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Gender, Equity, Disability and Neglected Tropical Diseases

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This presentation was given my Margaret Gyapong at the Coalition for Operational Research on Neglected Tropical Diseases (NTDs) (COR-NTD) meeting in 2015. She raises critical questions about the links between gender, equity, disability and NTDs.

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Gender, Equity, Disability and Neglected Tropical Diseases

  1. 1. Gender, Equity, Disability and NTD’s Margaret Gyapong, Sally Theobold, Kate Hawkins COUNTDOWN
  2. 2. Background Addressing bottlenecks in scale-up and acceleration towards 2020 targets ? Programme of implementation research to inform the effective and sustainable scaling-up of integrated Neglected Tropical Disease (NTD) control initiatives
  3. 3. Integrated Complementary Strategy Theme ICST 1 ICST 2 Rationale for research themes and approaches Liberia GhanaCameroon MDA Scale-up Themes (MST 1 – 3) control elimination Country & context-specific setting of MDA MST 1: Evidence synthesis Paul Garner and Cochrane group MST 2: Applied social science Sally Theobald and Margaret Gyapong MST 3: Health economics Louis Niessen ICST 1: ‘Hotspots’ and SAEs Mark Taylor, Lisa Riemer Nana Biritwum and Sam Wanji ICST 2: Access to MDA and CLTS Russ Stothard, Emily Adams, Louis Tchuem-Tchuente and Nana Biritwum scale-up in Nigeria
  4. 4. Context • Gender, equity and disability interact with NTDs in various ways. • Deeply rooted in local sociocultural contexts, the interventions need to be adapted to those contexts • Infected individuals incur added burdens due to stigma, isolation and other negative consequences • FGS • MGS • Reduce the acceptability of health services, leading to differential health care outcomes • Health care providers are unaware of issues arising from gender-based inequity in access to health care • Affect marginalised populations who have a right to be heard in various ways • Out of school children • Pregnant women • People living with disability .
  5. 5. “They are hiding their skin so that people cannot see them. I have not heard of anyone who wants others to know about it. No one will allow them to lead, and many people ignore them. They are considered dangerous. People fear contact with them. I feel sorry for them. Even me, I feared that from staying and meeting them we could get the disease … They find it hard to marry, and marriages can break because of this condition.” (25 year old Ugandan woman in an oncho endemic area) Weiss et al (2008) • Men are key decision makers • Women are not invited to meetings where issues of MDA are discussed and major decisions are taken Case one
  6. 6. Case two • Adolescent girls and women with FGS experience • Bleeding and unpleasant discharge from the vagina, • Genital lesions, • Nodules in the vulva, • General discomfort and pain during sex. • Sub-fertility, miscarriage and can affect vulnerability to HIV and the Human Papilloma Virus; • Symptoms of MGS in adolescent boys and men include • Bleeding and egg deposition within semen, • Yellow discoloration in semen and lumpy semen, the implications of which are poorly understood (Mbabazi et al 2011). • FGS and MGS are sensitive, private, and possibly stigmatising. • How men and women experience symptoms, their treatment seeking pathways and the impact on their livelihoods and well-being are poorly understood • How health care providers recognise, diagnose and treat these conditions is not well known and documented
  7. 7. Filling the gap • Understanding contexts • Understanding the physical, socio economic and cultural context within which these interventions are delivered • Understanding the health system within which these interventions are delivered • Key stakeholders and institutions needed to ensure the effective delivery of the interventions • Understand the issues at stake from the perspective of the • Patients and their networks • Unaffected people and their networks • Health care providers operating in a complex and under funded system

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