The intersections between NTDs, disability, and mental ill-health are increasingly recognised globally. Chronic morbidity resultant from many NTDs, particularly those affecting the skin—including lymphatic filariasis (LF), leprosy, Buruli ulcer (BU) and onchocerciasis—is well known and largely documented from a medicalised perspective. However less is known about the complex biosocial interaction shaping interconnected morbidities. We apply syndemic theory to explain the biosocial relationship between NTDs and mental distress in the context of structural violence in Liberia. By advancing syndemic theory to include intersectional thought, it is apparent that structural violence becomes embodied in different ways through interacting multi-level (macro, meso and micro) processes. Through the use of in-depth qualitative methods, we explore the syndemic interaction of NTDs and mental distress from the vantage point of the most vulnerable and suggest that: 1) the post-conflict environment in Liberia predisposes people to the chronic effects of NTDs as well as other ‘generalised stressors’ as a consequence of ongoing structural violence; 2) people affected by NTDs are additionally exposed to stigma and discrimination that cause additional stressors and synergistically produce negative health outcomes in relation to NTDs and mental distress; and 3) the impact and experience of consequential syndemic suffering is shaped by intersecting axes of inequity such as gender and generation which are themselves created by unequal power distribution across multiple systems levels. Bringing together health systems discourse, which is focused on service integration and centred around disease control, with syndemic discourse that considers the biosocial context of disease interaction offers new approaches. We suggest that taking a syndemic-informed approach to care in the development of people-centred health systems is key to alleviating the burden of syndemic suffering associated with NTDs and mental distress currently experienced by vulnerable populations in resource-limited settings.

For the large population living in Nairobi’s informal settlements, the long-term effects of Covid-19 pose a threat to livelihoods, health, and wellbeing. For those working in the informal sector, who are the lifeblood of the city, livelihoods have been severely supressed by Covid-19 restrictions such as curfews, pushing many into further poverty. This article draws on community data, meetings, and authors’ observations as community organisers, to explore the challenges posed by existing government responses from a community development perspective. We found that poor accountability structures and targeted income support only for the ‘most vulnerable’ exacerbates tensions, mistrust, and insecurity among already vulnerable communities. We draw on a rapid desk review of existing literature to argue that community-led enumeration to validate entitlement claims, improved accountability for distribution, and widening income support is required to build solidarity and improve the future resilience of these communities.

Background: This study sought to illuminate familial and socio-cultural drivers that contribute to intersectional gender inequities in scientific career progression in Sub-saharan Africa (SSA) by drawing on lived experiences of women and men researchers. The findings are drawn from a wider research study that was aimed at gaining an in-depth understanding of the barriers and enablers of gender equitable scientific career progression for researchers in SSA. This was nested within the context of ‘Developing Excellence in Leadership, Training and Science in Africa’ (DELTAS Africa) – a health-based scientific research capacity strengthening initiative. Methods: The study adopted an exploratory qualitative cross-sectional study design. In-depth interviews were conducted with fifty-eight (32 Female and 26 Male) trainees/research fellows at various career stages, supported and/or affiliated to three purposively selected African Research Consortia. The interviews were conducted between May and December 2018 in English. The data was analysed inductively based on emergent themes.Results: Four themes were identified. First: characterisation of the normative career pathway and progression requirements. Second: social power relations of gender within the family and wider society. Third: researchers’ experiences of navigating between the ‘two different lives’, and the resultant implications for their career progression and personal well-being. Fourth, potential strategies utilised by women for navigating the ‘two different lives’ and their impacts. Conclusions: This study offers important policy and practice measures and approaches for fostering equitable scientific research career progression for women and men within research capacity strengthening initiatives in SSA. These includes the need for: reforms in institutional human resources policies and systems; a more fundamental re-think of the normative scientific career structure to create equitable opportunities, improving diversity and well-being of both female and male researchers; additional support and potential adjustments to expectations for language minorities in science; and embracing gender transformative approaches in science.

ObjectivesChronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aimed to explore the perspectives of healthcare workers and other health policy stakeholders on the barriers to effective diagnosis and management of CRD in Kenya, Malawi, Sudan, Tanzania and Uganda.Study designQualitative descriptive study.SettingsPrimary, secondary and tertiary health facilities, government agencies and civil society organisations in five sub-Saharan African countries.ParticipantsWe purposively selected 60 national and district-level policy stakeholders, and 49 healthcare workers, based on their roles in policy decision-making or health provision, and conducted key informant interviews and in-depth interviews, respectively, between 2018 and 2019. Data were analysed through framework approach.ResultsWe identified intersecting vicious cycles of neglect of CRD at strategic policy and healthcare facility levels. Lack of reliable data on burden of disease, due to weak information systems and diagnostic capacity, negatively affected inclusion in policy; this, in turn, was reflected by low budgetary allocations for diagnostic equipment, training and medicines. At the healthcare facility level, inadequate budgetary allocations constrained diagnostic capacity, quality of service delivery and collection of appropriate data, compounding the lack of routine data on burden of disease.ConclusionHealth systems in the five countries are ill-equipped to respond to CRD, an issue that has been brought into sharp focus as countries plan for post-COVID-19 lung diseases. CRD are underdiagnosed, under-reported and underfunded, leading to a vicious cycle of invisibility and neglect. Appropriate diagnosis and management require health systems strengthening, particularly at the primary healthcare level.