Foul wind, spirits and witchcraft: illness conceptions and health-seeking behaviour for malaria in the Gambia

‘The strength of this study lies in its in-depth understanding of how malaria symptoms can be interpreted as different disease categories and thus attributed to different causes, leading to different health-seeking itineraries, even when an individual knows that ‘malaria’ is transmitted through mosquitoes and what the biomedically prescribed treatment regime is.’

CITATION: Foul wind, spirits and witchcraft: illness conceptions and health-seeking behaviour for malaria in the Gambia

Sarah O’Neill et al. Malaria Journal 2015, 14:167  doi:10.1186/s12936-015-0687-2

Corresponding author: Sarah O’Neill


Background: As the disease burden in the Gambia has reduced considerably over the last decade, heterogeneity in malaria transmission has become more marked, with infected but asymptomatic individuals maintaining the reservoir. The identification, timely diagnosis and treatment of malaria-infected individuals are crucial to further reduce or eliminate the human parasite reservoir. This ethnographic study focused on the relationship between local beliefs of the cause of malaria and treatment itineraries of suspected cases.

Methods: An ethnographic qualitative study was conducted in twelve rural communities in the Upper River Region and the Central River Region in the Gambia. The data collection methods included in-depth interviews, participant observation, informal conversations, and focus group discussions.

Results: While at first glance, the majority of people seek biomedical treatment for ‘malaria’, there are several constraints to seeking treatment at health centres. Certain folk illnesses, such as Jontinoojeand Kajeje, translated and interpreted as ‘malaria’ by healthcare professionals, are often not considered to be malaria by local populations but rather as self-limiting febrile illnesses ? consequently not leading to seeking care in the biomedical sectoor. Furthermore, respondents reported delaying treatment at a health centre while seeking financial resources, and consequently relying on herbal treatments. In addition, when malaria cases present symptoms, such as convulsions, hallucinations and/or loss of consciousness, the illness is often interpreted as having a supernatural aetiology, leading to diagnosis and treatment by traditional healers.

Conclusion: Although malaria diagnostics and treatment-seeking in the biomedical sector has been reported to be relatively high in the Gambia compared to other sub-Saharan African countries, local symptom interpretation and illness conceptions can delay or stop people from seeking timely biomedical treatment, which may contribute to maintaining a parasite reservoir of undiagnosed and untreated malaria patients.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  


Special Issue: “Telemedicine, Telehealth and Health Information Technology in Low Resource Countries”

Hello all,

Science Journal of Public Health (SJPH) , a peer-reviewed open access journal published bimonthly in English-language, provides a international forum for the presentation of research findings and scholarly exchange in the area of health and related fields. The journal has a special focus on the social determinants of health, the environmental, behavioral, epidemiology, health services research, nursing, social work, medicine, and occupational correlates of health and disease, and the impact of health policies, practices and interventions on the community. Although preference is given to manuscripts presenting the findings of original research, review and methodological pieces will also be considered.

has a special issue  on

“Telemedicine, Telehealth and Health Information Technology in Low Resource Countries”. I am the lead Guest Editor. You can visit and submit papers at

Thank you

Ebenezer Afarikumah,

“Be more concerned with your character than your reputation, because your character is what you really are, while your reputation is merely what others think you are”  John Wooden.

HIFA profile: Eben Afari-Kumah is a PhD candidate at the Accra Institute of Technology, Ghana. He is also a Research Scientist with the Council for Scientific and Industrial Research, Ghana, and an adjunct Lecturer at the University of Ghana (School of Public Health and Business School). His Master’s Dissertation was on “Developing patient data mining system for the University of Ghana Hospital. Eben is currently researching into the adoption, use and sustainabilty of Telemedicine in Ghana. He is a HIFA2015 Country Representative. eben.afari AT

Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)

Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)

Kristine Sørensen , Jürgen M. Pelikan , Florian Röthlin , Kristin Ganahl , Zofia Slonska , Gerardine Doyle , James Fullam , Barbara Kondilis , Demosthenes Agrafiotis , Ellen Uiters , Maria Falcon , Monika Mensing , Kancho Tchamov , Stephan van den Broucke , Helmut Brand

The European Journal of Public Health, 2015

First Published online: April 2015

Abstract / Resumen:

Background: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations.

Methods: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews.

Results: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29–62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model.

Discussion: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.

How to obtain this article / Como obtener el artículo: click here. (free access)


To send a message to the HIFA forum, simply send an email to:

THET guide: Technology for effective partnership collaboration

Technology for effective partnership collaboration

Tropical Health & Education Trust (THET) has developed a guide that identifies online and electronic tools that can help partnerships collaborate more effectively.

The guide can improve your partnership’s effectiveness in:

  • communicating with your team
  • communicating and working whilst travelling
  • communicating with your stakeholder
  • collaborating and working as a team
  • and managing information

Visit the THET website to download the guide.

Chipo Msengezi, ITOCA

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

WHO Guidelines for the treatment of malaria. Third edition, April 2015

For online version with hyperlinks to further information and publications, see:

As a personal comment, WHO is well recognised for its rigorous approach to guideline development (the process has been greatly improved in the past 10 years), but little is known about the effectiveness of guideline implementation.  I am reminded of the systematic review I circulated on HIFA about an hour ago – almost all the studies identified were in high-income countries. Much more needs to be done to understand and strengthen the assimilation and adaptation of guidelines at national level in low- and middle-income countries.


Malaria case management, which consists of prompt diagnosis and effective treatment, remains a vital component of malaria control and elimination strategies. This third edition of the WHO Guidelines for the treatment of malaria contains updated recommendations based on new evidence as well as a recommendation on the use of drugs to prevent malaria in high-risk groups.

The core principles underpinning this edition include: early diagnosis and prompt, effective treatment; rational use of antimalarial treatment to ensure that only confirmed malaria cases receive antimalarials; the use of combination therapy in preventing or delaying development of resistance; and appropriate weight-based dosing of antimalarials to ensure prolonged useful therapeutic life and an equal chance of being cured for all patients…

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

Usage of an online tool to help policymakers better engage with research: Web CIPHER

How can health policymakers be more empowered to deliver evidence-informed policy? Australian researchers are trying a new multifaceted approach called Web CIPHER, ‘an online tool with dynamic interactive elements such as hot topics, research summaries, blogs from trusted figures in health policy and research, a community bulletin board, multimedia section and research portal’. The study below aims to examine policymakers’ use of the site, and determines which sections are key drivers of use. You can read more about and join Web CIPHER here:

CITATION: Usage of an online tool to help policymakers better engage with research: Web CIPHER

Steve R Makkar, Frances Gilham, Anna Williamson and Kellie Bisset

Implementation Science 2015, 10:56  doi:10.1186/s13012-015-0241-1

Published: 23 April 2015

Corresponding author: Steve R Makkar

ABSTRACT (provisional)

Background: There is a need to develop innovations that help policymakers better engage with research in order to increase its use in policymaking. As part of the Centre for Informing Policy in Health with Evidence from Research (CIPHER), we established Web CIPHER, an online tool with dynamic interactive elements such as hot topics, research summaries, blogs from trusted figures in health policy and research, a community bulletin board, multimedia section and research portal. The aim of this study was to examine policymakers’ use of the website, and determine which sections were key drivers of use.

Methods: Google Analytics (GA) was used to gather usage data during a 16-month period. Analysis was restricted to Web CIPHER members from policy agencies. We examined descriptive statistics including mean viewing times, number of page visits and bounce rates for each section and performed analyses of variance to compare usage between sections. Repeated measures analyses were undertaken to examine whether a weekly reminder email improved usage of Web CIPHER, particularly for research-related content.

Results: During the measurement period, 223 policymakers from more than 32 organisations joined Web CIPHER. Users viewed eight posts on average per visit and stayed on the site for approximately 4 min. The bounce rate was less than 6%. The Blogs and Community sections received more unique views than all other sections. Blogs relating to improving policymakers’ skills in applying research to policy were particularly popular. The email reminder had a positive effect on improving usage, particularly for research-related posts.

Conclusions: The data indicated a relatively small number of users. However, this sample may not be representative of policymakers since membership to the site and usage was completely voluntarily. Nonetheless, those who used the site appeared to engage well with it. The findings suggest that providing blog-type content written by trusted experts in health policy and research as well as regular email reminders may provide an effective means of disseminating the latest research to policymakers through an online web portal.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:

Trends in guideline implementation: a scoping systematic review

This review ‘identified that, despite the availability of evidence, taxonomies, theories, models and instruments by which to plan implementation, guidelines are most often implemented using educational strategies and print material. Most of the studies reviewed here achieved positive impact, which perhaps conflicts with the results of systematic reviews demonstrating that educational meetings and print material have a small impact on professional behaviour. Therefore, ongoing research might focus on ways to optimize the design of educational strategies and print material’.

The authors identified 32 eligible studies. All but one were done in high-income countries and most (21) focused on diabetes with other studies on arthritis (4), colorectal cancer (3) and heart failure (4). What is missing is research on guideline implementation in low-resource settings.

CITATION: Trends in guideline implementation: a scoping systematic review

Implementation Science Sample


Anna R Gagliardi, Samia Alhabib, and the members of the Guidelines International Network Implementation Working Group


Corresponding author:


Background: There is currently no reliable way to choose strategies that are appropriate for implementing guidelines facing different barriers. This study examined trends in guideline implementation by topic over a 10-year period to explore whether and how strategies may be suitable for addressing differing barriers.

Methods: A scoping systematic review was performed. MEDLINE and EMBASE were searched from 2004 to 2013 for studies that evaluated the implementation of guidelines on arthritis, diabetes, colorectal cancer and heart failure. Data on study characteristics, reason for implementation (new guideline or quality improvement), implementation strategy used, rationale for selecting that strategy and reported impact were extracted and summarized. Interventions were mapped against a published taxonomy of guideline implementation strategies.

Results: The search resulted in 1,709 articles; 156 were retrieved and 127 were excluded largely because they did not evaluate guideline implementation, leaving 32 eligible for review (4 arthritis, 3 colorectal cancer, 21 diabetes, 4 heart failure). Six of 7 randomized trials and 8 of 25 observational studies had a low risk of bias. Most studies promoted guideline use for quality improvement (78.0%). Few studies rationalized strategy choice (18.8%). Most employed multiple approaches and strategies, most often educational meetings and print material for professionals or patients. Few studies employed organizational, financial or regulatory approaches. Strategies employed that were unique to the published taxonomy included professional (print material, tailoring guidelines, self-audit training or material) and patient strategies (education, counselling, group interaction, print material, reminders). Most studies achieved positive impact (87.5%). This did not appear to be associated with guideline topic, use of theory or barrier assessment, or number or type of implementation approaches and strategies.

Conclusions: While few studies were eligible, limiting insight on how to choose implementation strategies that address guideline-specific barriers, this review identified other important findings. Education for professionals or patients and print material were the most commonly employed strategies for translating guidelines to practice. Mapping of strategies onto the published taxonomy identified gaps in guideline implementation that represent opportunities for future research and expanded the taxonomy.


To send a message to the HIFA forum, simply send an email to:

J Med Internet Res: Twitter-based journal clubs for discussion of health research

Many of us are familiar with journal clubs, where learning takes place among health professionals through discussion of the latest health research papers. Below is the citation and abstract of an interesting paper that looks at the ‘Globalization of Continuing Professional Development by Journal Clubs via Microblogging [Twitter]’. Has anyone on HIFA tried the ‘Twitter journal club’ model? Let us know your experience with this and/or with conventional face-to-face journal clubs.

HIFA itself is a kind of virtual journal club and I would be interested in your thoughts on whether/how we can develop this further. Also, remember that HIFA also has an active Twitter account, which you can join here: @hifa_org  (with thanks to HIFA Twitter coordinator Julie Storr, HIFA Steering Group, WHO Department of Service Delivery and Safety).

CITATION: Roberts MJ, Perera M, Lawrentschuk N, Romanic D, Papa N, Bolton D.

Globalization of Continuing Professional Development by Journal Clubs via Microblogging: A Systematic Review

J Med Internet Res 2015;17(4):e103

DOI: 10.2196/jmir.4194

Corresponding author: Roberts MJ. Email: m.roberts2 [at]


Background: Journal clubs are an essential tool in promoting clinical evidence-based medical education to all medical and allied health professionals. Twitter represents a public, microblogging forum that can facilitate traditional journal club requirements, while also reaching a global audience, and participation for discussion with study authors and colleagues.

Objective: The aim of the current study was to evaluate the current state of social media–facilitated journal clubs, specifically Twitter, as an example of continuing professional development.

Methods: A systematic review of literature databases (Medline, Embase, CINAHL, Web of Science, ERIC via ProQuest) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of Twitter, the followers of identified journal clubs, and Symplur was also performed. Demographic and monthly tweet data were extracted from Twitter and Symplur. All manuscripts related to Twitter-based journal clubs were included. Statistical analyses were performed in MS Excel and STATA.

Results: From a total of 469 citations, 11 manuscripts were included and referred to five Twitter-based journal clubs (#ALiEMJC, #BlueJC, #ebnjc, #urojc, #meded). A Twitter-based journal club search yielded 34 potential hashtags/accounts, of which 24 were included in the final analysis. The median duration of activity was 11.75 (interquartile range [IQR] 19.9, SD 10.9) months, with 7 now inactive. The median number of followers and participants was 374 (IQR 574) and 157 (IQR 272), respectively. An overall increasing establishment of active Twitter-based journal clubs was observed, resulting in an exponential increase in total cumulative tweets (R2=.98), and tweets per month (R2=.72). Cumulative tweets for specific journal clubs increased linearly, with @ADC_JC, @EBNursingBMJ, @igsjc, @iurojc, and @NephJC, and showing greatest rate of change, as well as total impressions per month since establishment. An average of two tweets per month was estimated for the majority of participants, while the “Top 10” tweeters for @iurojc showed a significantly lower contribution to overall tweets for each month (P<.005). A linearly increasing impression:tweet ratio was observed for the top five journal clubs.

Conclusions: Twitter-based journal clubs are free, time-efficient, and publicly accessible means to facilitate international discussions regarding clinically important evidence-based research.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

WHO HIV and Infant Feeding Survey

In 2015, WHO will be updating the 2010 Guidelines on HIV and Infant Feeding. WHO and UNICEF would like to learn more about the progress and challenges of how to best support mothers living with HIV and their infant feeding practices.

We invite you to participate in this brief online survey to tell us about your experiences and your suggestions for improvement of the guidelines. It will cover six key areas of interest:

* policy,

* program implementation,

* capacity building,

* monitoring and evaluation,

* challenges in implementing current national guidelines, and

* suggestions for improving the WHO recommendations.

English Version:


French Version:


We encourage representatives from ministries of health, programme managers, frontline health workers, implementing partners, non-governmental organizations, community-based organizations, advocacy groups, and networks of people living with HIV to respond to this survey. As some individuals may have experience working in various countries, please fill out this survey based on the country where you currently work or reside or are most familiar with based on your experience. We also encourage you to share the survey with colleagues who are well-positioned to respond to these questions.



Jessica Rodrigues, MS

IATT Secretariat

HIV/AIDS Specialist, Knowledge Management

UNICEF House, 3 United Nations Plaza, Office #1034, New York, NY 10017

Telephone: 917.265.4533 |Cell: 718.755.3511 | Email:


Community of Practice:

What is happening at CCP?

Chiawelo Community Practice (CCP) functions as part of the public service in the Chiawelo Community Health Centre (CHC). A family physician and a clinical associate work in CCP as employees of Gauteng Health with 21 CHWs deployed into the community of Ward 11 (Soweto part), screening, educating and supporting health and intersectoral action, with the support of an enrolled nurse. The clinical associate, PHC nurse, enrolled nurse and and family physician, with Family Medicine registrar/students, are seeing all patients from this community in strong teamwork with CHWs. Local stakeholders are also engaged strongly, supporting a growing health promotion programme. CCP has been branded as a Wits initiative…..more

Chiawelo Community Practice

The Chiawelo Community Practice (CCP) is modeled on moving from a curative to a preventive/promotive focus in health services with:

  • Community health workers, as active parts of the team, building a profile of the community and strengthening daily interaction with the community.
  • Practice re-organization with teamwork around person, family and community, especially with strong problem-oriented record systems and innovative communication.
  • Strong structured collaboration with stakeholders in the health system, other government sectors/institutions and with the community.
  • Health promotion that accounts for the complexity of changing behaviour

See progress here and video

Integrated Management of Childhood Illness (IMCI)

IMCI is a strategy for delivering key interventions that prevent and treat the most common causes of mortality in children under five years old, including neonatal infections, pneumonia, diarrhoea, measles, malaria and undernutrition. IMCI includes the following components:

  1. Improvements in the case management skills of health workers IMCI standard case management guidelines provide a systematic approach to assessing, classifying and treating sick children from birth up to five years old including giving appropriate counselling.
  2. Improvements in the health system required to deliver child health interventions effectively System improvements that are needed in order to provide appropriate case management to newborns and children include adequate numbers of trained staff, an adequate supply of medicines and other supplies, regular supervision of first-level health workers, high-quality referral care and mechanisms for ensuring that those children who need referral are referred properly.
  3. Improvements in family and community practices A number of key family and community practices are important to prevent and treat the causes of child deaths.1 These include exclusive breastfeeding and complementary feeding, use of insecticide-treated bednets, seeking vaccines and vitamin A at the right times, recognition of when to seek care for a sick neonate or child and appropriate management of sick children in the home.

See these useful resources….1 2 3 4 5

A New Tool to Promote Gender Equality in the Health Workforce

New Health Workforce Productivity Toolkit

CapacityPlus announces the Health Workforce Productivity Analysis and Improvement Toolkit, a process to measure the productivity of facility-based health workers, understand causes of productivity problems, and identify interventions to address them.

Many countries are striving to meet the demand for family planning, end preventable child and maternal deaths, and achieve an AIDS-free generation.The health workforce is critical for ensuring access to high-quality services and improve health outcomes. While increasing the number of health workers where there are shortages is essential, it is equally important to improve the productivity of the existing workforce and make service delivery more efficient.

National stakeholders-including facility managers and health management teams at the district and regional level-can enter and save facility-level data on service delivery outputs and human resources costs. They can then calculate total health workforce productivity and compare rates across facilities. This process differentiates higher-productivity facilities from lower-productivity ones, which through a qualitative assessment can help managers consider which factors are affecting health workforce productivity in the facilities.

Help CapacityPlus spread the word about strengthening the health workforce. Follow us on Twitter ( and like us on Facebook (   

Carol Bales | Communications Officer

IntraHealth International, Inc. | Because Health Workers Save Lives.

6340 Quadrangle Drive, Suite 200 | Chapel Hill, NC 27517

t. +1 (919) 313-9174 | m.+1 (919) 360-4031

twitter | facebook

Monitoring SSA Physician Migration Post-WHO Code: Settlement Patterns in the USA

I wrote this recently released paper in anticipation to the forthcoming 68th World Health Assembly’s discussion of the relevance and effectiveness of WHO Code of Practice on the International Recruitment of Health Personnel. I hope some of you will find it informative. Please read and share among members of your various networks.

Monitoring Sub-Saharan African Physician Migration and Recruitment Post-Adoption of the WHO Code of Practice: Temporal and Geographic Patterns in the United States

DOI: 10.1371/journal.pone.0124734


Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians’ locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician “brain drain”, it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age = 35) SSA physicians.

Homo sum, humani nihil a me alienum puto (I am a human being, nothing human is alien to me). — Terence

I sit on a man’s back, choking him and making him carry me, and yet assure myself and others that I am very sorry for him and wish to ease his lot by all possible means — except by getting off his back. — Leo Tolstoy.

A tiger does not shout its tigritude: it pounces. A tiger in the jungle does not say: I am a tiger. Only on passing the tiger’s hunting ground and finding the skeleton of a gazelle do we feel the place abound with tigritude. — Wole Soyinka

The great historical tragedy of Africa has been not so much that it was too late in making contact with the rest of the world, as the manner in which that contact was brought about. — Aime Cesaire.

La corruption explique en partie la faim. Sans la complicité active du président Paul Biya, Bolloré et Vilgrain n’auraient jamais pu s’approprier des centaines de milliers d’hectares de terres fertiles, au Cameroun, dont les paysans ont été expulsés et où les cultures vivrières ont été remplacées par de la canne à sucre destinée à la production de biocarburants. — Jean Ziegler

HIFA profile: Akhenaten BS Tankwanchi is an Independent Research Consultant in the United States. Professional interests: health disparities, telehealth, mental health, global health, health equity, minority health, human development, community psychology, program evaluation, noncommunicable diseases, sub-Saharan Africa.  akhenaton.tankwanchi AT


To send a message to the HIFA forum, simply send an email to:

BMJ Open: Trading quality for relevance: non-health decision-makers’ use of evidence on the social determinants of health

CITATION: BMJ Open 2015;5:e007053 doi:10.1136/bmjopen-2014-007053

Trading quality for relevance: non-health decision-makers’ use of evidence on the social determinants of health

BMJ Open 2015;5:e007053 doi:10.1136/bmjopen-2014-007053


Objectives: Local government services and policies affect health determinants across many sectors such as planning, transportation, housing and leisure. Researchers and policymakers have argued that decisions affecting wider determinants of health, well-being and inequalities should be informed by evidence. This study explores how information and evidence are defined, assessed and utilised by local professionals situated beyond the health sector, but whose decisions potentially affect health: in this case, practitioners working in design, planning and maintenance of the built environment.

Design: A qualitative study using three focus groups. A thematic analysis was undertaken.

Setting: The focus groups were held in UK localities and involved local practitioners working in two UK regions, as well as in Brazil, USA and Canada.

Participants UK and international practitioners working in the design and management of the built environment at a local government level.

Results: Participants described a range of data and information that constitutes evidence, of which academic research is only one part. Built environment decision-makers value empirical evidence, but also emphasise the legitimacy and relevance of less empirical ways of thinking through narratives that associate their work to art and philosophy. Participants prioritised evidence on the acceptability, deliverability and sustainability of interventions over evidence of longer term outcomes (including many health outcomes). Participants generally privileged local information, including personal experiences and local data, but were less willing to accept evidence from contexts perceived to be different from their own.

Conclusions: Local-level built environment practitioners utilise evidence to make decisions, but their view of ‘best evidence’ appears to prioritise local relevance over academic rigour. Academics can facilitate evidence-informed local decisions affecting social determinants of health by working with relevant practitioners to improve the quality of local data and evaluations, and by advancing approaches to improve the external validity of academic research.

Key messages

  • Built environment practitioners in local authorities apply the word ‘evidence’ to a variety of knowledge sources including case studies.
  • Practitioners seek evidence of viability, a conflation of terms relating to the feasibility of intervention delivery and sustainability.
  • Emphasis is placed on immediate outputs and intermediate outcomes; evidence of long-term outcomes, including health outcomes, may be seen as unattainable.
  • Local knowledge is vital to local practice. Academic evidence is frequently irrelevant to practitioners’ local contexts
  • Academics could support work on the social determinants of health in local authorities more effectively by co-producing research with local practitioners, by developing geographical data at local authority level, and by improving local evaluation and research capacity through training.

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

BMC Public Health: Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study

‘The main barriers to modern contraceptive uptake among young women are myths and misconceptions’, says a new paper in the open-access journal BMC Public Health.

Below is the citation and abstract. The full text is available here:

CITATION: Ochako et al. Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study. BMC Public Health (2015) 15:118. DOI 10.1186/s12889-015-1483-1


Background: Young women in Kenya experience a higher risk of mistimed and unwanted pregnancy compared to older women. However, contraceptive use among youth remains low. Known barriers to uptake include side effects, access to commodities and partner approval.

Methods: To inform a youth focussed behaviour change communication campaign, Population Services Kenya developed a qualitative study to better understand these barriers among young women. The study was carried out in Nyanza, Coast, and Central regions. Within these regions, urban or peri-urban districts were purposively selected based on having contraceptive prevalence rate close to the regional average and having a population with low socioeconomic profiles. In depth interviews were conducted with a sample of sexually active women aged 15–24, both users and non-users, that were drawn from randomly selected households.

Results: All the respondents in the study were familiar with modern methods of contraception and most could describe their general mechanisms of action. Condoms were not considered as contraception by many users. Contraception was also associated with promiscuity and straying. Fear of side effects and adverse reactions were a major barrier to use. The biggest fear was that a particular method would cause infertility. Many fears were based on myths and misconceptions. Young women learn about both true side effects and myths from their social networks.

Conclusion: Findings from this research confirm that awareness and knowledge of contraception do not necessarily translate to use. The main barriers to modern contraceptive uptake among young women are

myths and misconceptions. The findings stress the influence of social network approval on the use of family planning, beyond the individual’s beliefs. In such settings, family planning programming should engage with the wider community through mass and peer campaign strategies. As an outcome from this study, Population Services Kenya developed a mass media campaign to address key myths and misconceptions among youth.

SELECTED QUOTES from full text:

“The woman inserts it (pill in the vagina) so that she doesn’t get pregnant” [Non-user, Kisumu]

“If they put that (implants) on you when you remove it (implants) you cannot give birth again” [User, Kisumu]”

“Pills are very bad and I don’t like anything to do with them… if you take the pill for so long, you may give birth to a paralyzed child…” [User, Mombasa]

“All these family planning methods interfere with our feelings (libido) be it a coil, be it a tablet, (pills) be it what, I heard that it (modern family planning) reduces feelings” [User, Mombasa)

“Sometimes they complain because of the way they (pills) make you feel tired, bring mood swings and sometimes you have a low libido. This will make him complain because he will start accusing you that you are being unfaithful to him” [User, Mombasa]

“And so they (men) say that only promiscuous women use the pills and that is why they are against those pills” [Non-user, Mombasa]

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA:  

Publication: What Does Big Data Mean for Wearable Sensor Systems?

What Does Big Data Mean for Wearable Sensor Systems?

S. J. Redmond,corresponding author, N. H. Lovell,G. Z. Yang, A. Horsch, P. Lukowicz, L. Murrugarra, and M. Marschollek

Reference Pubmed:

Cordiales saludos,

Lady V. Murrugarra Velarde


Oficina de Telesalud/Telemedicina

Instituto de Medicina Tropical Alexander von Humboldt;

Universidad Peruana Cayetano Heredia

Central: (51-1) 6139797 anexo 4040, 4823910, 4823903 anexo 15

Celular: RPC: (51)993470712 RPM: (51)962660798

Av. Honorio Delgado Nº340, San Martin de Porras

skype: ladymurrugarra , @ladymurrugarra

Save the date – High Impact Practices in Family Planning Webinar May 6th 9:00 to 10:30 AM EST

Please join WHO/IBP, UNFPA, USAID and the IBP HIPs Task Team for a Series of Webinars around Maximizing FP Investments through Evidence Based Programming. We will be hosting the first of the webinar series on High Impact Practices on May 6th, 2015 from 9:00 to 10:30 EST.  

Webinar 1:  How do we synthesize and translate more than 50 years of experience and learning from family planning programming?  Using High Impact Practices

High Impact Practices ( (HIPs) are effective service delivery or systems interventions that when scaled up and institutionalized, can strengthen a comprehensive family planning strategy. The HIPs briefs are concise summaries of these evidence-based practices to help focus FP resources and efforts.  In this webinar we will discuss the origin of the HIPs, the development of the HIP briefs, and their application to inform program decision making.

When: Wednesday, May 6th, 9:00am – 10:30am EST with time for discussion


·       Gifty Addico, UNFPA

·       Shawn Malarcher, USAID

·       Suzanne Reier, WHO-IBP

·       Alisa Wong, FP2020

Registration: Please click here ( to register. After registering, you will receive a confirmation email containing information about joining the webinar.


Twitter: #hips4fp

HIFA profile: Rebecca Shore is a Communications Specialist with Knowledge for Health (K4Health), Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Baltimore, Maryland, USA., Rebecca.Shore AT


To send a message to the HIFA forum, simply send an email to: