Christina Zarowsky's research while affiliated with Polytechnique Montréal and other places
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Publications (109)
Introduction:
Many adults diagnosed with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) also have other known or unknown comorbid conditions. The rising prevalence of GDM and T2DM within a broader context of multimorbidity can best be addressed through an integrated management response, instead of stand-alone programs targ...
![Figure 1 Behavioural Change Wheel framework [28] (Figure used with...](publication/363746404/figure/fig1/AS:11431281090870361@1666209414017/Behavioural-Change-Wheel-framework-28-Figure-used-with-permission-of-Prof-Susan_Q320.jpg)
Background:
Despite high gestational diabetes mellitus (GDM) prevalence in South Africa (9.1% in 2018), its screening and management are not well integrated into routine primary health care and poorly linked to post-GDM prevention of type 2 diabetes mellitus (T2DM) in South Africa's fragmented health system. This study explored women's, health car...
Contexte
Les canaux de communication utilisés lors de l'identification de maladies émergentes sont complexes, d'autant plus lorsque les systèmes de santé animale et humaine sont impliqués; ceux-ci peuvent néanmoins aider l'implantation d'une approche « Une Seule Santé ». Les objectifs de cette étude de cas sont de décrire les canaux de communicatio...
Objectives:
Intimate partner violence and sexual violence organizations such as women's shelters play a crucial role in advancing gender equality in Canada. COVID-19 has challenged how such organizations operate. This study explored how intimate partner violence and sexual violence organizations in Canada have been affected by COVID-19 and the con...
Background
The COVID-19 pandemic may increase risk of intimate partner and sexual violence and make relevant services less accessible. This study explored the perspectives of intimate partner and sexual violence workers across Canada on how the COVID-19 pandemic has affected the survivors with whom they work.
Methods
Using a qualitative descriptiv...
One Health (OH) is an integrated approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. On the basis of a review of OH doctoral programs, we advocate for integrating social-ecological systems thinking in OH doctoral training to maximize the impact of future OH research and interventions.
Background
The United Nations through universal health coverage, including sexual and reproductive health (SRH), pledges to include all people, leaving no one behind. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social iden...
While One Health initiatives are gaining in popularity, it is unclear if and how they are evaluated when implementation at scale is intended. The main purpose of this scoping review was to describe how One Health initiatives targeting infectious diseases and antimicrobial resistance at a large scale are evaluated. Secondary objectives included iden...
Purpose: The COVID-19 pandemic may increase risk of intimate partner and sexual violence and make relevant services less accessible. This study explored the perspectives of intimate partner and sexual violence workers across Canada on how the COVID-19 pandemic has affected the survivors with whom they work.
Methods: Using a qualitative descriptive...
Background: Information on health education institutions is required for planning, implementing and monitoring human resources for health strategies. Details on the number, type and distribution of medical and health science programs offered by African higher education institutions remains scattered.
Methods: We merged and updated datasets of healt...
Background
As Canadian global health researchers who conducted a qualitative study with adults with and without disabilities in Uganda, we obtained ethics approval from four institutional research ethics boards (two in Canada and two in Uganda). In Canada, research ethics boards and researchers follow the research ethics norms of the Tri-Council Po...
Recurrent conflicts and economic downturn hamper access to health care. We examined how renewed conflict in July 2016 in Torit County, South Sudan affected health facility utilization for pregnancy care. We analyzed key quantitative indicators before and since renewed conflict through monthly facility data covering January 2015 to December 2016 on...
Background
Short birth interval is associated with adverse perinatal, maternal, and infant outcomes, although evidence on actionable factors underlying short birth interval remains limited. We explored women and community views on short birth intervals to inform potential solutions to promote a culturally safe child spacing in Northern Uganda.
Met...
Background:
Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors' perceptions of existing pro-d...
Background Universal health coverage, including sexual and reproductive health (SRH), pledges to “leave no one behind”. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social identities and health determinants reveal a complex...
Objectives
Describe participatory codesign of interventions to improve access to perinatal care services in Northern Uganda.
Study design
Mixed-methods participatory research to codesign increased access to perinatal care. Fuzzy cognitive mapping, focus groups and a household survey identified and documented the extent of obstructions to access. D...
Background
Despite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most...
Background
Implementation of the programmes for the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) into antenatal care over the last three decades could inform implementation of interventions for other health challenges such as gestational diabetes mellitus (GDM). This study assessed PMTCT outcomes, and how...
Introduction
Persistent low rates of case notification and treatment coverage reflect that accessing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge, even though it is provided free of charge to patients. Equity in health access requires availability of comparable, appropriate services to all, based on...
Background
Despite the availability of free drug-resistant tuberculosis (DR-TB) care in Nigeria since 2011, the country continues to tackle low case notification and treatment rates. In 2018, 11% of an estimated 21,000 cases were diagnosed and 9% placed on treatment. These low rates are nevertheless a marked improvement from 2015 when only 3.4% wer...
Background
The diagnosis of gestational diabetes mellitus (GDM) may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM, could have benefits for sustainable long-term behavioural change following...
The coronavirus disease 2019 (COVID-19) has emerged as a serious threat to global public health, demanding urgent action and causing unprecedented worldwide change in a short space of time. This disease has devastated economies, infringed on individual freedoms, and taken an unprecedented toll on healthcare systems worldwide. As of 1 April 2020, ov...
This commentary discusses the contributions that One Health (OH) principles can make in improving the global response to the COVID-19 pandemic. We highlight four areas where the application of OH has the potential to significantly improve the governance of infectious diseases in general, and of COVID-19 in particular. First, more integrated surveil...
Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critic...
Background Despite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most...
Background
Despite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most...
Background Despite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most...
Background Despite progress in tuberculosis (TB) control globally, TB continues to be a leading cause of death from infectious diseases, claiming 1.2 million lives in 2018; 214,000 of these deaths were due to drug resistant strains. Of the estimated 10 million cases globally in 2018, 24% were in Africa, with Nigeria and South Africa making up most...
Introduction
Persistent low rates of case notification and treatment coverage reflect that accessing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge, even though it is provided free of charge to patients. Equity in health access requires availability of comparable, appropriate services to all, based on...
Background
Drug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resist...
Introduction: Persistent low rates of case notification and treatment coverage reflect that accessing free diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge. Equity in health access requires availability of comparable, appropriate services to all, based on needs, and irrespective of socio-demographic cha...
![Adapted study framework towards integrated PMTCT into PHC [40, 43–46]](publication/342475396/figure/fig2/AS:962838776512552@1606570061845/Adapted-study-framework-towards-integrated-PMTCT-into-PHC-40-43-46_Q320.jpg)
Background:
Integrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved mat...
The 2030 Sustainable Development Goals committed to "Leave No One Behind" regardless of social identity. While access to sexual and reproductive health (SRH) services has improved globally, people with disabilities continue to face enormous barriers to SRH, infringing on their SRH rights (SRHR). Uganda adopted pro-disability legislation to promote...
Background:
South Sudan has one of the highest maternal mortality ratios in the world, at 789 deaths per 100,000 live births. The majority of these deaths are due to complications during labor and delivery. Institutional delivery under the care of skilled attendants is a proven, effective intervention to avert some deaths. The aim was to determine...
Background Integrating vertical programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of Prevention of Mother-to-Child Transmission programmes (PMTCT) in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and...
Interuniversity global health partnerships are often between parties unequal in organizational capacity and performance using conventional academic output measures. Mutual benefit and reciprocity are called for but literature examining these concepts is limited. The objectives of this study are to analyse how reciprocity is practiced in internation...
Objectives
This study examines health facility utilization for pregnancy and delivery care and the health system challenges, in the light of renewed conflict in 2016, in Torit County, South Sudan.
We collected monthly facility data retrospectively on total Antenatal Care (ANC) visits, institutional deliveries, major obstetric, and neonatal complica...
Background
Lifestyle change can reduce the risk of developing type 2 diabetes among women with prior gestational diabetes mellitus (GDM). While understanding women’s lived experiences and views around GDM is critical to the development of behaviour change interventions to reduce this risk, few studies have addressed this issue in low- and middle- i...
Background:
Globalization and funding imperatives drive many universities to internationalize through global health programmes. University-based global health researchers, advocates and programmes often stress the importance of addressing health inequity through partnerships. However, empirical exploration of perspectives on why universities engag...
Objective:
To estimate national and geography-based variations in blood pressure and burden of hypertension in Cameroon, generally called 'miniature Africa'.
Methods:
PubMed, Medline, EMBASE, CINHAL, Web of Science, Popline, Scopus and BDSP were searched through November 2018, for hypertension studies among Cameroonians aged at least 18 years. H...
Estimated TB/DR-TB National case notification rates by geopolitical zones in Nigeria*.
*Study DR-TB data on number of diagnosed patients per state were used to calculate DR-TB case notification rates based on 2015 estimates. These were compared with the National TB case notification rates for the same year.
(TIF)
Variables in the diagnosis database (GX Alert).
(DOCX)
Background
There were an estimated 580,000 new cases of multidrug/rifampicin resistant TB (DR-TB) in 2015, and only 20% were initiated on treatment. This study explored health system and patient factors associated with initiation and timeliness of treatment among DR-TB patients in Nigeria, ranked 4th globally for estimated TB cases in 2015.
Method...
Estimated TB and DR-TB CDR by South-Western States of Nigeria*.
*Comparing number of diagnosed patients and case notification rates also showed significant regional differences.
(TIF)
Variables in the treatment database (E-TB Manager).
(DOCX)
Background
In remote rural Tanzania, the rate of linkage into HIV care was estimated at 28% in 2014. This study explored facilitators and barriers to linkage to HIV care at individual/patient, health care provider, health system, and contextual levels to inform eventual design of interventions to improve linkage to HIV care.
Methods
We conducted a...
Introduction
Multi-morbidity, defined as the co-existence of more than one chronic condition in one person, has been increasing due to comorbid non-communicable and infectious chronic diseases (CNCICDs). Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) incidences within the CNCICDs conditions are increasing and overwhelming already wea...
Anonymised data set.
(DTA)
Background
Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women.
Met...
Background
The Eastern Cape Province reports among the poorest health service indicators in South Africa with some of its districts standing out as worst performing as regards maternal health indicators. To understand key drivers and outcomes of this underperformance and to explore whether a participatory analysis could deepen action-oriented under...
Background
Like other countries, Tanzania instituted mobile and outreach testing approaches to address low HIV testing rates at health facilities and enhance linkage to care. Available evidence from hard-to-reach rural settings of Mbeya region, Tanzania suggests that clients testing HIV+ at facility-based sites are more likely to link to care, and...
Background:
Early detection and effective treatment are key to successful TB control. They are achieved by reducing the time from symptom onset to presentation at the TB health facility (patient delay), and the time to diagnosis and treatment (health system delay). Few studies on TB diagnosis and treatment delays have focused on drug-resistant TB (...
Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hos...
Background: Sexual and physical abuse in childhood creates a great health burden including on mental and reproductive health. A possible link between child abuse and HIV infection has increasingly attracted attention. This paper investigated whether a history of child physical and sexual abuse is associated with HIV infection among adult women.
Met...
Background:
Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there...
Background:
Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes.
Methods:
A cross sectional study was conducted with 2042 women aged 15-49 ye...
Background:
There are many interuniversity global health partnerships with African universities. Representatives of these partnerships often claim partnership success in published works, yet critical, contextualized, and comparative assessments of international, cross-border partnerships are few.
Objective:
The objectives of this paper are to de...
Background
The global scale-up of Prevention of mother-to-child transmission (PMTCT) services is credited for a 52% worldwide decline in new HIV infections among children between 2001 and 2012. However, the epidemic continues to challenge maternal and paediatric HIV control efforts in Sub Saharan Africa (SSA), with repercussions on other health ser...
Introduction:
Reproductive health remains a major global health issue. People with disabilities face additional discrimination and barriers to access which need to be better understood. To contribute to future interventions, we examined the intersections between gender and disability related to reproductive health in sub-Saharan Africa in the qual...
Background
Despite progress in tuberculosis (TB) control globally, it continues to be a leading cause of death, claiming 1.5 million in 2014, 190,000 of which were due to drug resistant strains. Out of the estimated 9.6 million cases globally in 2014, 28% were in Africa, with Nigeria and South Africa making up the bulk of these numbers. The mixture...
Background
Although the advantages of introducing point of care testing for syphilis in antenatal care (ANC) are well documented, there is little evidence on how to address structural issues within health systems. A better understanding of how these interventions work in a range of settings and contexts is needed in order to overcome bottlenecks at...
Background
Hypertension holds a unique place in population health and health care because it is the leading cause of cardiovascular disease and the most common noncommunicable condition seen in primary care worldwide. Without effective prevention and control, raised blood pressure significantly increases the risk of stroke, myocardial infarction, c...
ABSTRACT
Objective: Linkage to care is the bridge between HIV testing and HIV treatment, care and support. In Tanzania, mobile testing aims to address historically low testing rates. Linkage to care was reported at 14% in 2009 and 28% in 2014. The study compares linkage to care of HIV positive individuals tested at mobile/outreach versus public hea...
Objective
Linkage to care is the bridge between HIV testing and HIV treatment, care and support. In Tanzania, mobile testing aims to address historically low testing rates. Linkage to care was reported at 14% in 2009 and 28% in 2014. The study compares linkage to care of HIV-positive individuals tested at mobile/outreach versus public health facili...
Myanmar’s shortage of midwives led to shifting of pre/postnatal tasks to auxiliary midwives (AMWs). However, lack of training and supervision negatively affect the quality of their services. An NGO piloted Myanmar’s first point-of-care mHealth project after having developed an algorithm-based electronic clinical decision support application for pre...
Background
International university partnerships are recommended for increasing the capacity of sub-Saharan African universities. Many publications describe individual partnerships and projects, and tools are available for guiding collaborations, but systematic mappings of the basic, common characteristics of partnerships are scarce.
Objective
To...
