Journal Articles

Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915

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Author: search.filters.author.Bromhead CSubject: search.filters.subject.equity

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    Is equity meaningfully incorporated into pandemic preparedness and response? A scoping review and critical analysis of Ebola andCOVID-19 outbreak responses in Uganda 2019-2023
    (Taylor and Francis Group, 2025-12-31) Redondo G; Murray L; Bromhead C; Makumbi I
    Societal inequities produce vulnerabilities that infectious disease can exploit. Current approaches to pandemic prevention, detection and response are led by the International Health Regulations IHR and the Global Health Security Agenda. However, to contain the spread of infectious diseases, localised action to address systemic inequities must be considered. The purpose of this scoping review and equity analysis is to 1) Synthesise the available information on Uganda’s Ebola Virus Disease (EVD) and COVID-19 preparedness and outbreak responses between 2019 and 2023, and 2) Critique if and how Uganda’s Ministry of Health incorporated concepts of health equity in its EVD and COVID-19 interventions, while building national capacity to identify and prevent public health emergencies. This scoping review and critical analysis was conducted following the five-stage process defined by Levac et al. After identification and screening, the scoping review was based on six preparedness and response plans, three after-action reviews, and 20 grey literature and peer-reviewed articles. The findings revealed that the EVD and COVID-19 preparedness and response plans in Uganda show the country’s commitment and readiness for early detection and response to infectious disease outbreaks. However, further examination of the plans reveals missed opportunities to address systemic inequities. The ongoing mpox outbreak, declared a PHEIC by WHO on July 23, 2022, with significant impacts in African countries including Uganda, further underscores the need for a paradigm shift in managing infectious disease outbreaks. Such a shift may be similar to that experienced by the field of disaster risk reduction, which underwent a significant transformation at the Sendai Conference in 2015 towards a more holistic and proactive approach that addresses underlying systemic issues and focuses on building resilience. The exclusive focus on biomedical strategies to manage infectious diseases fails to address the social aspects of transmission, the local perceptions of illness, and community vulnerabilities often associated with social and historical perspectives. The social determinants of health disparities should be incorporated into pandemic planning and response. This will contribute to fostering equitable health outcomes and resilience in the face of the multifaceted challenges posed by future pandemics and environmental changes.
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    Human Papillomavirus (HPV) Self-Sampling among Never-and Under-Screened Indigenous Māori, Pacific and Asian Women in Aotearoa New Zealand: A Feasibility Study
    (MDPI (Basel, Switzerland), 2021-10) Bromhead C; Wihongi H; Sherman SM; Crengle S; Grant J; Martin G; Maxwell A; McPherson G; Puloka A; Reid S; Scott N; Bartholomew K
    In Aotearoa, New Zealand, the majority of cervical cancer cases occur in women who have never been screened or are under-screened. Wāhine Māori, Pacific and Asian women have the lowest rate of cervical screening. Self-sampling for human papillomavirus (HPV-SS) has been shown to increase participation in cervical cancer screening. A whole-of-system approach, driven by evidence in the most effective delivery of HPV-SS, is required to mitigate further widening of the avoidable gap in cervical screening access and outcomes between groups of women in Aotearoa. This single-arm feasibility and acceptability study of HPV self-sampling invited never- and under-screened (≥5 years overdue) 30-69-year-old women from general practices in Auckland, Aotearoa. Eligible women were identified by data matching between the National Cervical Programme (NCSP) Register and practice data. Focus groups were additionally held with eligible wāhine Māori, Asian and Pacific women to co-design new patient information materials. Questionnaires on HPV knowledge and post-test experience were offered to women. Our follow-up protocols included shared decision-making principles, and we committed to follow-up ≥90% of women who tested positive for HPV. Data matching identified 366 eligible never- and under-screened wāhine Māori, Pacific and Asian women in participating practices. We were only able to contact 114 women, and 17, during the discussion, were found to be ineligible. Identifying and contacting women overdue for a cervical screen was resource-intensive, with a high rate of un-contactability despite multiple attempts. We found the best uptake of self-sampling was at focus groups. Of the total 84 HPV-SS tests, there were five positive results (6%), including one participant with HPV18 who was found to have a cervical Adenocarcinoma at colposcopy. In our feasibility study, self-sampling was acceptable and effective at detecting HPV and preventing cervical cancer in under-screened urban wāhine Māori, Pacific and Asian women in Aotearoa. This is the first report of cervical Adenocarcinoma (Grade 1B) as a result of an HPV-18 positive self-sample in Aotearoa. We co-designed new patient information materials taking a health literacy and ethnicity-specific approach. This work provides policy-relevant information to the NCSP on the resources required to implement an effective HPV self-sampling programme to improve equity in national cervical cancer screening.