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Kinsman, John
Publications (10 of 66) Show all publications
Zulu, J. M., Kinsman, J., Hurtig, A.-K., Michelo, C., George, A. & Schneider, H. (2019). Integrating community health assistant-driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: mapping key actors, points of integration, and conditions shaping the process. Reproductive Health, 16(1), Article ID 122.
Open this publication in new window or tab >>Integrating community health assistant-driven sexual and reproductive health services in the community health system in Nyimba district in Zambia: mapping key actors, points of integration, and conditions shaping the process
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2019 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 16, no 1, article id 122Article in journal (Refereed) Published
Abstract [en]

Introduction: Although large scale public sector community health worker programs have been key in providing sexual and reproductive health (SRH) services in low- and middle-income countries, their integration process into community health systems is not well understood. This study aimed to identify the conditions and strategies through which Community Health Assistants (CHAs) gained entry and acceptability into community health systems to provide SRH services to youth in Zambia. The country's CHA program was launched in 2010.

Methodology: A phenomenological design was conducted in Nyimba district. All nine CHAs deployed in Nyimba district were interviewed in-depth on their experiences of navigating the introduction of SRH services for youth in community settings, and the data obtained analyzed thematically.

Results: In delivering SRH services targeting youth, CHAs worked with a range of community actors, including other health workers, safe motherhood action groups, community health workers, neighborhood health committees, teachers, as well as political, traditional and religious leaders. CHAs delivered SRH education and services in health facilities, schools, police stations, home settings, and community spaces. They used their health facility service delivery role to gain trust and entry into the community, and they also worked to build relationships with other community level actors by holding regular joint meetings, and acting as brokers between the volunteer health workers and the Ministry of Health. CHAs used their existing social networks to deliver SRH services to adolescents. By embedding the provision of information about SRH into general life skills at community level, the topic's sensitivity was reduced and its acceptability was enhanced. Further, support from community leaders towards CHA-driven services promoted the legitimacy of providing SRH for youth. Factors limiting the acceptability of CHA services included the taboo of discussing sexuality issues, a gender discriminatory environment, competition with other providers, and challenges in conducting household visits.

Conclusion: Strengthening CHAs' ability to negotiate and navigate and gain acceptability in the community health system as they deliver SRH, requires support from both the formal health system and community networks. Limitations to the acceptability of CHA-driven SRH services are a product of challenges both in the community and in the formal health system.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Community health assistants, Community health system, Sexual and reproductive health services
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162431 (URN)10.1186/s12978-019-0788-4 (DOI)000480717500002 ()31409362 (PubMedID)2-s2.0-85070755686 (Scopus ID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-09-02Bibliographically approved
Watkins, J. A., Wagner, F., Gomez-Olive, F. X., Wertheim, H., Sankoh, O. & Kinsman, J. (2019). Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site. American Journal of Tropical Medicine and Hygiene, 100(6), 1378-1390
Open this publication in new window or tab >>Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site
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2019 (English)In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 100, no 6, p. 1378-1390Article in journal (Refereed) Published
Abstract [en]

Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque's "Access to Healthcare" framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of "ABR" was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people's understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics.

Place, publisher, year, edition, pages
AMER SOC TROP MED & HYGIENE, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162028 (URN)10.4269/ajtmh.18-0171 (DOI)000476674600014 ()30994091 (PubMedID)
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-08Bibliographically approved
Abraha, A., Myléus, A., Byass, P., Kahsay, A. & Kinsman, J. (2019). Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia. PLoS ONE, 14(6), Article ID e0218101.
Open this publication in new window or tab >>Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia
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2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 6, article id e0218101Article in journal (Refereed) Published
Abstract [en]

Despite the significant reductions seen in under-5 child mortality in Ethiopia over the last two decades, more than 10,000 children still die each year in Tigray Region alone, of whom 75% die from preventable diseases. Using an equity lens, this study aimed to investigate the social determinants of child health in one particularly vulnerable district as a means of informing the health policy decision-making process. An exploratory qualitative study design was adopted, combining focus group discussions and qualitative interviews. Seven Focus Group Discussions with mothers of young children, and 21 qualitative interviews with health workers were conducted in Wolkayit district in May-June 2015. Data were subjected to thematic analysis. Mothers’ knowledge regarding the major causes of child mortality appeared to be good, and they also knew about and trusted the available child health interventions. However, utilization and practice of these interventions was limited by a range of issues, including cultural factors, financial shortages, limited female autonomy on financial resources, seasonal mobility, and inaccessible or unaffordable health services. Our findings pointed to the importance of a multi-sectoral strategy to improve child health equity and reduce under-5 mortality in Wolkayit. Recommendations include further decentralizing child health services to local-level Health Posts, and increasing the number of Health Facilities based on local topography and living conditions.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-160500 (URN)10.1371/journal.pone.0218101 (DOI)000471238300048 ()31194787 (PubMedID)
Funder
Swedish Research Council, C0615601
Available from: 2019-06-19 Created: 2019-06-19 Last updated: 2019-07-11Bibliographically approved
Sunpuwan, M., Punpuing, S., Jaruruengpaisan, W., Kinsman, J. & Wertheim, H. (2019). What is in the drug packet?: access and use of non-prescribed poly-pharmaceutical packs (Yaa Chud) in the community in Thailand. BMC Public Health, 19(1), Article ID 971.
Open this publication in new window or tab >>What is in the drug packet?: access and use of non-prescribed poly-pharmaceutical packs (Yaa Chud) in the community in Thailand
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 971Article in journal (Refereed) Published
Abstract [en]

Background: ‘Yaa Chud’ is a non-prescribed poly-pharmaceutical pack containing several types of drugs, including antibiotics and steroids, which can be purchased over the counter in Thailand for self-medication. Although it is illegal, it is still available at some community outlets. This study aimed to understand access to and use of Yaa Chud at the community level in order to raise awareness on its usage and to provide policy recommendations to address the problem.

Methods: This study employed qualitative methods, including in-depth interviews with 18 drug suppliers and 16 community members, and six focus group discussions. It included inventories from 17 drug suppliers. Data were collected in selected communities of the Kanchanaburi Demographic Surveillance System, located in the western region of Thailand.Thematic analysis was based upon the Health Services Utilization Model and conducted using the Open Code qualitative software program.

Results: Overcrowding, long waiting times, and a perceived unwelcoming environment at public health-care service outlets were identified as factors that drive people into the private sector, where loose regulation of drug laws facilitates access and use of Yaa Chud. Migrants and older people were most likely to seek and use Yaa Chud, especially for mild illness. Availability, easy access through a user’s network, low cost, and perceived effectiveness were identified as factors that enable access and use of Yaa Chud.

Conclusions: Though illegal in Thailand, Yaa Chud is likely to remain available for self-medication by community members, due to the persisting demand by the elderly and migrant workers. There is an urgent need to replace these mixed medications with better choices. Safer Yaa Chud may be a preferred, first-line health-care option, which could help reduce congestion in the formal health-care setting. At the same time, enforcement of regulatory compliance needs to be continued in order to stop the supply of unsafe Yaa Chud.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Yaa Chud, unknown medicine, Access, Use, Thailand
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-164654 (URN)10.1186/s12889-019-7300-5 (DOI)000484302000002 ()31331304 (PubMedID)
Available from: 2019-10-25 Created: 2019-10-25 Last updated: 2019-10-25Bibliographically approved
Cambaco, O., Kinsman, J., Sigauque, B., Wertheim, H., Nga, N. D., Langba, J., . . . Munguambe, K. (2018). Awareness about appropriate antibiotic use in a rural district in sub-saharan Africa: where is the startin point for prevention of antibiotic resistence?. Paper presented at 67th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTHM), OCT 28-NOV 01, 2018, New Orleans, LA. American Journal of Tropical Medicine and Hygiene, 99(4), 251-251
Open this publication in new window or tab >>Awareness about appropriate antibiotic use in a rural district in sub-saharan Africa: where is the startin point for prevention of antibiotic resistence?
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2018 (English)In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 99, no 4, p. 251-251Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
American Society of Tropical Medicine & Hygiene (ASTMH), 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158125 (URN)000461386603131 ()
Conference
67th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTHM), OCT 28-NOV 01, 2018, New Orleans, LA
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Schumann, B., Kinsman, J. & Lindvall, K. (2018). ClimRef project – Resilient public health in the context of large-scale, drought-related migration in East Africa: Knowledge status and knowledge needs: Ethiopia country report.
Open this publication in new window or tab >>ClimRef project – Resilient public health in the context of large-scale, drought-related migration in East Africa: Knowledge status and knowledge needs: Ethiopia country report
2018 (English)Report (Other academic)
Publisher
p. 24
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162172 (URN)
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-16Bibliographically approved
Schumann, B., Kinsman, J. & Lindvall, K. (2018). ClimRef project – Resilient public health in the context of large-scale, drought-related migration in East Africa: Knowledge status and knowledge needs: Kenya country report.
Open this publication in new window or tab >>ClimRef project – Resilient public health in the context of large-scale, drought-related migration in East Africa: Knowledge status and knowledge needs: Kenya country report
2018 (English)Report (Other academic)
Publisher
p. 25
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162171 (URN)
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-16Bibliographically approved
Schumann, B., Kinsman, J. & Lindvall, K. (2018). ClimRef project – Resilient public health in the context of large-scale, drought-related migration in East Africa: Knowledge status and knowledge needs: Somalia country report.
Open this publication in new window or tab >>ClimRef project – Resilient public health in the context of large-scale, drought-related migration in East Africa: Knowledge status and knowledge needs: Somalia country report
2018 (English)Report (Other academic)
Publisher
p. 23
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162170 (URN)
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-16Bibliographically approved
Zulu, J. M., Goicolea, I., Kinsman, J., Sandøy, I. F., Blystad, A., Mulubwa, C., . . . Hurtig, A.-K. (2018). Community based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A realist evaluation protocol from Zambia. Reproductive Health, 15, Article ID 145.
Open this publication in new window or tab >>Community based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A realist evaluation protocol from Zambia
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2018 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 15, article id 145Article in journal (Refereed) Published
Abstract [en]

Background: Research that explores how community-based interventions for strengthening adolescent sexual reproductive health and rights (SRHR) can be integrated and sustained in community health systems, is, to the best of our knowledge, very scarce, if not absent. It is important to document mechanisms that shape integration process in order to improve health systems' responsiveness towards adolescents' SRHR. This realist evaluation protocol will contribute to this knowledge in Zambia where there is increased attention towards promoting maternal, neonatal and child health as a means of addressing the current high early pregnancy and marriage rates. The protocol will ascertain: why, how, and under what conditions the integration of SRHR interventions into Zambian community health systems will optimise (or not) acceptability and adoption of SRHR services. This study is embedded within a randomized controlled trial - "Research Initiative to Support the Empowerment of Girls (RISE) "-which aims to reduce adolescent girl pregnancies and marriages through a package of interventions including economic support to families, payment of school fees to keep girls in school, pocket money for girls, as well as youth club and community meetings on reproductive health.

Methods: This is a multiple-case study design. Data will be collected from schools, health facilities and communities through individual and group interviews, photovoice, documentary review, and observations. The study process will involve 1) developing an initial causal theory that proposes an explanation of how the integration of a community-based intervention that aimed to integrate adolescent SRHR into the community health system may lead to adolescent-friendly services; 2) refining the causal theory through case studies; 3) identifying contextual conditions and mechanisms that shape the integration process; and 4) finally proposing a refined causal theory and set of recommendations to guide policy makers, steer further research, and inform teaching programmes.

Discussion: The study will document relevant values as well as less formal and horizontal mechanisms which shape the integration process of SRHR interventions at community level. Knowledge on mechanisms is essential for guiding development of strategies for effectively facilitating the integration process, scaling up processes and sustainability of interventions aimed at reducing SRH problems and health inequalities among adolescents.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Realist evaluation, Sexual and reproductive health, Community health systems, Adolescents, Zambia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-151783 (URN)10.1186/s12978-018-0590-8 (DOI)000443348900003 ()30153839 (PubMedID)
Funder
Swedish Research Council
Available from: 2018-09-14 Created: 2018-09-14 Last updated: 2018-09-14Bibliographically approved
Kinsman, J., Stöven, S., Elgh, F., Murillo, P. & Sulzner, M. (2018). Good practices and challenges in addressing poliomyelitis and measles in the European Union. European Journal of Public Health, 28(4), 730-734
Open this publication in new window or tab >>Good practices and challenges in addressing poliomyelitis and measles in the European Union
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2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 4, p. 730-734Article in journal (Refereed) Published
Abstract [en]

Background: All European Union (EU) and European Economic Area (EEA) Member States have pledged to ensure political commitment towards sustaining the region's poliomyelitis-free status and eliminating measles. However, there remain significant gaps between policy and practice in many countries. This article reports on an assessment conducted for the European Commission that aimed to support improvements in preparedness and response to poliomyelitis and measles in Europe.

Methods: A documentary review was complemented by qualitative interviews with professionals working in International and EU agencies, and in at-risk or recently affected EU/EEA Member States (six each for poliomyelitis and measles). Twenty-six interviews were conducted on poliomyelitis and 24 on measles; the data were subjected to thematic analysis. Preliminary findings were then discussed at a Consensus Workshop with 22 of the interviewees and eight other experts.

Results: Generic or disease-specific plans exist in the participating countries and cross-border communications during outbreaks were generally reported as satisfactory. However, surveillance systems are of uneven quality, and clinical expertise for the two diseases is limited by a lack of experience. Serious breaches of protocol have recently been reported from companies producing poliomyelitis vaccines, and vaccine coverage rates for both diseases were also sub-optimal. A set of suggested good practices to address these and other challenges is presented.

Conclusions: Poliomyelitis and measles should be brought fully onto the policy agendas of all EU/EEA Member States, and adequate resources provided to address them. Each country must abide by the relevant commitments that they have already made.

Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-150590 (URN)10.1093/eurpub/cky056 (DOI)000440944400026 ()29659793 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-09-11Bibliographically approved
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