scholarly journals Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative

2021 ◽  
Vol 6 (6) ◽  
pp. e005833
Author(s):  
Leena N Patel ◽  
Samantha Kozikott ◽  
Rodrigue Ilboudo ◽  
Moreen Kamateeka ◽  
Mohammed Lamorde ◽  
...  
Keyword(s):  
Health Facility ◽  
Healthcare Workers ◽  
National Level ◽  
Lessons Learned ◽  
Health Facilities ◽  
Infection Prevention And Control ◽  
Health Facility Level ◽  
Ensure Patient Safety ◽  
Increased Risk ◽  
Facility Level

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.

scholarly journals Eastern Cape Healthcare Workers Acquisition of SARS-CoV-2 (ECHAS): Cross-Sectional (Nested Cohort) Study Protocol

2021 ◽  
Vol 18 (1) ◽  
pp. 323
Author(s):  
Oladele Vincent Adeniyi ◽  
David Stead ◽  
Mandisa Singata-Madliki ◽  
Joanne Batting ◽  
Leo Hyera ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infection Rate ◽  
Healthcare Workers ◽  
Health Facilities ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Eastern Cape ◽  
Rt Pcr ◽  
Cross Sectional ◽  
Increased Risk

Healthcare workers (HCWs) are at increased risk of infection by the virulent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Though data exist on the positivity rate of the SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test as well as COVID-19-related deaths amongst HCWs in South Africa, the overall infection rate remains underestimated by these indicators. It is also unclear whether the humoral immune response after SARS-CoV-2 infection offers durable protection against reinfection. This study will assess the SARS-CoV-2 seroprevalence amongst HCWs in the Eastern Cape (EC) and examine the longitudinal changes (rate of decay) in the antibody levels after infection in this cohort. Using a multi-stage cluster sampling of healthcare workers in selected health facilities in the EC, a cross-sectional study of 2250 participants will be recruited. In order to assess the community infection rate, 750 antenatal women in the same settings will be recruited. Relevant demographic and clinical characteristics will be obtained by a self-administered questionnaire. A chemiluminescent microparticle immunoassay (CMIA) will be used for the qualitative detection of IgG antibodies against SARS-CoV-2 nucleocapsid protein. A nested cohort study will be conducted by performing eight-weekly antibody assays (X2) from 201 participants who tested positive for both SARS-CoV-2 RT-PCR and serology. Logistic regression models will be fitted to identify the independent risk factors for SARS-CoV-2 infection. The cumulative SARS-CoV-2 infection rate and infection fatality rate among the frontline HCWs will be estimated. In addition, the study will highlight the overall effectiveness of infection prevention and control measures (IPC) per exposure sites/wards at the selected health facilities. Findings will inform the South African Department of Health’s policies on how to protect HCWs better as the country prepares for the second wave of the SARS-CoV pandemic.

Evaluation of the Zimbabwe HIV Case Surveillance Pilot Program, 2019 (Preprint)

2020 ◽  
Author(s):  
Peter Nsubuga ◽  
Simbarashe Mabaya ◽  
Tsitsi Apollo ◽  
Ngwarai Sithole ◽  
Brian Komtenza ◽  
...  
Keyword(s):  
Child Care ◽  
Viral Load ◽  
Health Facility ◽  
Lessons Learned ◽  
Load Test ◽  
Test Results ◽  
Health Facility Level ◽  
Viral Load Test ◽  
Facility Level ◽  
Roll Out

BACKGROUND Zimbabwe has a high burden of HIV, with an estimated 1.3 million people living with the virus and an HIV prevalence and incidence of 13.8% and 0.48%, respectively (2017 Spectrum estimates). In 2017, the Zimbabwe Ministry of Health and Child Care (MOHCC) developed and implemented a pilot of HIV case surveillance (CS) based on the 2017 World Health Organisation (WHO) Person-centred HIV patient monitoring (PM) and case surveillance guidelines. As the case surveillance guidelines were new, lessons learned from field implementation experiences were intended to inform the development of HIV case surveillance implementation guidance and tools. OBJECTIVE At the end of the pilot phase, the Ministry of Health and Child Care (MOHCC) commissioned an evaluation to inform further steps. METHODS Two districts, Umzingwane in Matabeleland South Province and Mutare in Manicaland Province were commissioned to run the CS pilot from August 2017 to December 2018. During this period, 1602 people living with HIV (PLHIV) newly diagnosed with HIV were reported in the CS system, while other HIV sentinel events, including ART initiation and first viral load test, were routinely reported. A mixed-methods cross-sectional study of stakeholders and health facility staff was used to assess the following CS system features: design and operations, performance, usefulness, sustainability and scalability. A total of 13 stakeholders responded to an online questionnaire, while 33 health facility respondents were interviewed in 11 health facilities in the two pilot districts. RESULTS The HIV CS system was adequately designed for Zimbabwe’s context, integrated within existing health information systems at the facility level. However, the training was minimal, and an opportunity to train the data entry clerks in data analysis was missed. The system performed well in terms of surveillance and informatics attributes. However, viral load test results return was a significant problem. The system was used at the health facility level to track the HIV positive clients in their catchment area; all facilities that were visited were aware of what is happening to their clients. Almost all respondents believed that the country can roll out the HIV CS system to all facilities with partner support. CONCLUSIONS The HIV CS system was found useful at the health facility level and should be rolled out in a phased manner, beginning with all facilities in Manicaland and Matabeleland South provinces. An electronic link needs to be made between the health facilities and the laboratory to reduce viral load test results delays. Lessons learned from the provincial roll out can be used for a nationwide scale-up.

THE IMPORTANCE OF PUBLIC SECTOR HEALTH FACILITY-LEVEL DATA FOR MONITORING CHANGES IN MATERNAL MORTALITY RISKS AMONG COMMUNITIES: THE CASE OF PAKISTAN

2013 ◽  
Vol 45 (5) ◽  
pp. 601-613 ◽  
Author(s):  
ANRUDH K. JAIN ◽  
ZEBA SATHAR ◽  
MOMINA SALIM ◽  
ZAKIR HUSSAIN SHAH
Keyword(s):  
Public Sector ◽  
Maternal Mortality ◽  
Health Facility ◽  
Health Facilities ◽  
Mortality Risks ◽  
Live Births ◽  
Health Facility Level ◽  
Level Data ◽  
Public Sector Health ◽  
Facility Level

SummaryThis paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

scholarly journals Estimating the effect of pretreatment loss to follow up on TB associated mortality at public health facilities in Uganda

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241611
Author(s):  
Stella Zawedde-Muyanja ◽  
Joseph Musaazi ◽  
Yukari C. Manabe ◽  
Achilles Katamba ◽  
Joaniter I. Nankabirwa ◽  
...  
Keyword(s):  
Public Health ◽  
Health Facility ◽  
Health Facilities ◽  
Vital Status ◽  
Loss To Follow Up ◽  
Public Health Facilities ◽  
Tb Treatment ◽  
Health Facility Level ◽  
Facility Level

Introduction Tuberculosis (TB) mortality estimates derived only from cohorts of patients initiated on TB treatment do not consider outcomes of patients with pretreatment loss to follow-up (LFU). We aimed to assess the effect of pretreatment LFU on TB-associated mortality in the six months following TB diagnosis at public health facilities in Uganda. Methods At ten public health facilities, we retrospectively reviewed treatment data for all patients with a positive Xpert®MTB/RIF test result from January to June 2018. Pretreatment LFU was defined as not initiating TB treatment within two weeks of a positive test. We traced patients with pretreatment LFU to ascertain their vital status. We performed Kaplan Meier survival analysis to compare the cumulative incidence of mortality, six months after diagnosis among patients who did and did not experience pretreatment LFU. We also determined the health facility level estimates of TB associated mortality before and after incorporating deaths prior to treatment initiation among patients who experienced pretreatment LFU. Results Of 510 patients with positive test, 100 (19.6%) experienced pretreatment LFU. Of these, we ascertained the vital status of 49 patients. In the six months following TB diagnosis, mortality was higher among patients who experienced pretreatment LFU 48.1/1000py vs 22.9/1000py. Hazard ratio [HR] 3.18, 95% confidence interval [CI] (1.61–6.30). After incorporating deaths prior to treatment initation among patients who experienced pretreatment LFU, health facility level estimates of TB associated mortality increased from 8.4% (95% CI 6.1%-11.6%) to 10.2% (95% CI 7.7%-13.4%). Conclusion Patients with confirmed TB who experience pretreatment LFU have high mortality within the first six months. Efforts should be made to prioritise linkage to treatment for this group of patients. Deaths that occur prior to treatment initation should be included when reporting TB mortality in order to more accurately reflect the health impact of TB.

scholarly journals Evaluation of Infection, Prevention and Control Program in Goromonzi District, Zimbabwe, 2018: A process outcome evaluation

2019 ◽  
Author(s):  
Govha Emmanuel ◽  
Zizhou Simukai Tirivanhu ◽  
Shambira Gerald ◽  
Gombe Tafara Notion ◽  
Tsitsi Juru ◽  
...  
Keyword(s):  
Health Facility ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Health Workers ◽  
Outcome Evaluation ◽  
Hazard Identification ◽  
Health Facilities ◽  
Infection Prevention And Control ◽  
Hiv Test ◽  
And Control

Abstract Background A healthcare-associated infection (HAI) is defined as an infection originating in the environment of a health facility that was not present or incubating at the time of patient admission. HAIs can be prevented through infection, prevention and control (IPC) measures. No hazard identification and risk assessment IPC rounds and monthly meetings were conducted in Goromonzi district since 1st of January to 30th of June 2018. No trainings nor orientation for the new employees was conducted. We therefore evaluated Goromonzi District IPC program. Methods A process-outcome evaluation using the logic model was conducted in Goromonzi district’s 15 health facilities. Checklists, interviewer administered questionnaires and key informant guides were used to collect data on availability of inputs, knowledge of health workers, processes performed, outputs and outcomes achieved. Data were entered into Epi Info 7TM, which was used to generate frequencies and proportions. Qualitative data from checklists and key informants interviews was sorted manually into themes and analysed. Results All 15 health facilities had adequate stocks of HIV test kits and PEP kits. Adequate bins and detergents were found in only 3/15 (20%) of health facilities. All facilities failed to hold a single IPC meeting and none had specific budget for IPC in 2018. No IPC mentorship activities were carried out in the district. Only 7/13 (54%) health workers who had needle pricks received PEP with 2/7 (29%) of them finishing the course. No health facility had a functional HAI surveillance system. The overall knowledge rating was fair. Conclusion The IPC program inputs in Goromonzi district were inadequate hence its failure to achieve the intended outputs and outcomes. Inadequate knowledge, unavailability of health worker training plans, specific budgets and absence of IPC committees reflected non prioritisation of the program.

A systematic review of vaccine availability at the national, district, and health facility level in the WHO African Region

2020 ◽  
Vol 19 (7) ◽  
pp. 639-651
Author(s):  
Chinwe Juliana Iwu ◽  
Ntombehle Ngcobo ◽  
Anelisa Jaca ◽  
Alison Wiyeh ◽  
Elizabeth Pienaar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Facility ◽  
African Region ◽  
Health Facility Level ◽  
Facility Level ◽  
Vaccine Availability

scholarly journals Baseline results of the first malaria indicator survey in Iran at the health facility level

2011 ◽  
Vol 10 (1) ◽  
pp. 319 ◽  
Author(s):  
Ahmad Raiesi ◽  
Fatemeh Nikpour ◽  
Alireza Ansari-Moghaddam ◽  
Mansoor Ranjbar ◽  
Fatemeh Rakhshani ◽  
...  
Keyword(s):  
Health Facility ◽  
Malaria Indicator Survey ◽  
Health Facility Level ◽  
Facility Level

scholarly journals Factors influencing treatment outcomes in tuberculosis patients in Limpopo Province, South Africa, from 2006 to 2010: A retrospective study

Curationis ◽  
2014 ◽  
Vol 37 (1) ◽  
Author(s):  
Mohammed M. Gafar ◽  
Norman Z. Nyazema ◽  
Yoswa M. Dambisya
Keyword(s):  
South Africa ◽  
Treatment Outcomes ◽  
Health Facility ◽  
Treatment Regimen ◽  
Diagnostic Category ◽  
Limpopo Province ◽  
World Health ◽  
Factors Influencing ◽  
Health Facility Level ◽  
Facility Level

Background: South Africa has a high burden of tuberculosis (TB), with high human immunodeficiency virus (HIV)-TB co-infection rates and the emergence of multidrugresistant TB.Objectives: To describe treatment outcomes and factors influencing outcomes amongst pulmonary TB (PTB) patients in the Limpopo Province.Method: A retrospective review was conducted of data on the provincial electronic TB register (ETR.net) for the years 2006 to 2010 (inclusive), and a random sample of 1200 records was selected for further analysis. The Chi square test was used to examine the influence of age, gender, health facility level, diagnostic category and treatment regimen on treatment outcomes.Results: Overall 90 617 (54.6% male) PTB patients were registered between 2006 and 2010. Of the sampled 1200 TB cases, 72.6% were in persons aged 22 to 55 years and 86.2% were new cases. The TB mortality rate was 13.6% (much higher than the World Health Organization target of 3%), whilst the default rate was 9.8%. There was a strong association between age (P < 0.001), diagnostic category (P < 0.001), treatment regimen (P < 0.001), and health facility level (P < 0.001) and treatment outcome. Those aged 22–55, and 56–74 years were more likely to die (P < 0.05). Poor treatment outcomes were also associated with initial treatment failure, receiving treatment at hospital and treatment regimen II.Conclusion: The poor TB treatment outcomes in Limpopo, characterised by a high mortality and default rates, call for strengthening of the TB control programme, which should include integration of HIV and/or AIDS and TB services. 

scholarly journals Malaria risk factors in northern Namibia: The importance of occupation, age and mobility in characterizing high-risk populations

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252690
Author(s):  
Jennifer L. Smith ◽  
Davis Mumbengegwi ◽  
Erastus Haindongo ◽  
Carmen Cueto ◽  
Kathryn W. Roberts ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Health Facility ◽  
Latent Class ◽  
Indoor Residual Spraying ◽  
Malaria Risk ◽  
Health Facilities ◽  
Environmental Data ◽  
Behavioral Risk ◽  
Increased Risk

In areas of low and unstable transmission, malaria cases occur in populations with lower access to malaria services and interventions, and in groups with specific malaria risk exposures often away from the household. In support of the Namibian National Vector Borne Disease Program’s drive to better target interventions based upon risk, we implemented a health facility-based case control study aimed to identify risk factors for symptomatic malaria in Zambezi Region, northern Namibia. A total of 770 febrile individuals reporting to 6 health facilities and testing positive by rapid diagnostic test (RDT) between February 2015 and April 2016 were recruited as cases; 641 febrile individuals testing negative by RDT at the same health facilities through June 2016 were recruited as controls. Data on socio-demographics, housing construction, overnight travel, use of malaria prevention and outdoor behaviors at night were collected through interview and recorded on a tablet-based questionnaire. Remotely-sensed environmental data were extracted for geo-located village residence locations. Multivariable logistic regression was conducted to identify risk factors and latent class analyses (LCA) used to identify and characterize high-risk subgroups. The majority of participants (87% of cases and 69% of controls) were recruited during the 2016 transmission season, an outbreak year in Southern Africa. After adjustment, cases were more likely to be cattle herders (Adjusted Odds Ratio (aOR): 4.46 95%CI 1.05–18.96), members of the police or other security personnel (aOR: 4.60 95%CI: 1.16–18.16), and pensioners/unemployed persons (aOR: 2.25 95%CI 1.24–4.08), compared to agricultural workers (most common category). Children (aOR 2.28 95%CI 1.13–4.59) and self-identified students were at higher risk of malaria (aOR: 4.32 95%CI 2.31–8.10). Other actionable risk factors for malaria included housing and behavioral characteristics, including traditional home construction and sleeping in an open structure (versus modern structure: aOR: 2.01 95%CI 1.45–2.79 and aOR: 4.76 95%CI: 2.14–10.57); cross border travel in the prior 30 days (aOR: 10.55 95%CI 2.94–37.84); and outdoor agricultural work at night (aOR: 2.09 95%CI 1.12–3.87). Malaria preventive activities were all protective and included personal use of an insecticide treated net (ITN) (aOR: 0.61 95%CI 0.42–0.87), adequate household ITN coverage (aOR: 0.63 95%CI 0.42–0.94), and household indoor residual spraying (IRS) in the past year (versus never sprayed: (aOR: 0.63 95%CI 0.44–0.90). A number of environmental factors were associated with increased risk of malaria, including lower temperatures, higher rainfall and increased vegetation for the 30 days prior to diagnosis and residing more than 5 minutes from a health facility. LCA identified six classes of cases, with class membership strongly correlated with occupation, age and select behavioral risk factors. Use of ITNs and IRS coverage was similarly low across classes. For malaria elimination these high-risk groups will need targeted and tailored intervention strategies, for example, by implementing alternative delivery methods of interventions through schools and worksites, as well as the use of specific interventions that address outdoor transmission.

scholarly journals Covid-19 pandemic: chronicle of responses and experiences of the infection prevention and control committee at a tertiary hospital in southwest Nigeria

2021 ◽  
Vol 21 (3) ◽  
pp. 1093-1099
Author(s):  
Akinwumi Ayodeji Akinbodewa ◽  
Michael Simidele Odimayo ◽  
Olorunfemi Akinbode Ogundele ◽  
Tosin Oluwapelumi Ogunleye ◽  
Olanrewaju Olayinka Johnson ◽  
...  
Keyword(s):  
Prevention And Control ◽  
Healthcare Workers ◽  
Infection Prevention ◽  
Virus Disease ◽  
Healthcare Delivery ◽  
Healthcare Management ◽  
Lessons Learned ◽  
Healthcare Personnel ◽  
Infection Prevention And Control ◽  
And Control

Since the advent of 2019-Corona virus Disease (COVID-19) in Nigeria in February 2020, the number of confirmed cases has risen astronomically to over 61,307 cases within 8 months with more than 812 healthcare workers infected and some recorded deaths within their ranks. Infection prevention and control is a key component in ensuring safety of healthcare workers in the hospital as health- care-associated infection is one of the most common complications of healthcare management. Unbridled transmission of infection can lead to shortage of healthcare personnel, reduced system efficiency, increased morbidity and mortality among patients and in some instances, total collapse of healthcare delivery services. The Infection Prevention and Control Committee is a recognised group by the Centre for Disease Control and Prevention with their core programmes including drawing up activities, procedures and policies designed to achieve above-stated objectives before, during and after any disease outbreak, especially emerging and re-emerging ones such as the 2019 Coronavirus Disease. In this report, we highlight the roles played by the Infection Prevention and Control Committee of the University of Medical Sciences Teaching Hospital to prevent the spread of COVID-19 within and outside the hospital community and the lessons learned to date. Keywords: COVID-19; infection prevention; infection control; Nigeria.

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