Prisca Zwanikken - Academia.edu (original) (raw)

Papers by Prisca Zwanikken

Reproductive Health Matters, 2004

Annual Global Healthcare Conference, 2012

Tropical medicine & international health : TM & IH, 2013

In 2010-2011, recent graduates (2008 or earlier) of the Masters in International Health (MIH) (as... more In 2010-2011, recent graduates (2008 or earlier) of the Masters in International Health (MIH) (as offered by over 30 universities and institutions collaborating in the tropEd network) were surveyed. We aimed to examine whether the competencies gained proved appropriate for alumni's current positions and to develop the programme according to alumni's needs. An online questionnaire was sent to 327 alumni. One hundred and seventy-seven responded and 99 met the inclusion criteria. We calculated frequency distributions of the answers and performed a bivariate analysis of certain variables. Alumni feel confident in all areas covered by the MIH. Most competencies acquired are perceived as essential or very relevant to their current position. Many respondents (77%) changed jobs after graduation, mostly from curative care to public health. More African and Asian alumni work in their country of origin (66% and 63%, respectively) than alumni from other continents (42%). The respondents...

Abstract Background: The number of Master of Public Health (MPH) programmes in low- and middle-in... more Abstract
Background: The number of Master of Public Health (MPH) programmes in low- and middle-income countries
(LMICs) is increasing, but questions have been raised regarding the relevance of their outcomes and impacts on
context. Although processes for validating public health competencies have taken place in recent years in many
high-income countries, validation in LMICs is needed. Furthermore, impact variables of MPH programmes in the
workplace and in society have not been developed.
Method: A set of public health competencies and impact variables in the workplace and in society was designed
using the competencies and learning objectives of six participating institutions offering MPH programmes in or for
LMICs, and the set of competencies of the Council on Linkages Between Academia and Public Health Practice as a
reference. The resulting competencies and impact variables differ from those of the Council on Linkages in scope
and emphasis on social determinants of health, context specificity and intersectoral competencies. A modified
Delphi method was used in this study to validate the public health competencies and impact variables; experts and
MPH alumni from China, Vietnam, South Africa, Sudan, Mexico and the Netherlands reviewed them and made
recommendations.
Results: The competencies and variables were validated across two Delphi rounds, first with public health experts
(N = 31) from the six countries, then with MPH alumni (N = 30). After the first expert round, competencies and
impact variables were refined based on the quantitative results and qualitative comments. Both rounds showed
high consensus, more so for the competencies than the impact variables. The response rate was 100%.
Conclusion: This is the first time that public health competencies have been validated in LMICs across continents.
It is also the first time that impact variables of MPH programmes have been proposed and validated in LMICs
across continents. The high degree of consensus between experts and alumni suggests that these public health
competencies and impact variables can be used to design and evaluate MPH programmes, as well as for individual
and team assessment and continuous professional development in LMICs.
Keywords: Public health competencies, Impact, Low- and middle-income countries, Master of Public Health

Abstract Background: The human resources for health crisis has highlighted the need for high-leve... more Abstract
Background: The human resources for health crisis has highlighted the need for high-level public health education
to add specific capacities to the workforce. Recently, it was questioned whether Master of Public Health (MPH)
training prepared graduates with competencies relevant to low- and middle-income countries (LMICs). This study
aims to examine the influence of the MPH programs geared towards LMICs offered in Vietnam, China, South Africa,
Mexico, Sudan, and the Netherlands on graduates’ careers, application of acquired competencies, performance at
the workplace, and their professional contribution to society.
Methods: A self-administered questionnaire was sent to graduates from six MPH programs. Frequency distributions
of the answers were calculated, and a bivariate analysis and logistic regression of certain variables was performed.
Results: The response rate was 37.5%. Graduates reported change in leadership (69%), in technical position (69%),
acquiring new responsibilities (80%), and increased remuneration (63%); they asserted that MPH programs
contributed significantly to this. Graduates’ attribution of their application of 7 key competencies ‘substantially to
the MPH program’ ranged from 33% to 48%. Of the 26 impact variables, graduates attributed the effect they had
on their workplace substantially to the MPH program; the highest rated variable ranged from 31% to 73% and the
lowest ranged from 9% to 43%. Of the 10 impact variables on society, graduates attributed the effect they had on
society substantially to the MPH program; for the highest rated variable (13% to 71%); for the lowest rated variable
(4% to 42%). Candidates’ attribution of their application of acquired competencies as well as their impact at the
workplace varied significantly according to institution of study and educational background.
Conclusions: This study concludes that these MPH programs contribute to improving graduates’ careers and to
building leadership in public health. The MPH programs contribute to graduates’ application of competencies. MPH
programs contribute substantially towards impact variables on the workplace, such as development of research
proposals and reporting on population health needs, and less substantially to their impact on society, such as
contributing equitable access to quality services. Differences reported between MPH programs merit further study.
The results can be used for curriculum reform.

Preventive Medicine, 2004

Background. Chronic obstructive pulmonary disease (COPD) is a worldwide public health problem wit... more Background. Chronic obstructive pulmonary disease (COPD) is a worldwide public health problem with increasing morbidity and mortality. The aim of this proposal is to contribute to the improvement of COPD prevention by identifying groups at risk for COPD and targeting them for preventive interventions.Methods. Based on the existing organizational structures for COPD detection, detailed analysis of the determinants of COPD will allow to identify groups at high risk to develop COPD. The Stepwise Target Group-Oriented Prevention (STOP) model developed during this study proposes an integrated identification and intervention strategy for high-risk groups.Results. Apart from smoking, other environmental determinants and host factors contribute to further lung function's rapid decline. Combined with smoking, these factors increase the risk for COPD. Target groups for early disease detection and appropriate interventions can be identified by the presence of one or more known risk factors and by identification of high-risk groups.Conclusion. The Stepwise Target Group-Oriented Prevention (STOP) strategy is a step toward improvement in COPD prevention, by shifting the focus from the group of a focus symptomatic smokers aged 45+ years to much earlier and preventable stages of the disease, that is, from disease treatment to risk management.

Reproductive Health Matters, 2004

Sexual torture constitutes any act of sexual violence which qualifies as torture. Public awarenes... more Sexual torture constitutes any act of sexual violence which qualifies as torture. Public awareness of the widespread use of sexual torture as a weapon of war greatly increased after the war in the former Yugoslavia in the early 1990s. Sexual torture has serious mental, physical and sexual health consequences. Attention to date has focused more on the sexual torture of women than of men, partly due to gender stereotypes. This paper describes the circumstances in which sexual torture occurs, its causes and consequences, and the development of international law addressing it. It presents data from a study in 2000 in Croatia, where the number of men who were sexually tortured appears to have been substantial. Based on in-depth interviews with 16 health professionals and data from the medical records of three centres providing care to refugees and victims of torture, the study found evidence of rape and other forced sexual acts, full or partial castration, genital beatings and electroshock. Few men admit being sexually tortured or seek help, and professionals may fail to recognise cases. Few perpetrators have been prosecuted, mainly due to lack of political will. The silence that envelopes sexual torture of men in the aftermath of the war in Croatia stands in strange contrast to the public nature of the crimes themselves.Le terme « torture sexuelle » désigne tout acte sexuel correspondant à la définition de la torture. L'opinion a pris conscience de l'utilisation de la torture sexuelle comme arme de guerre après le conflit en ex-Yougoslavie, au début des années 90. Les tortures sexuelles ont de graves conséquences mentales, physiques et génésiques. Jusqu'à présent, on a davantage parlé des tortures sexuelles sur les femmes que sur les hommes, partiellement en raison de stéréotypes sexuels. Cet article décrit les circonstances de la torture sexuelle, ses causes et conséquences, et le développement du droit international dans ce domaine. Il présente les conclusions d'une étude réalisée en 2000 en Croatie, où beaucoup d'hommes auraient subi des tortures sexuelles. Des entretiens avec 16 professionnels de la santé et les dossiers médicaux de trois centres soignant des réfugiés et des victimes de la torture ont révélé des indices de viols et d'autres agressions sexuelles, de castration totale ou partielle, de chocs électriques et de coups sur les organes génitaux. Rares sont les hommes qui admettent avoir subi des tortures sexuelles ou qui demandent de l'aide, et les professionnels ne décèlent pas toujours les cas. Peu de responsables ont été jugés, principalement par manque de volonté politique. Le silence qui entoure les tortures sexuelles masculines au lendemain de la guerre en Croatie tranche étrangement avec la nature publique des crimes.La tortura sexual constituye cualquier acto de violencia sexual que se califica como tortura. La conciencia pública del uso amplio de la tortura sexual como un arma de guerra creció enormemente después de la guerra en la antigua Yugoslavia a principios de los años 90. La tortura sexual tiene graves consecuencias para la salud mental, fı́sica y sexual. Hasta la fecha, se ha puesto más atención en la tortura sexual de las mujeres que de los hombres, debido en parte a los estereotipos de género. Este artı́culo describe las circunstancias en que ocurre la tortura sexual, sus causas y consecuencias, y el desarrollo de la ley internacional que la aborda. Presenta datos de un estudio del año 2000 en Croacia, donde pareciera que el número de hombres torturados sexualmente sea significativo. Basado en entrevistas en profundidad con 16 profesionales de salud y datos de los archivos médicos de tres centros que atienden a refugiados y vı́ctimas de tortura, se encontró evidencia de violación y otros actos sexuales forzados, castración total o parcial, golpes y electrochoques en los genitales. Pocos hombres admiten haber sido torturados sexualmente o buscan ayuda, y es posible que los profesionales no reconozcan los casos. Se han procesado pocos perpetradores, por falta de voluntad polı́tica. El silencio que cubre la tortura sexual de hombres en la posguerra en Croacia es un contraste extraño ante el carácter público de los crı́menes mismos.

The open-ended nature of anthropological research processes and methods such as participatory obs... more The open-ended nature of anthropological research processes and methods such as participatory observation can be at odds with the demands of ethical review boards, which often require a fully worked-out proposal. However, clearance by an ethical review board is increasingly a requirement for all social scientists. Proponents argue that clearance is a logical necessity for compliance with international human rights standards and increased requests from national authorities. Critics argue that these boards are preventing original research because they require fully worked-out studies, which may lead to duplication in the field or run the risk of rigidly following a pre-defined protocol in the field.

Journal of Clinical Monitoring and Computing, 1985

We compared values of PaO2 and transcutaneous PO2 in 21 adult patients during anesthesia. In 282 ... more We compared values of PaO2 and transcutaneous PO2 in 21 adult patients during anesthesia. In 282 simultaneous determinations during anesthetic periods of 3–10 h, transcutaneous PO2 was a poor predictor of absolute PaO2 and changes in PaO2. Trancutaneous PO2 monitoring in adults during anesthesia is of unproven value.

Human Resources for Health, 2011

Introduction: Responsible governance is crucial to national development and a catalyst for achiev... more Introduction: Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low-and middle-income countries (LMIC). Methods: We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'.

Reproductive Health Matters, 2004

Annual Global Healthcare Conference, 2012

Tropical medicine & international health : TM & IH, 2013

Preventive Medicine, 2004

Reproductive Health Matters, 2004

Journal of Clinical Monitoring and Computing, 1985

Human Resources for Health, 2011

Reproductive Health Matters, 2004