Experiences of Healthcare Workers of Hospitalised Individuals with covid-19 in Kano, Nigeria: A Qualitative Study

Background: Management of patients with covid-19 needing hospitalisation is challenging worldwide. However, little or no information has been gathered regarding the experiences of healthcare workers (hcw s) involved in the care of patients with covid-19 in poorly resourced settings. This study explored the experiences of hcw s managing hospitalised patients with covid-19 in a treatment centre in Kano, Nigeria. Methods: hcw s directly or indirectly involved in managing patients with covid-19 in one of the two treatment centres in Kano, Nigeria, were sampled based on being information-rich cases. The study participants were interviewed individually via telephone using a semi-structured interview guide. Data collection was stopped when content saturation was attained. Data was analysed using thematic synthesis. Results: Eleven hcw s, comprising two medical doctors, five nurses, a laboratory staff member, a community health extension worker, an environmental health officer and a cleaner, participated in this study. Four major themes were generated: (i) the profile and readiness of hcw s prior to being engaged to work in a covid-19 treatment centre, (ii) the experience of hcw s while working in the covid-19 treatment wards, (iii) challenges with working in covid-19 treatment wards, and (iv) post-treatment support for covid-19 patients. The participants had variable prior experience in managing patients with infectious diseases. Interventions offered were mainly antiviral therapy, nursing care, counselling, nutritional interventions and toilet hygiene. Challenges encountered included insufficient cooperation from patients, poor personnel welfare, lack of human resources/equipment and issues interfering with wellbeing (stigma). Conclusion: The studied population exhibited professional competence and success in managing hospitalised patients with covid-19 during hospitalisation, despite existing challenges.

The performance of COVID-19 Surveillance System as timely containment strategy in Western Oromia, Ethiopia

Background COVID-19 has been swiftly spreading throughout the world ever since it emerged in Wuhan, China, in late December 2019. Case detection and contact identification remain the key surveillance objectives for effective containment of the pandemic. This study was aimed at assessing performance of surveillance in early containment of COVID 19 in Western Oromia, Ethiopia. Methods A cross-sectional study was conducted from August 1 to September 30, 2020, in the 7 kebeles of Nekemte and 2 kebeles of Shambu Town. Residents who lived there for at least the past six months were considered eligible for this study. Data were collected from community and health system at different levels using semi structured questionnaire and checklist, respectively. Participants’ health facility usage (dependent variable) and perceived risk, awareness, Socioeconomic Status, and practices (independent variable) were assessed. Bivariable analysis was computed to test the presence of an association between dependent and independent variables. Independent predictors were identified on multivariable logistic regression using a p-value of (<0.05) significance level. We have checked the model goodness of fit test by Hosmer-lemeshow test. Results One hundred seventy-nine (41%) of the participants believe that they have a high risk of contracting COVID-19 and 127 (29%) of them reported they have been visited by health extension worker. One hundred ninety-seven (45.2%) reported that they were not using health facilities for routine services during this pandemic. Except one hospital, all health facilities (92%) were using updated case definition. Three (33%) of the assessed health posts didn’t have community volunteers. On multivariable logistic regression analysis, the source of income AOR=0.30, 95% CI (0.11, 0.86), perceived level of risk AOR=3.42, 95% CI (2.04, 5.7) and not visited by health extension workers AOR=0.46, 95% CI (0.29, 0.74) were found to be independent predictors of not using health facilities during this pandemic. Conclusion Event based surveillance, both at community and health facility level, was not performing optimally in identifying potential suspects. Therefore, for effective early containment of epidemic, it is critical to strengthen event based surveillance and make use of surveillance data for tailored intervention in settings where mass testing is not feasible.

Evaluation of Maternal Death Surveillance and Response System in Dewachefa District, Oromia Zone, Amhara Region, Ethiopia, 2018

Background Maternal death surveillance and response (MDSR) is the “litmus test” of the health system that provides evidence for accomplishment, and provides information in real time and allows improvement towards catching all maternal mortalities. The aim of study was to evaluate maternal death surveillance and response system in Dewachefa. Methods A cross sectional study design was conducted in two health centers, five health post, district health office and from these facilities 32 health workers were included. Data were collected through focal person, health worker and health extension worker interview by using checklist. Collected data were entered into Epi data version 3.1. These data were exported to statistical package for social science for analysis. Analyzed data were presented in the form of text, table and figures. Result The overall knowledge of health professionals and health extension workers on MDSR were 40.9% and 40% respectively. The sensitivity of surveillance system was 3/5(60%). In public health emergency management (PHEM) unit, its representativeness was 3/17 (17.6%). All maternal deaths were notified after 8 day of death. The overall knowledge of Health professionals and health extension workers on MDSR was lower. The surveillance system is not sensitive, timeliness and representative. The System is not sustainable/ not standardized. More work should be needed to improve the sensitivity, representativeness, timeliness and sustainable of the surveillance system.

Intrauterine Device utilisation amongst short term contraceptive users in Hossana Town, Southern Ethiopia: a qualitative study

BackgroundIntrauterine devices (IUDs) are one of the long-acting, safe and effective methods of contraception in women across the world. However, this method is underutilised in many countries, including Ethiopia. Several quantitative studies have been used to address this problem and generated a list of factors associated with this problem. However, this list lacks detailed and local contexts that are necessary to inform local solutions. The current study uses a qualitative method to explore determinants of IUDs underutilization among short term modern contraceptive users from the maternal health services in the study setting. The use of a qualitative study design is necessary to obtain and rich contextual details that can inform the development of locally appropriate strategies to increase the IUDs uptake in the study area and improve women’s reproductive health outcomes.MethodA qualitative study was conducted in Hossana town public health facilities, southern Ethiopia from November 1–30, 2019. A total of thirteen in-depth interviews were conducted including with: 11 short term contraceptive users, one health centre head and one health extension worker. The interview guide comprised semi-structured questions. Interviews were audio recorded, transcribed and collected data analysed thematically.ResultThe main key determinants of IUDs service underutilisation were identified from participants’ narratives, including: (i) poor knowledge about the benefits of IUDs, (ii) insufficient counselling and ineffective delivery of health information to aid women in decision making, (iii) the absence of trained health personals, and shortage of supplies.ConclusionResults indicate that the poor utilisation of IUDs services is determined by both the service provider and the consumer related factors. Poor knowledge of short term users of contraception is a critical factor because without knowledge, clients may not use the available services effectively. The shortage of necessary supplies, poor provider-client relationships, and poor counselling by service providers are also service factors that act as barriers to uptake of IUDs. Efforts should be made to increase IUDs utilization by focusing on educating women about the importance of IUDs, improving counselling of mothers and strengthening the health systems, including allocating more resources to increase access to IUDs among the service users.

Performance of COVID-19 Surveillance System as Timely Containment Strategy in Western Oromia, Ethiopia.

Background: Since its occurrence in late December, 2019, in Wuhan, China; COVID-19 is rapidly spreading across the world nations. Case detection and contact identification remains the key surveillance objectives for effective containment of the pandemic. This study was aimed at evaluating the performance of COVID-19 surveillance in Western Oromia towns, Ethiopia.Methods: CDC-update guideline for surveillance system evaluation and surveillance documents prepared by Ethiopian Public Health Institute were used as a benchmark. Qualitative interview of health workers and quantitative review of surveillance data were conducted. Semi structured questionnaire was used to interview 436 systematically selected local community to assess their awareness, perceived risk, health system utilization experience and current practices. We analyzed the data using descriptive approach by aligning the data from community, health facility and health authority along with suspect identification, case detection and reporting process of the surveillance system.Results: One hundred seventy-nine (41%) of the participants believe they have high risk of contracting COVID-19 and 127 (29%) of them reported they have been visited by health extension worker. One hundred ninety-seven (45.2%) reported that they are not using health facilities for routine services during this pandemic. Except one hospital, all health facilities (92%) were using updated case definition. From March to July 30, 2020, there were 150 contacts, 116 suspects and 634 risk group tested for COVID-19 of which cases were found only from risk group testing, 10/521 (2%) in Nekemte and none from Shambu. Surveillance data was not being analyzed at all level. Conclusion: In this study it is reasonable to conclude that community/risk group testing was more effective than suspect or contact testing. Surveillance data was not being used to identify group and/or area most exposed for guiding response strategy. Therefore, targeting risk group for testing can improve the effectiveness of COVID-19 surveillance in settings where mass testing is not feasible. Surveillance data analysis should be done to identify areas and groups at higher risk and investigate to avoid further crisis.

Evaluation of Maternal Death Surveillance and Response System in Dewachefa District, Oromia Zone, Amhara Region, Ethiopia, 2018

Background: Maternal death surveillance and response (MDSR) is the “litmus test” of the health system that provides evidence for accomplishment and , provides information in real time and allows improvement towards catching all maternal mortalities. The aim of study was to evaluate maternal death surveillance and response system in Dewachefa.Methods: A cross sectional study design was conducted in two health centers, five health post, district health office and from these facilities 32 health workers were included. Data were collected through focal person, health worker and health extension worker interview by using checklist. Collected data were entered into Epi data version 3.1. These data were exported to statistical package for social science for analysis. Analyzed data were presented in the form of text, table and figures.Result: The average completeness of weekly report form of the district was 73.1%. Thirteen (59.1 %) of health professionals and 6(60%) of health extension workers had unsatisfactory knowledge on MDSR. All visited health facilities and Woredas focal person were trained. The system had under notification of maternal death from the community, poor involvement of health facility staff, and discordance of data between public health emergency management, and maternal and newborn health unit report. Establish rapid response team that includes maternal and child health staff’s maternal death review committees in all health facilities.

Understanding the importance of non-material factors in retaining community health workers in low-income settings: a qualitative case-study in Ethiopia

ObjectivesThe motivation and retention of community health workers (CHWs) is a challenge and inadequately addressed in research and policy. We sought to identify factors influencing the retention of CHWs in Ethiopia and ways to avert their exit.DesignA qualitative study was undertaken using in-depth interviews with the study participants. Interviews were audio-recorded, and then simultaneously translated into English and transcribed for analysis. Data were analysed in NVivo 12 using an iterative inductive-deductive approach.SettingThe study was conducted in two districts each in the Tigray and Southern Nations, Nationalities and People’s Republic (SNNPR) regions in Ethiopia. Respondents were located in a mix of rural and urban settings.ParticipantsLeavers of health extension worker (HEW) positions (n=20), active HEWs (n=16) and key informants (n=11) in the form of policymakers were interviewed.ResultsWe identified several extrinsic and intrinsic motivational factors affecting the retention and labour market choices of HEWs. While financial incentives in the form of salaries and material incentives in the form of improvements to health facility infrastructure, provision of childcare were reported to be important, non-material factors like HEWs’ self-image, acceptance and validation by the community and their supervisors were found to be critical. A reduction or loss of these non-material factors proved to be the catalyst for many HEWs to leave their jobs.ConclusionOur study contributes new empirical evidence to the global debate on factors influencing the motivation and retention of CHWs, by being the first to include job leavers in the analysis. Our findings suggest that policy interventions that appeal to the social needs of CHWs can prove to be more acceptable and potentially cost-effective in improving their retention in the long run. This is important for government policymakers in resource constrained settings like Ethiopia that rely heavily on lay workers for primary healthcare delivery.

Evaluation of Maternal Death Surveillance and Response System in Dewachefa Woreda, Oromia Zone, Amhara Region, Ethiopia, 2018

Background: Maternal death surveillance and response (MDSR) is the “litmus test” of the health system that provides evidence for accomplishment, links activities to results, makes maternal death visible at all levels, informs communities & health workers, increases country ownership of data, provides information in real time and allows improvement towards catching all maternal mortalities. The aim of study was to evaluate maternal death surveillance and response system in Dewachefa. Methods: A cross sectional study design was conducted in two health centers, five health post, district health office and from these facilities 32 health workers were included. Data were collected through focal person, health worker and health extension worker interview by using checklist. Collected data were entered into Epi data version 3.1. These data were exported to statistical package for social science for analysis. Analyzed data were presented in the form of text, table and figures. Result: The average completeness of weekly report form of the district was 77.4%. Twenty-eight (87.5%) of the health worker had not got Maternal death surveillance and response (MDSR) training. All visited health facilities and Woredas focal person were trained. The system had under notification of maternal death from the community, poor involvement of health facility staff, and discordance of data between public health emergency management, and maternal and newborn health unit report. Establish rapid response team that includes maternal and child health staff’s maternal death review committees in all health facilities.

Investigation Report of cVDPV2 Outbreak in Bokh Woreda of Dollo Zone, Somali Regional State, Ethiopia

Background. Poliovirus isolates detected in persons or in the environment can fall into three major categories: wild, Sabin and Sabin-like, or vaccine-derived. Detection of wild or vaccine-derived poliovirus may constitute an emergency, which can be categorized as an event that can lead to an outbreak, depending on characteristics of the isolate and the context in which it appears. The aim of the study was investigation report of cVDPV2 outbreak in Bokh woreda of Dollo Zone, Somali regional state, Ethiopia. Methods. A team of experts drawn from different organizations was deployed to Bokh woreda to make detailed field investigation from May 25 to June 17, 2019. By using standard World Health Organization polio outbreak investigation checklist, document review of surveillance, immunization, and clinical data related to the case was made. Key informant’s interview was made to health professionals, managers, parents of case, woreda and kebele leaders, religious leaders, and HEWs related to acute flaccid paralysis outbreak. Result. The notified AFP case was a 39-month-old female from Angalo kebele of Bokh woreda, Dollo Zone. On 19th May 2019, the patient developed high grade fever and was taken to Angalo Health Post on 20th May 2019. As per the examination by a health extension worker, the child had high grade fever and neck stiffness with preliminary diagnosis of meningitis for which ceftriaxone injection was prescribed. Contact sample was taken from three children on 28th May 2019 and 29th May 2019 and was sent to Addis Ababa National Polio Laboratory. All contact stool samples were found to be positive for poliovirus type 2 and referred for sequencing in National Institute of Communicable Diseases (NICD), South Africa, the Regional Polio Reference Laboratory. Conclusion and Recommendation. The clinical presentation of the cases is compatible with poliovirus infection, improving the quality and coverage of supplementary polio immunization activities through proper planning; strict supervision and follow-up can reduce the occurrence of acute flaccid paralysis.

‘I also take part in caring for the sick child’: a qualitative study on fathers’ roles and responsibilities in seeking care for children in Southwest Ethiopia

ObjectivesFathers play an important role in household decision-making processes and child health development. Nevertheless, they are under-represented in child health research, especially in low-income settings. Little is known about what roles fathers play in the care-seeking processes or how they interact with the health system when their child is sick. This study aimed to understand Ethiopian fathers’ roles and responsibilities in caring for their children when they are or become ill.DesignQualitative study using semistructured interviews with fathers.SettingThis study was conducted in three rural districts of the Southern Nations, Nationalities and People’s Region of Ethiopia.ParticipantsTwenty-four fathers who had at least one child between 2 and 59 months who visited a health extension worker with fever.ResultsThe overarching theme of this study was ‘changing perceptions of paternal responsibilities during children’s ill health’. It constituted three subthemes, namely, ‘fathers’ burden of earning money for care’, ‘fatherhood entails advocating children’s healthcare needs’ and ‘investing in children’s health can benefit the family in the future’. Fathers described that they were the ones mainly responsible for the financial arrangement of care and that this financial responsibility can involve stress when resources are scarce. Fathers knew what health services were available and accessible to them and were involved in different ways in the care seeking of the child. Changes in the importance ascribed to child health were expressed by fathers who described being more alert to children’s ill-health.ConclusionFathers play various roles in the care-seeking process during children’s illness episodes. This included, for instance, arranging resources to seek care, (co)-deciding where to seek care as well as accompanying the child to the health facility. The inability to organise necessary resources for care can lead to involuntary delays in care seeking for the child. This demonstrates the importance of including fathers in future interventions on maternal and child health.