In the three decades since the first reported case of Ebola virus, most known index cases have been consistently traced to the hunting of “bush meat”, and women have consistently recorded relatively high fatality rates in most catastrophic outbreaks. This paper discusses Ebola-related risk factors, which constantly interact with cultural values, and provides an insight into the link between gender and the risk of contracting infectious diseases, using Ebola virus as an example within Africa. A comprehensive search of the literature was conducted using the PubMed, Ovid Medline and Global Health CABI databases as well as CAB Abstracts, including gray literature. We used a descriptive and sex- and gender-based analysis to revisit previous studies on Ebola outbreaks since 1976 to 2014, and disaggregated the cases and fatality rates according to gender and the sources of known index cases based on available data. In total, approximately 1530 people died in all previous Ebola outbreaks from 1976 to 2012 compared with over 11,310 deaths from the 2014 outbreak. Women’s increased exposure can be attributed to time spent at home and their responsibility for caring for the sick, while men’s increased vulnerability to the virus can be attributed to their responsibility for caring for livestock and to time spent away from home, as most known sources of the index cases have been infected in the process of hunting. We present a conceptual model of a circle of interacting risk factors for Ebola in the African context. There is currently no evidence related to biological differences in female or male sex that increases Ebola virus transmission and vulnerability; rather, there are differences in the level of exposure between men and women. Gender is therefore an important risk factor to consider in the design of health programs. Building the capacity for effective risk communication is a worthwhile investment in public and global health for future emergency responses.

The COVID-19 pandemic has highlighted the global imperative to address health inequities. Observational studies are a valuable source of evidence for real-world effects and impacts of implementing COVID-19 policies on the redistribution of inequities. We assembled a diverse global multi-disciplinary team to develop interim guidance for improving transparency in reporting health equity in COVID-19 observational studies. We identified 14 areas in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist that need additional detail to encourage transparent reporting of health equity. We searched for examples of COVID-19 observational studies that analysed and reported health equity analysis across one or more social determinants of health. We engaged with Indigenous stakeholders and others groups experiencing health inequities to co-produce this guidance and to bring an intersectional lens. Taking health equity and social determinants of health into account contributes to the clinical and epidemiological understanding of the disease, identifying specific needs and supporting decision-making processes. Stakeholders are encouraged to consider using this guidance on observational research to help provide evidence to close the inequitable gaps in health outcomes.

Performance-based financing (PBF)—a supply-side strategy that incentivizes health providers based on predefined quality and quantity criteria—introduced an innovative approach to reaching the poor by means of using PBF equity instruments. These PBF equity instruments include paying providers more to reach out to poor women, selecting services used by the poor, subsidizing user fees to reduce out-of-pocket expenses, and adding complementary demand-side intervention. Before the implementation of the PBF equity instrument in Cameroon, there were few initiatives/schemes to enable the poor to access maternal health services. Moreover, there is a significant research gap on how the equity elements are defined and implemented across contexts. This study aims to understand (i) how health facilities define and classify the poor and vulnerable in the context of PBF, (ii) how the equity elements are implemented at the community and facility levels, and (iii) the potential impact on access to and the use of maternal health services at the facility level and challenges in the implementation process. We used key informant interviews and focus group discussions (FGDs) based on a grounded theory approach to gain an understanding of the social processes and experiences. Data were collected from three districts in the Southwest region of Cameroon from April 2021 to August 2021. Data were transcribed and analyzed using MaxQDA. The thematic analysis approach/technique was used to analyze data. Key informant interviews and focus groups were conducted with 79 participants, including 28 health professionals and service administrators, 27 pregnant women, and 24 community health workers in three districts. Health facilities employed various subjective approaches to assess and define poor and vulnerable (PAV) persons. Home visits were reported to have an impact in reaching the poor and vulnerable to improve access to maternal services. Meanwhile, a delay in the payment of PBF incentives was reported to be the main challenge that had a negative relationship with the consistent provision of care to the poor and vulnerable, especially in private health facilities. The theory generated from our findings suggests that the impact of the PBF equity elements specific to maternal health depends on (i) a shared understanding of the definition of PAV among different stakeholders, including providers and users, as well as how the PAV is operationalized (structure), and (ii) the appropriate and timely payment of incentives to health facilities and health providers.

Introduction: Across communities in low-middle income countries, digital health is currently revolutionizing the delivery of health services, particularly in the field of reproductive, maternal, newborn, and child health (RMNCH) services. While studies have shown the effectiveness of mHealth in delivering RMNCH services, there is little information about factors that enhance mHealth services utilization in low-cost settings including stakeholders’ level of influence on the implementation of digital health intervention in sub–Saharan Africa. This paper seeks to describe important lessons on the levels of stakeholders’ direct or indirect influence on the design and implementation of the BornFyne-PNMS digital health platform to support RMNCH services.Methods: A participatory research (PR) design approach was employed to explore stakeholders’ perspectives of a new initiative, through direct engagement of local priorities and perspectives. The process of introducing the digital application called the BornFyne-PNMS for district health delivery system and the community, and integrating it within the district health delivery system was guided by research-to-action, consistent with the PR approach. To explore stakeholders’ perspectives through a PR approach, we conducted a series of stakeholder meetings fashioned after focus group discussions.Results: Issues around male involvement in the program, sensitization and equity concerns arose. Emergent challenges and proposed strategies for implementation from diverse stakeholders evidently enriched the design and implementation process of the project intervention. Stakeholder meetings informed the addition of variables on the mobile application that were otherwise initially omitted, which will further enhance the RMNCH electronic data collection for health information systems strengthening in Cameroon.Discussion: This study charts a direction that is critical in digital health delivery of RMNCH in a rural and low-income community and describes the important iterative stakeholder input throughout the study. The strategy of stakeholders’ involvement in the BornFyne PNMS implementation charts a direction for ownership and sustainability in the strengthening of Cameroon's health information system.

Background: The process of stakeholder engagement in the implementation of a digital health platform is vital, especially in low-resourced countries like Cameroon, where the digital health ecosystem is still emerging. Stakeholder engagement can make meaningful contributions to a project allowing for increased project visibility and reach, uptake, acceptability, and sustainability. However, collaboration among stakeholders during stakeholder engagement cannot be implied. This article focuses solely on intersectoral collaboration amongst stakeholders in the implementation of the BornFyne-PNMS digital health platform in Cameroon. Method: The study took on a participatory action research approach using stakeholder discussions, feedback from participants, questions, and suggestions to inform the progress and continuous implementation. This also included follow-up discussions with stakeholders from various sectors. The intersectoral meetings took into consideration a wider perspective on the implementation process and the launch of universal health coverage in Cameroon. Results: A total of five stakeholder meetings were held during the implementation phase, and a total of 174 stakeholders were engaged. As a follow-up, a total of 19 letters were prepared by the Department of Family Health and addressed to strategic departments including international partners to introduce the BornFyne project. Findings are centered on six major themes that emerged from the coded data and they are as follows: (1) aligned goals and objectives; (2) enhanced health care delivery; (3) data quality and availability; (4) accessibility issues; (5) intersectoral collaboration for universal health coverage; and (6) equity aspects. Conclusion: This article underscores the relevance of engaging a diverse group of stakeholders as a strength in intersectoral collaboration and partnership in implementing digital health interventions. It ensures that the views and experiences of those directly impacted by the intervention are considered, and it contributes to a more well-rounded and impactful assessment of the BornFyne-PNMS platform's role in improving RMNCAH in rural settings.

Background: The mitigation of unfair and avoidable differences in health is an increasing global priority. Observational studies including cohort, cross-sectional and case-control studies tend to report social determinants of health which could inform evidence syntheses on health equity and social justice. However, the extent of reporting and analysis of equity in equity-relevant observational studies is unknown. Methods: We define studies which report outcomes for populations at risk of experiencing inequities as “equity-relevant”. Using a random sampling technique we will identify 320 equity-relevant observational studies published between 1 January 2020 to 27 April 2022 by searching the MEDLINE database. We will stratify sampling by 1) studies in high-income countries (HIC) and low- and middle-income countries (LMIC) according to the World Bank classification, 2) studies focused on COVID and those which are not, 3) studies focused on populations at risk of experiencing inequities and those on general populations that stratify their analyses. We will use the PROGRESS framework which stands for place of residence, race or ethnicity, occupation, gender or sex, religion, education, socioeconomic status, social capital, to identify dimensions where inequities may exist. Using a previously developed data extraction form we will pilot-test on eligible studies and revise as applicable. Conclusions: The proposed methodological assessment of reporting will allow us to systematically understand the current reporting and analysis practices for health equity in observational studies. The findings of this study will help inform the development of the equity extension for the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) reporting guidelines.