scholarly journals A Qualitative Study exploring health workers and patient caregivers’ hand hygiene practices in a neonatal unit in Blantyre, Malawi, implications for controlling outbreaks of drug resistant infections

2021 ◽  
Author(s):  
Eleanor MacPherson ◽  
Helen Mangochi ◽  
Rachel Tolhurst ◽  
Victoria Simpson ◽  
Kondwani Kawaza ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Neonatal Sepsis ◽  
Health Workers ◽  
Participant Observation ◽  
Neonatal Unit ◽  
Infection Prevention And Control ◽  
Drug Resistant ◽  
Structured Interviews ◽  
African Countries ◽  
Sub Saharan

Introduction: Neonatal sepsis is responsible for a considerable burden of morbidity and mortality in sub-Saharan African countries. Outcomes from neonatal sepsis are worsening due to increasing rates of antimicrobial resistance. Sub-optimal Infection Prevention and Control (IPC) practices of health care workers and caregivers are important drivers of infection transmission.Aim: The Chatinkha Neonatal Unit at Queen Elizabeth Central Hospital, Blantyre, Malawi has experienced multiple outbreaks of neonatal sepsis, associated with drug resistant Klebsiella pneumoniae. We aimed to understand the barriers to implementation of optimal IPC focusing on hand hygiene practice.Materials and Methods: We used a qualitative research methodology to meet the study aim. Combining participant observation (PO) over a seven-month period with semi structured interviews (SSI) to provide an in-depth understanding of activities relating to hygiene and IPC existing on the ward. Results: While most staff and some caregivers, had a good understanding of ideal IPC and understood the importance of good handwashing practices, they faced substantial structural limitations, and scarce resources (both material and human) which made implementation challenging. For staff, the overwhelming numbers of patients meant the workload was often unmanageable and practicing optimal IPC was typically impossible. Caregivers lacked access to basic amenities, including linen and chairs, meaning that it was almost impossible for them to maintain good hand hygiene. Limited access to soap and the erratic water supply for both caregivers and healthcare workers further worsened the situation. Communication challenges between different cadres of staff and with patient caregivers meant that those handling neonates and cleaning the wards were often unaware of outbreaks of drug resistant infection. Conclusion: For IPC to be improved, interventions need to address the chronic shortages of material resources and create an enabling environment for HCWs and patient caregivers.

scholarly journals Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review

2020 ◽  
Vol 5 (7) ◽  
pp. e002280 ◽  
Author(s):  
Charity Oga-Omenka ◽  
Azhee Tseja-Akinrin ◽  
Paulami Sen ◽  
Muriel Mac-Seing ◽  
Aderonke Agbaje ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health System ◽  
Barriers And Facilitators ◽  
Diagnosis And Treatment ◽  
Drug Resistant ◽  
African Countries ◽  
Drug Resistant Tuberculosis ◽  
Patient Level ◽  
Resistant Tuberculosis ◽  
Sub Saharan

BackgroundDrug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care.MethodsUsing an integrative design, we reviewed and narratively synthesised qualitative, quantitative and mixed-methods studies from nine electronic databases: Medline, Global Health, CINAHL, EMBASE, Scopus, Web of Science, International Journal of Tuberculosis and Lung Disease, PubMed and Google Scholar (January 2006 to June 2019).ResultsOf 3181 original studies identified, 55 full texts were screened, and 29 retained. The studies included were from 6 countries, mostly South Africa. Barriers and facilitators to DR-TB care were identified at the health system and patient levels. Predominant health system barriers were laboratory operational issues, provider knowledge and attitudes and information management. Facilitators included GeneXpert MTB/RIF (Xpert) diagnosis and decentralisation of services. At the patient level, predominant barriers were patients being lost to follow-up or dying due to lengthy diagnostic and treatment delays, negative public sector care perceptions, family, work or school commitments and using private sector care. Some patient-level facilitators were HIV positivity and having more symptoms.ConclusionCase detection and treatment for DR -TB in SSA currently relies on individual patients presenting voluntarily to the hospital for care. Specific interventions targeting identified barriers may improve rates and timeliness of detection and treatment.

scholarly journals The state of strategic plans for the health workforce in Africa

2019 ◽  
Vol 4 (Suppl 9) ◽  
pp. e001115 ◽  
Author(s):  
Doris Osei Afriyie ◽  
Jennifer Nyoni ◽  
Adam Ahmat
Keyword(s):  
Health Workforce ◽  
Health Workers ◽  
Human Resources For Health ◽  
Health Coverage ◽  
African Region ◽  
African Countries ◽  
Regional Office ◽  
Road Map ◽  
Strategic Plans ◽  
Sub Saharan

Many African countries have a shortage of health workers. As a response, in 2012, the Ministers of Health in the WHO African Region endorsed a Regional Road Map for Scaling Up the Health Workforce from 2012 to 2025. One of the key milestones of the roadmap was the development of national strategic plans by 2014. It is important to assess the extent to which the strategic plans that countries developed conformed with the WHO Roadmap. We examine the strategic plans for human resource for health (HRH) of sub-Saharan African countries in 2015 and assess the extent to which they take into consideration the WHO African Region’s Roadmap for HRH. A questionnaire seeking data on human resources for health policies and plans was sent to 47 Member States and the responses from 43 countries that returned the questionnaires were analysed. Only 72% had a national plan of action for attaining the HRH target. This did not meet the 2015 target for the WHO, Regional Office for Africa’s Roadmap. The plans that were available addressed the six areas of the roadmap. Despite all their efforts, countries will need further support to comprehensively implement the six strategic areas to maintain the health workers required for universal health coverage

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

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

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

scholarly journals Parents as carers on a neonatal unit: qualitative study of parental and staff perceptions in a low-income setting

2019 ◽  
Author(s):  
Sokhna Ndiaye ◽  
Johanna Bosowski ◽  
Lisine Tuyisenge ◽  
Loveday Penn-Kekana ◽  
Sarah Moxon ◽  
...  
Keyword(s):  
Low Income ◽  
Health Workers ◽  
Psychosocial Support ◽  
Neonatal Unit ◽  
Structured Interviews ◽  
Allied Health Professionals ◽  
Low Income Country ◽  
Parental Concerns ◽  
Psychosocial Concerns ◽  
Role Of Parents

Abstract Background. To determine parents’ experiences on a neonatal unit in a low-income country, how they and staff perceive the role of parents and if parent’s role as primary carers could be extended. Methods. Qualitative analysis using semi-structured interviews with 12 parents and 16 staff. Results. Parental themes were around their general impression, stress and discharge. They were satisfied with their baby’s care but feared their baby may die. Mothers were stressed from need to remain in the hospital throughout baby’s stay, to provide feeds day and night, comfort and clean their baby, and provide constant kangaroo mother care before discharge. They experienced loneliness from lack of visitors, difficulty finding food and somewhere to sleep, financial worries and concern about family and home. Mothers were desperate to be discharged. Staff were preoccupied with shortage of nurses limiting care provision and restricting their ability to educate parents as inpatients and after discharge and to provide follow-up, and their constant presence. Neither thought parent’s role could be extended. Conclusion. Staff and parent perceptions on improving parent’s experience differed. Staff thought that the solution was increasing nurse numbers to improve care and educate parents, but is unlikely in near future. Parents were severely stressed by psychosocial concerns and practical issues around hospitalization. Our identification of parental concerns suggests greatest potential for improving their stay on the neonatal unit may be from psychosocial support, potentially from experienced mothers, mothers’ groups, allied health professionals and community health workers and from improved facilities, particularly providing food and accommodation.

scholarly journals Roles of Infection Prevention and Control Nurses (IPCNs) in Preparing for Emerging Infectious Diseases

2018 ◽  
Vol 1 (1) ◽  
pp. 46
Author(s):  
Erna Tsalatsatul Fitriyah ◽  
Meidiana Dwidiyanti ◽  
Luky Dwiantoro
Keyword(s):  
Infectious Diseases ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Health Workers ◽  
Emerging Infectious Diseases ◽  
Monitoring And Evaluation ◽  
Hospital Environment ◽  
Infection Prevention And Control ◽  
Structured Interviews ◽  
And Control

Background: Infectious diseases have become one of the world’s serious problems including in Indonesia. Infectious diseases can originate from the community and hospital environment. Health workers performing inappropriate medical procedures could also be a cause of transmission of infectious diseases. Infection prevention and control nurses (IPCNs) as the pioneers of prevention and infection control in hospitals have not optimally played their roles.   Purpose: This study aimed to explore the roles of IPCNs and their constraints in preparing for emerging infectious diseases. Methods: The present study employed a qualitative design with the hermeneutic phenomenological approach. The samples were seven IPCNs for the primary participants, and two Infection Prevention and Control Officers (IPCOs) and 13 Infection Prevention and Control Link Nurses (IPCLNs) as the triangulation participants. The data were collected using in-depth semi-structured interviews analyzed using a content analysis technique.   Results: The results identified two themes: (1) IPCNs played roles as clinical practitioners, activity coordinators, administrators, and educators, and (2) the roles of IPCNs had not been optimal due to the lack of support from the hospital management, insufficient infrastructure, weak monitoring and evaluation, and the unavailability of appropriate rewards and  punishment.Conclusion: The majority of participants in this study agreed that IPCNs had tried well to play their roles. However, various obstacles were encountered, which hindered the IPCNs in performing their roles.

scholarly journals Community-orientated primary care: a scoping review of different models, and their effectiveness and feasibility in sub-Saharan Africa

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001489 ◽  
Author(s):  
Bob Mash ◽  
Sunanda Ray ◽  
Akye Essuman ◽  
Edu Burgueño
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Scoping Review ◽  
Health Workers ◽  
Historical Analysis ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Scoping Reviews ◽  
Study Characteristics ◽  
Sub Saharan

IntroductionCommunity-orientated primary care (COPC) is an approach to primary healthcare (PHC) that originated in South Africa and contributed to the formulation of the Declaration of Alma-Ata 40 years ago. Despite this, PHC remains poorly developed in sub-Saharan African countries. There has been a resurgence of interest in strengthening PHC systems in the last few years and identifying key knowledge gaps. COPC has been an effective strategy elsewhere, most notably Brazil. This scoping review investigated COPC in the sub-Saharan African context and looked for evidence of different models, effectiveness and feasibility.MethodsDatabases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Studies were grouped into five categories: historical analysis, models, implementation, educational studies and effectiveness.ResultsA total of 1997 publications were identified and 39 included in the review. Most publications were from the last 5 years (n = 32), research (n = 27), from South Africa (n = 27), focused on implementation (n = 25) and involving case studies (n = 9), programme evaluation (n = 6) or qualitative methods (n = 10). Nine principles of COPC were identified from different models. Factors related to the implementation of COPC were identified in terms of governance, finances, community health workers, primary care facilities, community participation, health information and training. There was very little evidence of effectiveness of COPC.ConclusionsThere is a need for further research to describe models of COPC in Africa, investigate the appropriate skills mix to integrate public health and primary care in these models, evaluate the effectiveness of COPC and whether it is included in training of healthcare workers and government policy.

scholarly journals Perception of Malaria Chemoprevention Interventions in Infants and Children in Eight Sub-Saharan African Countries: An End User Perspective Study

2021 ◽  
Vol 6 (2) ◽  
pp. 75
Author(s):  
Céline Audibert ◽  
André-Marie Tchouatieu
Keyword(s):  
Health Workers ◽  
Qualitative Interviews ◽  
Intermittent Preventive Treatment ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
End User ◽  
African Countries ◽  
Preventive Chemotherapy ◽  
High Staff Turnover ◽  
Sub Saharan

Preventive chemotherapy interventions have been identified as key tools for malaria prevention and control. Although a large number of publications have reported on the efficacy and safety profile of these interventions, little literature exists on end-user experience. The objective of this study was to provide insights on the perceptions and attitudes towards seasonal malaria chemoprevention (SMC) and intermittent preventive treatment of infants (IPTi) to identify drivers of and barriers to acceptance. A total of 179 in-depth qualitative interviews were conducted with community health workers (CHWs), health center managers, parents of children receiving chemoprevention, and national decision makers across eight countries in sub-Saharan Africa. The transcribed verbatim responses were coded and analyzed using a thematic approach. Findings indicate that, although SMC is largely accepted by end users, coverage remained below 100%. The main causes mentioned were children’s absenteeism, children being sick, parents’ reluctance, and lack of staff. Regarding IPTi, results from participants based in Sierra Leone showed that the intervention was generally accepted and perceived as efficacious. The main challenges were access to water, crushing the tablets, and high staff turnover. SMC and IPTi are perceived as valuable interventions. Our study identified the key elements that need to be considered to facilitate the expansion of these two interventions to different geographies or age groups.

scholarly journals Profiles of microorganisms isolated from neonates’ blood cultures, incubators, cradles, ventilators, washbasins, and health-workers of Libreville University Hospital Neonatal Service: focus on infection prevention and control measures

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Eliane Kuissi Kamgaing ◽  
Jean-Charles Ndong ◽  
Léonard Kouegnigan Rerambiah ◽  
Joel Fleury Djoba Siawaya
Keyword(s):  
Klebsiella Pneumoniae ◽  
Nosocomial Infection ◽  
Health Workers ◽  
Medical Personnel ◽  
Control Measures ◽  
Sub Saharan Africa ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Sub Saharan ◽  
Prevention And Control Measures

Background: Nosocomial infection outbreaks in neonatal services are a serious healthcare concern in both developed and developing countries, but few studies have been conducted in sub-Saharan Africa. Objective: This study explored the etiology of septicemia in neonates and associated patterns of antimicrobial susceptibility in Gabon. Methods: We analyzed cultures from neonates’ blood and swabs from medical personnel and equipment located in the neonatology service. Results: Sixty-eight microorganisms were isolated from the medical personnel and equipment; 46 microorganisms were isolated from neonates’ blood culture. Klebsiella pneumoniae spp pneumoniae was the most common bacteria found in both (30.6% and 26.9%, respectively). All Klebsiella pneumoniae spp pneumonia isolates were resistant to amoxicillin with clavulanic acid, gentamycin resistance ranged from 93% to 100%, and cephalosporin resistance ranged from 33.3% to 47%. Conclusions: Awareness of the etiology, prevalence, and outcome of nosocomial infection is the first and most important step to appropriate interventions

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