Data Integrity Module for Data Quality Assurance Within an e-Health System in Sub-Saharan Africa

Abstract Introduction Programmes that merge management of Human Immunodeficiency Virus (HIV) and tuberculosis (TB) aim to improve HIV/TB co-infected patients’ access to comprehensive treatment. However, several reports from sub-Saharan Africa (SSA) indicate suboptimal uptake of antiretroviral therapy (ART) even after integration of HIV and TB treatment. This study assessed ART uptake, its barriers and enablers in programmes integrating TB and HIV treatment in SSA. Method A systematic review was performed. Seven databases were searched for eligible quantitative, qualitative and mixed-methods studies published from March 2004 through July 2019. Random-effects meta-analysis was used to obtain pooled estimates of ART uptake. A thematic approach was used to analyse and synthesise data on barriers and enablers. Results Of 5139 references identified, 27 were included in the review: 23/27 estimated ART uptake and 10/27 assessed barriers to and/or enablers of ART uptake. The pooled ART uptake was 53% (95% CI: 42, 63%) and between-study heterogeneity was high (I2 = 99.71%, p < 0.001). WHO guideline on collaborative TB/HIV activities and sample size were associated with heterogeneity. There were statistically significant subgroup effects with high heterogeneity after subgroup analyses by region, guideline on collaborative TB/HIV activities, study design, and sample size. The most frequently described socioeconomic and individual level barriers to ART uptake were stigma, low income, and younger age group. The most frequently reported health system-related barriers were limited staff capacity, shortages in medical supplies, lack of infrastructure, and poor adherence to or lack of treatment guidelines. Clinical barriers included intolerance to anti-TB drugs, fear of drug toxicity, and contraindications to antiretrovirals. Health system enablers included good management of the procurement, supply, and dispensation chain; convenience and accessibility of treatment services; and strong staff capacity. Availability of psychosocial support was the most frequently reported enabler of uptake at the community level. Conclusions In SSA, programmes integrating treatment of TB and HIV do not, in general, achieve high ART uptake but we observe a net improvement in uptake after WHO issued the 2012 guidelines on collaborative TB/HIV activities. The recurrence of specific modifiable system-level and patient-level factors in the literature reveals key intervention points to improve ART uptake in these programmes. Systematic review registration: CRD42019131933.

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Health system challenges affecting falls prevention in persons living with HIV: perspectives from physiotherapists in four sub-Saharan regions

Primary Health Care Research & Development ◽

10.1017/s1463423620000663 ◽

2021 ◽

Vol 22 ◽

Author(s):

Maria Y. Charumbira ◽

Karina Berner ◽

Quinette A. Louw

Keyword(s):

Primary Care ◽

Health Care ◽

Health System ◽

Fall Prevention ◽

Falls Prevention ◽

Sub Saharan Africa ◽

Prevention Services ◽

Persons Living With Hiv ◽

Sub Saharan ◽

Living With Hiv

Abstract Aim: The aim of this study was to explore the perspectives of physiotherapists in four selected regions of sub-Saharan Africa regarding health system challenges impacting the integration of physiotherapy-led falls prevention services in the primary care of persons living with HIV (PLWH). Background: Falls may pose a significant problem among younger PLWH in low- and middle-income countries. Physiotherapists’ role in optimising function and quality of life can do much in the prevention of falls in PLWH and reducing the harm that results. However, falls prevention strategies have not been implemented effectively especially in primary health care settings in sub-Saharan Africa. Physiotherapists’ account of the health system challenges they encounter may provide insights into potential strategies that may be considered in optimising fall prevention for PLWH in poorly resourced settings. Methods: A descriptive qualitative study was conducted in selected urban districts in the capital cities of four sub-Saharan African countries. In-depth interviews were conducted with 21 purposively selected physiotherapists involved in the primary care of PLWH. Audio recordings of interviews were transcribed verbatim and analysed using deductive thematic content analysis. Findings: The main results are presented in the theme ‘Health care system challenges’ and in nine categories informed by the WHO health system framework: lack of policies and clinical practice guidelines, shortage/Inaccessible falls prevention services, inadequate human resource, physiotherapists not adequately equipped in falls prevention, inaccessible/No facilities for BMD measurement, inefficient data capturing systems, lack of evidence regarding falls among PLWH, unclear physiotherapy role descriptions, inefficient referral system. Physiotherapists highlighted the need for more information and research regarding fall prevention for PLWH, promote their role in the primary care of PLWH and adopt a patient-centred approach to fall prevention.

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Health system adaptations and considerations to facilitate optimal oral pre-exposure prophylaxis scale-up in sub-Saharan Africa

The Lancet HIV ◽

10.1016/s2352-3018(21)00129-6 ◽

2021 ◽

Author(s):

Daniel K Were ◽

Abednego Musau ◽

Kaitlyn Atkins ◽

Prakriti Shrestha ◽

Jason Reed ◽

...

Keyword(s):

Health System ◽

Scale Up ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Exposure Prophylaxis

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Building capacity in neurodevelopment assessment of children in sub-Saharan Africa: A quality assurance model to implement standardized neurodevelopment testing

Child Neuropsychology ◽

10.1080/09297049.2018.1497588 ◽

2018 ◽

Vol 25 (4) ◽

pp. 466-481 ◽

Cited By ~ 3

Author(s):

Horacio Ruiseñor-Escudero ◽

Itziar Familiar ◽

Mary Nyakato ◽

Agatha Kutessa ◽

Jackie Namukooli ◽

...

Keyword(s):

Quality Assurance ◽

Sub Saharan Africa ◽

Building Capacity ◽

Sub Saharan

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External Quality Assurance Performance of Clinical Research Laboratories in Sub-Saharan Africa

American Journal of Clinical Pathology ◽

10.1309/ajcp8pcm4jvleeqr ◽

2012 ◽

Vol 138 (5) ◽

pp. 720-723 ◽

Cited By ~ 12

Author(s):

Timothy K. Amukele ◽

Kurt Michael ◽

Mary Hanes ◽

Robert E. Miller ◽

J. Brooks Jackson

Keyword(s):

Quality Assurance ◽

Clinical Research ◽

Sub Saharan Africa ◽

External Quality Assurance ◽

External Quality ◽

Sub Saharan

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The Technical Feasibility of Integrating Primary Eye Care Into Primary Health Care Systems in Nigeria: Protocol for a Mixed Methods Cross-Sectional Study (Preprint)

10.2196/preprints.17263 ◽

2019 ◽

Author(s):

Ada Aghaji ◽

Helen Burchett ◽

Shaffa Hameed ◽

Jayne Webster ◽

Clare Gilbert

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health System ◽

Assessment Tools ◽

Sub Saharan Africa ◽

Eye Care ◽

Technical Feasibility ◽

Primary Eye Care ◽

Primary Health ◽

Sub Saharan

BACKGROUND Approximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities. OBJECTIVE Our objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria. METHODS This study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC. RESULTS Consensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed. CONCLUSIONS This study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17263

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Scoping review protocol on the use of telephone in the implementation of citizen participation in the processes of developing health system strengthening reforms/policies in Sub-Saharan Africa (participation in decision-making) v1 (protocols.io.bky7kxzn)

protocols.io ◽

10.17504/protocols.io.bky7kxzn ◽

2020 ◽

Author(s):

Wendkouni Adelphe ◽

Sandrine Biau ◽

Emmanuel Bonnet ◽

Valery Ridde

Keyword(s):

Decision Making ◽

Health System ◽

Citizen Participation ◽

Scoping Review ◽

Sub Saharan Africa ◽

Health System Strengthening ◽

Review Protocol ◽

Participation In Decision Making ◽

Sub Saharan

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Lockdown measures in response to COVID-19 in Sub-Saharan Africa: A rapid study of nine countries

10.1101/2020.07.09.20149054 ◽

2020 ◽

Cited By ~ 1

Author(s):

Najmul Haider ◽

Abdinasir Yusuf Osman ◽

Audrey Gadzekpo ◽

George O. Akpede ◽

Danny Asogun ◽

...

Keyword(s):

South Africa ◽

North America ◽

Health System ◽

Sierra Leone ◽

Sub Saharan Africa ◽

Community Transmission ◽

Holistic Assessment ◽

Sub Saharan

Lockdown measures have been introduced worldwide to contain the transmission of COVID-19. This paper defines the term lockdown and describes the design, timing and implementation of lockdown in nine countries in Sub Saharan Africa: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe. It also discusses the manner in which lockdown is enforced, the need to mitigate the harms of lockdown, and the association between lockdown and the reported number of COVID-19 cases and deaths. While there are some commonalities in the implementation of lockdown, a more notable finding is the variation in the design, timing and implementation of lockdown measures across the nine countries. We found that the number of reported cases is heavily dependent on the number of tests done, and that testing rates ranged from 9 to 21,261 per million population. The reported number of COVID-19 deaths per million population also varies, but is generally low when compared to countries in Europe and North America. While lockdown measures may have helped inhibit some community transmission, the pattern and nature of the epidemic remains unclear. Of concern are signs of lockdown harming health by affecting the functioning of the health system and causing social and economic harms. This paper highlights the need for inter-sectoral and trans-disciplinary research capable of providing a rigorous and holistic assessment of the harms and benefits of lockdown.

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Improving quality of surgical and anaesthesia care at hospital level in sub-Saharan Africa: a systematic review protocol of health system strengthening interventions

BMJ Open ◽

10.1136/bmjopen-2019-036615 ◽

2020 ◽

Vol 10 (5) ◽

pp. e036615

Author(s):

Nataliya Brima ◽

Justine Davies ◽

Andrew JM Leather

Keyword(s):

Systematic Review ◽

Health System ◽

Primary Outcome ◽

Sub Saharan Africa ◽

Health System Strengthening ◽

African Countries ◽

Implementation Outcomes ◽

Sub Saharan ◽

Anaesthesia Care

IntroductionOver 5 billion people in the world do not have access to safe, affordable surgical and anaesthesia care when needed. In order to improve health outcomes in patients with surgical conditions, both access to care and the quality of care need to be improved. A recent commission on high-quality health systems highlighted that poor-quality care is now a bigger barrier than non-utilisation of the health system for reducing mortality.AimTo carry out a systematic review to provide an evidence-based summary of hospital-based interventions associated with improved quality of surgical and anaesthesia care in sub-Saharan African countries (SSACs).Methods and analysisThree search strings (1) surgery and anaesthesia, (2) quality improvement hospital-based interventions and (3) SSACs will be combined. The following databases EMBASE, Global Health, MEDLINE, CINAHL, Web of Science and Scopus will be searched. Further relevant studies will be identified from national and international health organisations and publications and reference lists of all selected full-text articles. The review will include all type of original articles in English published between 2008 and 2019. Article screening, data extraction and assessment of methodological quality will be done by two reviewers independently and any disputes will be resolved by a third reviewer or team consensus. Three types of outcomes will be collected including clinical, process and implementation outcomes. The primary outcome will be mortality. Secondary outcomes will include other clinical outcomes (major and minor complications), as well as process and implementation outcomes. Descriptive statistics and outcomes will be summarised and discussed. For the primary outcome, the methodological rigour will be assessed.Ethics and disseminationThe results will be published in a peer reviewed open access journal and presented at national and international conferences. As this is a review of secondary data no formal ethical approval is required.PROSPERO registration numberCRD42019125570.

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Factors Impacting Sustainability of Community Health Worker Programming in rural Uganda: A Qualitative Study

10.21203/rs.3.rs-16098/v1 ◽

2020 ◽

Author(s):

Scholastic Ashaba ◽

Manasseh Tumuhimbise ◽

Esther Beebwa ◽

Francis Oriokot ◽

Jennifer L Brenner ◽

...

Keyword(s):

Health Promotion ◽

Health System ◽

Community Health ◽

Health Worker ◽

Child Mortality ◽

Community Health Worker ◽

Sub Saharan Africa ◽

Team Approach ◽

Sub Saharan ◽

And Training

Abstract Background Despite significant global progress towards decreased child mortality over the past decades, over 5 million children died before reaching their fifth birthday in 2018. Additionally, the number of women dying during pregnancy and childbirth was 295, 000 in 2017. Majority of these deaths occurred in sub Saharan Africa yet these deaths are preventable with known interventions. A huge global investment has been made in initiating community health work (CHW) programs which play a critical role in health promotion with increasing scale up in sub Saharan Africa. The government of Uganda continues to identify maternal, newborn and child health (MNCH) programming as a priority and national policies continue to encourage community-based approaches for health promotion through the Village Health Team approach to reduce maternal and child mortality. However, sustaining of CHWs programs remains a challenge and less is known about if and how these CHW networks can be maintained. Methods A sustainability-focused qualitative evaluation was conducted five years following a district-wide comprehensive MNCH intervention that involved selection and training of a large CHW network (n =2626) in 2 rural districts in southwest Uganda. Focus Group discussions (FGDs) and in-depth interviews (IDIs) were conducted to gain insights into the factors affecting CHW program sustainability. Interviews were digitally recorded then translated and transcribed directly into English. Data was managed using NVivo software (version 12, QSR International, Burlington Mass.). Thematic content analysis was done to identify themes relevant to sustainability. Results Enablers and barriers to CHW sustainability identified by study participants included health system effectiveness (availability of supplies, medicines and services and availability of facility health providers), community health worker program factors (CHW selection and training, CHW recognition and incentives, CHW supervision and CHW refresher trainings), community attitudes and beliefs, and stakeholder engagement (alignment with district priorities and programs and local government involvement). Conclusion Effectiveness of health systems and human resources were major factors in sustainability for this community health intervention. Sustainability could be strengthened through increased community member involvement during implementation and improved support for general health system effective functioning.

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