purpose. Through quota sampling, the survey targeted populations most affected by mpox at the time of data collection (March–July 2024), including gay, bisexual, and other men who have sex with men (GBMSM), and healthcare workers. The survey primarily explored anticipated stigma. Respondents with previous mpox diagnoses were asked about personal experiences of stigma. Results Of 479 respondents who initiated the survey, 437 (91%) were included in analyses. In modules related to drivers of stigma, pre-existing prejudices towards associated groups such as GBMSM and migrants were emphasised, alongside fear and misinformation. On average, respondents anticipated higher levels of negative judgement and unwarranted avoidance compared to other forms of social stigma, particularly from casual partners and the public. Among the 13 respondents who reported a previous mpox diagnosis, 11 (85%) had experienced mpox-related stigma. Nearly a quarter of respondents (24%) said they would not, or were unlikely to, tell a recent sexual partner about an mpox diagnosis. Feelings of shame were considered the most common barrier to care-seeking (299 respondents, 68%). Conclusions This analysis of mpox stigma in the UK offers insights for international outbreak response, particularly in countries with similarly affected communities. Lessons learnt may also be transferable to other disease outbreaks. We propose practical recommendations for reducing stigma in future outbreaks, including peer support initiatives, distributing accessible information about safe timelines for returning to socialising and work or school, and co-designing public communications and contact tracing programmes with affected community members.

Following the Supreme Court's 2022 decision in , Louisiana enacted a \"trigger law\" banning nearly all abortions. Attempts to reform existing restrictive legislation so as to allow for abortions under exceptions have been unsuccessful to date. This study aims to describe how abortion discourse is framed in public testimony around House Bill 346 in the 2023 Louisiana legislative session, which attempted to pass an abortion exception for pregnancy in the case of rape or incest. We conducted a conventional qualitative content analysis utilizing a rhetorical lens, using testimony transcripts from the May 10, 2023, Louisiana Administration of Criminal Justice Committee hearing. An iterative coding approach allowed us to categorize salient themes, language patterns, speaker characteristics, emotional tones, and rhetorical strategies. Demographic characteristics were ascribed to speakers based on perceived gender and race when not self-identified. Testimony analysis revealed four primary themes: (1) conflicting representations of abortion, (2) religion's role in shaping discourse, (3) humanization of fetuses vs. pregnant individuals, and (4) debate over available resources for survivors and children. Abortion is represented as being traumatic, adding to the trauma caused by sexual violence, while representing childbearing as healing from trauma. Being conceived as a result of sexual violence is used as an identity marker worthy of protection. Religious rhetoric permeates testimony both in support and in opposition to abortion exceptions, making a \"pro-life\" stance the starting point for debate. Lastly, we find evidence of dehumanization of survivors' and others' experience. The testimonies around HB346 expose deeply polarized discourse that reflects moral, religious, and ethical conflicts, as well as mismatched conversations that are unlikely to persuade opposing sides. Addressing these dissonant narratives requires nuanced advocacy strategies and resources to support effective testimony.