• Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home

      Mabhala, Mzwandile; Yohannes, Asmait; University of Chester; Asmait Skin Care
      Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories—education, employment, and health—emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one’s way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health.
    • Cost of non-alcoholic steatohepatitis in Europe and the USA: The GAIN study.

      O'Hara, Jamie; Finnegan, Alan; Dhillon, Harpal; Ruiz-Casas, Leonardo; Pedra, Gabriel; Franks, Bethany; Morgan, George; Hebditch, Vanessa; Jönsson, Bengt; Mabhala, Mzwandile; et al. (2020-07-15)
      Non-alcoholic steatohepatitis (NASH) leads to cirrhosis and is associated with a substantial socioeconomic burden, which, coupled with rising prevalence, is a growing public health challenge. However, there are few real-world data available describing the impact of NASH. The Global Assessment of the Impact of NASH (GAIN) study is a prevalence-based burden of illness study across Europe (France, Germany, Italy, Spain, and the UK) and the USA. Physicians provided demographic, clinical, and economic patient information via an online survey. In total, 3,754 patients found to have NASH on liver biopsy were stratified by fibrosis score and by biomarkers as either early or advanced fibrosis. Per-patient costs were estimated using national unit price data and extrapolated to the population level to calculate the economic burden. Of the patients, 767 (20%) provided information on indirect costs and health-related quality of life using the EuroQOL 5-D (EQ-5D; n = 749) and Chronic Liver Disease Questionnaire - Non-Alcoholic Fatty Liver Disease (CLDQ-NAFLD) (n = 723). Mean EQ-5D and CLDQ-NAFLD index scores were 0.75 and 4.9, respectively. For 2018, the mean total annual per patient cost of NASH was €2,763, €4,917, and €5,509 for direct medical, direct non-medical, and indirect costs, respectively. National per-patient cost was highest in the USA and lowest in France. Costs increased with fibrosis and decompensation, driven by hospitalisation and comorbidities. Indirect costs were driven by work loss. The GAIN study provides real-world data on the direct medical, direct non-medical, and indirect costs associated with NASH, including patient-reported outcomes in Europe and the USA, showing a substantial burden on health services and individuals. There has been little research into the socioeconomic burden associated with non-alcoholic steatohepatitis (NASH). The GAIN study provides real-world data on the direct medical, direct non-medical, and indirect costs associated with NASH, including patient-reported outcomes in five European countries (UK, France, Germany, Spain, and Italy) and the USA. Mean total annual per patient cost of NASH was estimated at €2,763, €4,917, and €5,509 for the direct medical, direct non-medical, and indirect cost categories, respectively. [Abstract copyright: © 2020 The Author(s).]
    • Homelessness Is Socially Created: Cluster Analysis of Social Determinants of Homelessness (SODH) in North West England in 2020

      Mabhala, Mzwandile; Esealuka, Winifred Adaobi; Nwufo, Amanda Nkolika; Enyinna, Chinwe; Mabhala, Chelsea Nonkosi; Udechukwu, Treasure; Reid, John; Yohannes, Asmait; University of Chester; University of East Anglia; École des Hautes Études en Santé Publique; Asmait Skincare and Design
      Abstract: Poverty creates social conditions that increase the likelihood of homelessness. These include exposure to traumatic life experiences; social disadvantages such as poor educational experiences; being raised in a broken family, care homes or foster care; physical, emotional, and sexual abuse; and neglect at an early age. These conditions reduce people’s ability to negotiate through life challenges. This cross-sectional study documents the clustering and frequency of adverse social conditions among 152 homeless people from four cities in North West England between January and August 2020. Two-step cluster analysis showed that having parents with a criminal record, care history, and child neglect/abuse history was predictive of homelessness. The cluster of indicator variables among homeless people included sexual abuse (χ2 (N = 152) = 220.684, p < 0.001, Cramer’s V = 0.7), inappropriate sexual behaviour (χ2 (N = 152) = 207.737, p < 0.001, Cramer’s V = 0.7), emotional neglect (χ2 (N = 152) = 181.671, p < 0.001, Cramer’s V = 0.7), physical abuse by step-parent (χ2 (N = 152) = 195.882, p < 0.001, Cramer’s V = 0.8), and physical neglect (χ2 (N = 152) = 205.632, p < 0.001, Cramer’s V = 0.8). Poverty and homelessness are intertwined because of the high prevalence of poverty among the homeless. Poverty sets up a chain of interactions between social conditions that increase the likelihood of unfavourable outcomes: homelessness is at the end of the interaction chain. Interventions supporting families to rise out of poverty may also reduce entry into homelessness.
    • Mind your Language: Discursive Practices Produce Unequal Power and Control Over Infectious Disease: A Critical Discourse Analysis

      Mabhala, Mzwandile; Yohannes, Asmait; Massey, Alan; Reid, John; University of Chester
      Abstract Background: Power, socioeconomic inequalities, and poverty are recognized as some of the fundamental determinants of differences in vulnerability of societies to infectious disease threats. The economic south is carrying a higher burden than those in the economic north. This raises questions about whether social preventions and biomedical preventions for infectious disease are given equal consideration, and about social institutions and structures that frame the debate about infectious disease. This article examines how institutionalized ways of talking about infectious disease reinforces, creates, and sustains health inequalities. Methodology: Critical discourse analysis was considered to be epistemologically and ontologically consistent with the aims and context of this study. Results: The study examined three types of infectious disease: • Emerging infectious diseases/pathogens • Neglected tropical diseases • Vector-borne infections. Examination revealed that poverty is the most common determinant of all three. Conclusion: A sustainable reduction in infectious disease in the southern countries is most likely to be achieved through tackling socioeconomic determinants. There is a need for a change in the discourse on infectious disease, and adopt a discourse that promotes self-determination, rather than one that reinforces the hero-victim scenario and power inequalities. Keyword: Critical discourse, inequalities, infectious disease, poverty, power
    • Public health in nurse education

      Mabhala, Mzwandile; University of Chester
      This study is about PHNEs’ knowledge of teaching public health, and therefore it was considered worthwhile to explore the literature relating to the pedagogies used generally in nursing education, and to teach public health in particular. The exploration of literature revealed two broad pedagogic approaches that underpin nursing education: conventional and interpretive pedagogies. This section presents three examples of interpretive pedagogies – narrative, critical and transformative –that were found to be commonly used in public health nursing.
    • Retention and sustained viral suppression in HIV patients transferred to community refill centres in Kinshasa, DRC

      Moudachirou, Ramsia; Van Cutsem, G; Chuy, R; Tweya, H; Senkoro, Mbazi; Mabhala, Mzwandile; Zolfo, Maria; University of Chester
      Background The adoption of the UNAIDS 90-90-90 targets acceleration plan and the implementation of ‘test and treat’ strategy has resulted in a significant increase in the number of people living with HIV/AIDS (PLWHA) receiving lifelong antiretroviral therapy (ART). To improve and sustain ART retention in care and virologic suppression, innovative service delivery models are needed. In 2010, Médecins Sans Frontières (MSF) set-up decentralized community ART refill centres (“poste de distribution communautaire”, PODI) for follow-up of stable ART patients from Kabinda Hospital (CHK), in Kinshasa, Democratic Republic of Congo. Objective To assess retention in care and virologic suppression on ART after transfer to the three main PODIs in Kinshasa. Methods A retrospective cohort study was conducted using routine program data for PLWH aged >15 years and stable on ART transferred from CHK to a PODI between January 2015 and June 2017. Kaplan-Meier analysis was used to estimate retention in care. Viral load (VL) suppression was defined as a VL ≤ 1000 copies/ml. Results A total of 337 patients were transferred to a PODI. Of these, 306 (91%) patients were on ART 12 months after transfer to PODI and were eligible for the 12-month routine VL testing. A total of 118 (39%) had VL done at 12 months; VL suppression was 93% (n=110). Median time from enrolment into PODI to 12-month routine VL was 14.6 months [IQR: 12.2-20.8]. Overall, 189 (62%) patients had at least one VL load test done during follow-up. Retention in PODI at 6, 12 and 18 months was 96%, 92% and 88% respectively. Retention at 18 months was statistically different between PODIs; 91%, 88% and 78% in PODI East, PODI West and PODI Central respectively, (p=0.0349). Conclusion Retention and VL suppression in community-based ART refill centers were high, although VL coverage was low. HIV programs need to scale–up VL testing services PLWHA receiving ART in PODIs.
    • Sexual violence against migrants and asylum seekers. The experience of the MSF clinic on Lesvos Island, Greece.

      Mabhala, Mzwandile; Belanteri, Rea; Hinderaker, Sven Gudmund; Wilkinson, Ewan; Episkopou, Maria; Timire, Collins; De Plecker, Eva; Takarinda, Kudakwashe; Van den Bergh, Rafael; Unversity of Chester
      Sexual violence can have destructive impact on the lives of people. It is more common in unstable conditions such as during displacement. On the Greek island of Lesvos, Médecins Sans Frontières provided medical care to survivors of sexual violence among the population of asylum seekers arriving there. This study aimed to describe the patterns of sexual violence reported by migrants and asylum seekers and the clinical care provided to them. Methods This is s a descriptive study using routine program data. The study population consisted of migrants and asylum seekers treated for conditions related to sexual violence at the Médecins Sans Frontières clinic on Lesvos Island (September 2017-January 2018). Results We enrolled 215 survivors of sexual violence who reported and were treated, of whom 60 (28%) were male. The majority of incidents reported (90%) were cases of rape; 174 (81%) of survivors were from Africa and 185 (86%) occurred over a month before presentation. Half the incidents (118) occurred in transit, mainly in Turkey, and 76 (35%) in the country of origin; 10 cases (5%) on Lesvos were also observed. The perpetrator was known in 23% of the cases. Only XXX received mental health care, and the need exceeded the capacity of available mental care services. Conclusion Even though the majority of cases delayed seeking medical care after the incident, it is crucial that access to mental health services is guaranteed for those in need. Such access and protection measures for people in transit need to be put in place along migration routes, including in countries nominally considered safe, and secure routes need to be developed.