scholarly journals Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study

2021 ◽  
pp. bmjqs-2020-012751
Author(s):  
Morgane Clarke ◽  
Chiara Pittalis ◽  
Eric Borgstein ◽  
Leon Bijlmakers ◽  
Mweene Cheelo ◽  
...  
Keyword(s):  
Quality Control ◽  
Mixed Methods ◽  
Adverse Events ◽  
Control Systems ◽  
Low Income ◽  
Quality Systems ◽  
Continuous Training ◽  
Surgical Morbidity ◽  
Cross Sectional ◽  
District Hospitals

BackgroundIn low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems.AimTo assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia.MethodsA mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers.Results53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms.ConclusionsSurgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes.

scholarly journals The COVID-19 vaccination experience in Bangladesh: Findings from a cross-sectional study

2021 ◽  
Vol 35 ◽  
pp. 205873842110656
Author(s):  
Md. Rabiul Islam ◽  
Moynul Hasan ◽  
Waheeda Nasreen ◽  
Md. Ismail Tushar ◽  
Mohiuddin Ahmed Bhuiyan
Keyword(s):  
Adverse Events ◽  
Low Income ◽  
Heart Diseases ◽  
Developed Countries ◽  
Cross Sectional Study ◽  
Low Income Countries ◽  
Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
Mass Immunization

Objectives Vaccination rollout against COVID-19 has started in developed countries in early December 2020. Mass immunization for poor or low-income countries is quite challenging before 2023. Being a lower–middle-income country, Bangladesh has begun a nationwide COVID-19 vaccination drive in early February 2021. Here, we aimed to assess the opinions, experiences, and adverse events of the COVID-19 vaccination in Bangladesh. Methods We conducted this online cross-sectional study from 10 February 2021, to 10 March 2021, in Bangladesh. A self-reported semi-structured survey questionnaire was used using Google forms. We recorded demographics, disease history, medication records, opinions and experiences of vaccination, and associated adverse events symptoms. Results We observed leading comorbid diseases were hypertension (25.9%), diabetes (21.1%), heart diseases (9.3%), and asthma (8.7%). The most frequently reported adverse events were injection site pain (34.3%), fever (32.6%), headache (20.2%), fatigue (16.6%), and cold feeling (15.4%). The chances of having adverse events were significantly higher in males than females ( p = 0.039). However, 36.4% of respondents reported no adverse events. Adverse events usually appeared after 12 h and went way within 48 h of vaccination. Besides, 85.5% were happy with the overall vaccination management, while 88.0% of the respondents recommended the COVID-19 vaccine for others for early immunization. Conclusion According to the present findings, reported adverse events after the doses of Covishield in Bangladesh were non-serious and temporary. In Bangladesh, the early vaccination against COVID-19 was possible due to its prudent vaccine deal, previous mass vaccination experience, and vaccine diplomacy.

scholarly journals The burden of drug resistant tuberculosis in a predominantly nomadic population in Uganda: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Brenda Nakafeero Simbwa ◽  
Achilles Katamba ◽  
Elizabeth B. Katana ◽  
Eva A. O. Laker ◽  
Sandra Nabatanzi ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Low Income ◽  
Conditional Logistic Regression ◽  
Drug Resistant ◽  
Cross Sectional ◽  
Drug Resistant Tuberculosis ◽  
Public Health Burden ◽  
Factors Associated ◽  
Tb Treatment ◽  
Resistant Tuberculosis

Abstract Background Emergence of drug resistant tuberculosis (DR-TB) has aggravated the tuberculosis (TB) public health burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population in Karamoja, Uganda with a high-TB burden (3500 new cases annually) and sought to determine the prevalence, patterns, factors associated with DR-TB. Methods We used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case control study with conditional logistic regression and robust standard errors respectively were used to the determine prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth interviews and key informant interviews. Results The overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64,197 (0.1%) among the new and 37/2693 (1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI 1.552–110.135) and drug stock-outs aOR 0.027 (95%CI 0.002–0.364). The nomadic lifestyle, substance use, congested homesteads and poor health worker attitudes were a great challenge to effective treatment of TB. Conclusion Despite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education may help to stem the burden of TB disease in this nomadic population.

scholarly journals Developing a self-directed career guidance intervention for South African high school learners amidst severe COVID-19 restrictions

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Michelle Jäckel-Visser ◽  
Stephan Rabie ◽  
Anthony V. Naidoo ◽  
Izanette Van Schalkwyk ◽  
Francois J. Van den Berg ◽  
...  
Keyword(s):  
High School ◽  
Mixed Methods ◽  
South African ◽  
Low Income ◽  
Career Guidance ◽  
Western Cape ◽  
Cross Sectional ◽  
Interpersonal Contact ◽  
Guidance Intervention ◽  
Perceived Impact

Background: South African schools have been severely impacted by the coronavirus disease 2019 (COVID-19) pandemic in 2020. State-imposed restrictions to mitigate the spread of the infection have significantly limited direct interpersonal contact, curtailing the existing career guidance and counselling activities in schools. Crucially, in low-income settings, the social distancing regulations implied that in a year of increasing anxiety and uncertainty, many high school learners would have had to make important career-related decisions with limited or no tacit career guidance.Objectives: In response to these challenges, this study developed a self-directed career guidance intervention to provide continued career guidance support for Grade 9 learners amidst the unfolding global pandemic.Method: A cross-sectional mixed-methods design was employed to evaluate feasibility and acceptability of the intervention amongst a sample of 498 learners across eight high schools in the Cape Winelands district, Western Cape province, South Africa.Results: Favourable quantitative results were obtained assessing learners’ experiences of participating in the intervention and on the perceived impact of the intervention on their career preparedness. Participants reported a mean score of 41.25 (out of 50) for acceptability of the intervention. In addition, they reported a mean score of 17.1 (out of 20) for perceived impact of the intervention on their career preparedness. In terms of feasibility, qualitative findings revealed that the intervention improved learners’ self-knowledge and career directionality.Conclusion: The mixed-methods results confirm the feasibility and utility of implementing a self-directed career guidance intervention amongst secondary school learners. Whilst learners reported positive evaluations of the self-directed career guidance booklet, they also expressed the need for one-on-one or group engagement with the intervention content.

scholarly journals The Burden of Drug Resistant Tuberculosis in a predominantly nomadic population in Uganda. A Mixed Methods Study

2021 ◽  
Author(s):  
Brenda Nakafeero Simbwa ◽  
Elizabeth B. Katana ◽  
Sandra Nabatanzi ◽  
Emmanuel Sendaula ◽  
Charles A. Karamagi ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Low Income ◽  
Conditional Logistic Regression ◽  
Drug Resistant ◽  
Cross Sectional ◽  
Drug Resistant Tuberculosis ◽  
Public Health Burden ◽  
Factors Associated ◽  
Tb Treatment ◽  
Resistant Tuberculosis

Abstract Background: Emergence of Drug Resistant Tuberculosis (DR-TB) has aggravated the Tuberculosis (TB) public health burden worldwide and especially in low income settings. We present findings from a predominantly nomadic population in Karamoja, Uganda with a high-TB burden (3,500 new cases annually) and sought to determine the prevalence, patterns, factors associated with DR-TB. Methods: We used mixed methods of data collection. We enrolled 6890 participants who were treated for tuberculosis in a programmatic setting between January 2015 and April 2018. A cross sectional study and a matched case control study with conditional logistic regression and robust standard errors respectively were used to the determine prevalence and factors associated with DR-TB. The qualitative methods included focus group discussions, in-depth interviews and key informant interviews. Results: The overall prevalence of DR-TB was 41/6890 (0.6%) with 4/64197 (0.1%) among the new and 37/2693 (1.4%) among the previously treated TB patients respectively. The drug resistance patterns observed in the region were mainly rifampicin mono resistant (68.3%) and Multi Drug-Resistant Tuberculosis (31.7%). Factors independently associated with DR-TB were previous TB treatment, adjusted odds ratio (aOR) 13.070 (95%CI: 1.552 – 110.135) and drug stock-outs aOR 0.027 (95%CI: 0.002-0.364). The nomadic lifestyle, substance use, congested homesteads and poor health worker attitudes were a great challenge to effective treatment of TB. Conclusion: Despite having the highest national TB incidence, Karamoja still has a low DR-TB prevalence. Previous TB treatment and drug stock outs were associated with DR-TB. Regular supply of anti TB medications and health education may help to stem the burden of TB disease in this nomadic population.

scholarly journals A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals

2017 ◽  
Vol 2 ◽  
pp. 119
Author(s):  
Georgina A.V. Murphy ◽  
Vivian N. Nyakangi ◽  
David Gathara ◽  
Morris Ogero ◽  
Mike English ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Low Income ◽  
Medical Records ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Appropriate Care ◽  
District Hospitals ◽  
Admission Policies ◽  
Using Data

Background: Small and sick newborns need high quality specialised care within health facilities to address persistently high neonatal mortality in low-income settings, including Kenya. Methods: We examined neonatal admissions in 12 public-sector County (formerly District) hospitals in Kenya between November 2014 and November 2016. Using data abstracted from newborn unit (NBU) admission registers and paediatric ward (PW) medical records, we explore the magnitude and distribution of admissions. In addition, interviews with senior staff were conducted to understand admission policies for newborns in these facilities. Results: Of the total 80,666 paediatric admissions, 28,884 (35.8%) were aged ≤28 days old. 24,212 (83.8%) of newborns were admitted to organisationally distinct NBU and 4,672 (16.2%) to general PW, though the proportion admitted to NBUs varied substantially (range 59.9-99.0%) across hospitals, reflecting widely varying infrastructure and policies. Neonatal mortality was high in NBU (12%) and PW (11%), though varied widely across facilities, with documentation of outcomes poor for the NBU. Conclusion: Improving quality of care on NBUs would affect almost a third of paediatric admissions in Kenya. However, comprehensive policies and strategies are needed to ensure sick newborns on general PWs also receive appropriate care.

scholarly journals A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals

2018 ◽  
Vol 2 ◽  
pp. 119
Author(s):  
Georgina A.V. Murphy ◽  
Vivian N. Nyakangi ◽  
David Gathara ◽  
Morris Ogero ◽  
Mike English ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Low Income ◽  
Medical Records ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Appropriate Care ◽  
District Hospitals ◽  
Admission Policies ◽  
Using Data

Background: Small and sick newborns need high quality specialised care within health facilities to address persistently high neonatal mortality in low-income settings, including Kenya. Methods: We examined neonatal admissions in 12 public-sector County (formerly District) hospitals in Kenya between November 2014 and November 2016. Using data abstracted from newborn unit (NBU) admission registers and paediatric ward (PW) medical records, we explore the magnitude and distribution of admissions. In addition, interviews with senior staff were conducted to understand admission policies for neonates in these facilities. Results: Of the total 80,666 paediatric admissions, 28,884 (35.8%) were aged ≤28 days old. 24,212 (83.8%) of neonates were admitted to organisationally distinct NBUs and 4,672 (16.2%) to general PWs, though the proportion admitted to NBUs varied substantially (range 59.9-99.0%) across hospitals, reflecting widely varying infrastructure and policies. Neonatal mortality was high in NBUs (12%) and PWs (11%), though varied widely across facilities, with documentation of outcomes poor for the NBUs. Conclusion: Improving quality of care on NBUs would affect almost a third of paediatric admissions in Kenya. However, comprehensive policies and strategies are needed to ensure sick neonates on general PWs also receive appropriate care.

scholarly journals Women Do Not Utilise Family Planning According to Their Needs in Southern Malawi: A Cross-Sectional Survey

2021 ◽  
Vol 18 (8) ◽  
pp. 4072
Author(s):  
Maria Lisa Odland ◽  
Oda Vallner ◽  
Marlen Toch-Marquardt ◽  
Elisabeth Darj
Keyword(s):  
Family Planning ◽  
Low Income ◽  
Unwanted Pregnancy ◽  
Unmet Need ◽  
High Fertility ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Associated ◽  
Validated Questionnaire ◽  
District Hospitals

Malawi is a low-income country with a high maternal mortality rate. This study aimed to investigate the use of contraception and factors associated with unmet need of family planning among fertile women in selected health facilities in southern Malawi. A cross-sectional study design was employed using a validated questionnaire to investigate the unmet need. A total of 419 pregnant women, who attended antenatal clinics at a central hospital and two district hospitals, voluntarily participated in the study. Logistic regression analysis was used to identify possible factors associated with unmet needs. Amongst the participants, 15.1% reported unmet need, 27.0% had never used a contraceptive method, and 27.2% had an unwanted pregnancy. Being married, 20–24 years of age, living in a rural area, and high parity were protective factors against having unmet need regarding family planning. Malawi, a country with a young population and a high fertility rate, has a high level of unmet family planning need. Barriers and facilitators need to be identified and addressed at different levels by the health care system, society, and the government of Malawi.

A View of the Lexical–Grammatical Link in Young Latinos With Specific Language Impairment Using Language-Specific and Conceptual Measures

2019 ◽  
Vol 62 (6) ◽  
pp. 1775-1786 ◽  
Author(s):  
Lucía I. Méndez ◽  
Gabriela Simon-Cereijido
Keyword(s):  
Low Income ◽  
Language Impairment ◽  
Specific Language Impairment ◽  
L2 Acquisition ◽  
Cross Sectional ◽  
Specific Language ◽  
Vocabulary Skills ◽  
In The Beginning ◽  
Study Participants ◽  
L1 And L2

Purpose This study investigated the nature of the association of lexical–grammatical abilities within and across languages in Latino dual language learners (DLLs) with specific language impairment (SLI) using language-specific and bilingual measures. Method Seventy-four Spanish/English–speaking preschoolers with SLI from preschools serving low-income households participated in the study. Participants had stronger skills in Spanish (first language [L1]) and were in the initial stages of learning English (second language [L2]). The children's lexical, semantic, and grammar abilities were assessed using normative and researcher-developed tools in English and Spanish. Hierarchical linear regressions of cross-sectional data were conducted using measures of sentence repetition tasks, language-specific vocabulary, and conceptual bilingual lexical and semantic abilities in Spanish and English. Results Results indicate that language-specific vocabulary abilities support the development of grammar in L1 and L2 in this population. L1 vocabulary also contributes to L2 grammar above and beyond the contribution of L2 vocabulary skills. However, the cross-linguistic association between vocabulary in L2 and grammar skills in the stronger or more proficient language (L1) is not observed. In addition, conceptual vocabulary significantly supported grammar in L2, whereas bilingual semantic skills supported L1 grammar. Conclusions Our findings reveal that the same language-specific vocabulary abilities drive grammar development in L1 and L2 in DLLs with SLI. In the early stages of L2 acquisition, vocabulary skills in L1 also seem to contribute to grammar skills in L2 in this population. Thus, it is critical to support vocabulary development in both L1 and L2 in DLLs with SLI, particularly in the beginning stages of L2 acquisition. Clinical and educational implications are discussed.

Relationship of Scabies With Pioderma: As a Risk Factor

2018 ◽  
Vol 1 (1) ◽  
pp. 33-42
Author(s):  
Yulia Farida Yahya ◽  
Fifa Argentina ◽  
Rusmawardiana Rusmawardiana
Keyword(s):  
Staphylococcus Aureus ◽  
Elementary School ◽  
Risk Factor ◽  
Low Income ◽  
Primary Schools ◽  
Pediatric Patients ◽  
Group A Streptococcus ◽  
Cross Sectional ◽  
The Government ◽  
Scabies Infestation

Scabies is a parasitic infestation of the skin, that is affecting on the low income and crowded community in many tropical countries, especially developing countries such as Indonesia. Scabies infestation increases the incidence of secondary pyoderma include impetigo, folliculitis, cellulitis, ecthyma, abscess. Secondary pyoderma is a skin infection disease mainly caused by     group A Streptococcus (GAS) and Staphylococcus aureus (SA). Pyoderma is a risk factor for the glomerulonephritis infection, rheumatic diseases, which significantly increases morbidity and mortality, causing the government burden. The aim of this study is  determining the etiology and correlation of pyoderma infection in scabies patient. To determine sosio-demographic included sex, age in pediatric patients in primary schools (SD) in the district of Kertapati Palembang. The study design was cross sectional, and study samples were new scabies patients in the elementary school (age 6-14-year-old) with or without pyoderma. Clinical findings included history, physical examination and diagnostic procedure, which was investigation of skin scraping specimen material (SSB = skin surface biopsy) in confirmation with dermoscopic polar examination (DS) to show Sarcoptes scabiei mites. Microbiological examination with Gram stain identified the etiology of pyoderma.  Results of this study shows that there was a significance relationship between scabies infestation and pyoderma in children in elementary school. Staphylococcus aureus dan GAS are the most common caused of pyoderma in pediatric patients with scabies. Conclusion is there is a significant correlation between scabies and pyoderma. There is  a need to provide scabies and pyoderma medication at primary care health center as well as counseling for prevention in Palembang area with crowded population periodically.  

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