Yves Bergevin’s research while affiliated with McGill University and other places

This study aims to determine the knowledge, attitudes, and practices (KAP) of community health workers (CHWs) working in the eastern region of São Paulo, Brazil, regarding noncommunicable diseases (NCDs) and their risk factors, as a preliminary step toward training optimization. We conducted an online cross-sectional survey study with KAP questions on NCD risk factors, cardiovascular diseases (CVD), diabetes, chronic obstructive pulmonary disease (COPD), and cancer. CHWs working full-time in family health teams were invited to participate in the months of January and February 2019. Descriptive analyses were performed for all survey questions, and knowledge scores were calculated from the sum of correct answers to the knowledge questions. The survey was completed by 1071 CHWs (85% response rate). Most respondents were women and had less than five years of work experience. The mean overall knowledge score was 62%. The highest score was obtained for the CVD category (80.2%), and the lowest scores in the COPD (28%) and cervical cancer (32.9%) categories. The majority of CHWs considered diabetes as the most important NCD in their communities. At the practice level, CHWs reported being the most confident about their counseling on cervical and breast cancer screening, and the least confident about colon cancer screening. Several knowledge and practice gaps across different NCDs have been identified, which can inform the optimization of CHWs’ training and clinical activities in order to improve their effectiveness in preventing and managing NCDs in the Brazilian context.

Many voices have called for dismantling the colonial legacies that permeate healthcare systems. McGill’s Interprofessional Global Health Course 2021 online edition adopted the theme of decolonizing global health. This study aimed to understand the perspectives of students enrolled in this course on a) colonial patterns embedded in global health, and b) future actions that students can take to decolonize global health. A qualitative descriptive methodology was employed. The study population included students who completed the course during the Winter 2021 semester. Following the last session, students were asked to answer four open-ended questions. The answers were analyzed thematically using inductive and deductive coding. Eighty-one of the 105 students registered for the course answered the questions and data saturation was reached after analyzing 24 answer sheets. Two themes emerged: the course informed students about the role of colonial legacies in shaping global health systems and the course helped students understand global health decolonization and plan to take relevant actions. To promote global health decolonization, future healthcare workers need to be sensitized to the ongoing impacts of colonialism. Healthcare education can serve this function through the examination and modification of curricula, but also through the employment of innovative educational approaches that help students reflect on their professional roles and responsibilities towards global health decolonization.

Background This study assesses the impact of the Interprofessional Global Health Course (IPGHC) on students’ fundamental global health knowledge and personal viewpoints on global health domains. It explores the evolution of students’ understanding of global health specifically in relation to the COVID-19 pandemic. Methods Ninety-nine students were selected from 123 McGill student applicants based on their motivation and commitment to take part in IPGHC’s ten-week 2020 curriculum. These IPGHC students were eligible to participate in the study. The study’s design is sequential explanatory mixed methods. The cross-sectional survey (quantitative phase) appraises students’ global health learning outcomes using pre- and post-course surveys, with the use of 5-point Likert-scale questions. The descriptive qualitative survey (qualitative phase) further explores the impact of IPGHC on student’s understanding of global health and the reflections of students on the COVID-19 pandemic after IPGHC. The post-course survey included a course evaluation for quality improvement purposes. Results Of the 99 students, 81 students across multiple undergraduate and graduate disciplines participated in the study by completing the course surveys. Mean knowledge scores of the following 11 global health topics were increased between pre- and post-course survey: Canadian Indigenous health ( P < 0.001), global burden of disease ( P < 0.001), global surgery ( P < 0.001), infectious diseases and neglected tropical diseases ( P < 0.001), refugee and immigrant health ( P < 0.001), research and development of drugs ( P < 0.001), role of politics and policies in global health ( P = 0.02), role of technology in global health ( P < 0.001), sexual violence ( P < 0.001), systemic racism in healthcare ( P = 0.03), and trauma in the global health context ( P < 0.001). A positive change in student viewpoints was observed in response to questions regarding their perception of the importance of global health education in their own professional health care programs ( P < 0.001), and their understanding of the roles and responsibilities of other healthcare professionals ( P < 0.001). In the post-course survey open-ended questions, students exemplified their knowledge gained during the course to create a more informed definition of global health. Several recurring themes were identified in the student reflections on the COVID-19 pandemic, notably policy and politics, followed by access to healthcare and resources. Conclusion This study emphasizes the need for interprofessional global health education at the university level and demonstrates how rapidly global health learners can apply their knowledge to evolving contexts like the COVID-19 pandemic.

Background: An estimated 200 million women and girls in low and middle-income countries (LMICs) wish to delay, space or avoid becoming pregnant, yet are not using contraceptives. This study seeks to investigate the effectiveness of mass media interventions for increasing knowledge and use of contraceptives, and to identify barriers to program implementation. Methods: Using a mixed-methods systematic approach, we searched five electronic databases using pre-determined search strategies and hand-searching of articles of any study design published from 1994 to 2017 of mass media interventions for family planning education. Two reviewers independently applied clearly defined eligibility criteria to the search results, quality appraisal, data extraction from published reports, and data analysis (using meta-analysis and thematic analysis) following PRISMA guidelines. Results: We identified 59 eligible studies. Although the majority of studies suggest a positive association between media interventions and family planning outcomes, the pooled results are still consistent with possibly null intervention effects. The reported prevalence ratios (PR) for media interventions association with increased contraceptive knowledge range from 0.97 to 1.41, while the PRs for contraceptive use range from 0.54 to 3.23. The qualitative analysis indicates that there are barriers to contraceptive uptake at the level of individual knowledge (including demographic factors and preconceived notions), access (including issues relating to mobility and financing), and programming (including lack of participatory approaches). Conclusions: There is a need for rigorous impact evaluation, including randomised controlled trials, of mass media interventions on knowledge and uptake of family planning in LMIC settings. Interventions should be better tailored to cultural and socio-demographic characteristics of the target populations, while access to resources should continue to remain a priority and be improved, where possible.

Maternal mortality has been reduced by half from 1990 to 2010, yet a woman in sub-Saharan Africa has a lifetime risk of maternal death of 1 in 39 compared with around 1 in 10,000 in industrialized countries. Annual rates of reduction of maternal mortality of over 10% have been achieved in several countries. Highly cost-effective interventions exist and are being scaled up, such as family planning, emergency obstetric and newborn care, quality service delivery, midwifery, maternal death surveillance and response, and girls' education; however, coverage still remains low. Maternal mortality reduction is now high on the global agenda. We examined scenarios of reduction of maternal mortality by 2035. Ending preventable maternal deaths could be achieved in nearly all countries by 2035 with challenging yet realistic efforts: (1) massive scaling-up and skilling up of human resources for family planning and maternal health; (2) reaching every village in every district and every urban slum toward universal health coverage; (3) enhanced financing; (4) knowledge for action: enhanced monitoring, accountability, evaluation, and R&D. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Background: Several countries in sub-Saharan Africa have recently adopted policies that remove user fees for facility-based delivery services. There is little rigorous evidence of the impact of these policies on utilization of delivery services and no evaluations have examined effects on neonatal mortality rates (NMR). In this article, we estimate the causal effect of removing user fees on the proportion of births delivered in facilities, the proportion of births delivered by Caesarean section, and NMR. Methods: We used data from Demographic and Health Surveys conducted in 10 African countries between 1997 and 2012. Kenya, Ghana and Senegal adopted policies removing user fees for facility-based deliveries between 2003 and 2007, while seven other countries not changing user fee policies were used as controls. We used a difference-in-differences (DD) regression approach to control for secular trends in the outcomes that are common across countries and for time invariant differences between countries. Results: According to covariate-adjusted DD models, the policy change was consistent with an increase of 3.1 facility-based deliveries per 100 live births (95% confidence interval (CI): 0.9, 5.2) and an estimated reduction of 2.9 neonatal deaths per 1000 births (95% CI: -6.8, 1.0). In relative terms, this corresponds to a 5% increase in facility deliveries and a 9% reduction in NMR. There was no evidence of an increase in Caesarean deliveries. We examined lead and lag-time effects, finding evidence that facility deliveries continued to increase following fee removal. Conclusions: Our findings suggest removing user fees increased facility-based deliveries and possibly contributed to a reduction in NMR. Evidence from this evaluation may be useful to governments weighing the potential benefits of removing user fees.

Background: Neonatal mortality rates (NMRs) in countries of low and middle income have been only slowly decreasing; coverage of essential maternal and newborn health services needs to increase, particularly for disadvantaged populations. Our aim was to produce comparable estimates of changes in socioeconomic inequalities in NMR in the past two decades across these countries. Methods: We used data from Demographic and Health Surveys (DHS) for countries in which a survey was done in 2008 or later and one about 10 years previously. We measured absolute inequalities with the slope index of inequality and relative inequalities with the relative index of inequality. We used an asset-based wealth index and maternal education as measures of socioeconomic position and summarised inequality estimates for all included countries with random-effects meta-analysis. Findings: 24 low-income and middle-income countries were eligible for inclusion. In most countries, absolute and relative wealth-related and educational inequalities in NMR decreased between survey 1 and survey 2. In five countries (Cameroon, Nigeria, Malawi, Mozambique, and Uganda), the difference in NMR between the top and bottom of the wealth distribution was reduced by more than two neonatal deaths per 1000 livebirths per year. By contrast, wealth-related inequality increased by more than 1·5 neonatal deaths per 1000 livebirths per year in Ethiopia and Cambodia. Patterns of change in absolute and relative educational inequalities in NMR were similar to those of wealth-related NMR inequalities, although the size of educational inequalities tended to be slightly larger. Interpretation: Socioeconomic inequality in NMR seems to have decreased in the past two decades in most countries of low and middle income. However, a substantial survival advantage remains for babies born into wealthier households with a high educational level, which should be considered in global efforts to further reduce NMR. Funding: Canadian Institutes of Health Research.