How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa

Davis, A. et al. (2022) How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa. Antimicrobial Resistance and Infection Control, 11(1), 34. (doi: 10.1186/s13756-022-01071-5) (PMID:35164886) (PMCID:PMC8842514)

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Abstract

Background: The current Coronavirus disease pandemic reveals political and structural inequities of the world’s poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania. Methods: We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. Results: Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. Conclusion: Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in ‘normal’ circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.

Item Type:Articles
Additional Information:This research was funded by the Antimicrobial Resistance Cross-Council Initiative through a grant from the Medical Research Council, a Council of UK Research and Innovation and the National Institute for Health Research (MRC/AMR/ MR/S004815/1). Hilton’s time was also funded by a core grant for the Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit (MC_UU_12017/14; SPHSU14; MC_UU_12017/15; SPHSU15). This publication was supported by the University of Edinburgh and the University of Glasgow Jointly Funded PhD studentships (Loosli).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mutua, Dr Edna and Nimegeer, Dr Amy and Laurie, Dr Emma and MMBAGA, Professor Blandina Theoph and Nthambi, Dr Mary and Matthews, Professor Louise and Loosli, Kathrin and Lembo, Dr Tiziana and Davis, Dr Alicia and Hilton, Professor Shona
Authors: Davis, A., Lembo, T., Laurie, E., Mutua, E., Loosli, K., Nthambi, M., Nimegeer, A., Mnzava, K., Msoka, E. F., Nasuwa, F., Melubo, M., Shirima, G., Matthews, L., Hilton, S., Mshana, S. E., and Mmbaga, B. T.
College/School:College of Medical Veterinary and Life Sciences > Institute of Biodiversity Animal Health and Comparative Medicine
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Science and Engineering > School of Geographical and Earth Sciences
College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
Journal Name:Antimicrobial Resistance and Infection Control
Publisher:BioMed Central
ISSN:2047-2994
ISSN (Online):2047-2994
Copyright Holders:Copyright © The Author(s) 2022
First Published:First published in Antimicrobial Resistance and Infection Control 11(1):34
Publisher Policy:Reproduced under a Creative Commons Licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303374Supporting the National Action Plan for Antimicrobial Resistance (SNAP-AMR) in TanzaniaShona HiltonMedical Research Council (MRC)MR/S004815/1Institute of Biodiversity, Animal Health and Comparative Medicine
727661Complexity in Health ImprovementLaurence MooreMedical Research Council (MRC)MC_UU_12017/14HW - MRC/CSO Social and Public Health Sciences Unit
727661Complexity in Health ImprovementLaurence MooreChief Scientist Office (CSO)SPHSU14HW - MRC/CSO Social and Public Health Sciences Unit
727671Informing Healthy Public PolicyPeter CraigMedical Research Council (MRC)MC_UU_12017/15HW - MRC/CSO Social and Public Health Sciences Unit
727671Informing Healthy Public PolicyPeter CraigChief Scientist Office (CSO)SPHSU15HW - MRC/CSO Social and Public Health Sciences Unit