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Importance The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse. Objective To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries. Design, setting, and participants Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening. Exposures World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics. Main outcomes and measures Self-report of having ever had a screening test for cervical cancer. Results Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened. Conclusions and relevance In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening.

Abstract Background Older adults benefit considerably from Internet use, as it can improve their overall health and quality of life, for example through accessing healthcare services and reducing social isolation. The aim of this study is to assess the prevalence and characteristics of Indigenous older adults in Canada who do not use the Internet. Methods The Aboriginal Peoples Survey (APS) 2017 was used and analysis was restricted to those above 65 years of age. The main outcome variable was non-use of the internet in a typical month. Multivariable logistic regression was conducted to assess the relationship between each of the sociodemographic, socioeconomic, lifestyle and health factors and internet non-use. Results The prevalence of Indigenous older adults who reported never using the Internet in a typical month was 33.6% with the highest prevalence reported by residents of the Canadian territories while the lowest prevalence was reported in British Columbia. After adjustment, results indicated that older age (OR = 4.02, 95% CI 3.54–4.57 comparing 80+ to 65–69 years of age), being a male (OR = 1.52, 95% CI 1.41–1.63), married (OR = 1.34, 95% CI 1.25–1.44), and living in rural areas (OR = 1.95, 95% CI 1.79–2.13) increased the odds of not using the Internet. First Nation individuals and those who have a strong sense of belonging to the Indigenous identity were more likely to not use the Internet compared to their counterparts. In addition, those who were less educated (OR = 8.74, 95% CI 7.03–1 0.87 comparing less than secondary education to Bachelor’s Degree and above), unemployed (OR = 1.41, 95% CI 1.26–1.57), smoked cigarettes, used marijuana and those with lower self-perceived mental health and unmet health needs were at increased odds of Internet non-use compared to their counterparts. Conclusions Findings from this study show that a large proportion of the Indigenous older adults in Canada do not use the internet. It is necessary to address Indigenous communities’ lack of internet access and to create interventions that are consistent with Indigenous values, traditions, and goals.

Background Multiple sclerosis (MS) causes pervasive motor, sensory and cognitive dysfunction. The Expanded Disability Status Scale (EDSS) is the gold standard for assessing MS disability. The EDSS is biased towards mobility and may not accurately measure MS-related disabilities in the upper limb or in cognitive functions (e.g. executive function). Objective Our objectives were to determine the feasibility of using the Kinarm robotic system to quantify neurological deficits related to arm function and cognition in MS patients, and examine relationships between traditional clinical assessments and Kinarm variables. Methods Individuals with MS performed 8 robotic tasks assessing motor, cognitive, and sensory ability. We additionally collected traditional clinical assessments and compared these to the results of the robotic assessment. Results Forty-three people with MS were assessed. Most participants could complete the robotic assessment. Twenty-six (60%) were impaired on at least one cognitive task and twenty-six (60%) were impaired on at least one upper-limb motor task. Cognitive domain task performance correlated most strongly with the EDSS. Conclusions Kinarm robotic assessment of people with MS is feasible, can identify a broad range of upper-limb motor and sensory, as well as cognitive, impairments, and complements current clinical rating scales in the assessment of MS-related disability.

International audience; In 2003, the then Chief Minister of Tamil Nadu in southern India, Jayaram Jayalalithaa, gave a speech about the “silent revolution” of the empowerment of Indian women. But 15 years on, regrettably, the promises of that revolution do not seem to have been fulfilled. Thanks to the various programs set up to champion women’s empowerment (involving local NGOs, public programs, and international support), women are now more prominent in certain public spaces and are able to play a genuine advocacy role with regard to the public authorities. Girls education has also significantly improved. But it has not brought about improved employment opportunities. Women are in fact losing out on paid employment (as is the case in India as a whole). They are also heavily indebted (not only from microcredit, but also informal lending and lending from private financial companies). Their indebtedness is disproportionate to their income, and compared to men. Moreover, women almost exclusively put debt toward the social reproduction of families. Reduced opportunities for paid employment and massive debt have hit Dalit women particularly hard. The analyses of this chapter use data collected over more than a decade in a rural area of Tamil Nadu, drawing together ethnography and quantitative data, including panel data (2010–2016). They shed light on the complexity of social change, intertwining forms of domination (here, caste, and gender), and the ambiguous qualities of so-called empowerment programs, whose impacts have been various and unexpected

Abstract This paper analyses the consequences of responsibilization for women in natural resource management in Southern Tanzania. Participatory forest management (PFM) and Participatory Land Use Planning in Southern Tanzania provide a case study to interrogate how responsibilization impacts on the existing social order in a given community. As the study findings show, participatory initiatives have not fully reached rural women who are still under-represented and insufficiently equipped to participate in public decision-making, which maintains women's marginalization. In Tanzania there has been progress in community rights for forest management. Following the Forest Policy (1998) and Forest Act (2002), Tanzanian villages can establish Village Land Forest Reserves and manage and utilize natural resources for the benefit of the community. The success of decentralized forest governance depends on the interplay between power, authority and social relations. This is determined by the capacity of communities to participate and by the government's responsiveness to the people's voice. Based on our case study, women do not have equal opportunities to raise their voice like men, and women are marginalized in the decisions made about forest management and in the distribution of benefits from the natural resources with which their communities are endowed. This has policy implications in the sense that processes and structures of decentralized forest governance seem unable to address the needs of women.

Around the world, regimes of identification regulate people’s interactions with state and commercial institutions. These regimes promise access to resources and entitlements, while also facilitating people’s visibility to states and therefore their governability. For many, proving one’s identity presents no challenge; however, it is estimated that a billion people have no official proof of identity. Meanwhile, the humanitarian sector is undergoing a transformation in which digital identity, mobile connectivity and digital finance are central features. Through a data justice lens, this paper explores customer identification regimes in two country contexts in which large displaced populations are present: Uganda and Bangladesh. The two cases reveal divergent approaches to regulating refugee identification: while Uganda's policy environment has recently become more inclusive, Bangladesh's proves to be particularly restrictive. We reflect on what these cases mean for the future development of digital identity systems by the humanitarian sector and the implications for data justice.

BACKGROUND: Low- and middle-income countries (LMICs) are the worst affected by a lack of safe and affordable access to safe surgery. The significant unmet surgical need can be in part attributed to surgical workforce shortages that disproportionately affect rural areas of these countries. To combat this, Malawi has introduced a cadre of non-physician clinicians (NPCs) called clinical officers (COs), trained to the level of a Bachelor of Science (BSc) in Surgery. This study explored the barriers and enablers to their retention in rural district hospitals (DHs), as perceived by the first cohort of COs trained to BSc in Surgery level in Malawi. METHODS: A longitudinal qualitative research approach was used based on interviews with 16 COs, practicing at DHs, during their BSc training (2015); and again with 15 of them after their graduation (2019). Data from both time points were analysed and compared using a top-down thematic analysis approach. RESULTS: Of the 16 COs interviewed in 2015, 11 intended to take up a post at a DH following graduation; however, only 6 subsequently did so. The major barriers to remaining in a DH post as perceived by these COs were lack of promotion, a more attractive salary elsewhere; and unclear, stagnant career progression within surgery. For those who remained working in DH posts, the main enablers are a willingness to accept a low salary, to generate greater opportunities to engage in additional earning opportunities; the hope of promotional opportunities within the government system; and greater responsibility and recognition of their surgical knowledge and skills as a BSc-holder at the district level. CONCLUSION: The sustainability of surgically trained NPCs in Malawi is not assured and further work is required to develop and implement successful retention strategies, which will require a multi-sector approach. This paper provides insights into barriers and enablers to retention of this newly-introduced cadre and has important lessons for policy-makers in Malawi and other countries employing NPCs to deliver essential surgery. Contains fulltext : 287908.pdf (Publisher’s version ) (Open Access)