Survey of the perceived treatment gap in status epilepticus care across Sub-Saharan countries from the perspective of healthcare providers

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.

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2626-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 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.

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03701-z ◽

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.

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Community awareness of which seizure type should present to healthcare providers; a potential risk factor of the epilepsy treatment gap

10.21203/rs.3.rs-992880/v1 ◽

2021 ◽

Author(s):

Ismat Babiker ◽

Mohamed K. Elnaeim ◽

Awab K.Elnaeim

Keyword(s):

Health Care ◽

Health Care Providers ◽

Demographic Data ◽

Healthcare Providers ◽

Seizure Type ◽

Absence Seizure ◽

Care Providers ◽

Treatment Gap ◽

Cross Sectional ◽

Epilepsy Treatment

Abstract Objective: the objective of this study was to assess the awareness of the community in Sudan of which seizure type(s) should present to health care providers.Methods: This is a cross-sectional descriptive internet-based survey that was conducted in Sudan during the period from January to April 2018, using google forms. The survey consisted of demographic data (age, gender, educational level), a statement evaluating participants’ sources of obtaining information regarding epilepsy, a statement assessing awareness about the primary care provider for people with epilepsy (PWE), and a statement describing the symptomatology of different seizure types in simple Arabic, asking what description(s) participants thought should present to health care providers. We included participants residing in Sudan, and those with a college degree or higher education. Four hundred sixty-seven participants completed the survey.Results: 467 participants were included, of whom, 279 (60%) were females. The mean age of participants was 28 years. Two-thirds of participants obtained their information from non-scientific sources. 84% of the participants were aware that doctors are the primary health care providers for people with epilepsy.The majority (92.%) of participants were aware that patients with symptoms corresponding to the generalized tonic-clonic seizure description should present to doctors, compared with two-thirds of participants for focal seizure symptom description, and only 30.6 % of participants for absence seizure symptom description.Conclusion: This study demonstrated poor awareness about the necessity of presentation for focal and absence seizures. We hypothesize that this lack of awareness may contribute to the epilepsy treatment gap, and we recommend further studies to examine this hypothesis.

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

International Health ◽

10.1093/inthealth/ihz061 ◽

2019 ◽

Vol 12 (2) ◽

pp. 148-154 ◽

Cited By ~ 2

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.

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Epilepsy treatment gap in Sub‐Saharan Africa: Meta‐analysis of community‐based studies

Acta Neurologica Scandinavica ◽

10.1111/ane.13246 ◽

2020 ◽

Vol 142 (1) ◽

pp. 3-13

Author(s):

L. F. Owolabi ◽

S. D. Owolabi ◽

B. Adamu ◽

A.M. Jibo ◽

I. D. Alhaji

Keyword(s):

Meta Analysis ◽

Sub Saharan Africa ◽

Treatment Gap ◽

Community Based ◽

Epilepsy Treatment ◽

Sub Saharan

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Caring for HIV-positive children: healthcare providers' pre-and post-disclosure experiences in Nairobi, Kenya

African Journal of Midwifery and Women s Health ◽

10.12968/ajmw.2018.0022 ◽

2019 ◽

Vol 13 (3) ◽

pp. 1-7

Author(s):

Drusilla Makworo ◽

Theresa Odero

Keyword(s):

Health Professionals ◽

Healthcare Providers ◽

Hiv Disclosure ◽

Sub Saharan Africa ◽

Hiv Positive ◽

Number Of Children ◽

High Resource ◽

Main Challenge ◽

Before And After ◽

Sub Saharan

Background The number of children living with HIV has increased worldwide, largely due to improvements in antiretroviral therapy. Most of these children are living in sub-Saharan Africa. The rate of disclosure to children of their HIV-positive status is low in low-resource countries compared to high-resource countries. Aim To explore health professionals' experiences of caring for HIV-positive children before and after their HIV-positive status was disclosed to them. The health professionals included nurses, counsellors, nutritionists, social workers, pharmacists and clinicians with at least 1 year of experience at the paediatric section of the comprehensive care centre. Methods Nine health professionals were interviewed. Findings Results revealed that there were more challenges before disclosure than after. The main challenge was communicating with the children. The children's main concerns before disclosures included the reason for treatment and its duration, and clinic follow-up. Conclusions Health professionals should be trained on the benefits of HIV disclosure to children, in order to allow for open and direct communication between healthcare providers, parents/carers and children.

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Systematic review of burnout among healthcare providers in sub-Saharan Africa

BMC Public Health ◽

10.1186/s12889-019-7566-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 10

Author(s):

Benyam W. Dubale ◽

Lauren E. Friedman ◽

Zeina Chemali ◽

John W. Denninger ◽

Darshan H. Mehta ◽

...

Keyword(s):

Systematic Review ◽

Nursing Students ◽

Psychological Health ◽

Healthcare Providers ◽

Quantitative Measure ◽

Maslach Burnout Inventory ◽

Epidemiologic Studies ◽

Sub Saharan Africa ◽

Thomson Reuters ◽

Sub Saharan

Abstract Background Burnout is characterized by physical and emotional exhaustion from long-term exposure to emotionally demanding work. Burnout affects interpersonal skills, job performance, career satisfaction, and psychological health. However, little is known about the burden of burnout among healthcare providers in sub-Saharan Africa. Methods Relevant articles were identified through a systematic review of PubMed, Web of Science (Thomson Reuters), and PsycINFO (EBSCO). Studies were selected for inclusion if they examined a quantitative measure of burnout among healthcare providers in sub-Saharan Africa. Results A total of 65 articles met our inclusion criteria for this systematic review. Previous studies have examined burnout in sub-Saharan Africa among physicians (N = 12 articles), nurses (N = 26), combined populations of healthcare providers (N = 18), midwives (N = 2), and medical or nursing students (N = 7). The majority of studies assessed burnout using the Maslach Burnout Inventory. The highest levels of burnout were reported among nurses, although all healthcare providers showed high burnout. Burnout among healthcare providers is associated with their work environments, interpersonal and professional conflicts, emotional distress, and low social support. Conclusions Available studies on this topic are limited by several methodological challenges. More rigorously designed epidemiologic studies of burnout among healthcare providers are warranted. Health infrastructure improvements will eventually be essential, though difficult to achieve, in under-resourced settings. Programs aimed at raising awareness and coping with burnout symptoms through stress management and resilience enhancement trainings are also needed.

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High-risk neuroblastoma in a sub-Saharan African country: telling it like it is

Tropical Doctor ◽

10.1177/0049475517704363 ◽

2017 ◽

Vol 47 (4) ◽

pp. 370-374 ◽

Cited By ~ 3

Author(s):

GP Hadley ◽

J van Heerden

Keyword(s):

High Risk ◽

Poor Prognosis ◽

African Country ◽

Primary Tumour ◽

Healthcare Providers ◽

Current Treatment ◽

Delayed Presentation ◽

High Risk Disease ◽

Sub Saharan ◽

The Cost

Neuroblastoma is uncommon in Africa, but when seen usually presents as high-risk disease with a poor prognosis. This aggressive biology of the tumour is frequently augmented by delayed presentation. Current treatment depends upon technologies and skills that are scarce in developing countries and the cost involved is generally beyond the means of healthcare providers who are faced with a myriad more pressing healthcare issues. The presentation, treatment and outcome of 45 African children with neuroblastoma are described. Due to a lack of resources precise risk stratification was impossible but visceral or bone metastases were present in 73% of patients at diagnosis. In 91% the primary tumour was intra-abdominal. Three children (7%) were paraplegic on admission. A localised tumour was seen in one child (2%). Fifteen children (33%) underwent a surgical procedure, with intent to cure in five among whom resection was incomplete in three. For all other children, treatment was palliative using chemotherapy with judicious use of radiotherapy. Thirteen children (29%) survived longer than six months. Overall survival at three years was 4%.

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