Table 1 Challenges, exclusion, health outcomes and recommendations
Category | Source of Exclusion | Health Outcomes | Recommendations | Reviewed Literature |
|---|---|---|---|---|
The uneducated especially Adolescents and youth | Poor health outcomes related to education being despised in favour of quick returns from fishing ‘having a partner with boats is a destination status …’ Negative peer influence and incorrect health information among the island community | Limited access to health information results in poor health seeking behaviour Early, teen and unplanned pregnancies Delay in testing for HIV and continued transmission of the virus | Appropriate sexual and reproductive health education Use positive role models to challenge negative norms Create micro-targets on each island to reach young people with clinical services Provide support services for key populations and link with CBOs Work with “gatekeepers/ and all stakeholders” to emphasize adolescent health, women welfare, education attainment and health as a means of personal and community development | Dingake, O. B. K. (2018) [33]. Engel, D. M. C., Paul, M., Chalasani, S., Gonsalves, L., Ross, D. A., Chandra-Mouli, V., & Ferguson, B. J. (2019) [34]. Ong, K. K. X., Ng, J. S., Om, C., Chhoun, P., Tuot, S., & Yi, S. (2020) [35]. Ali, M., Cordero, J. P., Khan, F., & Folz, R. (2019). |
The uneducated especially Adolescents and youth | Poor health outcomes related to education being despised in favour of quick returns from fishing ‘having a partner with boats is a destination status …’ Negative peer influence and incorrect health information among the island community | Limited access to health information results in poor health seeking behaviour Early, teen and unplanned pregnancies Delay in testing for HIV and continued transmission of the virus | Appropriate sexual and reproductive health education Use positive role models to challenge negative norms Create micro-targets on each island to reach young people with clinical services Provide support services for key populations and link with CBOs Work with “gatekeepers/ and all stakeholders” to emphasize adolescent health, women welfare, education attainment and health as a means of personal and community development | Dingake, O. B. K. (2018) [33]. Engel, D. M. C., Paul, M., Chalasani, S., Gonsalves, L., Ross, D. A., Chandra-Mouli, V., & Ferguson, B. J. (2019) [34]. Ong, K. K. X., Ng, J. S., Om, C., Chhoun, P., Tuot, S., & Yi, S. (2020) [35]. Ali, M., Cordero, J. P., Khan, F., & Folz, R. (2019). |
Pregnant Single Adolescents and Women in far flung islands | Negative cultural attitudes towards teenage pregnancy, estrangement and limited resources | Limited access to health services out of for fear of discrimination Consequences of termination of pregnancy leading to death | Recruit and train peer educators to serve as change agents Use social media for dissemination of youth-friendly health services Engage with communities on why delivering babies in health facilities is safer for both mother and baby Explore and adopt the use of technology and telemedicine for example the use of medical drones in remote locations Implement express of supplies and delivery for key populations. | Senior, K. A., & Chenhall, R. D. (2012) [36]. Woog, V., & Kågesten, A. (2017) [37]. Kennedy, E. C., Bulu, S., Harris, J., Humphreys, D., Malverus, J., & Gray, N. J. (2013) [38]. |
Requirement of husbands/ spouses having to accompany pregnant woman to health facility for ANC Dependence on males/ spouses for permission and resources to attend clinic | Pregnant women without a willing partner are discriminated against and thus do not regularly attend ANC Pregnant women resort to bringing any man available which works against the intended benefits of male involvement Proxy husbands can result in GBV | Conduct Sexual and Reproductive Health Behavioural Change Communication (SRHBCC) targeting men to promote responsibility Empower women to be independent and able to access health care services. Invest in research that would cut costs of travel and delivery in terms of time and consumables. Upgrade the existing health facilities to be able to host and work with the new -proposed technology | Kakaire, O., Kaye, D. K., & Osinde, M. O. (2011) [39]. Kalisa, R., & Malande, O. O. (2016) [40]. Kaye, D. K., Kakaire, O., Nakimuli, A., Osinde, M. O., Mbalinda, S. N., & Kakande, N. (2014) [41]. Nkuoh, G. N., Meyer, D. J., Tih, P. M., & Nkfusai, J. (2010) [42]. Sialubanje, C., Massar, K., Hamer, D. H., & Ruiter, R. A. (2015) [43]. | |
Sero- Positive persons | Internalized stigma Poverty and the lack of resources for transportation and health care services | Delay in seeking ARV treatment Take ARVS in hiding Do not have resources to get refills for ARVs | Explore alternative sites for distributions of ARVs and more practical modes of delivery. Increase income earning and focus on Poverty alleviation interventions through skilling, value chains and community infrastructure | Winchester, M. S., McGrath, J. W., Kaawa-Mafigiri, D., Namutiibwa, F., Ssendegye, G., Nalwoga, A., & Rwabukwali, C. (2017) [44]. |
Male Youth | Negative masculinity norms: fear of betraying culture especially letting women take control in decision making Preference for traditional healers on account of confidentiality, accessibility and negotiated payment terms. Leave school to fish | Men seek health services when they are in gross pain and the medical condition has progressed Alcohol and drug abuse Do not disclose full information Negative resilience and masculinities. | Mobile services and community outreaches Explore the viability of Health camps Conduct community level ‘test and treat’ outreach campaigns for the most at-risk key populations. Explore the use of male peers to promote appropriate male involvement and reach males | Easton, S. D., Saltzman, L. Y., & Willis, D. G. (2014) [45]. Lehman, P. (2007) [46]. Fleming, P. J., Lee, J. G., & Dworkin, S. L. (2014) [47]. Sileo, K. M., Fielding-Miller, R., Dworkin, S. L., & Fleming, P. J. (2019) [48]. |