scholarly journals The Impact of Covid-19 on Malaria Services in Three High Endemic Districts in Rwanda – A Mixed-Method Study

2021 ◽  
Author(s):  
Dieudonne Hakizimana ◽  
Christian NTIZIMIRA ◽  
Aimable Mbituyumuremyi ◽  
Emmanuel Hakizimana ◽  
Hani Mahmoud ◽  
...  
Keyword(s):  
Severe Malaria ◽  
Health Care Providers ◽  
Uncomplicated Malaria ◽  
Health Workers ◽  
Comparative Method ◽  
Health Facilities ◽  
Mitigation Measures ◽  
Care Providers ◽  
Community Members ◽  
The Impact

Abstract Background: Rwanda has achieved impressive reductions in malaria morbidity and mortality over the past two decades. However, the disruption of essential services due to the current Covid-19 pandemic can lead to a reversal of these gains in malaria control unless targeted, evidence-based interventions are implemented to mitigate the impact of the pandemic. The extent to which malaria services have been disrupted has not been fully characterized. In this study, we thus assessed the impact of Covid-19 on malaria services in Rwanda. Methods: We conducted a mixed-methods study in three purposively selected districts in Rwanda. The quantitative data included malaria aggregated data reported at the health facility level and the community level. The data included the number of malaria tests, uncomplicated malaria cases, severe malaria cases, and malaria deaths. We collected qualitative data using focus group discussions with community members and community health workers, as well as in-depth interviews with health care providers and staff working in the malaria program. We conducted interrupted time series analysis to compare changes in malaria presentations between the pre-Covid-19 period (January 2019 to February 2020) and Covid-19 periods (from March 2020 to November 2020). We used the constant comparative method in qualitative thematic analysis. Results: Compared to pre-Covid-19 period, there was a monthly reduction in patients tested in health facilities of 5.09 per 1000 population and a monthly increase in patients tested in the community of 3.13 per 1000 population during the Covid-19 period. There was no change in presentation rate for uncomplicated malaria or severe malaria. Additionally, although healthcare providers continued to provide malaria services, they were fearful that this would expose them and their families to Covid-19. Covid-19 mitigation measures limited the availability of transportation options for the community to seek care in health facilities and delayed the implementation of some key malaria interventions. The focus on Covid-19-related communication also reduced the amount of health information for other diseases provided to community members. Conclusion The Covid-19 pandemic resulted in patients increasingly seeking care in the community and poses challenges to maintaining delivery of malaria services in Rwanda. Interventions to mitigate these challenges should focus on strengthening programming for community and home-based care models and integrating malaria messages into Covid-19-related communication. Additionally, implementation of the interrupted interventions should be timed and overlap with the malaria transmission season to mitigate Covid-19 consequences on malaria.

scholarly journals Impact of Breast Cancer Early Detection Training on Rwandan Health Workers’ Knowledge and Skills

2018 ◽  
pp. 1-10 ◽  
Author(s):  
Lydia E. Pace ◽  
Jean-Marie Vianney Dusengimana ◽  
Nancy L. Keating ◽  
Vedaste Hategekimana ◽  
Vestine Rugema ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Center ◽  
Health Care Providers ◽  
Health Workers ◽  
Critical Role ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Knowledge And Skills ◽  
Written Test ◽  
The Impact

Purpose In April 2015, we initiated a training program to facilitate earlier diagnosis of breast cancer among women with breast symptoms in rural Rwanda. The goal of this study was to assess the impact of the training intervention in breast cancer detection on knowledge and skills among health center nurses and community health workers (CHWs). Methods We assessed nurses’ and CHWs’ knowledge about breast cancer risk factors, signs and symptoms, and treatability through a written test administered immediately before, immediately after, and 3 months after trainings. We assessed nurses’ skills in clinical breast examination immediately before and after trainings and then during ongoing mentorship by a nurse midwife. We also examined the appropriateness of referrals made to the hospital by health center nurses. Results Nurses’ and CHWs’ written test scores improved substantially after the trainings (overall percentage correct increased from 73.9% to 91.3% among nurses and from 75.0% to 93.8% among CHWs ( P < .001 for both), and this improvement was sustained 3 months after the trainings. On checklists that assessed skills, nurses’ median percentage of actions performed correctly was 24% before the training. Nurses’ skills improved significantly after the training and were maintained during the mentorship period (the median score was 88% after training and during mentorship; P < .001). In total, 96.1% of patients seen for breast concerns at the project’s hospital-based clinic were deemed to have been appropriately referred. Conclusion Nurses and CHWs demonstrated substantially improved knowledge about breast cancer and skills in evaluating and managing breast concerns after brief trainings. With adequate training, mentorship, and established care delivery and referral systems, primary health care providers in sub-Saharan Africa can play a critical role in earlier detection of breast cancer.

scholarly journals Who are CHWs? An ethnographic study of the multiple identities of community health workers in three rural Districts in Tanzania

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mohamed Yunus Rafiq ◽  
Hannah Wheatley ◽  
Hildegalda P. Mushi ◽  
Colin Baynes
Keyword(s):  
Health Care ◽  
Family Planning ◽  
Health Services ◽  
Health Care Providers ◽  
Rural Areas ◽  
Health Workers ◽  
Multiple Roles ◽  
Care Providers ◽  
Professional Identities ◽  
Community Members

Abstract Background Numerous studies have examined the role of community health workers (CHWs) in improving the delivery of health services and accelerating progress towards national and international development goals. A limited but growing body of studies have also explored the interactions between CHWs’ personal, communal and professional identities and the implications of these for their profession. CHWs possess multiple, overlapping roles and identities, which makes them effective primary health care providers when properly supported with adequate resources, but it also limits their ability to implement interventions that only target certain members of their community, follow standard business working days and hours. In some situations, it even prevents them from performing certain duties when it comes to sensitive topics such as family planning. Methods To understand the multiple identities of CHWs, a mixture of qualitative and ethnographic methods was utilized, such as participant observation, open-ended and semi-structured interviews, and focus group discussions with CHWs, their supervisors, and their clients. The observation period began in October 2013 and ended in June 2014. This study was based on implementation research conducted by the Connect Project in Rufiji, Ulanga and Kilombero Districts in Tanzania and aimed to understand the role of CHWs in the provision of maternal and child health services in rural areas. Results To our knowledge, this was the first study that employed an ethnographic approach to examine the relationship between personal, communal and professional identities, and its implications for CHWs’ work in Tanzania. Our findings suggest that it is difficult to distinguish between personal and professional identities among CHWs in rural areas. Important aspects of CHW services such as personalization, access, and equity of health services were influenced by CHWs’ position as local agents. However, the study also found that their personal identity sometimes inhibited CHWs in speaking about issues related to family planning and sexual health. Being local, CHWs were viewed according to the social norms of the area that consider the gender and age of each worker, which tended to constrain their work in family planning and other areas. Furthermore, the communities welcomed and valued CHWs when they had curative medicines; however, when medical stocks were delayed, the community viewed the CHWs with suspicion and disinterest. Community members who received curative services from CHWs also tended to become more receptive to their preventative health care work. Conclusion Although CHWs’ multiple roles constrained certain aspects of their work in line with prevalent social norms, overall, the multiple roles they fulfilled had a positive effect by keeping CHWs embedded in their community and earned them trust from community members, which enhanced their ability to provide personalized, equitable and relevant services. However, CHWs needed a support system that included functional supply chains, supervision, and community support to help them retain their role as health care providers and enabled them to provide curative, preventative, and referral services.

scholarly journals Feasibility testing of a community dialogue approach for promoting the uptake of family planning and contraceptive services in Zambia

2020 ◽  
Author(s):  
Margarate Nzala Munakampe ◽  
Theresa Nkole ◽  
Adam Silumbwe ◽  
Joseph Mumba Zulu ◽  
Joanna Paula Cordero ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Care Providers ◽  
Health Workers ◽  
Quality Care ◽  
Healthcare Providers ◽  
Care Providers ◽  
Community Members ◽  
Community Dialogue ◽  
Awareness Programs ◽  
Feasibility Testing

Abstract Background: Community dialogues have been used in participatory approaches in various health prevention and awareness programs, including family planning interventions to increase understanding and alignment of particular issues from different peoples’ perspectives. The main aim of this paper is to document the feasibility testing of a community dialogue approach, which aimed to promote dialogue between healthcare providers and community members. The feasibility testing was part of formative-phase research needed to design an intervention, with the ultimate goal of increasing the uptake of family planning and contraception. The community dialogue intervention generated discussions on key approaches to improve family planning and contraception provision and uptake.Methods: Key stages of the community dialogue were undertaken, with representation from healthcare providers and community members. Participants included frontline and managerial health care providers, community health workers, family planning and contraception users, the youth, other stakeholders from the education sector, and civil society. How the dialogue was implemented (operational feasibility) as well as the cultural feasibility of the community dialogue content was evaluated through participant observations during the dialogue, using a standardised feasibility testing tick-list, and through focus group discussions with the stakeholders who participated in the community dialogue.Results: Overall, 21 of the 30 invited participants attended the meeting- 70 per cent attendance. The approach facilitated discussions on how quality care could be achieved in family planning and contraception provision, guided by the ground rules that were agreed upon by the different stakeholders. A need for more time for the discussion was noted. Also, more balanced representation from the adolescents, other stakeholders in family planning such as the community members was noted, especially in comparison to the healthcare providers. Some participants were not comfortable with the language used. And the young people felt older participants used complicated terminologies.Conclusion: Generally, the community dialogue was well received by the community members and the healthcare providers, as was observed from the sentiments expressed by both categories. Some key considerations for refining the approach included soliciting maximum participation from otherwise marginalized groups like the youth would provide stronger representation.

Health Promotion and Risk Reduction in Congregations

2017 ◽  
Author(s):  
Dennis Myers ◽  
Terry A. Wolfer ◽  
Maria L. Hogan
Keyword(s):  
Health Care ◽  
Health Promotion ◽  
Risk Reduction ◽  
Health Care Providers ◽  
Well Being ◽  
Marital Stability ◽  
Care Providers ◽  
Community Members ◽  
Health Related ◽  
The Impact

A complex web of attitudinal, cultural, economic, and structural variables condition the decision to respond to communications promoting healthy behavior and participation in risk reduction initiatives. A wide array of governmental, corporate, and voluntary sector health-related organizations focus on effective messaging and health care options, increasing the likelihood of choices that generate and sustain wellness. Researchers also recognize the significant and multifaceted ways that religious congregations contribute to awareness and adoption of health-promoting behaviors. These religiously based organizations are credible disseminators of health education information and accessible providers of venues that facilitate wellness among congregants and community members. The religious beliefs, spirituality, and faith practices at the core of congregational cultural life explain the trustworthiness of their messaging, the health of their adherents, and the intention of their care provision. Considerable inquiry into the impact of religion and spirituality on health reveals substantive correlations with positive psychological factors known to sustain physical and psychological health—optimism, meaning and purpose, hope, well-being, self-esteem, gratefulness, social support, and marital stability. However, the beliefs and practices that create receptivity to health-related communications, care practices, and service provision can also be a deterrent to message impact and participation in healthy behaviors. When a productive relationship between spirituality and health exists, congregational membership offers rituals (e.g., worship, education, mission) and relationships that promote spiritual well-being. Research demonstrates increased life satisfaction and meaning in life, with health risk reduction associated with a sense of belonging, enriched social interactions, and shared experiences. Congregations communicate their commitment to wellness of congregants and community members alike through offering a variety of congregationally based and collaborative wellness and risk reduction programs. These expressions of investment in individual and community health range across all age, gender, and ethnic demographics and address most of the prominent diagnostic categories. These programs are ordered along three dimensions: primary prevention (health care messaging and education), secondary prevention (risk education), and tertiary prevention (treatment). Applying the dimensions of sponsorship, goal/mission, focus, services, staffing, and intended outcome highlights the similarities and differences among them. Several unique facets of congregational life energize the effectiveness of these programs. Inherent trust and credibility empower adherence, and participation decisions and financial investment provide service availability. These assets serve as attractive contributions in collaborations among congregations and between private and public health care providers. Current research has not yet documented the best practices associated with program viability. However, practice wisdom in the planning, implementation, and evaluation of congregationally based and collaborative health-related programs suggests guidelines for future investigation. Congregational leaders and health care professionals emphasize well-designed needs assessment. Effective congregational health promotion and risk reduction may be linked to the availability and expertise of professionals and volunteers enacting the roles of planner/program developer, facilitator, convener/mediator, care manager/advocate, health educator, and direct health care service provider.

scholarly journals Care Pathways in Persistent Orofacial Pain

2016 ◽  
Vol 2 (1) ◽  
pp. 48-57 ◽  
Author(s):  
M. Breckons ◽  
S.M. Bissett ◽  
C. Exley ◽  
V. Araujo-Soares ◽  
J. Durham
Keyword(s):  
Health Care Providers ◽  
Orofacial Pain ◽  
Care Pathway ◽  
Comparative Method ◽  
Qualitative Interviews ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Centered Care ◽  
The Impact

Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the “fluidity of the care pathway,” in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a “failure to progress,” where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the “effects of unmanaged pain,” where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.

scholarly journals Principles of Midwifery Care during Virulent Outbreaks

2021 ◽  
Author(s):  
Erhuvwukorotu S. Kollie
Keyword(s):  
Health Care Providers ◽  
Postnatal Care ◽  
Health Workers ◽  
Disease Outbreaks ◽  
Care Providers ◽  
Recent Past ◽  
Midwifery Care ◽  
The World ◽  
The Impact ◽  
Different Parts

In recent past virulent disease outbreaks have ravaged different parts of the world. The impact have been felt worldwide. During these outbreaks health workers are usually at high risk for contracting the infections. Rendering maternal antenatal, intrapartum, and postnatal care can be challenging during these outbreaks. Some of these disease that have debuted fearsome outbreaks in the recent past are described briefly in terms of their characteristics, pathology, and treatments. The struggles involved in containing one of the outbreaks are highlighted. The dilemma that ensued as a result of seeking for balance between obligation, heroic midwifery interventions, and sense of calling have been explored. Special emphasis is accorded to highlighting the experiences of midwives during the recent 2014–2015 Ebola outbreak in West Africa. Recommended principles to guide midwifery practices suitable for sustaining the safety of families needing midwifery care and health care providers rendering midwifery care are described.

scholarly journals Knowledge and Awareness of MTCT and PMTCT Post-Natal Follow-up Services Among HIV Infected Mothers in the Mankweng Region, South Africa

2017 ◽  
Vol 11 (1) ◽  
pp. 36-44
Author(s):  
Refilwe Ramoshaba ◽  
Sello Levy Sithole
Keyword(s):  
Health Care Providers ◽  
Health Workers ◽  
Health Facilities ◽  
Care Providers ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Continuous Training ◽  
Cross Sectional ◽  
Mother To Child

Background:The pandemic of Human Immunodeficiency Virus (HIV) is the most severe health challenge affecting children across the world. It is estimated that more than 90% of all HIV infections in children result from Mother-to-Child Transmission (MTCT). Poor knowledge and awareness of MTCT and Prevention of Mother-to-Child Transmission (PMTCT) among HIV positive mothers and their babies is a major setback to the success of the PMTCT programmes.Methods:A qualitative approach and a cross-sectional design were applied in this study. The sample size of the study was 26 participants. Purposive sampling was used to select HIV infected mothers enrolled for PMTCT follow-up services and health care providers responsible for the implementation of the PMTCT programmes. In-depth interviews were conducted with fifteen HIV infected mothers at two health facilities. Two Focus Group Discussions (FGDs) were conducted with eleven health workers at the two health facilities. Focus groups comprised of six participants from Mankweng Clinic and five participants from Mankweng Gateway Clinic.Results:The findings from the study reveal that the majority of the respondents were aware of MTCT, but lacked knowledge and understanding about how a mother can transmit HIV to her child during pregnancy, labour and breastfeeding. The majority of the participants did not understand the risk of MTCT after birth and failed to mention breastfeeding as a mode of transmission. However, most of the participants were aware that MTCT can be prevented. The respondents were aware of the importance of treatment adherence as a prevention measure to avoid MTCT.Conclusion:Based on these findings, a number of recommendations were made. The first is that educational and awareness programmes need to be developed or strengthened on health risks. Mass campaign media should provide information on the importance of PMTCT activities through the use of community radio stations, Television, newsletters, bill boards etc. People need to know more about PMTCT activities, health personnel need continuous training to provide clear information on PMTCT activities.

scholarly journals Physical disabilities in pregnant women: impact on care and pregnancy outcome

2017 ◽  
Vol 6 (4) ◽  
pp. 1306
Author(s):  
Swati Chitnis ◽  
Padmaja Samant
Keyword(s):  
Pregnant Women ◽  
Health Care Providers ◽  
Health Workers ◽  
Tertiary Care Hospital ◽  
Physical Disabilities ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Providers ◽  
Tract Infections ◽  
The Impact

Background: Health care providers are often insensitive to and unfamiliar with the needs of pregnant women with disability. Medical services are many times not tailored to the needs of the disabled. This study analyzes the impact of disabilities on pregnancy in women delivering in a tertiary care hospital in India.Methods: Prospective study of total of 50 pregnant women with various disabilities was conducted in a tertiary care hospital in Mumbai, India. Each patient’s antepartum, intrapartum and postpartum course were noted. Patients were also interviewed with help of a structured questionnaire for difficulties accessing services, and impact on their daily life, pain.Results: Rate of cesarean deliveries due to pelvic problems, and complications like urinary tract infections which arise due to mobility issues were significantly higher in patients with physical disabilities. 30% participants found examination tables unsuitable and 20% found it difficult access toilets.  Over all patients were satisfied with skills of health workers.Conclusions: Healthcare facilities have to be equipped for receiving patients with disabilities and should train health workers in management of these clients. They require pre-conceptional counseling and planning.

scholarly journals Malaria Case-Management in Urban Area: Various Challenges in Public and Private Health Facilities in Benin, West Africa

2018 ◽  
Vol 11 (1) ◽  
pp. 54-61
Author(s):  
Badirou Aguemon ◽  
Barikissou Georgia Damien ◽  
Antoine Vickey Hinson ◽  
Géraud Padonou ◽  
Abévi Fleury Bruno Agbessinou ◽  
...  
Keyword(s):  
Public Health ◽  
Case Management ◽  
Health Care Providers ◽  
Malaria Case ◽  
Uncomplicated Malaria ◽  
Health Facilities ◽  
Malaria Case Management ◽  
Care Providers ◽  
Public And Private ◽  
The Public

Background:In Benin, malaria remains endemic and perennial throughout the year in most areas. During the last decade, a substantial increase was noticed in the procurement of Artemisinin-based combination therapies and malaria RDT. This study aimed to evaluate the quality of uncomplicated malaria cases-management in public and private health facilities.Methods:A cross-sectional survey was carried out in public and private health facilities in the municipality of Abomey-Calavi in southern Benin from August to September 2016. The study focused on two targets: (i) patients with uncomplicated malaria who sought care in a health facility in Abomey-Calavi during the study period; and (ii) the health care providers in public and private health facilities authorized by the Ministry of Health.Results:In 27 health facilities investigated, 15 in the public sector and 12 in the private sector, a total of 313 patients and 93 health care providers were included. Forty-four percent (44%) had no education. Among the patients, 60% were identified in the public health facilities. About 87% of uncomplicated malaria patients were tested in public facilities while 63% were tested in private facilities. In the same way, 54% of patients were treated in accordance with National Malaria Control Program (NMCP) guidelines.Conclusions:The present study showed a poor performance in uncomplicated malaria case-management in private health facilities compared to public health facilities. Strategy to improve access and utilization of malaria case-management supplies needs to be reviewed in both public and private health facilities.

Sign in / Sign up

Export Citation Format

Share Document