Quality of Sample Testing in the Laboratory Unit: Current Situation and Strategies for Improvement

The purpose of this study was to understand the status quo of quality sample testing in the laboratory unit. A quantitative research method was used. An extensive laboratory documents (protocol, worksheets, laboratory analytical plan, standard operating procedures and manuals) review was performed and a networking approach to both management and lab staff at all levels was reviewed in order to identify all non-conformities occurred in the past three years. Results identified 36 number of results deviated from reference standards among different test performed, 400 number of samples lost, the number of laboratory personnel who were not sufficiently trained to take the task properly decreased from 16 in 2016 to 6 in 2018 after conducting training on laboratory quality management system, 36 controlled documents including sample management standard operating procedure, bench job aids were missing and 8 customer complains about the delay of results and quality laboratory of services have been identified.

Using a human-centred design approach to develop a comprehensive newborn monitoring chart for inpatient care in Kenya

Introduction Job aids such as observation charts are commonly used to record inpatient nursing observations. For sick newborns, it is important to provide critical information, intervene, and tailor treatment to improve health outcomes, as countries work towards reducing neonatal mortality. However, inpatient vital sign readings are often poorly documented and little attention has been paid to the process of chart design as a method of improving care quality. Poorly designed charts do not meet user needs leading to increased mental effort, duplication, suboptimal documentation and fragmentation. We provide a detailed account of a process of designing a monitoring chart. Methods We used a Human-Centred Design (HCD) approach to co-design a newborn monitoring chart between March and May 2019 in three workshops attended by 16–21 participants each (nurses and doctors) drawn from 14 hospitals in Kenya. We used personas, user story mapping during the workshops and observed chart completion to identify challenges with current charts and design requirements. Two new charts were piloted in four hospitals between June 2019 and February 2020 and revised in a cyclical manner. Results Challenges were identified regarding the chart design and supply, and how staff used existing charts. Challenges to use included limited staffing, a knowledge deficit among junior staff, poor interprofessional communication, and lack of appropriate and working equipment. We identified a strong preference from participants for one chart to capture vital signs, assessment of the baby, and feed and fluid prescription and monitoring; data that were previously captured on several charts. Discussion Adopting a Human-Centred Design approach, we designed a new comprehensive newborn monitoring chart that is unlike observation charts in the literature that only focus on vital signs. While the new chart does not address all needs, we believe that once implemented, it can help build a clearer picture of the care given to newborns. Conclusion The chart was co-designed and piloted with the user and context in mind resulting in a unique monitoring chart that can be adopted in similar settings.

Implementing health communication tools at scale: mobile audio messaging and paper-based job aids for front-line workers providing community health education to mothers in Bihar, India

IntroductionAs part of an investment by the Bill & Melinda Gates Foundation to support the Government of Bihar to improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) statewide, BBC Media Action implemented multiple communication tools to support front-line worker (FLW) outreach. We analyse the impacts of a package of mHealth audio messaging and paper-based job aids used by FLWs during government-sponsored village health, sanitation and nutrition days (VHSNDs) on knowledge and practices of childbearing women across the RMNCHN continuum of care.MethodsData from two surveys collected between July and September 2016 were analysed using logistic regression to compare health-related knowledge and behaviours between women who had been exposed at VHSNDs to the mHealth GupShup Potli (GSP) audio recordings or interpersonal communication (IPC) tools versus those who were unexposed.ResultsExposure to GSP recordings (n=2608) was associated with improved knowledge across all continuum-of-care domains, as well as improved health-related behaviours in some domains. The odds of having taken iron-folic acid (IFA) tablets were significantly higher in exposed women (OR 1.5, 95% CI 1.1 to 2.2), as was contraceptive use (OR 2.0, 95% CI 1.2 to 3.2). There were no differences in birth preparedness or complementary feeding practices between groups. Exposure to IPC paper-based tools (n=2002) was associated with a twofold increased odds of IFA consumption (OR 2.3, 95% CI 1.7 to 3.2) and contraceptive use (OR 1.8, 95% CI 1.2 to 2.8). Women exposed to both tools were generally at least twice as likely to subsequently discuss the messages with others.ConclusionBBC Media Action’s mHealth audio messaging job aids and paper-based IPC tools were associated with improved knowledge and practices of women who were exposed to them across multiple domains, suggesting their important potential for improving health outcomes for beneficiaries at scale in low-resource settings.Trial registration numberNCT02726230.

Exploring the mechanism through which a child-friendly storybook addresses barriers to child-participation during HIV care in primary healthcare settings in KwaZulu-Natal, South Africa

Background Healthcare workers (HCWs) in South Africa widely use job-aids as practical tools to enhance the provision of HIV services, thereby improving patient-provider interactions during the care process. Job-aids are visual support materials that provide appropriate information using graphics and words in a simple and yet effective manner. We explored the mechanism through the KidzAlive Talk tool storybook (Talk tool), a child-centred job-aid for HCWs that facilitates child-participation during HIV consultations in primary healthcare (PHC) clinics implementing the KidzAlive model. Methods The study was conducted in PHC clinics across four districts; namely: uMkhanyakude, Zululand, uMgungundlovu, and eThekwini in KwaZulu-Natal (KZN), South Africa. We conducted in-depth interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained and mentored HCWs (n = 20). Data were collected in both English and isiZulu languages through user-specific, structured in-depth interviews. All the interviews were audio-recorded (with participants’ assent and consent, respectively). Data were transcribed verbatim, prior to translating the isiZulu transcripts to English. Translations were done by a member of the research team competent in both languages. Electronic data were imported to NVivo 10 for analysis and subsequently analysed using a thematic analysis method followed by a constant comparative and modified grounded theory analysis method. Results The findings identified the following barriers to child-participation: Primary caregiver limiting the child’s involvement due to fear of traumatising them; HCWs’ limited knowledge and skills to deliver child-centred HIV care; childhood developmental stage-related limitations and healthcare institutional paternalism. The Talk tool addresses the above barriers by using simple language and terminology to cater for children at various stages of development; alleviating HCWs’ and PCGs’ fear of possible psychological harm to the child; using storytelling and colourful cartoon illustrations for child edutainment; Being versatile by allowing for multiple utility and tackling institutional paternalism that limit child-involvement in the process of care. Conclusions This study provided evidence on how the Talk tool storybook addresses barriers to child-participation in the HIV care process. The evidence generated from this study is compelling enough to recommend the scale-up of this innovation in low-resource settings.

Myanmar Continues to Curb Malaria amid Coronavirus Disease-2019 Crisis

Background: Myanmar has targeted Plasmodium falciparum malaria elimination by 2025 and all human malaria elimination by 2030. Coronavirus Disease-2019 (COVID-19) pandemic could jeopardize the current gains. The objective of the study is to assess the impact of COVID-19 on epidemiology and malaria services in Myanmar. Methods: This is cross sectional study using retrospective routine programme data reported by Ministry of Health and Sports (for COVID-19) and National Malaria Control Programme (NMCP) (for malaria) during January – September 2019 and 2020. Results: Myanmar implemented whole of society COVID-19 response since its first 2 cases were detected on 23 March 2020. NMCP mobilized US$ 7 mil to support, protect and mitigate COVID-19 impact on malaria through implementation of tailored guidelines, job aids and risk communication materials starting April 2020. Front line health workers were protected through supplies of surgical masks, hand sanitizer, aprons, gloves, non-contact digital thermometers among others. During January-September 2020, reported malaria cases, severe cases and deaths declined by 11%, 34% and 27%, respectively in the same period in 2019. Total P. falciparum cases declined by 55% with minimal increase in tests (0.14%). 80% of cases and 98% of foci were investigated in 2020 in comparison to 68% and 54% in 2019, respectively (p<0.05). In 2020, NMCP distributed 72% of the targeted long-lasting insecticidal nets (vs 49% in 2019) (p<0.05). Integrated Community Malaria Volunteers (ICMVs) trained in 2020 was 49% in comparison to 94% in 2019 (P<0.05), while number of functional ICMVs remained at 91% (vs 94% in 2019). Overall monthly reports from all reporting units received slightly dropped by 5%. In 2020, NMCP was able to conduct 59% supervision visits at various levels, which was higher than 2019 (56%). Conclusions: Malaria cases, severe cases and deaths continued to decline amid COVID-19 in Myanmar with 55% decline in P. falciparum . Programme need to continue essential malaria services during the upsurge of COVID-19 and simultaneously plan proactively to ensure uninterrupted supply of essential malaria commodities for 2021 to ensure P. falciparum elimination by 2025.

Hand hygiene compliance among healthcare workers in Ghana’s health care institutions: An observational study

Objective To assess hand hygiene compliance in selected primary hospitals in Ghana. Design A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients.

The Cognitive Process of Wildland Fire Chainsaw Troubleshooting: Structure, Content, and Training

Wildland firefighting often involves the creation of a fireline (a break in vegetative fuels), an operation commonly hindered by the break-down of gas-powered chainsaws. Some firefighters may not possess the knowledge and skills needed to address break-downs quickly, which threatens productivity and safety. The Applied Cognitive Task Analysis method was used to examine the troubleshooting process of an expert wildland fire sawyer. This included elicitations of key steps in this process, specific pieces of valuable knowledge, and sources of expertise. These results show that much of the expert understanding of complex faults was developed on-the-job rather than during a formal training program. This study highlights areas where training and job aids may be improved to support wildland firefighters in chainsaw troubleshooting and provides preliminary support of ACTA as a tool for training specialists in this domain.

The effect of job aids on knowledge retention among Patent and Proprietary Medicine Vendors trained to administer injectable contraceptives: longitudinal results from implementation science in Nigeria

Background To increase access to voluntary family planning (FP) services, Nigerian policymakers are debating how to task share injectable contraceptive services to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Task sharing FP services to drug shops is a promising practice, but information is needed on how to ensure high quality FP services. This analysis assesses the effects of job aids on PPMVs’ knowledge of injectable contraceptives 9 months after receiving a standardized training. Methods One hundred ninety-four PPMVs were trained on FP counseling and administration of injectable contraceptives in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed before, after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common injectable side effects. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training. Results Over half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs’ knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge remained higher than pre-test levels but generally reduced compared to posttest levels. PPMVs who reported using at least two FP job aids were 2.6 (95% CI: 1.4–5.1) times more likely to have DMPA-IM knowledge 9 months after the training compared to those who used one or no job aids, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2–4.6) and side effects (AOR: 2.5; 95% CI: 1.3–4.8). Conclusion PPMVs who used at least two FP job aids were more likely to correctly answer key injectable contraceptive questions 9 months after training. Incorporating proven job aids into routine trainings is a low-cost strategy that can reinforce knowledge and help PPMVs to retain information.