School of Medicine, Pharmacy and Health

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. The RIPPLE Study Team This paper presents data on the need for sexual health information and advice of 4353 students aged 13/14 years in 13 English secondary schools. Data were collected by peer educators as part of a sex education programme, and through a questionnaire survey administered by researchers. Data illustrate young people's need for concrete information and advice on issues related to physical development and puberty; transmission of sexually transmitted diseases; accessing and using condoms and other contraception; using sexual health services; managing relationships and dealing with jealousy, love and sexual attraction; how people have sex; sexual pleasure; masturbation; and homosexuality. Differences between the concerns and interests raised by young people and current UK guidance on sex and relationships education are examined, and the implications of these findings for designing future policy and effective school based sex education programmes are discussed. The paper highlights some of the wider social norms around sex and sexuality that influence young people's understanding and sexual behaviour, and the importance of addressing these within sex education is noted. Factors influencing the processes of expressing and assessing needs are explored.

The RIPPLE study is a randomized controlled trial of peer-led sex education in English secondary schools. In 1997, 27 schools were recruited and randomly allocated to a programme of peer-led sex education or to act as control schools. In experimental schools peer educators in Year 12 (aged 16/17 years) were recruited in two successive cohorts and, having received a standardized training programme, delivered classroom-based sex education sessions to Year 9 students (aged 13/14 years). This paper is the first of two focusing on data gathered from these peer educators. Through analysis of pre-(n ⍧ 505) and post-(n ⍧ 331) programme questionnaire data, the paper describes the profile of peer educators and examines the impact on them of their involvement. Compared to the students receiving the peer-led sex education, more peer educators were female, white, high academic achievers and less socially disadvantaged. Peer educators reported positive changes in sexual knowledge and changes towards more liberal attitudes, and believed the programme would have a positive impact on their confidence in relationships and on their sexual behaviour. There was an increase in confidence about communication and interaction in groups. The paper discusses the methodological difficulties of

This article examines the quantity and content of sex and relationship education (SRE) delivered to students in Years 9-11 (aged 13-16 years) in 12 coeducational state secondary schools in England during 1997-2000. Teachers reported the delivery of an average of seven (range 0-12) sessions of SRE across the three years, with no SRE delivered in up to five schools in each year. Most teachers reported having covered contraception, sexually transmitted diseases and relationships at least once. Topics such as homosexuality and the negotiation of relationships and sexual encounters were rarely covered. Data collected from students provided a slightly different picture. At least one-half of students in all schools reported having received some SRE during Year 9 and at least 85% reported receiving some SRE during Years 10 and/or 11. Teachers identified various factors that limited the quality of the SRE delivered. The article discusses some of the challenges that arose when attempting to reconcile data gathered from students and teachers.

This paper is the second of two presenting data gathered from peer educators in the RIPPLE study-a randomized controlled trial of peer-led sex education in English secondary schools. Peer educators were recruited from Year 12 students (aged 16/17 years) in 13 schools in two successive cohorts in 1997 and 1998. Following a standardized training programme they delivered sex education sessions to Year 9 students (aged 13/14 years). Through analysis of 18 focus group discussions and of post-programme questionnaire data (n ⍧ 301), this paper aims to identify the issues and processes considered by peer educators to be important in implementing a peer education programme, and to examine peer educators' views on the relationship between themselves and the Year 9 students. Methodological issues arising when collecting, analysing and presenting such data are discussed, and some recommendations are outlined for carrying out school-based peer education.

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. The RIPPLE Study Team This paper presents data on the need for sexual health information and advice of 4353 students aged 13/14 years in 13 English secondary schools. Data were collected by peer educators as part of a sex education programme, and through a questionnaire survey administered by researchers. Data illustrate young people's need for concrete information and advice on issues related to physical development and puberty; transmission of sexually transmitted diseases; accessing and using condoms and other contraception; using sexual health services; managing relationships and dealing with jealousy, love and sexual attraction; how people have sex; sexual pleasure; masturbation; and homosexuality. Differences between the concerns and interests raised by young people and current UK guidance on sex and relationships education are examined, and the implications of these findings for designing future policy and effective school based sex education programmes are discussed. The paper highlights some of the wider social norms around sex and sexuality that influence young people's understanding and sexual behaviour, and the importance of addressing these within sex education is noted. Factors influencing the processes of expressing and assessing needs are explored.

The RIPPLE study is a randomized controlled trial of peer-led sex education in English secondary schools. In 1997, 27 schools were recruited and randomly allocated to a programme of peer-led sex education or to act as control schools. In experimental schools peer educators in Year 12 (aged 16/17 years) were recruited in two successive cohorts and, having received a standardized training programme, delivered classroom-based sex education sessions to Year 9 students (aged 13/14 years). This paper is the first of two focusing on data gathered from these peer educators. Through analysis of pre-(n ⍧ 505) and post-(n ⍧ 331) programme questionnaire data, the paper describes the profile of peer educators and examines the impact on them of their involvement. Compared to the students receiving the peer-led sex education, more peer educators were female, white, high academic achievers and less socially disadvantaged. Peer educators reported positive changes in sexual knowledge and changes towards more liberal attitudes, and believed the programme would have a positive impact on their confidence in relationships and on their sexual behaviour. There was an increase in confidence about communication and interaction in groups. The paper discusses the methodological difficulties of

This article examines the quantity and content of sex and relationship education (SRE) delivered to students in Years 9-11 (aged 13-16 years) in 12 coeducational state secondary schools in England during 1997-2000. Teachers reported the delivery of an average of seven (range 0-12) sessions of SRE across the three years, with no SRE delivered in up to five schools in each year. Most teachers reported having covered contraception, sexually transmitted diseases and relationships at least once. Topics such as homosexuality and the negotiation of relationships and sexual encounters were rarely covered. Data collected from students provided a slightly different picture. At least one-half of students in all schools reported having received some SRE during Year 9 and at least 85% reported receiving some SRE during Years 10 and/or 11. Teachers identified various factors that limited the quality of the SRE delivered. The article discusses some of the challenges that arose when attempting to reconcile data gathered from students and teachers.

This paper is the second of two presenting data gathered from peer educators in the RIPPLE study-a randomized controlled trial of peer-led sex education in English secondary schools. Peer educators were recruited from Year 12 students (aged 16/17 years) in 13 schools in two successive cohorts in 1997 and 1998. Following a standardized training programme they delivered sex education sessions to Year 9 students (aged 13/14 years). Through analysis of 18 focus group discussions and of post-programme questionnaire data (n ⍧ 301), this paper aims to identify the issues and processes considered by peer educators to be important in implementing a peer education programme, and to examine peer educators' views on the relationship between themselves and the Year 9 students. Methodological issues arising when collecting, analysing and presenting such data are discussed, and some recommendations are outlined for carrying out school-based peer education.

Using data collected through semi-structured interviews and focus group discussions with 37 adult men living in Brunei Darussalam, this paper explores how masculinities and expectations about male roles across the life course influence men's perceptions, of and attitudes towards health and health helpseeking behaviour. Bruneian men gave accounts that consistently spoke of a series of masculine roles and associated attributes and behaviours, which mapped across the life course. Men described health and the steps that they had taken to protect their health in terms of responsibilities associated with being a breadwinner, provider of support for parents, role model and leader of the family. Whilst adherence to Bruneian norms about masculinity could obstruct men's engagement with health help-seeking, we also found that men mobilised their understanding of Bruneian masculinity such that it provided culturally legitimate way of engaging in health help-seeking. We conclude by considering implications for further development of conceptualisations of masculinities, particularly responding to the call to consider Connell's theory of 'hegemonic masculinity' in the context of the Global South. We also consider the implications of the findings of this research for policy and practice in provision of health promotion and services in Brunei.

Adverse surgical incidents affect both patients and health professionals. This study sought to explore the effect of surgical incidents on operating theatre staff and their subsequent behaviours. Eligible studies were primary research or reviews that focused on the effect of incidents on operating theatre staff in primary, secondary or tertiary care settings. MEDLINE, Embase, CINALH and PsycINFO were searched. A data extraction form was used to capture pertinent information from included studies and the Critical Appraisal Skills Programme (CASP) tool to appraise their quality. PRISMA-P reporting guidelines were followed and the review is registered with PROSPERO. A total of 3918 articles were identified, with 667 duplicates removed and 3230 excluded at the title, abstract and full-text stages. Of 21 included articles, eight focused on the impact of surgical incidents on surgeons and anaesthetists. Only two involved theatre nurses and theatre technicians. Five key themes emerged: the...

Over the last five years, media reports in West African countries have suggested a tramadol abuse ‘crisis’ characterised by a precipitous rise in use by youth in the region. This discourse is connected to evidence of an emerging global opioid crisis. While the reported increase in tramadol abuse in West Africa is likely true, few studies have critically interrogated structural explanations for tramadol use by youth. Nascent academic literature has sought to explain the rise in drug use as a function of moral weakness among youth. This Ghanaian case study draws on primary and secondary data sources to explore the pain that precedes tramadol abuse. Through a discourse analysis of 295 media articles and 15 interviews (11 with youth who currently use tramadol and 4 with health system stakeholders), this study draws on structural violence and moral panic theories to contribute to the emerging literature on tramadol (ab)use in West Africa. The evidence parsed from multiple sources reveals...

Background Universal Health Coverage (UHC) remains a critical public health goal that continues to elude many countries of the global south. As countries strive for its attainment, it is important to track progress in various subregions of the world to understand current levels and mechanisms of progress for shared learning. Our aim was to compare multidimensional equity gaps in access to skilled attendant at birth (SAB) and coverage of the third dose of Diphtheria-Tetanus-Pertussis (DTP3) across 14 West African countries. Methods The study was a cross sectional comparative analysis that used publicly available, nationally representative health surveys. We extracted data from Demographic and Health Surveys, and Multiple Indicator Cluster Surveys conducted between 2010 and 2017 in Benin, Burkina Faso, Cote d’ Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo. The World Health Organization’s Health Equity Assessment Toolkit...

Background Lack of a unified and comparable classification system to unravel the underlying causes of stillbirth hampers the development and implementation of targeted interventions to reduce the unacceptably high stillbirth rates (SBR) in sub-Saharan Africa. Our aim was to track the SBR and the predominant maternal and fetal causes of stillbirths using the WHO ICD-PM Classification system. Methods This was a retrospective observational study in a major referral centre in northeast Nigeria between 2010 and 2018. Specialist Obstetricians and Gynaecologists assigned causes of stillbirths after an extensive audit of available stillbirths’ records. Cause of death was assigned via consensus using the ICD-PM classification system. Results There were 21,462 births between 1 January 2010 and 31 December 2018 in our study setting; of these, 1177 culminated in stillbirths with a total hospital SBR of 55 per 1000 births (95% CI: 52, 58). There were two peaks of stillbirths in 2012 [62 per 1000...

Background Global obesity estimates show a steadily increasing pattern across socioeconomic and geographical divides, especially among women. Our analysis tracked and described obesity trends across multiple equity dimensions among women of reproductive age (15–49 y) in 11 sub-Saharan African (SSA) countries during 1994–2015. Methods This study consisted of a cross-sectional series analysis using nationally representative demographic and health surveys (DHS) data. The countries included were Cameroon, Comoros, Congo, Cote d'Ivoire, Ghana, Kenya, Lesotho, Nigeria, Senegal, Zambia and Zimbabwe. The data reported are from a reanalysis conducted using the WHO Health Equity Assessment Toolkit that assesses inter- and intra-country health inequalities across socioeconomic and geographical dimensions. We generated equiplots to display intra- and inter-country equity gaps. Results There was an increasing trend in obesity among women of reproductive age across all 11 SSA countries. Obesi...

Background Globally, more than 800 million people are affected by chronic undernutrition (stunting and wasting), with sub-Saharan Africa (SSA) disproportionately represented [1]. In 2017 alone, the prevalence of stunting among children in SSA was 30.3% [2]. Meanwhile, over the last two decades, the number of children with overnutrition in SSA rose steeply, from 5.4 million in 1990 to 10.3 million in 2015 [3], with a prevalence of overweight/obesity of 6.8% among preschool children in 2010 [4]. Instead of the two distinct silos of under-nutrition or over-nutrition thought to be restricted to countries of the global south or global north respectively, a double burden of malnutrition (DBM) has emerged globally [5-7], with an increasing prevalence

Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother’s area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A...

Background Multisectoral approaches to health are collaborations between stakeholders across multiple sectors, usually formed to combat issues that affect health but go beyond the purview of one particular sector. The signi cance of multisectoral partnerships to attain health equity has been widely acknowledged. However, the extent which equity can be attained depends upon the perceptions of various stakeholders. We examine how multisectoral partnerships promoting healthy eating and active living conceptualized and employed an equity lens in their work. Method This study is part of a larger pan-Canadian mixed-method research and knowledge sharing program entitled MUSE (Multisectoral Urban Systems for health and Equity in Canadian cities). Data collected from both quantitative and qualitative sources for two sites of the MUSE project-Saskatoon and Toronto were analyzed. In the qualitative part, 30 semi-structured key informant interviews were conducted with key stakeholders from six different multisectoral partnerships based in Saskatoon and Toronto. Data were analyzed in an inductive way. In the quantitative part, a survey with 37 stakeholder organizations was carried out. Simple descriptive statistics (means and percentages) were used to see the distribution of data and to supplement the qualitative analysis. Results Equity was not a central component in program design although participants addressing equity, did so by discussing accessibility. How much consideration was given to equity varied as a function of the type of partnership. Most participants emphasized geographical accessibility but a few mentioned nancial accessibility. Collaborative leadership style facilitated participatory decision-making process, and thereby upheld equity in the partnership decision making process. Communication, networking, and negotiation skills were found to be core competencies of a leader that contributed in upholding equity in partnership dynamics. The study also found some challenges to embed equity in partnership works, such as the lack of comprehensive understanding of population health and the equity tenet within it. Conclusions Findings indicate that multisectoral partnerships aimed at promoting healthy eating and physical activity struggle to attain equity within the partnership as well as in the partnership-based works aimed at reducing health equity in populations. Factors identi ed can support decision-makers commit to and work to attaining equity within their partnerships as well as in the partnership-based work in the community and beyond.