scholarly journals Analysis of clinical knowledge, absenteeism and availability of resources for maternal and child health: a cross-sectional quality of care study in 10 African countries

2020 ◽  
Vol 5 (12) ◽  
pp. e003377
Author(s):  
Laura Di Giorgio ◽  
David K Evans ◽  
Magnus Lindelow ◽  
Son Nam Nguyen ◽  
Jakob Svensson ◽  
...  
Keyword(s):  
Health Workers ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Clinical Knowledge ◽  
Health Providers ◽  
African Countries ◽  
Cross Sectional ◽  
Drug Availability ◽  
Minimum Quality Standards ◽  
Sub Saharan

ObjectiveAssess the quality of healthcare across African countries based on health providers’ clinical knowledge, their clinic attendance and drug availability, with a focus on seven conditions accounting for a large share of child and maternal mortality in sub-Saharan Africa: malaria, tuberculosis, diarrhoea, pneumonia, diabetes, neonatal asphyxia and postpartum haemorrhage.MethodsWith nationally representative, cross-sectional data from ten countries in sub-Saharan Africa, collected using clinical vignettes (to assess provider knowledge), unannounced visits (to assess provider absenteeism) and visual inspections of facilities (to assess availability of drugs and equipment), we assess whether health providers are available and have sufficient knowledge and means to diagnose and treat patients suffering from common conditions amenable to primary healthcare. We draw on data from 8061 primary and secondary care facilities in Kenya, Madagascar, Mozambique, Nigeria, Niger, Senegal, Sierra Leone, Tanzania, Togo and Uganda, and 22 746 health workers including doctors, clinical officers, nurses and community health workers. Facilities were selected using a multistage cluster-sampling design to ensure data were representative of rural and urban areas, private and public facilities, and of different facility types. These data were gathered under the Service Delivery Indicators programme.ResultsAcross all conditions and countries, healthcare providers were able to correctly diagnose 64% (95% CI 62% to 65%) of the clinical vignette cases, and in 45% (95% CI 43% to 46%) of the cases, the treatment plan was aligned with the correct diagnosis. For diarrhoea and pneumonia, two common causes of under-5 deaths, 27% (95% CI 25% to 29%) of the providers correctly diagnosed and prescribed the appropriate treatment for both conditions. On average, 70% of health workers were present in the facilities to provide care during facility hours when those workers are scheduled to be on duty. Taken together, we estimate that the likelihood that a facility has at least one staff present with competency and key inputs required to provide child, neonatal and maternity care that meets minimum quality standards is 14%. On average, poor clinical knowledge is a greater constraint in care readiness than drug availability or health workers’ absenteeism in the 10 countries. However, we document substantial heterogeneity across countries in the extent to which drug availability and absenteeism matter quantitatively.ConclusionOur findings highlight the need to boost the knowledge of healthcare workers to achieve greater care readiness. Training programmes have shown mixed results, so systems may need to adopt a combination of competency-based preservice and in-service training for healthcare providers (with evaluation to ensure the effectiveness of the training), and hiring practices that ensure the most prepared workers enter the systems. We conclude that in settings where clinical knowledge is poor, improving drug availability or reducing health workers’ absenteeism would only modestly increase the average care readiness that meets minimum quality standards.

scholarly journals Suicidal ideation and associated factors among school-going adolescents in rural Ghana

2021 ◽  
Author(s):  
Emmanuel Nii-Boye Quarshie ◽  
Samuel Kofi Odame
Keyword(s):  
Suicidal Ideation ◽  
Associated Factors ◽  
Attempted Suicide ◽  
Sub Saharan Africa ◽  
Rural Adolescents ◽  
African Countries ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Rural Ghana ◽  
Sub Saharan

AbstractSuicidal ideation is a critical risk for attempted suicide and eventual suicide. Little is known about suicidal ideation among rural adolescents in most sub-Saharan African countries. We aimed to estimate the 12-month prevalence of suicidal ideation and to describe some of the common and gender-specific associated factors among in-school adolescents in rural Ghana. We conducted a cross-sectional survey involving a random sample of 1101 in-school adolescents aged 10–19 years in a rural district in Eastern Ghana. The Suicidal Behavior Questionnaire-Revised was used to assess suicidal ideation. Overall, 25.1% participants (95% CI = 22.5–27.7), representing 28.3% females (95% CI = 24.7–32.2) and 21.5% males (95% CI = 18.0–25.2) reported suicidal ideation during the previous 12 months. Females who experienced personal and interpersonal adversities mainly outside the family context were likely to report suicidal ideation, while suicidal ideation among males was associated with conflict with parents. Regardless of gender, adolescents who reported exposure to a friend’s attempted suicide were about two times more likely to report suicidal ideation. The prevalence of suicidal ideation among adolescents in rural Ghana compares with in-school estimates from other countries within sub-Saharan Africa, but also underscores the need for targeted and universal prevention programmes and intervention efforts to mitigate the potential transition from suicidal ideations to suicidal attempts and eventual deaths by suicide among rural adolescents.

scholarly journals Mastalgia: Prevalence at a Sub-Saharan African Tertiary Hospital

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
T. Makumbi ◽  
M. Galukande ◽  
A. Gakwaya
Keyword(s):  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Western World ◽  
African Countries ◽  
Breast Clinic ◽  
Cross Sectional ◽  
Ethical Approval ◽  
Sub Saharan ◽  
Cyclical Mastalgia

Introduction. Mastalgia is a common breast condition among women referred to breast clinics worldwide. Whereas the prevalence is known in the Western world and Asia, the prevalence of the disease is unknown in many African countries. The aim of this study therefore was to determine the prevalence and describe factors associated with mastalgia among women attending a tertiary hospital in sub-Saharan Africa. Methods. A cross-sectional study was done in Kampala, Uganda. Mastalgia was defined as self-reported breast pain (unilateral or bilateral) for a period not less than two months. A pretested questionnaire was used to collect the data and statistical analysis was performed using SPSS version 11. Ethical approval was obtained. Results. Out of the 1048 women who presented to the breast clinic during the study period, 168 (16%) were diagnosed with mastalgia in the absence of breast cancer. Noncyclical and cyclical mastalgia were 22/168 (13%) and 5/168 (3%), respectively. The onset of noncyclical category as compared to the cyclical type of mastalgia was observed to manifest before 24 years of age (P=0.006). Conclusion. Mastalgia was a common condition among women in this sub-Saharan African setting as is elsewhere. The early onset mastalgia in this sub-Saharan African study requires further exploration for determination of its risk factors.

scholarly journals Birth registration and child undernutrition in sub-Saharan Africa

2015 ◽  
Vol 19 (10) ◽  
pp. 1757-1767 ◽  
Author(s):  
Ornella Comandini ◽  
Stefano Cabras ◽  
Elisabetta Marini
Keyword(s):  
Nutritional Status ◽  
Permutation Test ◽  
Negative Relationship ◽  
Wealth Quintile ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Birth Registration ◽  
African Countries ◽  
Cross Sectional ◽  
Sub Saharan

AbstractObjectiveIn many countries of the world millions of people are not registered at birth. However, in order to assess children’s nutritional status it is necessary to have an exact knowledge of their age. In the present paper we discuss the effects of insufficient or imprecise age data on estimates of undernutrition prevalence.DesignBirth registration rates and levels of stunting, underweight and wasting were retrieved from Multiple Indicator Cluster Surveys and Demographic and Health Surveys of thirty-seven sub-Saharan African countries, considering the subdivision in wealth quintiles. The composition of the cross-sectional sample used for nutritional evaluation was analysed using a permutation test. Logistic regression was applied to analyse the relationship between birth registration and undernutrition. The 95 % probability intervals and Student’s t test were used to evaluate the effect of age bias and error.ResultsHeterogeneous sampling designs were detected among countries, with different percentages of children selected for anthropometry. Further, registered children were slightly more represented within samples used for nutritional analysis than in the total sample. A negative relationship between birth registration and undernutrition was recognized, with registered children showing a better nutritional status than unregistered ones, even within each wealth quintile. The over- or underestimation of undernutrition in the case of systematic over- or underestimation of age, respectively, the latter being more probable, was quantified up to 28 %. Age imprecision was shown to slightly overestimate undernutrition.ConclusionsSelection bias towards registered children and underestimation of children’s age can lead to an underestimation of the prevalence of undernutrition.

scholarly journals Investigation of the Possible Moderators of Alcohol-Related Intimate Partner Violence in Sub-Saharan Africa

2021 ◽  
Vol 4 (2) ◽  
pp. 67-83
Author(s):  
Ekpenyong M.S. ◽  
Tawari E. P.2
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Meta Analysis ◽  
Intimate Partner ◽  
Sub Saharan Africa ◽  
Public Health Issue ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Cross Sectional ◽  
Sub Saharan

Alcohol-related intimate partner violence (IPV) is a serious public health issue which has attracted a lot of research and debates. While some studies have reported the relationship between alcohol and IPV to be linear, others have reported threshold effects. While some studies have found the link to be strong, others have reported it to be weak or to show no association. The aim of this study was to determine the possible moderators on the alcohol-IPV link in sub-Saharan Africa. For the quantitative study, secondary analysis and meta-analysis were used to analyze cross-sectional data from the demographic and health surveys of ten countries in sub-Saharan Africa (Burkina Faso, Ghana, Kenya, Liberia, Malawi, Nigeria, Sao Tome and Principe, Tanzania, Zambia, and Zimbabwe). Logistic regression analysis of possible moderators of the alcohol-IPV link was determined in ten sub-Saharan African countries. The nature of moderation was different among countries. The results of this study can be applied in planning country-specific and multi-faceted intervention programmes.

scholarly journals Determinants of knowledge, attitudes, and practices of front-line health workers during the first wave of COVID-19 in Africa: a multi-center online cross-sectional study

2021 ◽  
Author(s):  
Larrey Kasereka Kamabu ◽  
Hervé Monka Lekuya ◽  
Richard Newton Iranya ◽  
Bienvenu Muhindo Kasusula ◽  
Franck Katembo Sikakulya ◽  
...  
Keyword(s):  
Health Workers ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
Sectional Study ◽  
Front Line ◽  
African Countries ◽  
Cross Sectional ◽  
Poor Knowledge ◽  
Attitude And Practice ◽  
Good Attitude

Abstract Background: During its first wave of COVID-19 infection in sub-Saharan Africa, there was insufficient understanding of the pandemic among front-line health care professionals that has led to a misidentification, and mistreatment of affected patients, with a potential risk of contracting and spreading the disease. This study was carried out to determine the Knowledge, attitude, and practices (KAP) of front-line health workers (HWs) towards COVID-19 in Africa and their related factors.Methods: This was a multi-centers online cross-sectional study conducted over a 3-months study-period using a google survey link among front lines HWs involved in the COVID-19 response in 26 African countries. Chi-square test & logistic regression were used in the bivariate and multivariate analysis respectively to assess determinants of KAP. Statistical analysis was done using STATA version 16; all tests were two-sided with 95% confidence interval. Results: Five hundred and seventeen (517, 96.3%) consented to participate in this study from 26 African countries; 289 (55.9%) were male and 228 (44.1%) female. Overall, most of HWs, 379 (73.3%) showed poor knowledge about COVID-19 infection and preventive measures. In contrast, majority of them showed good attitude (89%) and practice (90.3%) towards prevention of COVID-19 infections. Knowledge varied among countries; Uganda had the greatest number of HWs with good knowledge. (OR = 28.09, p <0.0001) followed by Ghana (OR=10.92, p=0.001) and DRC (OR: 4.59, p=0.015). The cadre of HWs also influenced knowledge; doctors were the most knowledgeable as compared to other cadres (OR: 3.4, p= 0.005). Additionally, knowledge increased with increasing HWs’ education level (p=0.011).Attitude and practice were both influenced by HWs country of workplace (p=0.05 & p< 0.0001 respectively) and their cadre (p = 0.025 & p < 0.0001 respectively).Conclusions: Majority of the front-line HWs in the African region had an overall good attitude and practice towards COVID-19 infection and practice measures despite relatively poor Knowledge. The KAP is influenced by HWs country of workplace, their cadre and level of education.

scholarly journals Economics & Religious Implications On Adult Literacy In Sub-Saharan Africa

2011 ◽  
Vol 25 (1) ◽  
Author(s):  
Amon O. Okpala ◽  
Comfort O. Okpala
Keyword(s):  
Adult Literacy ◽  
Urban Population ◽  
Religious Affiliation ◽  
Least Square ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Cross Sectional ◽  
Ordinary Least Square ◽  
Sub Saharan ◽  
The Impact

<p class="MsoNormal" style="margin: 0in 0.5in 0pt;"><span style="font-size: 10pt;"><span style="font-family: Times New Roman;">Although literacy rates have improved somehow in recent years, there are still large numbers of people that are illiterates in developing countries.<span style="mso-spacerun: yes;">&nbsp; </span>This paper examines the impact of public education expenditures, the percentage of urban population and religious affiliation on adult literacy rate in Sub-Saharan Africa. In this study, a cross-sectional data of 34 Sub-Saharan African countries with adequate data information were analyzed. The results from the ANOVA and Ordinary Least Square (OLS) regression analysis are quite conclusive - that urban population, government expenditures on education and religious affiliations do have strong statistical impact on literacy.</span></span></p>

scholarly journals The Role Of School Life Expectancy And Urbanization On Adult Literacy Rates In Sub-Saharan Africa

2014 ◽  
Vol 13 (2) ◽  
pp. 329
Author(s):  
Amon Okpala ◽  
Comfort Okpala
Keyword(s):  
Life Expectancy ◽  
Adult Literacy ◽  
Percent Level ◽  
Sub Saharan Africa ◽  
School Life ◽  
African Countries ◽  
Cross Sectional ◽  
Sub Saharan ◽  
The Impact

It is important to examine the role of urbanization, government, and school life expectancy (the years of schooling a child is expected to have) on adult literacy because literacy contributes to economic success. Using cross-sectional data on 46 Sub-Saharan African countries, this study examines 1) the impact of school life expectancy on adult literacy, 2) the influence of urban population on adult literacy, and 3) the effectiveness of government educational expenditure on adult literacy. OLS regression analysis showed that the percentage of the population residing in urban centers and the school life expectancy were positively significant at the 5 percent level. Government expenditure, as a percentage of GDP, was positively significant at the 1 percent level.

scholarly journals African Physician Migration to High-Income Nations: Diverse Motives to Emigrate ("We Are not Florence Nightingale") or Stay in Africa ("There Is No Place Like Home") Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

2020 ◽  
Author(s):  
Akhenaten Siankam Tankwanchi ◽  
Amy Hagopian ◽  
Sten H. Vermund
Keyword(s):  
Large Scale ◽  
Health Workers ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Right To Health ◽  
Sub Saharan Africa ◽  
Global Public Health ◽  
Cross Sectional ◽  
Medical Migration ◽  
The Right

Research in assessing the global and asymmetric flows of health workers in general, and international medical graduates in particular, is fraught with controversy. The complex goal of improving health status of the citizens of home nations while ensuring the right of health workers to migrate generates policy discussions and decisions that often are not adequately informed by evidence. In times of global public health crises like the current coronavirus disease 2019 (COVID-19) global pandemic, the need for equitable distribution and adequate training of health workers globally becomes even more pressing. Brugha et al report suboptimal training and working conditions among Irish and foreign medical doctors practicing in Ireland, while predicting large-scale outward migration. We comment on health personnel migration and retention based on our own experience in this area of research. Drawing from our examination of medical migration dynamics from sub-Saharan Africa, we argue for greater consideration of health workforce retention in research and policy related to resource-limited settings. The right to health suggests the need to retain healthcare providers whose education was typically subsidized by the home nation. The right to migrate may conflict with the right to health. Hence, a deeper understanding is needed as to healthcare worker motives based on interactions of psychosocial processes, economic and material determinants, and quality of work environments.

scholarly journals Cultural Adaptations of the Standard EMDR Protocol in Five African Countries

2021 ◽  
Vol 15 (1) ◽  
pp. 29-43
Author(s):  
Femke Bannink Mbazzi ◽  
Anne Dewailly ◽  
Kalkidan Admasu ◽  
Yvonne Duagani ◽  
Kizito Wamala ◽  
...  
Keyword(s):  
Health Workers ◽  
Group Discussion ◽  
Sub Saharan Africa ◽  
Mental Health Workers ◽  
Standard Protocol ◽  
African Countries ◽  
Cultural Adaptations ◽  
Study Results ◽  
Sub Saharan ◽  
Age Range

Since 2007, mental health workers in sub-Saharan Africa have been trained in eye movement desensitization and reprocessing (EMDR) therapy. This qualitative study used an Afrocentric design with thematic analysis to investigate adaptations to the EMDR standard protocol that make it culturally relevant for African clients. Participants were 25 EMDR therapists (three male, age range 32–60 years, x̄ = 44) from five African countries, who practiced EMDR for 1–11 years (x̄ = 7). All answered a survey questionnaire, eight participated in a focus group discussion, and two provided a supervision notes analysis. Participants found EMDR a useful and beneficial therapy and preferred it over other therapies because of its nonnarrative nature and quick results. We identified four areas in which African therapists consistently made adaptations to the standard protocol: wording of the protocol text, cultural expression of thoughts and emotions, stimulation choice, and simplification of quantitative scales. Based on the study results, we make numerous recommendations for cultural adaptions to the EMDR protocol. These include language changes to take into account the clients' “we oriented” communication; cultural interpretations of positive and negative thoughts and events; adding cultural activities such as dance, music, and religious practices as resourcing exercises; using hand gestures or the pictorial faces scale instead of ordinal scales; and using tapping for bilateral stimulation instead of eye movements, which were sometimes seen as “witchcraft.” The relevance of the findings for EMDR practice and training are discussed. We recommend that African researchers further study the acceptability, use, and effectiveness of EMDR in their countries.

scholarly journals COVID-19 Knowledge, Perception, Preventive Measures, Stigma, and Mental Health Among Healthcare Workers in Three Sub-Saharan African Countries: A Phone Survey

2021 ◽  
Author(s):  
Nega Assefa ◽  
Abdramane Soura ◽  
Elena C. Hemler ◽  
Michelle L. Korte ◽  
Dongqing Wang ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Stigma ◽  
Healthcare Providers ◽  
Sub Saharan Africa ◽  
Prevention Measures ◽  
African Countries ◽  
Health Crisis ◽  
Adjusted Risk ◽  
Adequate Knowledge ◽  
Sub Saharan

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented public health crisis globally. Understanding healthcare providers’ (HCPs’) knowledge and perceptions of COVID-19 is crucial to identifying effective strategies to improve their ability to respond to the pandemic in sub-Saharan Africa. A phone-based survey of 900 HCPs in Burkina Faso, Ethiopia, and Nigeria (300 per country) was conducted to assess knowledge, perceptions, COVID-19 prevention measures, stigma, and mental health of HCPs. Modified Poisson regression models were used to evaluate predictors of knowledge, perceptions, and prevention measures; adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) were calculated. Three-fourths of the HCPs had adequate knowledge, and over half had correct perceptions of risk and high levels of self-reported prevention measures. The majority of the HCPs (73.7%) reported self-perceived social stigma. There was relatively low prevalence of depression (6.6%), anxiety (6.6%), or psychological distress (18%). Compared with doctors, being a nurse was associated with lower levels of knowledge (ARR: 0.83; 95% CI: 0.77–0.90) and was also negatively associated with having correct perceptions toward COVID-19 (AOR: 0.82; 95% CI: 0.73–0.92). HCPs treating COVID-19 patients had higher likelihood of having high levels of prevention measures (AOR: 1.37; 95% CI: 1.23–1.53). Despite high levels of knowledge among HCPs in sub-Saharan Africa, there is a need to improve COVID-19 perceptions and compliance with prevention measures as well as address social stigma toward HCPs to better ensure their safety and prepare them to deliver health services.

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