scholarly journals Organizational factors associated with health worker protection during the COVID-19 pandemic in four provinces of South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Muzimkhulu Zungu ◽  
Kuku Voyi ◽  
Nosimilo Mlangeni ◽  
Saiendhra Vasudevan Moodley ◽  
Jonathan Ramodike ◽  
...  
Keyword(s):  
South Africa ◽  
Occupational Health ◽  
Health Worker ◽  
Personal Protective Equipment ◽  
Health Workers ◽  
Health Facilities ◽  
Protective Equipment ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries

Abstract Background Health workers, in short supply in many low-and-middle-income countries, are at increased risk of SARS-CoV-2 infection. This study aimed to assess how South Africa, prepared to protect its health workers from SARS-CoV-2 infection. Methods This was a cross-sectional study design applying participatory action research in four provinces of South Africa. A semi-structured questionnaire and a qualitative observational HealthWISE walkthrough risk assessment was carried out to collect data on occupational safety and health (OSH) systems in 45 hospitals across four provinces to identify factors associated with health worker protection. Adapting the International Labour Organization (ILO) and World Health Organization (WHO) HealthWISE tool, we compiled compliance scores through walkthrough surveys. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures. Results We found that health facilities in all four provinces had SARS-CoV-2 plans for the general population but no comprehensive OHS plan for health workers. Provincial Departments of Health (PDoH) varied in how they were organized to respond: Provinces A and D had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health; Province A had an occupational health doctor and nurse; while Province B had an occupational health nurse; Province A and D PDoHs had functional OSH committees; and Province D had conducted some health risk assessments specific to SARS-CoV-2. However, none of the assessed health facilities had an acceptable HealthWISE compliance score (≥ 75%) due to poor ventilation and inadequate administrative control measures. While the supply of personal protective equipment was adequate, it was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher personal protective equipment and ventilation scores. In addition, our analysis showed that hospitals with higher compliance scores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98). Conclusions Despite some initial preparedness, greater effort to protect health workers is still warranted. Low-and-middle-income countries may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers’ health.

scholarly journals Organizational Factors Associated with Health Worker Protection: A Participatory Mixed-Method Cross-Sectional Analysis in Four Provinces of South Africa

2021 ◽  
Author(s):  
Muzimkhulu Zungu ◽  
Kuku Voyi ◽  
Nosimilo Mlangeni ◽  
Saiendhra Moodley ◽  
Jonathan Ramodike ◽  
...  
Keyword(s):  
South Africa ◽  
Occupational Health ◽  
Health Worker ◽  
Mixed Method ◽  
Health Workers ◽  
Health Facilities ◽  
Infection Rates ◽  
Factors Associated ◽  
Health Nurse ◽  
Occupational Health Nurse

Abstract Background: Health workers, in short supply in many low-and-middle-income countries (LMICs), are at increased risk of SARS-CoV-2 infection during their employment. This study aimed to assess how South Africa, an LMIC, prepared to protect its health workers from SARS-CoV-2. Methods: This was a participatory mixed method study conducted in four provinces of South Africa. We used a semi-structured questionnaire and a walkthrough survey to collect data on occupational safety and health (OSH) systems in 45 hospitals across four provinces to identify factors associated with health worker protection. Adapting the International Labour Organization (ILO) and World Health Organization (WHO) HealthWISE tool, we compiled compliance scores through walkthrough surveys. For the questionnaire, the participants were provincial OSH managers. For the walkthrough survey, they were frontline health workers, facility managers, and OSH and Infection Prevention and Control (IPC) professionals. We used logistic regression to analyze the relationship between readiness indicators and the actual implementation of protective measures. We also evaluated the association between OSH compliance and hospital infection rates.Results: We found that health facilities in all four provinces had SARS-CoV-2 plans for the general population but no comprehensive OHS plan for health workers. Province A and D Provincial Department of Health (PDoH) had an OSH SARS-CoV-2 provincial coordinating team and a dedicated budget for occupational health. Province A had an occupational health doctor and an occupational health nurse, while Province B had an occupational health nurse. Province A and D PDoHs had functional OSH committees, and Province D had conducted some health risk assessments specific to SARS-CoV-2. However, none of the assessed health facilities had an acceptable HealthWISE compliance score (≥ 75%) due to poor ventilation and inadequate administrative control measures. While the supply of personal protective equipment (PPE) was adequate, PPE was often not worn properly. Our study found that having an OSH SARS-CoV-2 policy was significantly associated with higher PPE and ventilation scores. In addition, our analysis showed that hospitals with higher compliance scores had significantly lower infection rates (IRR 0.98; 95% CI: 0.97, 0.98).Conclusions: Despite some initial preparedness, greater effort to protect health workers is still warranted. LMICs may need to pay more attention to OSH systems and consider using tools, such as ILO/WHO HealthWISE tool, to protect health workers' health.

scholarly journals Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jaya Gupta ◽  
Mariya C. Patwa ◽  
Angel Khuu ◽  
Andreea A. Creanga
Keyword(s):  
Systematic Review ◽  
Randomized Trial ◽  
Health Worker ◽  
Work Motivation ◽  
Health Workers ◽  
Trial Group ◽  
Middle Income ◽  
Group Design ◽  
Middle Income Countries ◽  
Worker Motivation

AbstractPoor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial—group design, one used a non-randomized trial—group design, one used a cross-sectional design, and one used a pretest–posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.

scholarly journals A health worker knowledge, attitudes and practices survey of SARS-CoV-2 infection prevention and control in South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saiendhra Vasudevan Moodley ◽  
Muzimkhulu Zungu ◽  
Molebogeng Malotle ◽  
Kuku Voyi ◽  
Nico Claassen ◽  
...  
Keyword(s):  
South Africa ◽  
Health Worker ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Health Workers ◽  
Health Facilities ◽  
World Health ◽  
Infection Prevention And Control ◽  
Successful Implementation ◽  
And Control

Abstract Background Health workers are crucial to the successful implementation of infection prevention and control strategies to limit the transmission of SARS-CoV-2 at healthcare facilities. The aim of our study was to determine SARS-CoV-2 infection prevention and control knowledge and attitudes of frontline health workers in four provinces of South Africa as well as explore some elements of health worker and health facility infection prevention and control practices. Methods A cross-sectional study design was utilised. The study population comprised both clinical and non-clinical staff working in casualty departments, outpatient departments, and entrance points of health facilities. A structured self-administered questionnaire was developed using the World Health Organization guidance as the basis for the knowledge questions. COVID-19 protocols were observed during data collection. Results A total of 286 health workers from 47 health facilities at different levels of care participated in the survey. The mean score on the 10 knowledge items was 6.3 (SD = 1.6). Approximately two-thirds of participants (67.4%) answered six or more questions correctly while less than a quarter of all participants (24.1%) managed to score eight or more. A knowledge score of 8 or more was significantly associated with occupational category (being either a medical doctor or nurse), age (< 40 years) and level of hospital (tertiary level). Only half of participants (50.7%) felt adequately prepared to deal with patients with COVD-19 at the time of the survey. The health workers displaying attitudes that would put themselves or others at risk were in the minority. Only 55.6% of participants had received infection prevention and control training. Some participants indicated they did not have access to medical masks (11.8%) and gloves (9.9%) in their departments. Conclusions The attitudes of participants reflected a willingness to engage in appropriate SARS-CoV-2 infection prevention and control practices as well as a commitment to be involved in COVID-19 patient care. Ensuring adequate infection prevention and control training for all staff and universal access to appropriate PPE were identified as key areas that needed to be addressed. Interim and final reports which identified key shortcomings that needed to be addressed were provided to the relevant provincial departments of health.

scholarly journals Prevalence and maternal socio-demographic factors associated with stillbirth in health facilities in Anambra, South-East Nigeria

1970 ◽  
Vol 19 (4) ◽  
pp. 3055-3062
Author(s):  
Nonye E Anyichie ◽  
Evelyn N Nwagu
Keyword(s):  
Rural Communities ◽  
Demographic Factors ◽  
Health Facilities ◽  
Women Empowerment ◽  
Middle Income ◽  
Anambra State ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Case Files ◽  
Socio Demographic Factors

Background: Stillbirth is a major adverse perinatal outcome especially in low and middle income countries across the globe. Certain factors relating to mothers from such countries may be associated with this adverse condition.Objectives: To determine the prevalence of stillbirth and also explore the maternal socio-demographic factors associated with stillbirth among mothers in rural communities in Anambra Central Senatorial District of Anambra State Nigeria who gave birth between January 2012 and December 2016.Methods: All case files of mothers who were delivered of their babies were accessed at the sampled health facilities in the district. Data were collected using a structured proforma. A total of 313 stillbirth cases were recorded across the health facilities from 2012-2016.Results: The highest prevalence of stillbirth was recorded in 2012 (38.07 per 1,000 total births). The prevalence of stillbirth was significantly associated with the maternal level of education, occupation, age and type of health facility the mother utilized (p<0.05).Conclusions: We recommend that women empowerment should be a priority at both family and community levels to enable women to seek and obtain necessary care during pregnancy and delivery.Keywords: Stillbirth; mothers; prevalence; health facilities.

scholarly journals Prevalence and factors associated with poor mental health among healthcare professionals in low- and lower-middle-income countries: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Julia Lohmann ◽  
Denny John ◽  
Aso Dzay
Keyword(s):  
Mental Health ◽  
Healthcare Professionals ◽  
Health Workers ◽  
Poor Mental Health ◽  
Psychological Wellbeing ◽  
Health Issues ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Mental Health Issues

Abstract Background A healthy and productive health workforce is central to a well-functioning health system. However, health workers are at high risk of poor psychological wellbeing due to their particularly strenuous work demands. While mental health of health workers is a well-researched issue in high-income countries, research from low- and lower-middle-income countries (LLMIC) has begun to emerge only recently. The review aims to synthesize this body of research, specifically to assess the prevalence of mental health issues among health workers in LLMIC, to identify factors associated with good or poor mental health, and to highlight gaps in knowledge. Methods We will perform a systematic search of the published English and French language literature (from inception onwards) in MEDLINE, EMBASE, and PsycINFO. Eligible for inclusion are observational studies (e.g., cross-sectional, case-control, or cohort) and control arms of randomized controlled trials reporting investigations on the nature, prevalence, and factors associated with mental health or psychological wellbeing among formally trained health professionals and health associate professionals delivering health services in formal healthcare facilities in LLMIC. The primary outcomes will be burnout, depression, and general psychological wellbeing. Secondary outcomes include other specific mental health diagnoses, as well as general psychological stress, distress and/or trauma if work-related and explicitly framed as a mental health issue. Two authors will independently examine the studies against the eligibility criteria in the stages of title, abstract, and full-text study selection, as well as assess the risk of bias in included studies using standard checklists depending on study design. Disagreements will be resolved in discussion with the third author. Data will be extracted from included studies using a predefined and piloted coding framework. Given the anticipated heterogeneity of studies, we do not expect to be able to conduct meta-analysis and plan to summarize the extracted data in narrative form. The framework method will be used to organize narrative data by subthemes and explore patterns. Discussion In assessing the prevalence of mental health issues among healthcare professionals in LLMIC and identifying factors associated with positive or poor mental health, the review aims to synthesize all possible available information for policy makers and health system managers on a potentially highly important but not yet much-discussed issue and to highlight gaps in currently available knowledge. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO (registration number CRD42019140036)

scholarly journals Awareness and utilization of personal protective equipment among small-scale welders in Cross River State, Nigeria: a descriptive cross-sectional study

2021 ◽  
Vol 4 (1) ◽  
pp. 1-7
Author(s):  
Ekpereonne Esu ◽  
Utibeabasi Ekanem
Keyword(s):  
Personal Protective Equipment ◽  
Small Scale ◽  
Protective Equipment ◽  
Cross Sectional ◽  
Rapid Urbanization ◽  
Middle Income ◽  
Cross River ◽  
Cross River State ◽  
Middle Income Countries ◽  
Low And Middle Income

Objective: Rapid urbanization and industrialization in the many low- and middle-income countries means that there is a growing demand for the welding industry. Previous studies in Nigeria, and other low- and middle-income countries have reported a significant discrepancy between awareness and consistent and appropriate use of personal protective equipment (PPE). This study assessed the awareness and utilization of PPE among small-scale welders in Calabar South, Cross River State, Nigeria. Methods: This study was conducted in Calabar South Local Government Area using a descriptive cross-sectional design. Data collection was with an interviewer-administered semi-structured questionnaire, and an observation checklist was used to monitor the use of PPE among small-scale welders. Results:  One hundred and sixteen small-scale welders were surveyed with a mean age of 34.9 ±9.1 years. Almost 90% of respondents had completed at least primary education. Eighty-one respondents (69.8%) were aware of PPE. Three-quarters of respondents (61/81) knew PPE protected the user from injury. The most frequently identified type of welding PPE among the respondents aware of PPE, were safety goggles (38.3%), hand gloves (25.9%), safety boots (19.8%), and coveralls (9.9%). 83.6% had access to PPE at work. However, only 14.4% reported using PPE consistently. Observation revealed that the PPE most frequently used, sunglasses, were not the recommended welding goggles. Conclusion:  The low utilization of PPE calls for stricter enforcement of occupational health and safety regulations among welders in the informal sector, including implementing PPE awareness programs.

scholarly journals A Practical Measure of Health Facility Efficiency: an Innovation in the Application of Routine Health Information to Determine Health Worker Productivity in Ethiopia

2021 ◽  
Author(s):  
Md Zabir Hasan ◽  
Girmaye D. Dinsa ◽  
Peter Berman
Keyword(s):  
Health Worker ◽  
Health Facility ◽  
Health Workers ◽  
Principal Component ◽  
Practical Application ◽  
Summary Measure ◽  
Worker Productivity ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract BackgroundA simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low and middle-income countries. This paper presents a proof of concept of using routine information from primary healthcare (PHC) facilities to measure health workers’ productivity and its application in three regions of Ethiopia.MethodsIn four steps, we constructed a productivity measure of the health workforce of Health Centers (HCs) and demonstrated its practical application: (1) developing an analytical dataset using secondary data from health management information systems (HMIS) and human resource information system (HRIS); (2) principal component analysis and factor analysis to estimate a summary measure of output from five indicators (annual service volume of outpatient visits, family planning, first antenatal care visits, facility-based deliveries by skilled birth attendance, and children [<1 year] with three pentavalent vaccines); (3) calculating a productivity score by combining the summary measure and the total number of health workers (input); and (4) implementing regression models to identify the determinant of productivity and ranking HCs based on their adjusted productivity score. ResultsWe developed an analytical dataset of 1,128 HCs; however, significant missing values and outliers were reported in the data. The principal component and factor scores developed from the five output measures were highly consistent (correlation coefficient = 0.98). We considered the factor score as the summary measure of outputs for estimating productivity. A very weak association was observed between the summary measure of output and the total number of staff. The result also highlighted a large variability in productivity across similar health facilities in Ethiopia, represented by the significant dispersion in summary measure of output occurring at similar levels of the health workers. ConclusionsWe successfully demonstrated the analytical steps to estimate health worker productivity and its practical application using HMIS and HRIS. The methodology presented in this study can be readily applied in low and middle-income countries using widely available data – such as DHIS2 – that will allow further explorations to understand the causes of technical inefficiencies in the health system.

scholarly journals Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison

2019 ◽  
Vol 16 (8) ◽  
pp. 1341 ◽  
Author(s):  
Septi Kurnia Lestari ◽  
Nawi Ng ◽  
Paul Kowal ◽  
Ailiana Santosa
Keyword(s):  
South Africa ◽  
Older People ◽  
Health Behaviours ◽  
World Health ◽  
Adult Health ◽  
Cross Sectional ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Adl Disability

The low- and middle-income countries (LMICs) are experiencing rapid population ageing, yet knowledge about disability among older populations in these countries is scarce. This study aims to identify the prevalence and factors associated with disability among people aged 50 years and over in six LMICs. Cross-sectional data from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007–2010) in China, Ghana, India, Mexico, the Russian Federation, and South Africa was used. Multivariable logistic regression analyses were undertaken to examine the association between sociodemographic factors, health behaviours, chronic conditions, and activities of daily living (ADL) disability. The prevalence of disability among older adults ranged from 16.2% in China to 55.7% in India. Older age, multimorbidity, and depression were the most common factors related to disability in all six countries. Gender was significant in China (OR = 1.14, 95% CI: 1.01–1.29), Ghana (OR = 1.22, 95% CI: 1.01–1.48) and India (OR = 1.65, 95% CI: 1.37–1.99). Having no access to social capital was significantly associated with ADL disability in China (OR = 2.57, 95% CI: 1.54–4.31) and South Africa (OR = 4.11, 95% CI: 1.79–9.43). Prevalence data is valuable in these six ageing countries, with important evidence on mitigating factors for each. Identifying determinants associated with ADL disability among older people in LMICs can inform how to best implement health prevention programmes considering different country-specific factors.

scholarly journals A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries

2020 ◽  
Vol 7 ◽  
Author(s):  
Belinda O'Sullivan ◽  
Bruce Chater ◽  
Amie Bingham ◽  
John Wynn-Jones ◽  
Ian Couper ◽  
...  
Keyword(s):  
Health Worker ◽  
Health Workers ◽  
Scale Up ◽  
Field Testing ◽  
Workforce Training ◽  
Practical Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Rural Workforce ◽  
Low And Middle Income

Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem.Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period.Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type.Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of “grow your own” strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.

scholarly journals Safe Healthcare Facilities: A Systematic Review on the Costs of Establishing and Maintaining Environmental Health in Facilities in Low- and Middle-Income Countries

2021 ◽  
Vol 18 (2) ◽  
pp. 817
Author(s):  
Darcy M. Anderson ◽  
Ryan Cronk ◽  
Donald Fejfar ◽  
Emily Pak ◽  
Michelle Cawley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Waste Management ◽  
Vector Control ◽  
Environmental Health ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Middle Income ◽  
Healthcare Facilities ◽  
Middle Income Countries ◽  
Low And Middle Income

A hygienic environment is essential to provide quality patient care and prevent healthcare-acquired infections. Understanding costs is important to budget for service delivery, but costs evidence for environmental health services (EHS) in healthcare facilities (HCFs) is lacking. We present the first systematic review to evaluate the costs of establishing, operating, and maintaining EHS in HCFs in low- and middle-income countries (LMICs). We systematically searched for studies costing water, sanitation, hygiene, cleaning, waste management, personal protective equipment, vector control, laundry, and lighting in LMICs. Our search yielded 36 studies that reported costs for 51 EHS. There were 3 studies that reported costs for water, 3 for sanitation, 4 for hygiene, 13 for waste management, 16 for cleaning, 2 for personal protective equipment, 10 for laundry, and none for lighting or vector control. Quality of evidence was low. Reported costs were rarely representative of the total costs of EHS provision. Unit costs were infrequently reported. This review identifies opportunities to improve costing research through efforts to categorize and disaggregate EHS costs, greater dissemination of existing unpublished data, improvements to indicators to monitor EHS demand and quality necessary to contextualize costs, and development of frameworks to define EHS needs and essential inputs to guide future costing.

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