scholarly journals Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa

2021 ◽  
Vol 11 (2) ◽  
pp. 283-296
Author(s):  
Robin Green ◽  
David Webb ◽  
Prakash Mohan Jeena ◽  
Mike Wells ◽  
Nadia Butt ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Consensus Recommendations ◽  
Sub Saharan ◽  
Primary Healthcare Providers

scholarly journals Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shannen M. C. van Duijn ◽  
Angela K. Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
National Guidelines ◽  
Private Providers ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan

Abstract Background In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu. Methods Our intervention was performed Oct 2017–Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4 to 30.2% between providers, significantly more amongst the poor (p < 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6–63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT. Conclusion We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.

scholarly journals Understanding cause of stillbirth: a prospective observational multi-country study from sub-Saharan Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mamuda Aminu ◽  
Sarah Bar-Zeev ◽  
Sarah White ◽  
Matthews Mathai ◽  
Nynke van den Broek
Keyword(s):  
Sierra Leone ◽  
Cause Of Death ◽  
Expert Panel ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Primary Data ◽  
Middle Income ◽  
Computer Based ◽  
Sub Saharan ◽  
Low And Middle Income

Abstract Background Every year, an estimated 2.6 million stillbirths occur worldwide, with up to 98% occurring in low- and middle-income countries (LMIC). There is a paucity of primary data on cause of stillbirth from LMIC, and particularly from sub-Saharan Africa to inform effective interventions. This study aimed to identify the cause of stillbirths in low- and middle-income settings and compare methods of assessment. Methods This was a prospective, observational study in 12 hospitals in Kenya, Malawi, Sierra Leone and Zimbabwe. Stillbirths (28 weeks or more) were reviewed to assign the cause of death by healthcare providers, an expert panel and by using computer-based algorithms. Agreement between the three methods was compared using Kappa (κ) analysis. Cause of stillbirth and level of agreement between the methods used to assign cause of death. Results One thousand five hundred sixty-three stillbirths were studied. The stillbirth rate (per 1000 births) was 20.3 in Malawi, 34.7 in Zimbabwe, 38.8 in Kenya and 118.1 in Sierra Leone. Half (50.7%) of all stillbirths occurred during the intrapartum period. Cause of death (range) overall varied by method of assessment and included: asphyxia (18.5–37.4%), placental disorders (8.4–15.1%), maternal hypertensive disorders (5.1–13.6%), infections (4.3–9.0%), cord problems (3.3–6.5%), and ruptured uterus due to obstructed labour (2.6–6.1%). Cause of stillbirth was unknown in 17.9–26.0% of cases. Moderate agreement was observed for cause of stillbirth as assigned by the expert panel and by hospital-based healthcare providers who conducted perinatal death review (κ = 0.69; p < 0.0005). There was only minimal agreement between expert panel review or healthcare provider review and computer-based algorithms (κ = 0.34; 0.31 respectively p < 0.0005). Conclusions For the majority of stillbirths, an underlying likely cause of death could be determined despite limited diagnostic capacity. In these settings, more diagnostic information is, however, needed to establish a more specific cause of death for the majority of stillbirths. Existing computer-based algorithms used to assign cause of death require revision.

scholarly journals Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Monica Ansu-Mensah ◽  
Frederick Inkum Danquah ◽  
Vitalis Bawontuo ◽  
Peter Ansu-Mensah ◽  
Tahiru Mohammed ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Research Question ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Sub Saharan Africa ◽  
Healthcare Financing ◽  
Maternal Healthcare ◽  
Sub Saharan ◽  
The Impact

Abstract Background Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers’ and providers’ perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers’ and providers’ perspectives of free maternal healthcare and the quality of care in SSA. Methods We used Askey and O’Malley’s framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. Results In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers’ and providers’ perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. Conclusion This study established evidence of existing literature on the quality of care based on healthcare providers’ and managers’ perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.

scholarly journals Provider-perceived barriers to diagnosis and treatment of acute coronary syndrome in Tanzania: a qualitative study

2019 ◽  
Vol 12 (2) ◽  
pp. 148-154 ◽  
Author(s):  
Julian T Hertz ◽  
Godfrey L Kweka ◽  
Preeti Manavalan ◽  
Melissa H Watt ◽  
Francis M Sakita
Keyword(s):  
Acute Coronary Syndrome ◽  
Healthcare Providers ◽  
Care Patient ◽  
Cost Of Care ◽  
Sub Saharan Africa ◽  
Coronary Syndrome ◽  
Provider Perspectives ◽  
Northern Tanzania ◽  
Sub Saharan ◽  
Clinical Officers

Abstract Background The incidence of acute coronary syndrome (ACS) is growing across sub-Saharan Africa and many healthcare systems are ill-equipped for this growing burden. Evidence suggests that healthcare providers may be underdiagnosing and undertreating ACS, leading to poor health outcomes. The goal of this study was to examine provider perspectives on barriers to ACS care in Tanzania in order to identify opportunities for interventions to improve care. Methods Semistructured in-depth interviews were conducted with physicians and clinical officers from emergency departments and outpatient departments in northern Tanzania. Thematic analysis was conducted using an iterative cycle of coding and consensus building. Results The 11 participants included six physicians and five clinical officers from health centers, community hospitals and one referral hospital. Providers identified barriers related to providers, systems and patients. Provider-related barriers included inadequate training regarding ACS and poor application of textbook-based knowledge. System-related barriers included lack of diagnostic equipment, unavailability of treatments, referral system delays, lack of data regarding disease burden, absence of locally relevant guidelines and cost of care. Patient-related barriers included inadequate ACS knowledge, inappropriate healthcare-seeking behavior and non-adherence. Conclusions This study identified actionable barriers to ACS care in northern Tanzania. Multifaceted interventions are urgently needed to improve care.

Primary healthcare providers' attitudes and beliefs about the menopause-related care needs of women who have migrated from low- and middle-income countries to Australia

2020 ◽  
Vol 26 (1) ◽  
pp. 88
Author(s):  
Karin A. Stanzel ◽  
Karin Hammarberg ◽  
Jane Fisher
Keyword(s):  
Primary Healthcare ◽  
Online Survey ◽  
Healthcare Providers ◽  
Migrant Women ◽  
Care Needs ◽  
Middle Income ◽  
Structural Support ◽  
Middle Income Countries ◽  
Primary Healthcare Providers ◽  
Low And Middle Income

Health behaviour during midlife is linked to health outcomes in older age. Primary healthcare providers (PHCPs) are ideally placed to provide health-promoting information opportunistically to women in midlife. The aim of this study was to explore PHCPs views about the menopause-related care needs of migrant women from low- and middle-income countries and what they perceive as barriers and enablers for providing this. Of the 139 PHCPs who responded to an anonymous online survey, less than one-third (29.9%) routinely offered menopause-related information during consultations with migrant women. Most agreed that short appointments times (70.8%), lack of culturally and linguistically appropriate menopause information (82.5%) and lack of confidence in providing menopause-related care (32.5%) are barriers for providing comprehensive menopause-related care to migrant women. To overcome these, a menopause-specific Medicare item number and a one-stop website with health information in community languages were suggested. These findings suggest that menopause-related care is not routinely offered by PHCPs to migrant women from low- and middle- income countries and that their capacity to do this may be improved with adequate educational and structural support.

Sign in / Sign up

Export Citation Format

Share Document