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Rahman A, Friberg IK, Dolphyne A, Fjeldheim I, Khatun F, O'Donnell B, Pervin J, Rahman M, Rahman AMQ, Nu UT, Sarker BK, Venkateswaran M, Frøen JF. An Electronic Registry for Improving the Quality of Antenatal Care in Rural Bangladesh (eRegMat): Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e26918. [PMID: 34255723 PMCID: PMC8292932 DOI: 10.2196/26918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Digital health interventions (DHIs) can alleviate several barriers to achieving better maternal and child health. The World Health Organization's guideline recommendations for DHIs emphasize the need to integrate multiple DHIs for maximizing impact. The complex health system of Bangladesh provides a unique setting for evaluating and understanding the role of an electronic registry (eRegistry) for antenatal care, with multiple integrated DHIs for strengthening the health system as well as improving the quality and utilization of the public health care system. OBJECTIVE The aim of this study is to assess the effect of an eRegistry with DHIs compared with a simple digital data entry tool without DHIs in the community and frontline health facilities. METHODS The eRegMat is a cluster-randomized controlled trial conducted in the Matlab North and Matlab South subdistricts in the Chandpur district, Bangladesh, where health facilities are currently using the eRegistry for digital tracking of the health status of pregnant women longitudinally. The intervention arm received 3 superimposed data-driven DHIs: health worker clinical decision support, health worker feedback dashboards with action items, and targeted client communication to pregnant women. The primary outcomes are appropriate screening as well as management of hypertension during pregnancy and timely antenatal care attendance. The secondary outcomes include morbidity and mortality in the perinatal period as well as timely first antenatal care visit; successful referrals for anemia, diabetes, or hypertension during pregnancy; and facility delivery. RESULTS The eRegistry and DHIs were co-designed with end users between 2016 and 2018. The eRegistry was implemented in the study area in July 2018. Recruitment for the trial started in October 2018 and ended in June 2020, followed by an 8-month follow-up period to capture outcome data until February 2021. Trial results will be available for publication in June 2021. CONCLUSIONS This trial allows the simultaneous assessment of multiple integrated DHIs for strengthening the health system and aims to provide evidence for its implementation. The study design and outcomes are geared toward informing the living review process of the guidelines for implementing DHIs. TRIAL REGISTRATION ISRCTN Registry ISRCTN69491836; https://www.isrctn.com/ISRCTN69491836. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26918.
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Affiliation(s)
- Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Ingrid K Friberg
- Tacoma-Pierce County Health Department, Tacoma, WA, United States
| | - Akuba Dolphyne
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingvild Fjeldheim
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Monjur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - A M Qaiyum Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - U Tin Nu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
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de Silva R, Huber-Krum S, Samarasekera A, Karra M, Pearson E, Senanayake H, Canning D, Shah I. Provider perspectives in implementing the Postpartum Intrauterine Device Initiative in Sri Lanka: a qualitative study. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:193-199. [PMID: 33214196 DOI: 10.1136/bmjsrh-2020-200876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Integration of maternal care and family planning services has the potential to reduce unintended pregnancies and closely spaced births, leading to reductions in maternal mortality and morbidity. However, few models exist detailing how to implement/integrate such services. This study explored the implementation of the Postpartum Intrauterine Device (PPIUD) Initiative in Sri Lanka, which trained healthcare providers on how to counsel women about contraception during routine antenatal care and insert PPIUD immediately following delivery. METHODS We applied a qualitative design to ascertain the perspectives of maternal health service providers who participated in the PPIUD Initiative. We conducted 12 in-depth interviews with providers. We used thematic analysis to analyse the data and the results were interpreted within the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS Findings indicated that providers were willing to adopt the intervention and reiterated the importance of postpartum family planning. However, the intervention was not consistently implemented as intended, including provider bias in counselling and lack of attention to women's preferences. Organisational barriers to implementation included time constraints and inadequate training. Providers suggested that a range of paramedical staff be trained in counselling and PPIUD insertion to mitigate barriers and to facilitate scaling up the intervention. CONCLUSIONS To improve and scale up the PPIUD Initiative, training efforts should be expanded to primary and secondary care facilities and implementation strategies better utilised (eg, on-the-job training). The training can be strengthened by improving providers' knowledge of all types of methods and interpersonal communication skills, and emphasising the importance of unbiased, evidence-based contraceptive counselling techniques.
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Affiliation(s)
- Ranjith de Silva
- Sri Lanka College of Obstetricians and Gynaecologists, Colombo, Sri Lanka
| | - Sarah Huber-Krum
- Harvard T H Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | | | - Mahesh Karra
- Frederick S Pardee School of Global Studies, Boston University, Boston, Massachusetts, USA
| | | | | | - David Canning
- Harvard T H Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Iqbal Shah
- Harvard T H Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
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53
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Lavender T, Bedwell C, Kasengele CT, Kimaro D, Kuzenza F, Lyangenda K, Mills TA, Nsemwa L, Shayo H, Tuwele K, Wakasiaka S, Laisser R. Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania. BMJ Glob Health 2021; 6:bmjgh-2020-004725. [PMID: 33926891 PMCID: PMC8094336 DOI: 10.1136/bmjgh-2020-004725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Quality of maternal and newborn care is integral to positive clinical, social and psychological outcomes. Respectful care is an important component of this but is suboptimum in many low-income settings. A renewed energy among health professionals and academics is driving an international agenda to eradicate disrespectful health facility care around the globe. However, few studies have explored respectful care from different vantage points. Methods We used Strauss and Corbin’s grounded theory methodology to explore intrapartum experiences in Tanzania and Zambia. In-depth interviews were conducted with 98 participants (48 women, 18 partners, 21 health-providers and 11 key stakeholders), resulting in data saturation. Analysis involved constant comparison, comprising three stages of coding: open, axial and selective. The process involved application of memos, reflexivity and positionality. Results Findings demonstrated that direct and indirect social discrimination led to inequity of care. Health-providers were believed to display manipulative behaviours to orchestrate situations for their own or the woman’s benefit, and were often caring against the odds, in challenging environments. Emergent categories were related to the core category: respectful care, an added extra, which reflects the notion that women did not always expect or receive respectful care, and tolerated poor experiences to obtain services believed to benefit them or their babies. Respectful care was not seen as a component of good quality care, but a luxury that only some receive. Conclusion Both quality of care and respectful care were valued but were not viewed as mutually inclusive. Good quality treatment (transactional care) was often juxtaposed with disrespectful care; with relational care having a lower status among women and healthcare providers. To readdress the balance, respectful care should be a predominant theme in training programmes, policies and audits. Women’s and health-provider voices are pivotal to the development of such interventions.
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Affiliation(s)
- Tina Lavender
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, Liverpool, UK
| | - Carol Bedwell
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, Liverpool, UK
| | | | - Debora Kimaro
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Flora Kuzenza
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Kutemba Lyangenda
- Department of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - Tracey A Mills
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, Liverpool, UK
| | - Livuka Nsemwa
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Happiness Shayo
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
| | - Khuzuet Tuwele
- Department of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - Sabina Wakasiaka
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Rose Laisser
- Archbishop Antony Mayala School of Nursing, Catholic University of Health and Allied Sciences Bugando, Mwanza, Tanzania
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Gill PJ, Ali SM, Elsobky Y, Okechukwu RC, Ribeiro TB, Soares Dos Santos Junior AC, Umpierre D, Richards GC. Building capacity in evidence-based medicine in low-income and middle-income countries: problems and potential solutions. BMJ Evid Based Med 2021; 26:82-84. [PMID: 31757839 DOI: 10.1136/bmjebm-2019-111272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Peter J Gill
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Yasmin Elsobky
- El-Galaa Military Medical Complex, Cairo, Egypt
- NAPHS Consultancy, Alexandria, Egypt
| | | | - Tatiane B Ribeiro
- Department of Preventive Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Daniel Umpierre
- Instituto de Avaliação de Tecnologia em Saúde (INCT IATS)/Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Whitehorn A, Fu L, Porritt K, Lizarondo L, Stephenson M, Marin T, Aye Gyi A, Dell K, Mignone A, Lockwood C. Mapping Clinical Barriers and Evidence-Based Implementation Strategies in Low-to-Middle Income Countries (LMICs). Worldviews Evid Based Nurs 2021; 18:190-200. [PMID: 33973346 PMCID: PMC8251858 DOI: 10.1111/wvn.12503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
Background Low‐to‐middle income countries (LMICs) experience a high burden of disease from both non‐communicable and communicable diseases. Addressing these public health concerns requires effective implementation strategies and localization of translation of knowledge into practice. Aim To identify and categorize barriers and strategies to evidence implementation in LMICs from published evidence implementation studies. Methods A descriptive analysis of key characteristics of evidence implementation projects completed as part of a 6‐month, multi‐phase, intensive evidence‐based clinical fellowship program, conducted in LMICs and published in the JBI Database of Systematic Reviews and Implementation Reports was undertaken. Barriers were identified and categorized to the Donabedian dimensions of care (structure, process, and outcome), and strategies were mapped to the Cochrane effective practice and organization of care taxonomy. Results A total of 60 implementation projects reporting 58 evidence‐based clinical audit topics from LMICs were published between 2010 and 2018. The projects included diverse populations and were predominantly conducted in tertiary care settings. A total of 279 barriers to implementation were identified. The most frequently identified groupings of barriers were process‐related and associated predominantly with staff knowledge. A total of 565 strategies were used across all projects, with every project incorporating more than one strategy to address barriers to implementation of evidence‐based practice; most strategies were categorized as educational meetings for healthcare workers. Linking Evidence to Action Context‐specific strategies are required for successful evidence implementation in LMICs, and a number of common barriers can be addressed using locally available, low‐cost resources. Education for healthcare workers in LMICs is an effective awareness‐raising, workplace culture, and practice‐transforming strategy for evidence implementation.
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Affiliation(s)
| | - Liang Fu
- JBI, The University of Adelaide, Adelaide, SA, Australia.,Department of Nursing, Jinhua Municipal Central Hospital, Jinhua, Zhejiang Province, China.,School of Nursing, Fudan University, Shanghai, China
| | - Kylie Porritt
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | | | | | - Tania Marin
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Aye Aye Gyi
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Kim Dell
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Alex Mignone
- JBI, The University of Adelaide, Adelaide, SA, Australia
| | - Craig Lockwood
- JBI, The University of Adelaide, Adelaide, SA, Australia
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Anjorin SS, Ayorinde AA, Abba MS, Oyebode OO, Uthman OA. Variation in financial protection and it association with health expenditure indicators: an analysis of low- and middle-income countries. J Public Health (Oxf) 2021; 44:428-437. [PMID: 33890116 PMCID: PMC9234505 DOI: 10.1093/pubmed/fdab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/21/2020] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An insight into variation in financial protection among countries and the underpinning factors associated with the variations observed will help to inform public health policy and practice. METHOD Secondary datasets from Global Health Expenditure Database and World Bank Development Indicators collected between 2000 and 2016 were used. Financial protection was measured in 75 low- and middle-income countries (LMICs) using the sustainable development goals framework. Funnel plot charts were used to explore the variation, and regression models were used to measure associations. RESULT Fifty-three (67%) countries were within the 99% control limits indicating common-cause variation; 11 countries were above the upper control limit and 15 countries were below the lower control limit. In the fully adjusted model, country, spending on health relative to their economy had the strongest association with the variation in catastrophic spending. Every 1% increase in health spending relative to gross domestic product (GDP) was found to be associated with a reduction of 0.13% in the number of people that incurred catastrophic health spending. CONCLUSION There is substantial variation in financial protection, as measured by the number of people that incurred catastrophic health spending, in LMICs; a proportion of this could be explained by the difference in GDP and external health expenditure.
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Affiliation(s)
- Seun S Anjorin
- Population Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Abimbola A Ayorinde
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Mustapha S Abba
- Population Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Oyinlola O Oyebode
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Riaz A, Cambaco O, Ellington LE, Lenahan JL, Munguambe K, Mehmood U, Lamorte A, Qaisar S, Baloch B, Kanth N, Nisar MI, Volpicelli G, Bassat Q, Jehan F, Ginsburg AS. Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings: a qualitative study. BMJ Open 2021; 11:e042547. [PMID: 33707268 PMCID: PMC7957133 DOI: 10.1136/bmjopen-2020-042547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Paediatric pneumonia burden and mortality are highest in low-income and middle-income countries (LMIC). Paediatric lung ultrasound (LUS) has emerged as a promising diagnostic tool for pneumonia in LMIC. Despite a growing evidence base for LUS use in paediatric pneumonia diagnosis, little is known about its potential for successful implementation in LMIC. Our objectives were to evaluate the feasibility, usability and acceptability of LUS in the diagnosis of paediatric pneumonia. DESIGN Prospective qualitative study using semistructured interviews SETTING: Two referral hospitals in Mozambique and Pakistan PARTICIPANTS: A total of 21 healthcare providers (HCPs) and 20 caregivers were enrolled. RESULTS HCPs highlighted themes of limited resource availability for the feasibility of LUS implementation, including perceived high cost of equipment, maintenance demands, time constraints and limited trained staff. HCPs emphasised the importance of policymaker support and caregiver acceptance for long-term success. HCP perspectives of usability highlighted ease of use and integration into existing workflow. HCPs and caregivers had positive attitudes towards LUS with few exceptions. Both HCPs and caregivers emphasised the potential for rapid, improved diagnosis of paediatric respiratory conditions using LUS. CONCLUSIONS This was the first study to evaluate HCP and caregiver perspectives of paediatric LUS through qualitative analysis. Critical components impacting feasibility, usability and acceptability of LUS for paediatric pneumonia diagnosis in LMIC were identified for initial deployment. Future research should explore LUS sustainability, with a particular focus on quality control, device maintenance and functionality and adoption of the new technology within the health system. This study highlights the need to engage both users and recipients of new technology early in order to adapt future interventions to the local context for successful implementation. TRIAL REGISTRATION NUMBER NCT03187067.
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Affiliation(s)
- Atif Riaz
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Olga Cambaco
- Centro de Investigação em Saúde de Manhiça, Manhica, Maputo, Mozambique
| | | | | | - Khatia Munguambe
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Usma Mehmood
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Alessandro Lamorte
- Emergency Medicine, Umberto Parini Hospital, Aosta, Valle d'Aosta, Italy
| | - Sana Qaisar
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Benazir Baloch
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Neel Kanth
- Children's Hospital-Poverty Eradication Initiative, Sindh Government Hospital Karachi, Karachi, Sindh, Pakistan
| | | | | | - Quique Bassat
- ISGLOBAL, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Fyezah Jehan
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Amy Sarah Ginsburg
- Clinical Trial Center, University of Washington, Seattle, Washington, USA
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Tilahun B, Gashu KD, Mekonnen ZA, Endehabtu BF, Angaw DA. Mapping the role of digital health technologies in the case detection, management, and treatment outcomes of neglected tropical diseases: a scoping review. Trop Med Health 2021; 49:17. [PMID: 33618757 PMCID: PMC7898439 DOI: 10.1186/s41182-021-00307-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/10/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are a diverse group of communicable diseases that principally impact the world's poorest people. The use of digital health technologies is an emerging and promising way to improve disease prevention, diagnosis, case detection, treatment delivery, and patient follow-up and facilitating health facility appointments thereby improving health outcomes. While the growing implementation of digital health technologies is evident, there is a lack of comprehensive evidence on the impact of digital health technologies in the control of NTDs. The main objective of this review was to map different pieces of evidence on the use of digital health technologies for case detection, management, and treatment outcome of the neglected tropical diseases. METHODS We conducted a scoping review guided by the Joanna Briggs Institute guidelines. The studies were searched using electronic databases like MEDLINE (PubMed), Science Direct, Cochrane Library, and manual searching engines. Two authors extracted the data and compared the results. Discrepancies were resolved by discussion or the third reviewer made the decision. We produced the distribution of geographical locations, residents (setting), types of publications, and digital health technologies used on neglected tropical diseases using tables and graphs. FINDINGS A total of 996 potentially relevant studies were generated from the initial search, and six studies were found to satisfy all the inclusion criteria and included in the final review. The review found that telehealth, eHealth, mHealth, telemedicine, and electronic health record were used digital health technologies to assess their impact on case detection, disease management, and treatment outcome of neglected tropical diseases. Mobile health was a feasible digital health technology for lymphatic filariasis patient identification and mHealth, eHealth, and electronic health records found to improve the service access, outcomes, and monitoring of visceral leishmaniasis at the community health system. CONCLUSION The scoping review identified that there were limited studies to see the impact of digital health technologies on case detection, management, and treatment outcomes for neglected tropical diseases. We also found that digital health technologies like ehealth, electronic medical linkage, telemed, and telehealth were practicable for patient identification, for treatment and diagnosis through contact with health professionals and teleconsultation, and support in improving health service delivery at the community-health system for managing the disease in both rural and urban settings.
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Affiliation(s)
- Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Dessie Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Health System Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Health System Directorate, Ministry of Health, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Chabeda S, Oluoch D, Mwangome M, Jones C. Infant malnutrition treatment in Kenya: Health worker and breastfeeding peer supporter experiences. MATERNAL AND CHILD NUTRITION 2021; 17:e13148. [PMID: 33528108 PMCID: PMC8189199 DOI: 10.1111/mcn.13148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/18/2020] [Accepted: 01/12/2021] [Indexed: 12/22/2022]
Abstract
Acute malnutrition in infants under 6 months (u6m) is increasingly recognised as a global public health problem. The World Health Organisation (WHO) guidelines for inpatient nutritional rehabilitation of infants u6m is re-lactation: the re-establishment of exclusive breastfeeding. Evidence suggests these guidelines are rarely followed in many low-income settings. Two studies of infant nutritional rehabilitation undertaken in three public hospitals in coastal Kenya employed breastfeeding peer supporters (BFPSs) to facilitate WHO guideline implementation. To explore the acceptability of the strategy to health workers (HWs) and the BFPSs, in-depth interviews were conducted with 20 HWs and five BFPSs in the three study hospitals. The HWs reported that the presence of the BFPSs changed the way infant nutritional rehabilitation was managed, increasing efforts at relactation and decreasing reliance on supplemental milk. BFPSs were said to help address staff shortages and had dedicated time to support and assist the mothers. Key to the success of the BFPSs was the social relationships they were able to establish with the mothers due to the similarity in their experiences and backgrounds. Despite the success of the BFPSs, human resource management and infrastructure challenges remained. BFPSs can successfully be employed to facilitate the implementation of the WHO guidelines for the nutritional rehabilitation of acutely malnourished infants u6m in hospitals in Kenya, establishing supportive social relationships and trust with the mothers of the acutely malnourished infants and helping to address the issue of human resource shortages.
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Affiliation(s)
- Sophie Chabeda
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dorothy Oluoch
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Martha Mwangome
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Caroline Jones
- Centre for Geographic Medicine (Coast), Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, UK
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mHealth in public health sector: challenges and opportunities in low- and middle-income countries. Digit Health 2021. [DOI: 10.1016/b978-0-12-820077-3.00007-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Gautier L, Karambé Y, Dossou JP, Samb OM. Rethinking development interventions through the lens of decoloniality in sub-Saharan Africa: The case of global health. Glob Public Health 2020; 17:180-193. [PMID: 33290183 DOI: 10.1080/17441692.2020.1858134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There has been much talk about decolonizing global health lately. The movement, which has arisen in various communities around the world, suggests an interesting critique of the Western dominant model of representations. Building upon the 'decolonial thinking' movement from the perspective of Francophone African philosophers, we comment on its potential for inspiring the field of global healthinterventions. Using existing literature and personal reflections, we reflect on two widely known illustrations of global health interventions implemented in sub-Saharan Africa - distribution of contraceptives and dissemination of Ebola virus prevention and treatment devices - featuring different temporal backdrops. We show how these solutions have most often targeted the superficial dimensions of global health problems, sidestepping the structures and mental models that shape the actions and reactions of African populations. Lastly, we question the ways through which the decolonial approach might indeed offer a credible positioning for rethinking global health interventions.
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Affiliation(s)
- Lara Gautier
- Département de Gestion, Évaluation et Politique de Santé, Université de Montréal, Montreal, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.,Department of Sociology, McGill University, Montreal, Canada
| | | | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Oumar Mallé Samb
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Canada
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Lee A, Davies A, Young AE. Systematic review of international Delphi surveys for core outcome set development: representation of international patients. BMJ Open 2020; 10:e040223. [PMID: 33234639 PMCID: PMC7684826 DOI: 10.1136/bmjopen-2020-040223] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/20/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES A core outcome set (COS) describes a minimum set of outcomes to be reported by all clinical trials of one healthcare condition. Delphi surveys are frequently used to achieve consensus on core outcomes. International input is important to achieve global COS uptake. We aimed to investigate participant representation in international Delphi surveys, with reference to the inclusion of patients and participants from low and middle income countries as stakeholders (LMICs). DESIGN Systematic review. DATA SOURCES EMBASE, Medline, Web of Science, COMET database and hand-searching. ELIGIBILITY CRITERIA Protocols and studies describing Delphi surveys used to develop an international COS for trial reporting, published between 1 January 2017 and 6 June 2019. DATA EXTRACTION AND SYNTHESIS Delphi participants were grouped as patients or healthcare professionals (HCPs). Participants were considered international if their country of origin was different to that of the first or senior author. Data extraction included participant numbers, country of origin, country income group and whether Delphi surveys were translated. We analysed the impact these factors had on outcome prioritisation. RESULTS Of 90 included studies, 69% (n=62) were completed and 31% (n=28) were protocols. Studies recruited more HCPs than patients (median 60 (IQR 30-113) vs 30 (IQR 14-66) participants, respectively). A higher percentage of HCPs was international compared with patients (57% (IQR 37-78) vs 20% (IQR 0-68)). Only 31% (n=28) studies recruited participants from LMICs. Regarding recruitment from LMICs, patients were under-represented (16% studies; n=8) compared with HCPs (22%; n=28). Few (7%; n=6) studies translated Delphi surveys. Only 3% studies (n=3) analysed Delphi responses by geographical location; all found differences in outcome prioritisation. CONCLUSIONS There is a disproportionately lower inclusion of international patients, compared with HCPs, in COS-development Delphi surveys, particularly within LMICs. Future international Delphi surveys should consider exploring for geographical and income-based differences in outcome prioritisation. PROSPERO REGISTRATION NUMBER CRD42019138519.
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Affiliation(s)
- Alice Lee
- Academic Foundation Doctor, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anna Davies
- Senior Research Fellow, Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Amber E Young
- Consultant Paediatric Anaesthetist and Lead Children's Burns Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Senior Research Fellow, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Emergency Transportation Interventions for Reducing Adverse Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review. Ann Glob Health 2020; 86:147. [PMID: 33262936 PMCID: PMC7678559 DOI: 10.5334/aogh.2934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To assess the effect of emergency transportation interventions on the outcome of labor and delivery in low- and middle-income countries (LMICs). Methods: Eleven databases were searched through December 2019: Medline/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), SCIELO, LILACS, JSTOR, POPLINE, Google Scholar, the Cochrane Pregnancy and Childbirth Group’s Specialized Register, and the Cochrane Central Register of Controlled Trials. Methodological quality of included studies was assessed using the ROBINS-I tool. Results: Nine studies (three in Asia and six in Africa) were included: one cluster randomized controlled trial, three controlled before-and-after (CBA) studies, four uncontrolled before and after studies, and one case-control study. The means of emergency obstetric transportation evaluated by the studies included bicycle (n = 1) or motorcycle ambulances (n = 3), 4-wheel drive vehicles (n = 3), and formal motor-vehicle ambulances (n = 2). Transportation support was offered within multi-component interventions including financial incentives (n = 1), improved communication (n = 7), and community mobilization (n = 2). Two controlled before-and-after studies that implemented interventions including financial support, three-wheeled motorcycles, and use of mobile phones reported reduction of maternal mortality. One cluster-randomized study which involved community mobilization and strengthening of referral, and transportation, and one controlled before-and-after that implemented free-of-charge, 24-hour, 4 × 4 wheel ambulance and a mobile phone showed reductions in stillbirth, perinatal, and neonatal mortality. Six studies reported increases in facility delivery ranging from 12–50%, and one study showed a 19% reduction in home delivery. There was a significant increase of caesarian sections in two studies; use of motorcycle ambulances compared to car ambulance resulted in reduction in referral delay by 2 to 4.5 hours. Only three included studies had low risk of bias on all domains. Conclusion: Integrating emergency obstetric transportation with complimentary maternal health interventions may reduce adverse pregnancy outcomes and increase access to skilled obstetric services for women in LMICs. The strength of evidence is limited by the paucity of high-quality studies.
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Manzi F, Marchant T, Hanson C, Schellenberg J, Mkumbo E, Mlaguzi M, Tancred T. Harnessing the health systems strengthening potential of quality improvement using realist evaluation: an example from southern Tanzania. Health Policy Plan 2020; 35:ii9-ii21. [PMID: 33156943 PMCID: PMC7646731 DOI: 10.1093/heapol/czaa128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/13/2022] Open
Abstract
Quality improvement (QI) is a problem-solving approach in which stakeholders identify context-specific problems and create and implement strategies to address these. It is an approach that is increasingly used to support health system strengthening, which is widely promoted in Sub-Saharan Africa. However, few QI initiatives are sustained and implementation is poorly understood. Here, we propose realist evaluation to fill this gap, sharing an example from southern Tanzania. We use realist evaluation to generate insights around the mechanisms driving QI implementation. These insights can be harnessed to maximize capacity strengthening in QI and to support its operationalization, thus contributing to health systems strengthening. Realist evaluation begins by establishing an initial programme theory, which is presented here. We generated this through an elicitation approach, in which multiple sources (theoretical literature, a document review and previous project reports) were collated and analysed retroductively to generate hypotheses about how the QI intervention is expected to produce specific outcomes linked to implementation. These were organized by health systems building blocks to show how each block may be strengthened through QI processes. Our initial programme theory draws from empowerment theory and emphasizes the self-reinforcing nature of QI: the more it is implemented, the more improvements result, further empowering people to use it. We identified that opportunities that support skill- and confidence-strengthening are essential to optimizing QI, and thus, to maximizing health systems strengthening through QI. Realist evaluation can be used to generate rich implementation data for QI, showcasing how it can be supported in ‘real-world’ conditions for health systems strengthening.
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Affiliation(s)
- Fatuma Manzi
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tanya Marchant
- Department of Disease Control, London School of Hygiene and Tropical Medicine, UK
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Sweden
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, UK
| | - Elibariki Mkumbo
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mwanaidi Mlaguzi
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Tara Tancred
- Department of Disease Control, London School of Hygiene and Tropical Medicine, UK
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Leonard E, de Kock I, Bam W. Barriers and facilitators to implementing evidence-based health innovations in low- and middle-income countries: A systematic literature review. EVALUATION AND PROGRAM PLANNING 2020; 82:101832. [PMID: 32585317 DOI: 10.1016/j.evalprogplan.2020.101832] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/23/2020] [Accepted: 06/04/2020] [Indexed: 05/25/2023]
Abstract
The unsuccessful implementation of health innovations occurs frequently, leading to missed opportunities where improvements could have been made on various aspects of a health system. The purpose of this study is to identify, assess and synthesise the facilitators and barriers to sustainably implementing evidence-based health innovations in a low- and middle-income country (LMIC) context. To identify the LMIC specific facilitators and barriers, a systematic literature review was conducted. 79 studies were analysed, and the implementation barriers and facilitators identified in each study were extracted. The extracted barriers and facilitators were categorised and synthesized into one of seven concepts: context, innovation, relations and networks, institutions, knowledge, actors or resources. There were no substantial variations between the frequency that each concept was identified as a facilitator or barrier to implementation. However, resources, which includes time, human, financial and physical resources, was the most frequently mentioned concept; emphasising the need to focus on the resource situation in LMICs. This study contributes to the growing literature that aims to inform health system planners and evaluators in LMICs on effectively and sustainably implementing evidence-based health innovations.
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Affiliation(s)
- Elizabeth Leonard
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa.
| | - Imke de Kock
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Wouter Bam
- Department of Industrial Engineering, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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Haddad SM, Souza RT, Cecatti JG, Barreix M, Tamrat T, Footitt C, Mehl GL, Syah IF, Shankar AH, Tunçalp Ö. Building a Digital Tool for the Adoption of the World Health Organization's Antenatal Care Recommendations: Methodological Intersection of Evidence, Clinical Logic, and Digital Technology. J Med Internet Res 2020; 22:e16355. [PMID: 33001032 PMCID: PMC7983224 DOI: 10.2196/16355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 11/14/2022] Open
Abstract
Background One of the key mandates of the World Health Organization (WHO) is to develop guidelines, defined as “a document containing recommendations for clinical practice or public health policy.” Guidelines represent the global standard for information sources shaping clinical practice and public health policies. Despite the rigorous development process and the value of guidelines for setting standards, implementing such standards within local contexts and at the point of care is a well-documented challenge. Digital technologies enable agile information management and may facilitate the adaptation of guidelines to diverse settings of health services delivery. Objective The objective of this paper is to detail the systematic and iterative process involved in transforming the WHO Antenatal Care (ANC) guidelines into a digital decision-support and patient-record application for routine use in primary health care settings, known as the WHO digital ANC module. Methods The WHO convened a team of clinical and digital health experts to develop the WHO digital ANC module as a tool to assist health care professionals in the implementation of WHO evidence-based recommendations for pregnant women. The WHO digital ANC module’s creation included the following steps: defining a minimum viable product (MVP), developing clinical workflows and algorithms, algorithm testing, developing a data dictionary, and the creation of a user interface or application development. The overall process of development took approximately 1 year to reach a stable prototype and to finalize the underlying content requirements of the data dictionary and decision support algorithms. Results The first output is a reference software reflecting the generic WHO ANC guideline content, known as the WHO digital ANC module. Within it, all actionable ANC recommendations have related data fields and algorithms to confirm whether the associated task was performed. WHO recommendations that are not carried out by the health care worker are saved as pending tasks on a woman’s health record, and those that are adequately fulfilled trigger messages with positive reinforcement. The second output consists of the structured documentation of the different components which contributed to the development of the WHO digital ANC module, such as the data dictionary and clinical decision support workflows. Conclusions This is a novel approach to facilitate the adoption and adaptation of recommendations through digital systems at the health service delivery level. It is expected that the WHO digital ANC module will support the implementation of evidence-based practices and provide information for monitoring and surveillance; however, further evidence is needed to understand how the WHO digital ANC module impacts the implementation of WHO recommendations. Further, the module’s implementation will inform the WHO’s ongoing efforts to create a pathway to adaptive and integrated (Smart) Guidelines in Digital Systems to improve health system quality, coverage, and accountability.
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Affiliation(s)
- Samira M Haddad
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Center for Research in Reproductive Health of Campinas (CEMICAMP), Campinas, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Center for Research in Reproductive Health of Campinas (CEMICAMP), Campinas, Brazil
| | - Jose Guilherme Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.,Center for Research in Reproductive Health of Campinas (CEMICAMP), Campinas, Brazil
| | - Maria Barreix
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Tigest Tamrat
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Garrett L Mehl
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Anuraj H Shankar
- Summit Institute of Development, Mataram, Indonesia.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Özge Tunçalp
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Magge H, Kiflie A, Nimako K, Brooks K, Sodzi-Tettey S, Mobisson-Etuk N, Mulissa Z, Bitewulign B, Abate M, Biadgo A, Alemu H, Seman Y, Kassa M, Barker P, Burrsa DG. The Ethiopia healthcare quality initiative: design and initial lessons learned. Int J Qual Health Care 2020; 31:G180-G186. [PMID: 31834384 DOI: 10.1093/intqhc/mzz127] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/09/2019] [Accepted: 11/12/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the development, implementation and initial outcomes of a national quality improvement (QI) intervention in Ethiopia. DESIGN Retrospective descriptive study of initial prototype phase implementation outcomes. SETTING All public facilities in one selected prototype district in each of four agrarian regions. PARTICIPANTS Facility QI teams composed of managers, healthcare workers and health extension workers. INTERVENTIONS The Ethiopian Federal Ministry of Health (FMoH) and the Institute for Healthcare Improvement co-designed a three-pronged approach to accelerate health system improvement nationally, which included developing a national healthcare quality strategy (NHQS); building QI capability at all health system levels and introducing scalable district MNH QI collaboratives across four regions, involving healthcare providers and managers. OUTCOME MEASURES Implementation outcomes including fidelity, acceptability, adoption and program effectiveness. RESULTS The NHQS was launched in 2016 and governance structures were established at the federal, regional and sub-regional levels to oversee implementation. A total of 212 federal, regional and woreda managers have been trained in context-specific QI methods, and a national FMoH-owned in-service curriculum has been developed. Four prototype improvement collaboratives have been completed with high fidelity and acceptability. About 102 MNH change ideas were tested and a change package was developed with 83 successfully tested ideas. CONCLUSION The initial successes observed are attributable to the FMoH's commitment in implementing the initiative, the active engagement of all stakeholders and the district-wide approach utilized. Challenges included weak data systems and security concerns. The second phase-in 26 district-level collaboratives-is now underway.
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Affiliation(s)
- Hema Magge
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Abiyou Kiflie
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | - Kojo Nimako
- Institute for Healthcare Improvement, Boston, MA, USA
| | | | | | | | - Zewdie Mulissa
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | | | - Mehiret Abate
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | - Abera Biadgo
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | | | - Yakob Seman
- Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Munir Kassa
- Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Pierre Barker
- Institute for Healthcare Improvement, Boston, MA, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Wilcox ES, Chimedza IT, Mabhele S, Romao P, Spiegel JM, Zungu M, Yassi A. Empowering Health Workers to Protect Their Own Health: A Study of Enabling Factors and Barriers to Implementing HealthWISE in Mozambique, South Africa, and Zimbabwe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4519. [PMID: 32586002 PMCID: PMC7345796 DOI: 10.3390/ijerph17124519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 12/13/2022]
Abstract
Ways to address the increasing global health workforce shortage include improving the occupational health and safety of health workers, particularly those in high-risk, low-resource settings. The World Health Organization and International Labour Organization designed HealthWISE, a quality improvement tool to help health workers identify workplace hazards to find and apply low-cost solutions. However, its implementation had never been systematically evaluated. We, therefore, studied the implementation of HealthWISE in seven hospitals in three countries: Mozambique, South Africa, and Zimbabwe. Through a multiple-case study and thematic analysis of data collected primarily from focus group discussions and questionnaires, we examined the enabling factors and barriers to the implementation of HealthWISE by applying the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework. Enabling factors included the willingness of workers to engage in the implementation, diverse teams that championed the process, and supportive senior leadership. Barriers included lack of clarity about how to use HealthWISE, insufficient funds, stretched human resources, older buildings, and lack of incident reporting infrastructure. Overall, successful implementation of HealthWISE required dedicated local team members who helped facilitate the process by adapting HealthWISE to the workers' occupational health and safety (OHS) knowledge and skill levels and the cultures and needs of their hospitals, cutting across all constructs of the i-PARiHS framework.
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Affiliation(s)
- Elizabeth S. Wilcox
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | | | - Simphiwe Mabhele
- International Labour Organization, Decent Work Team for East and Southern Africa, Pretoria 0020, South Africa;
| | - Paulo Romao
- International Labour Organization, Maputo, Mozambique;
| | - Jerry M. Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Muzimkhulu Zungu
- National Institute for Occupational Health, a division of the National Health Laboratory Service, Johannesburg 2001, South Africa;
- School of Health Systems and Public Health, University of Pretoria, Pretoria 0001, South Africa
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
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Dahab R, Sakellariou D. Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124292. [PMID: 32560132 PMCID: PMC7344902 DOI: 10.3390/ijerph17124292] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/16/2022]
Abstract
The new Sustainable Development Goals (SDGs) to 2030 aim to reduce maternal mortality and provide equitable access to maternal healthcare. Compromised access to maternal health facilities in low-income countries, and specifically in Africa, contribute to the increased prevalence of maternal mortality. We conducted a systematic review to investigate access barriers to maternal health in low-income countries in Africa since 2015, from the perspective of both community members and health providers. The findings show that the most important barriers to maternal health are transportation barriers to health facilities, economic factors, and cultural beliefs, in addition to lack of family support and poor quality of care. Further research is required to guide policymakers towards firm multi-sectoral action to ensure appropriate and equitable access to maternal health in line with the SDGs to 2030.
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Affiliation(s)
- Rana Dahab
- Formerly London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK;
| | - Dikaios Sakellariou
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK
- Correspondence:
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Preparing to introduce new maternal immunizations in low- and lower-middle-income countries: A report from the Bill & Melinda Gates Foundation convening "Allies in Maternal and Newborn Care"; May 3-4, 2018. Vaccine 2020; 38:4355-4361. [PMID: 32418791 DOI: 10.1016/j.vaccine.2020.04.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/25/2020] [Accepted: 04/29/2020] [Indexed: 01/30/2023]
Abstract
New strategies will be critical to reduce infant mortality and severe morbidity - there are still 5.2 million newborn deaths and stillbirths each year. The decline in newborn mortality has not kept pace with the reduction in under-five deaths and is slowest in low- and lower-middle-income countries (LMICs). Maternal immunization is a promising intervention to protect infants when they are most vulnerable - in utero and their first few months of life, before they can receive their own vaccines. Successfully introducing new vaccines for pregnant women in LMICs will require collaboration between two fields - (1) immunization and (2) maternal, newborn and child health - that use different service delivery approaches, operate under different policy and funding paradigms, and are not always integrated. In May 2018, stakeholders from these distinct communities convened to identify challenges and opportunities associated with delivering new maternal immunizations. Participants agreed that antenatal care is a logical platform. However, in many resource-constrained settings, antenatal care providers are already overburdened, and most women do not receive the recommended number of antenatal visits. Implementing maternal immunization could help increase antenatal care attendance by offering an additional safe and effective intervention that women value. Substantial effort is needed to demonstrate the benefits of maternal immunization to decision-makers and providers, and to ensure that countries and health systems are ready for introduction. To that end, participants identified the following priorities: assure coherence of policies for introducing new vaccines for pregnant women and strengthen maternal health interventions; generate demand for existing, recommended, and new maternal vaccines; conduct socio-behavioral, health systems and implementation research to shape optimal vaccine delivery strategies; and strengthen antenatal and perinatal care quality. To achieve these aims, collaboration across fields will be essential. Given that new maternal vaccines are advancing in clinical development, time is of the essence.
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Vu GV, Ha GH, Nguyen CT, Vu GT, Pham HQ, Latkin CA, Tran BX, Ho RCM, Ho CSH. Interventions to Improve the Quality of Life of Patients with Chronic Obstructive Pulmonary Disease: A Global Mapping During 1990-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3089. [PMID: 32365510 PMCID: PMC7246922 DOI: 10.3390/ijerph17093089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) has been considered a significant health challenge globally in recent years, which affects different aspects of the quality-of-life (QoL). A review was conducted of research output, research topics, and landscape to have a global view of the papers mentioning the interventions to increase QoL of patients with COPD. A total of 3242 research items from Web of Science during the period 1990-2018 were downloaded and analyzed. Analyses based on the different levels of data and methods using using VOSviewer software tool (version 1.16.15, Centre for Science and Technology Studies (CWTS), Leiden University, Leiden, The Netherlands) and Latent Dirichlet allocation. By exploring the trends in research productivity and topics, an increase was found in the number of papers mentioning non-pharmacological interventions as well as mental health illness and QoL among patients with COPD. In conclusion, the research on the interventions to increase the QoL of patients with COPD has attracted scientists globally. It is suggested that more research should be conducted on the effectiveness of non-pharmacological therapies to increase QoL of patients with COPD that can be applied broadly in the community. The collaboration and support from developed countries to developing countries are needed to increase the QoL of people living with COPD.
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Affiliation(s)
- Giap Van Vu
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Pharmacy, Duy Tan University, Da Nang 550000, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Hai Quang Pham
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Roger C. M. Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore
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Kinshella MLW, Walker CR, Hiwa T, Vidler M, Nyondo-Mipando AL, Dube Q, Goldfarb DM, Kawaza K. Barriers and facilitators to implementing bubble CPAP to improve neonatal health in sub-Saharan Africa: a systematic review. Public Health Rev 2020; 41:6. [PMID: 32368359 PMCID: PMC7189679 DOI: 10.1186/s40985-020-00124-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 04/07/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Bubble continuous positive airway pressure (CPAP) has been shown to be effective in supporting breathing in newborns with respiratory distress. The factors that influence implementation in resource-constrained settings remain unclear. The objective of this review is to evaluate the barriers and facilitators of CPAP implementation for newborn care at sub-Saharan African health facilities and how different facility levels and types of bubble CPAP systems may impact utilization. METHODS A systematic search (database inception to July 2019) was performed on MEDLINE Ovid, EMBASE, CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), the WHO Regional Database for Africa, African Index Medicus (AIM), African Journals Online, grey literature and the references of relevant articles. Studies that met the inclusion criteria (primary research, bubble CPAP implementation with neonates ≤ 28 days old at a health facility in sub-Saharan Africa) were included in the review and assessed with National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) quality assessment tools. The review protocol was published to PROSPERO (CRD42018116082). RESULTS Seventeen studies were included in the review. Reliable availability of equipment, effectively informing and engaging caregivers and staffing shortages were frequently mentioned barriers to the implementation of bubble CPAP. Understaffed neonatal units and high turnover of nurses and doctors compromised effective training. Provider-to-provider clinical mentorship models as well as affordability and cost-effectiveness of innovative bubble CPAP systems were identified as frequently mentioned facilitators of implementation. CONCLUSIONS With a strong recommendation by the World Health Organization for its use with premature infants with respiratory distress, it is important to understand the barriers and facilitators that can inform the implementation of bubble CPAP. More research is needed into health system factors that can support or impede the use of this potentially promising intervention.
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Affiliation(s)
- Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Celia R. Walker
- Department of Pathology and Laboratory Medicine, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Tamanda Hiwa
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Alinane Linda Nyondo-Mipando
- School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Queen Dube
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - David M. Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Irmansyah I, Susanti H, James K, Lovell K, Idaiani S, Imah S, Hargiana G, Keliat BA, Utomo B, Colucci E, Brooks H. Civic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders. BMC Psychiatry 2020; 20:172. [PMID: 32295558 PMCID: PMC7161291 DOI: 10.1186/s12888-020-02575-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/30/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals' and other key stakeholders' perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia. METHODS Qualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multi-disciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited. RESULTS Despite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings. CONCLUSIONS Key mental health stakeholders have identified that central aspects of Indonesian culture are well aligned to the ethos of civic engagement which has the potential to facilitate the enactment of recent global health policy. However, full realisation is likely to be impeded by prevailing paternalistic cultures in mental health services and high levels of stigma and discrimination towards those with mental illness in Indonesia without intervention.
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Affiliation(s)
- Irman Irmansyah
- National Institute of Health Research and Development, Jakarta, Indonesia.,Marzoeki Mahdi Hospital, Bogor, Indonesia
| | - Herni Susanti
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Karen James
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston and St Georges, London, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sri Idaiani
- National Institute of Health Research and Development, Jakarta, Indonesia
| | - Soimah Imah
- National Institute of Health Research and Development, Jakarta, Indonesia
| | - Giur Hargiana
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | | | | | | | - Helen Brooks
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Room B112, Waterhouse Building Block B, Liverpool, UK.
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Adegoke O, Danso-Bamfo S, Sheehy M, Tarimo V, Burke TF, Garg LF. A condom uterine balloon device among referral facilities in Dar Es Salaam: an assessment of perceptions, barriers and facilitators one year after implementation. BMC Pregnancy Childbirth 2020; 20:34. [PMID: 31931785 PMCID: PMC6958625 DOI: 10.1186/s12884-020-2721-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is the leading cause of maternal death in Tanzania. The Every Second Matters for Mothers and Babies- Uterine Balloon Tamponade (ESM-UBT) device was developed to address this problem in women with atonic uterus. The objective of this study was to understand the barriers and facilitators to optimal use of the device, in Dar es Salaam Tanzania 1 year after implementation. METHODS Semi-structured interviews of skilled-birth attendants were conducted between May and July 2017. Interviews were recorded, coded and analyzed for emergent themes. RESULTS Among the participants, overall there was a positive perception of the ESM-UBT device. More than half of participants reported the device was readily available and more than 1/3 described ease and success with initial use. Barriers included fear and lack of refresher training. Finally, participants expressed a need for training and device availability at peripheral hospitals. CONCLUSION The implementation and progression to optimal use of the ESM-UBT device in Tanzania is quite complex. Ease of use and the prospect of saving a life/preserving fertility strongly promoted use while fear and lack of high-level buy-in hindered utilization of the device. A thorough understanding and investigation of these facilitators and barriers are required to increase uptake of the ESM-UBT device.
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Affiliation(s)
- Oluwakemi Adegoke
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA. .,Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Sandra Danso-Bamfo
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA
| | - Margaret Sheehy
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Thomas F Burke
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lorraine F Garg
- Department of Emergency Medicine, Division of Global Health Innovation, Massachusetts General Hospital, 125 Nashua St, Suite 910, Boston, MA, 02114, USA
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Naseem M, Akhund R, Arshad H, Ibrahim MT. Exploring the Potential of Artificial Intelligence and Machine Learning to Combat COVID-19 and Existing Opportunities for LMIC: A Scoping Review. J Prim Care Community Health 2020; 11:2150132720963634. [PMID: 32996368 PMCID: PMC7533955 DOI: 10.1177/2150132720963634] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the face of the current time-sensitive COVID-19 pandemic, the limited capacity of healthcare systems resulted in an emerging need to develop newer methods to control the spread of the pandemic. Artificial Intelligence (AI), and Machine Learning (ML) have a vast potential to exponentially optimize health care research. The use of AI-driven tools in LMIC can help in eradicating health inequalities and decrease the burden on health systems. METHODS The literature search for this Scoping review was conducted through the PubMed database using keywords: COVID-19, Artificial Intelligence (AI), Machine Learning (ML), and Low Middle-Income Countries (LMIC). Forty-three articles were identified and screened for eligibility and 13 were included in the final review. All the items of this Scoping review are reported using guidelines for PRISMA extension for scoping reviews (PRISMA-ScR). RESULTS Results were synthesized and reported under 4 themes. (a) The need of AI during this pandemic: AI can assist to increase the speed and accuracy of identification of cases and through data mining to deal with the health crisis efficiently, (b) Utility of AI in COVID-19 screening, contact tracing, and diagnosis: Efficacy for virus detection can a be increased by deploying the smart city data network using terminal tracking system along-with prediction of future outbreaks, (c) Use of AI in COVID-19 patient monitoring and drug development: A Deep learning system provides valuable information regarding protein structures associated with COVID-19 which could be utilized for vaccine formulation, and (d) AI beyond COVID-19 and opportunities for Low-Middle Income Countries (LMIC): There is a lack of financial, material, and human resources in LMIC, AI can minimize the workload on human labor and help in analyzing vast medical data, potentiating predictive and preventive healthcare. CONCLUSION AI-based tools can be a game-changer for diagnosis, treatment, and management of COVID-19 patients with the potential to reshape the future of healthcare in LMIC.
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Mekonnen T, Dune T, Perz J. Maternal health service utilisation of adolescent women in sub-Saharan Africa: a systematic scoping review. BMC Pregnancy Childbirth 2019; 19:366. [PMID: 31638927 PMCID: PMC6805384 DOI: 10.1186/s12884-019-2501-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/11/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Sub-Saharan Africa has the highest rate of adolescent pregnancy in the world. While pregnancy during adolescence poses higher risks for the mother and the baby, the utilisation of maternity care to mitigate the effects is low. This review aimed to synthesise evidence on adolescent mothers’ utilisation of maternity care in Sub-Saharan Africa and identify the key determinant factors that influence adolescent mothers’ engagement with maternity care. Method A systematic review of scholarly literature involving seven databases: ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit was conducted. Studies published in English between 1990 and 2017 that examined Sub-Saharan adolescent mothers’ experiences of utilising biomedical maternity care during pregnancy, delivery and the post-partum period were included. Results From 296 relevant articles 27 were identified that represent the experience of adolescent mothers’ maternal health service utilisation in Sub-Saharan Africa. The review indicates that maternal health service utilisation in the majority of Sub-Saharan African countries is still low. There is also a wide discrepancy in the use of maternity care services by adolescent mothers across countries in Sub-Saharan Africa. Conclusions The review reveals that a significant number of adolescents in Sub-Saharan Africa do not access and use maternity services during pregnancy. Several factors from individual to systemic levels contributed to low access and utilisation. This implies that interventions targeting the women, their partners, healthcare professionals, communities and the organisations (local to national) are necessary to improve adolescent mother’s engagement with maternity care in Sub-Saharan Africa.
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Affiliation(s)
- Tensae Mekonnen
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia.
| | - Tinashe Dune
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia.,School of Science and Health, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Janette Perz
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW, 2751, Australia
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Qiu M, Sawadogo-Lewis T, Ngale K, Cane RM, Magaço A, Roberton T. Obstacles to advancing women's health in Mozambique: a qualitative investigation into the perspectives of policy makers. Glob Health Res Policy 2019; 4:28. [PMID: 31572806 PMCID: PMC6757408 DOI: 10.1186/s41256-019-0119-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022] Open
Abstract
Background Despite substantial investment in women’s health over the past two decades, and enthusiastic government support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest in the world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408; the estimated HIV prevalence for women of 15–24 years is over twice that for men; and only 12.1% of women are estimated to be using modern contraception. This study explores the perspectives of policy makers in the Mozambican health system and affiliates on the challenges that are preventing Mozambique from achieving greater gains in women’s health. Methods We conducted in-depth interviews with 39 senior- and mid-level policy makers in the Ministry of Health and affiliated institutions (32 women, 7 men). Participants were sampled using a combination of systematic random sampling and snowball sampling. Participants were asked about their experiences formulating and implementing health policies and programs, what is needed to improve women’s health in Mozambique, and the barriers and opportunities to achieving such improvement. Results Participants unanimously argued that women’s health is already sufficiently prioritized in national health policies and strategies in Mozambique; the problem, rather, is the implementation and execution of existing women’s health policies and programs. Participants raised challenges related to the policy making process itself, including an ever-changing, fragmented decision-making process, lack of long-term perspective, weak evaluation, and misalignment of programs across sectors. The disproportionate influence of donors was also mentioned, with lack of ownership, rapid transitions, and vertical programming limiting the scope for meaningful change. Finally, participants reported a disconnect between policy makers at the national level and realities on the ground, with poor dissemination of strategies, limited district resources, and poor consideration of local cultural contexts. Conclusions To achieve meaningful gains in women’s health in Mozambique, more focus must be placed on resolving the bottleneck that is the implementation of existing policies. Barriers to implementation exist across multiple health systems components, therefore, solutions to address them must also reach across these multiple components. A holistic approach to strengthening the health system across multiple sectors and at multiple levels is needed. Supplementary information Supplementary information accompanies this paper at (10.1186/s41256-019-0119-x).
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Affiliation(s)
- Mary Qiu
- 1Johns Hopkins University - Bloomberg School of Public Health, Baltimore, USA
| | | | - Katia Ngale
- 1Johns Hopkins University - Bloomberg School of Public Health, Baltimore, USA
| | | | - Amilcar Magaço
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Timothy Roberton
- 1Johns Hopkins University - Bloomberg School of Public Health, Baltimore, USA
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Bottom-up development of national obstetric guidelines in middle-income country Suriname. BMC Health Serv Res 2019; 19:651. [PMID: 31500615 PMCID: PMC6734520 DOI: 10.1186/s12913-019-4377-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/29/2019] [Indexed: 11/16/2022] Open
Abstract
Background Obstetric guidelines are useful to improve the quality of care. Availability of international guidelines has rapidly increased, however the contextualization to enhance feasibility of implementation in health facilities in low and middle-income settings has only been described in literature in a few instances. This study describes the approach and lessons learned from the ‘bottom-up’ development process of context-tailored national obstetric guidelines in middle-income country Suriname. Methods Local obstetric health care providers initiated the guideline development process in Suriname in August 2016 for two common obstetric conditions: hypertensive disorders of pregnancy (HDP) and post partum haemorrhage (PPH). Results The process consisted of six steps: (1) determination of how and why women died, (2) interviews and observations of local clinical practice, (3) review of international guidelines, (4) development of a primary set of guidelines, (5) initiation of a national discussion on the guidelines content and (6) establishment of the final guidelines based on consensus. Maternal enquiry of HDP- and PPH-related maternal deaths revealed substandard care in 90 and 95% of cases, respectively. An assessment of the management through interviews and labour observations identified gaps in quality of the provided care and large discrepancies in the management of HDP and PPH between the hospitals. International recommendations were considered unfeasible and were inconsistent when compared to each other. Local health care providers and stakeholders convened to create national context-tailored guidelines based on adapted international recommendations. The guidelines were developed within four months and locally implemented. Conclusion Development of national context-tailored guidelines is achievable in a middle-income country when using a ‘bottom-up’ approach that involves all obstetric health care providers and stakeholders in the earliest phase. We hope the descriptive process of guideline development is helpful for other countries in need of nationwide guidelines. Electronic supplementary material The online version of this article (10.1186/s12913-019-4377-6) contains supplementary material, which is available to authorized users.
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Davis W, Odhiambo A, Oremo J, Otieno R, Mwaki A, Rajasingham A, Kim S, Quick R. Evaluation of a Water and Hygiene Project in Health-Care Facilities in Siaya County, Kenya, 2016. Am J Trop Med Hyg 2019; 101:576-579. [PMID: 31333162 DOI: 10.4269/ajtmh.18-0945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To address water and hygiene infrastructure deficiencies in health-care facilities (HCFs) in Siaya County, Kenya, portable water stations, soap, and water treatment products were provided to 109 HCFs in 2005. In 2011 and again in 2016, we interviewed staff in 26 randomly selected HCFs, observed water sources, water stations, and tested source and stored water for chlorine residual and Escherichia coli. Of 26 HCFs, 22 (85%) had improved water supplies, and 22 (85%) had functioning handwashing and drinking water stations, but < 50% provided soap or water treatment. Thirteen (50%) of 26 source water samples yielded E. coli; 24 (92%) of 26 stored water samples yielded no E. coli, including nine with residual chlorine and nine untreated samples from sources yielding no E. coli. Eleven years after implementation, 85% of HCFs continued to use water stations that protected water from recontamination. Sustainable provision of soap and water treatment products could optimize intervention use.
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Affiliation(s)
- William Davis
- Centers for Disease Control and Prevention, Waterborne Diseases Prevention Branch, Atlanta, Georgia
| | | | | | | | - Alex Mwaki
- Safe Water and AIDS Project, Kisumu, Kenya
| | - Anu Rajasingham
- Centers for Disease Control and Prevention, Emergency Recovery and Response Branch, Atlanta, Georgia
| | - Sunkyung Kim
- Centers for Disease Control and Prevention, Biostatistics and Information Management Office, Atlanta, Georgia
| | - Robert Quick
- Centers for Disease Control and Prevention, Waterborne Diseases Prevention Branch, Atlanta, Georgia
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Improvement of Quality of Antenatal Care (ANC) Service Provision at the Public Health Facilities in Lao PDR: Perspective and Experiences of Supply and Demand Sides. BMC Pregnancy Childbirth 2019; 19:255. [PMID: 31331276 PMCID: PMC6647136 DOI: 10.1186/s12884-019-2345-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The maternal mortality rate in Lao PDR (Laos) is still the highest in Southeast Asia, at 197 per 100,000 live births. Antenatal care (ANC) could contribute to maternal and child mortality reduction. The quality of ANC service remains inadequate and little information is available on the quality of health education and counseling services of health providers in Laos. This study aims to gain insight into the perceptions of stakeholders on both supply and demand sides of public ANC services in Laos and evidence for recommendations to improve the quality of ANC services. METHODS Semi-structured interviews were conducted with 50 participants from different stakeholder groups; on the demand side, couples with a currently pregnant woman and mothers with children under one year of age and a family member; and on the supply side, health providers, managers, policy makers of the Ministry of Health, and development partners. The interviews were voice recorded and transcribed verbatim for analysis by open and thematic coding, using the MAXQDA software program. RESULTS All respondents reported that the number of pregnant women who visit ANC services has increased. However, an analysis of the supply side identified issues related to the quality of ANC that need to be improved in the areas of facilities, human resources, privacy and confidentiality, providers' behavior, attitudes, and ineffective communication skills when it comes to providing health education and counseling to pregnant women and their family members. The analysis of the demand side mainly emphasized the issues of providers' behavior, attitude, communication and unequal treatment, and the lack of privacy. Both sides also suggested solutions to the problems, such as training, effective materials, rewarding good role models, and building a feedback system. CONCLUSION The number of public ANC services has increased, but both supply and demand sides experienced challenges with the quality of ANC. All respondents proposed possible solutions to improve quality of ANC service in public health facilities in Laos.
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Jean E, Sevilla Guerra S, Contandriopoulos D, Perroux M, Kilpatrick K, Zabalegui A. Context and implementation of advanced nursing practice in two countries: An exploratory qualitative comparative study. Nurs Outlook 2019; 67:365-380. [DOI: 10.1016/j.outlook.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 01/09/2019] [Accepted: 02/02/2019] [Indexed: 11/15/2022]
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Lizarondo L, Lockwood C, McArthur A. Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action. Worldviews Evid Based Nurs 2019; 16:131-141. [PMID: 30977592 DOI: 10.1111/wvn.12355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Culture- and context-specific issues in African countries such as those related to language, resources, technology, infrastructure and access to available research may confound evidence implementation efforts. Understanding the factors that support or inhibit the implementation of strategies aimed at improving care and health outcomes specific to their context is important. AIMS The aim of this study was to determine barriers and facilitators to evidence implementation in African healthcare settings, based on implementation projects undertaken as part of the Joanna Briggs Institute (JBI) Clinical Fellowship program. METHODS Reports of implementation projects conducted in Africa were obtained from the JBI database and printed monographs associated with the fellowship program. A purpose-built data extraction form was used to collect data from individual reports. Data were analysed using content analysis. RESULTS Eleven published and nine unpublished implementation reports were reviewed. The most frequently reported barriers to evidence implementation operate at the health organization or health practitioner level. Health organization-level barriers relate to human resources, material resources and policy issues. Health practitioner-level barriers relate to practitioners' knowledge and skills around evidence-based practice, and attitudes to change. Barriers at the government and consumer levels were uncommon. Only a few facilitators were identified and were related to health practitioners' attitudes or support from the organization's management. LINKING EVIDENCE TO ACTION The study identified a core set of barriers and facilitators in African healthcare settings, which are common to other low- and middle-income countries. These can be used to develop a method by which implementation programs can systematically undertake barrier or facilitator analysis. Future research should aim to develop a process by which these barriers and facilitators can be prioritised so that a structured decision support procedure can be established.
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Affiliation(s)
- Lucylynn Lizarondo
- Implementation Science, Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Craig Lockwood
- Implementation Science, Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Alexa McArthur
- Transfer Science, Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
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Ehiri JE, Alaofè HS, Yesufu V, Balogun M, Iwelunmor J, Kram NAZ, Lott BE, Abosede O. AIDS-related stigmatisation in the healthcare setting: a study of primary healthcare centres that provide services for prevention of mother-to-child transmission of HIV in Lagos, Nigeria. BMJ Open 2019; 9:e026322. [PMID: 31110094 PMCID: PMC6530297 DOI: 10.1136/bmjopen-2018-026322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess AIDS stigmatising attitudes and behaviours by prevention of mother-to-child transmission (PMTCT) service providers in primary healthcare centres in Lagos, Nigeria. DESIGN Cross-sectional survey. SETTING Thirty-eight primary healthcare centres in Lagos, Nigeria. PARTICIPANTS One hundred and sixty-one PMTCT service providers. OUTCOME MEASURES PMTCT service providers' discriminatory behaviours, opinions and stigmatising attitudes towards persons living with HIV/AIDS (PLWHAs), and nature of the work environment (HIV/AIDS-related policies and infection-control guidelines/supplies). RESULTS Reported AIDS-related stigmatisation was low: few respondents (4%) reported hearing coworkers talk badly about PLWHAs or observed provision of poor-quality care to PLWHAs (15%). Health workers were not worried about secondary AIDS stigmatisation due to their occupation (86%). Opinions about PLWHAs were generally supportive; providers strongly agreed that women living with HIV should be allowed to have babies if they wished (94%). PMTCT service providers knew that consent was needed prior to HIV testing (86%) and noted that they would get in trouble at work if they discriminated against PLWHAs (83%). A minority reported discriminatory attitudes and behaviours; 39% reported wearing double gloves and 41% used other special infection-control measures when providing services to PLWHAs. Discriminatory behaviours were correlated with negative opinions about PLWHAs (r=0.21, p<0.01), fear of HIV infection (r=0.16, p<0.05) and professional resistance (r=0.32, p<0.001). Those who underwent HIV training had less fear of contagion. CONCLUSIONS This study documented generally low levels of reported AIDS-related stigmatisation by PMTCT service providers in primary healthcare centres in Lagos. Policies that reduce stigmatisation against PLWHA in the healthcare setting should be supported by the provision of basic resources for infection control. This may reassure healthcare workers of their safety, thus reducing their fear of contagion and professional resistance to care for individuals who are perceived to be at high risk of HIV.
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Affiliation(s)
- John E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Halimatou S Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Victoria Yesufu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mobolanle Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, School of Public Health, University of St. Louis, St. Louis, Missouri, USA
| | - Nidal A-Z Kram
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Breanne E Lott
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Olayinka Abosede
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
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84
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Mocumbi S, McKee K, Munguambe K, Chiau R, Högberg U, Hanson C, Wallin L, Sevene E, Bergström A. Ready to deliver maternal and newborn care? Health providers' perceptions of their work context in rural Mozambique. Glob Health Action 2019; 11:1532631. [PMID: 30387378 PMCID: PMC6225433 DOI: 10.1080/16549716.2018.1532631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. Constraints relate to lack of human and financial resources and weak health systems, however limited resources alone do not explain the variance. Understanding the healthcare context ahead of implementing new interventions can inform the choice of strategies to achieve a successful implementation. The Context Assessment for Community Health (COACH) tool was developed to assess modifiable aspects of the healthcare context that theoretically influence the implementation of evidence. Objectives: To investigate the comprehensibility and the internal reliability of COACH and its use to describe the healthcare context as perceived by health providers involved in maternal care in Mozambique. Methods: A response process evaluation was completed with six purposively selected health providers to uncover difficulties in understanding the tool. Internal reliability was tested using Cronbach’s α. Subsequently, a cross-sectional survey using COACH, which contains 49 items assessing eight dimensions, was administered to 175 health providers in 38 health facilities within six districts in Mozambique. Results: The content of COACH was clear and most items were understood. All dimensions were near to or exceeded the commonly accepted standard for satisfactory internal reliability (0.70). Analysis of the survey data indicated that items on all dimensions were rated highly, revealing positive perception of context. Significant differences between districts were found for the Work culture, Leadership, and Informal payment dimensions. Responses to many items had low variance and were left-skewed. Conclusions: COACH was comprehensible and demonstrated good reliability, although biases may have influenced participants’ responses. The study suggests that COACH has the potential to evaluate the healthcare context to identify shortcomings and enable the tailoring of strategies ahead of implementation. Supplementing the tool with qualitative approaches will provide an in-depth understanding of the healthcare context.
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Affiliation(s)
- Sibone Mocumbi
- a Department of Obstetrics and Gynaecology, Faculty of Medicine , Universidade Eduardo Mondlane (UEM) , Maputo , Mozambique.,b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Kevin McKee
- c School of Education, Health and Social Studies , Dalarna University , Falun , Sweden
| | - Khátia Munguambe
- d Department of Public Health , Faculty of Medicine, Universidade Eduardo Mondlane (UEM) , Maputo , Mozambique.,e Centro de Investigação em Saúde de Manhiça (CISM) , Manhiça , Mozambique
| | - Rogério Chiau
- e Centro de Investigação em Saúde de Manhiça (CISM) , Manhiça , Mozambique
| | - Ulf Högberg
- b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Claudia Hanson
- f Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,g Department of Disease Control , London School of Hygiene and Tropical Medicine , London , UK
| | - Lars Wallin
- c School of Education, Health and Social Studies , Dalarna University , Falun , Sweden.,h Department of Neurobiology, Care Sciences and Society, Division of Nursing , Karolinska Institutet , Stockholm , Sweden.,i Department of Health and Care Sciences , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Esperança Sevene
- e Centro de Investigação em Saúde de Manhiça (CISM) , Manhiça , Mozambique.,j Department of Physiological Science, Clinical Pharmacology , Faculty of Medicine, Universidade Eduardo Mondlane (UEM) , Maputo , Mozambique
| | - Anna Bergström
- b Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.,k Institute for Global Health , University College London , London , UK
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85
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Puchalski Ritchie LM, Debebe F, Azazh A. Barriers to and facilitators of the development and utilization of context appropriate evidence based clinical algorithms to optimize clinical care and patient outcomes in the Tikur Anbessa emergency department: a multi-component qualitative study. BMC Health Serv Res 2019; 19:181. [PMID: 30894150 PMCID: PMC6425575 DOI: 10.1186/s12913-019-4008-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 03/13/2019] [Indexed: 11/18/2022] Open
Abstract
Background Evidence-based clinical algorithms (EBCA) are knowledge tools to promote evidence use by codifying evidence into action plans to facilitate appropriate care. However, their impact on process and outcomes of care varies considerably across practice settings and providers, highlighting the need for tailoring of both these knowledge tools and their implementation strategies to target end users and the setting in which EBCAs are to be employed. Leadership at the Tikur Anbessa Specialized Hospital emergency department (TASH-ED) in Addis Ababa, Ethiopia identified a need for context-appropriate EBCAs to improve evidence uptake to mitigate care gaps in this high volume, high acuity setting. We aimed to identify barriers and facilitators to utilization of EBCAs in the TASH-ED, to identify priority targets for development of EBCAs tailored for the TASH-ED context and to understand the process of care in the TASH-ED to inform implementation planning. Methods We employed a multi-component qualitative design including: semi-structured interviews with TASH-ED clinical, administrative and support services staff, and Toronto EM physicians who had worked in the TASH-ED; direct observation of the process of care in TASH-ED; document review. Results Although most TASH-ED participants reported an awareness of EBCAs, they noted little or no experience using them, primarily due to the poor fit of many EBCAs to their practice setting. All participants felt that context-appropriate EBCAs were needed to ensure standardized and evidence-based care and improve patient outcomes for common ED presentations. Trauma, sepsis, acute cardiac conditions, hypertensive emergencies, and diabetic keto-acidosis were most commonly identified as priorities for EBCA development. Lack of medication, equipment and human resources were identified as the primary barriers to use of EBCAs in the TASH-ED. Support from leadership and engagement of stakeholders outside the ED where EBCAs were believed to be less well accepted were identified as essential facilitators to implementation of EBCAs in the TASH-ED. Conclusions This study found a perceived need for EBCAs tailored to the TASH-ED setting to support uptake of evidence-based care into routine practice for common clinical presentations. Barriers and facilitators provide information essential to development of both context-appropriate EBCAs and plans for their implementation in the TASH-ED. Electronic supplementary material The online version of this article (10.1186/s12913-019-4008-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Canada. .,Department of Emergency Medicine, University Health Network, Toronto, Canada. .,Knowledge Translation Program, Li Ka Shing Knowledge Institue, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Finot Debebe
- Department of Emergency Medicine and Critical Care, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
| | - Aklilu Azazh
- Department of Emergency Medicine and Critical Care, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia
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86
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Koroma MM, Kamara MA, Keita N, Lokossou VK, Sundufu AJ, Jacobsen KH. Access to Essential Medications and Equipment for Obstetric and Neonatal Primary Care in Bombali District, Sierra Leone. WORLD MEDICAL & HEALTH POLICY 2019. [DOI: 10.1002/wmh3.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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87
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Tessema GA, Gomersall JS, Laurence CO, Mahmood MA. Healthcare providers' perspectives on use of the national guideline for family planning services in Amhara Region, Ethiopia: a qualitative study. BMJ Open 2019; 9:e023403. [PMID: 30787080 PMCID: PMC6398659 DOI: 10.1136/bmjopen-2018-023403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore healthcare providers' views on barriers to and facilitators of use of the national family planning (FP) guideline for FP services in Amhara Region, Ethiopia. DESIGN Qualitative study. SETTING Nine health facilities including two hospitals, five health centres and two health posts in Amhara Region, Northwest Ethiopia. PARTICIPANTS Twenty-one healthcare providers working in the provision of FP services in Amhara Region. PRIMARY AND SECONDARY OUTCOME MEASURES Semistructured interviews were conducted to understand healthcare providers' views on barriers to and facilitators of the FP guideline use in the selected FP services. RESULTS While the healthcare providers' views point to a few facilitators that promote use of the guideline, more barriers were identified. The barriers included: lack of knowledge about the guideline's existence, purpose and quality, healthcare providers' personal religious beliefs, reliance on prior knowledge and tradition rather than protocols and guidelines, lack of availability or insufficient access to the guideline and inadequate training on how to use the guideline. Facilitators for the guideline use were ready access to the guideline, convenience and ease of implementation and incentives. CONCLUSIONS While development of the guideline is an important initiative by the Ethiopian government for improving quality of care in FP services, continued use of this resource by all healthcare providers requires planning to promote facilitating factors and address barriers to use of the FP guideline. Training that includes a discussion about healthcare providers' beliefs and traditional practices as well as other factors that reduce guideline use and increasing the sufficient number of guideline copies available at the local level, as well as translation of the guideline into local language are important to support provision of quality care in FP services.
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Affiliation(s)
- Gizachew Assefa Tessema
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Judith Streak Gomersall
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Caroline O Laurence
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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88
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Lall D, Engel N, Devadasan N, Horstman K, Criel B. Models of care for chronic conditions in low/middle-income countries: a 'best fit' framework synthesis. BMJ Glob Health 2018; 3:e001077. [PMID: 30687524 PMCID: PMC6326308 DOI: 10.1136/bmjgh-2018-001077] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 11/23/2022] Open
Abstract
Management of chronic conditions is a challenge for healthcare delivery systems world over and especially for low/middle-income countries (LMIC). Redesigning primary care to deliver quality care for chronic conditions is a need of the hour. However, much of the literature is from the experience of high-income countries. We conducted a synthesis of qualitative findings regarding care for chronic conditions at primary care facilities in LMICs. The themes identified were used to adapt the existing chronic care model (CCM) for application in an LMIC using the ‘best fit’ framework synthesis methodology. Primary qualitative research studies were systematically searched and coded using themes of the CCM. The results that could not be coded were thematically analysed to generate themes to enrich the model. Search strategy keywords were: primary health care, diabetes mellitus type 2, hypertension, chronic disease, developing countries, low, middle-income countries and LMIC country names as classified by the World Bank. The search yielded 404 articles, 338 were excluded after reviewing abstracts. Further, 42 articles were excluded based on criteria. Twenty-four studies were included for analysis. All themes of the CCM, identified a priori, were represented in primary studies. Four additional themes for the model were identified: a focus on the quality of communication between health professionals and patients, availability of essential medicines, diagnostics and trained personnel at decentralised levels of healthcare, and mechanisms for coordination between healthcare providers. We recommend including these in the CCM to make it relevant for application in an LMIC.
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Affiliation(s)
- Dorothy Lall
- Health Service Research, Institute of Public Health, Bengaluru, India
| | - Nora Engel
- Department of Health Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Klasien Horstman
- Department of Health Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Bart Criel
- Department of Health Financing, Institute of Tropica Medicine, Antwerp, Belgium
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89
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Bell D, Gachuhi N, Assefi N. Dynamic Clinical Algorithms: Digital Technology Can Transform Health Care Decision-Making. Am J Trop Med Hyg 2018; 98:9-14. [PMID: 29141738 PMCID: PMC5928722 DOI: 10.4269/ajtmh.17-0477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Most health care in low-income countries is delivered at a primary care level by health workers who lack quality training and supervision, often distant from more experienced support. Lack of knowledge and poor communication result in a poor quality of care and inefficient delivery of health services. Although bringing great benefits in sectors such as finance and telecommunication in recent years, the Digital Revolution has lightly and inconsistently affected the health sector. These advances offer an opportunity to dramatically transform health care by increasing the availability and timeliness of information to augment clinical decision-making, based on improved access to patient histories, current information on disease epidemiology, and improved incorporation of data from point-of-care and centralized diagnostic testing. A comprehensive approach is needed to more effectively incorporate current digital technologies into health systems, bringing external and patient-derived data into the clinical decision-making process in real time, irrespective of health worker training or location. Such dynamic clinical algorithms could provide a more effective framework within which to design and integrate new digital health technologies and deliver improved patient care by primary care health workers.
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Affiliation(s)
- David Bell
- Intellectual Ventures Global Good Fund, Bellevue, Washington
| | - Noni Gachuhi
- Intellectual Ventures Global Good Fund, Bellevue, Washington
| | - Nassim Assefi
- Intellectual Ventures Global Good Fund, Bellevue, Washington
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90
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Factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries: a mixed-method study. Eur J Clin Microbiol Infect Dis 2018; 37:1923-1929. [PMID: 30097753 DOI: 10.1007/s10096-018-3327-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/10/2018] [Indexed: 02/05/2023]
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91
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Charanthimath U, Vidler M, Katageri G, Ramadurg U, Karadiguddi C, Kavi A, Joshi A, Mungarwadi G, Bannale S, Rakaraddi S, Sawchuck D, Qureshi R, Sharma S, Payne BA, von Dadelszen P, Derman R, Magee LA, Goudar S, Mallapur A, Bellad M, Bhutta Z, Naik S, Mulla A, Kamle N, Dhamanekar V, Drebit SK, Kariya C, Lee T, Li J, Lui M, Khowaja AR, Tu DK, Revankar A. The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India. Reprod Health 2018; 15:101. [PMID: 29945662 PMCID: PMC6019995 DOI: 10.1186/s12978-018-0532-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy. METHODS This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software. RESULTS There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy. CONCLUSION Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
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Affiliation(s)
- Umesh Charanthimath
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Geetanjali Katageri
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Umesh Ramadurg
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | | | - Avinash Kavi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Anjali Joshi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Geetanjali Mungarwadi
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Sheshidhar Bannale
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Sangamesh Rakaraddi
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Diane Sawchuck
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
| | - Rahat Qureshi
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Beth A. Payne
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
| | - Peter von Dadelszen
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
| | - Richard Derman
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Laura A. Magee
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
| | - Shivaprasad Goudar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - Ashalata Mallapur
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
| | - Mrutyunjaya Bellad
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
| | - and the Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Zulfiqar Bhutta
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Sheela Naik
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Anis Mulla
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Namdev Kamle
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Vaibhav Dhamanekar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Sharla K. Drebit
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Chirag Kariya
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Tang Lee
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Jing Li
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Mansun Lui
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Asif R. Khowaja
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Domena K. Tu
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
| | - Amit Revankar
- KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka India
- Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka India
- Department of Research, Vancouver Island Health Authority, Victoria, BC Canada
- Division of Women and Child Health, Aga Khan University, Karachi, Sindh Pakistan
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England
- Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA USA
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92
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Dalinjong PA, Wang AY, Homer CSE. The implementation of the free maternal health policy in rural Northern Ghana: synthesised results and lessons learnt. BMC Res Notes 2018; 11:341. [PMID: 29843780 PMCID: PMC5975462 DOI: 10.1186/s13104-018-3452-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/24/2018] [Indexed: 01/15/2023] Open
Abstract
Objective A free maternal health policy was implemented under Ghana’s National Health Insurance Scheme to promote the use of maternal health services. Under the policy, women are entitled to free services throughout pregnancy and at childbirth. A mixed methods study involving women, providers and insurance managers was carried out in the Kassena-Nankana municipality of Ghana. It explored the affordability, availability, acceptability and quality of services. In this manuscript, we present synthesised results categorised as facilitators and barriers to access as well as lessons learnt (implications). Results Reasonable waiting times, cleanliness of facilities as well as good interpersonal relationships with providers were the facilitators to access. Barriers included out of pocket payments, lack of, or inadequate supply of drugs and commodities, equipment, water, electricity and emergency transport. Four lessons (implications) were identified. Firstly, out of pocket payments persisted. Secondly, the health system was not strengthened before implementing the free maternal health policy. Thirdly, lower level facilities were poorly resourced. Finally, the lack of essential inputs and infrastructure affected quality of care and therefore, access to care. It is suggested that the Government of Ghana, the Health Insurance Scheme and other stakeholders improve the provision of resources to facilities.
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Affiliation(s)
| | - Alex Y Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, Australia
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93
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Lal S, Ndyomugenyi R, Paintain L, Alexander ND, Hansen KS, Magnussen P, Chandramohan D, Clarke SE. Caregivers' compliance with referral advice: evidence from two studies introducing mRDTs into community case management of malaria in Uganda. BMC Health Serv Res 2018; 18:317. [PMID: 29720163 PMCID: PMC5932808 DOI: 10.1186/s12913-018-3124-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/15/2018] [Indexed: 11/16/2022] Open
Abstract
Background Several malaria endemic countries have implemented community health worker (CHW) programmes to increase access to populations underserved by health care. There is considerable evidence on CHW adherence to case management guidelines, however, there is limited evidence on the compliance to referral advice and the outcomes of children under-5 referred by CHWs. This analysis examined whether caregivers complied with CHWs referral advice. Methods Data from two cluster (village) randomised trials, one in a moderate-to-high malaria transmission setting, another in a low-transmission setting conducted between January 2010–July 2011 were analysed. CHW were trained to recognise signs and symptoms that required referral to a health centre. CHW in the intervention arm also had training on; malaria rapid diagnostic tests (mRDT) and administering artemisinin based combination therapy (ACT); CHW in the control arm were trained to treat malaria with ACTs based on fever symptoms. Caregivers’ referral forms were linked with CHW treatment forms to determine whether caregivers complied with the referral advice. Factors associated with compliance were examined with logistic regression. Results CHW saw 18,497 child visits in the moderate-to-high transmission setting and referred 15.2% (2815/18,497) of all visits; in the low-transmission setting, 35.0% (1135/3223) of all visits were referred. Compliance to referral was low, in both settings < 10% of caregivers complied with referral advice. In the moderate-to-high transmission setting compliance was higher if children were tested with mRDT compared to children who were not tested with mRDT. In both settings, nearly all children treated with pre-referral rectal artesunate failed to comply with referral and compliance was independently associated with factors such as health centre distance and day of referral by a CHW. In the moderate-to-high transmission setting, time of presentation, severity of referral were also associated with compliance, whilst in the low-transmission setting, compliance was low if an ACT was prescribed. Conclusions This analysis suggests there are several barriers to comply with CHWs referral advice by caregivers. This is concerning for children who received rectal artesunate. As CHW programmes continue scale-up, barriers to referral compliance need to be addressed to ensure a continuum of care from the community to the health centre. Trial registration The study was registered with ClinicalTrials.gov. Identifier NCT01048801, 13th January 2010. Electronic supplementary material The online version of this article (10.1186/s12913-018-3124-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sham Lal
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
| | | | - Lucy Paintain
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Neal D Alexander
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kristian S Hansen
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark.,Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Siân E Clarke
- Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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94
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Pryor W, Newar P, Retis C, Urseau I. Compliance with standards of practice for health-related rehabilitation in low and middle-income settings: development and implementation of a novel scoring method. Disabil Rehabil 2018; 41:2264-2271. [DOI: 10.1080/09638288.2018.1462409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Wesley Pryor
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Pushpak Newar
- Rehabilitation Division, HI-Humanity and Inclusion, Lyon, France
| | - Chiara Retis
- Rehabilitation Division, HI-Humanity and Inclusion, Lyon, France
| | - Isabelle Urseau
- Rehabilitation Division, HI-Humanity and Inclusion, Lyon, France
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95
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Modi RN, Chapman L, Gajria C, Tang EYH. ‘The best laid schemes o’ mice an’ men’: a workshop to teach the application of evidence based medicine in low- and middle-income countries. EDUCATION FOR PRIMARY CARE 2018; 29:107-112. [DOI: 10.1080/14739879.2017.1413597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rakesh Narendra Modi
- Institute for Global Health, University College London, London, UK
- Department of Primary Care and Population Health, University College London, London, UK
- Junior International Committee, Royal College of General Practitioners, London, UK
| | | | - Camille Gajria
- Junior International Committee, Royal College of General Practitioners, London, UK
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96
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Iyer A, Srinidhi V, Sreevathsa A, Sen G. Adapting maternal health practice to co-morbidities and social inequality: A systematic approach. Canadian Journal of Public Health 2017; 108:e448-e451. [PMID: 29120320 DOI: 10.17269/cjph.108.5571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/30/2017] [Accepted: 01/15/2017] [Indexed: 11/17/2022]
Abstract
The process of adapting universal guidelines to local institutional and cultural settings is recognized as important to their implementation and uptake. However, clarity on what, why and how to adapt in an evidence-based manner is still somewhat elusive. Health providers in low and middle income country contexts often have to deal with widely present co-morbidities and social inequalities among pregnant women. Since neither of these problems finds adequate discussion within the usual guidelines, and given the continual pressures posed by resource scarcity, health providers respond through ad hoc adaptations inimical to maternal safety and equity. We argue for, and describe, a grounded process of systematic adaptation of available guidelines through the example of a handbook on maternal risks for primary care doctors and staff nurses. The systematic adaptation in this practical, action-oriented handbook builds on research for a long-standing community-based project on maternal safety and rights. It takes a case-based problem-solving approach. Reiterating guidelines and best practices in diagnostic decision-making and risk management, it indicates how these can respond to co-morbidities and social inequality via complex clinical cases and new social science information.
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Affiliation(s)
- Aditi Iyer
- Senior Research Scientist & Adjunct Associate Professor, Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India.
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97
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Samnani AABA, Rizvi N, Ali TS, Abrejo F. Barriers or gaps in implementation of misoprostol use for post-abortion care and post-partum hemorrhage prevention in developing countries: a systematic review. Reprod Health 2017; 14:139. [PMID: 29078777 PMCID: PMC5659002 DOI: 10.1186/s12978-017-0383-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 09/11/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Around 303,000 maternal deaths occur every year; most of these are preventable (World Health Organization), ICD-10: International classification of diseases and related health problems, 10th revision. Volume 2: Instruction manual, 2010). Ninety-nine percent of these maternal deaths occur in developing countries. PPH contributed 35 % (35%) of total maternal. Several interventions being done to reduce the number of maternal deaths. It has been noted that a simple low cost intervention of providing misoprostol timely could prevent these deaths. OBJECTIVES The objectives of this systematic review was to identify barriers/gaps in the implementation of misoprostol use for prevention of postpartum hemorrhage and management of Post-abortion care services in developing countries. METHODS This study was a systematic review of published qualitative and quantitative literature on misoprostol in developing countries. Documents included were local and international peer reviewed articles and program reports on misoprostol implementation. PubMed, Google Scholars and Science direct databases were used along with Grey literature and manual search using terms "implementation gaps", "misoprostol use", "postpartum hemorrhage", "post-abortion care" and "developing countries". RESULTS Gaps or barriers in misoprostol use identified through systematic review can be categorized into six broader thematic areas including: inconsistency in supplies and its distribution; inadequate staffing; lack of knowledge of providers and end users, absence of the registration of drug and fear and apprehensions related to its use at provider and policy level. CONCLUSION It is concluded that barriers and gaps can be addressed through providing enabling environment through supportive policies, designing a formal plan for supplies, task shifting strategies and use of guidelines and protocols for successful implementation.
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Affiliation(s)
| | - Narjis Rizvi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
| | - Farina Abrejo
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
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98
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Maaløe N, Housseine N, Meguid T, Nielsen BB, Jensen A, Khamis RS, Mohamed AG, Ali MM, Said SM, van Roosmalen J, Bygbjerg IC. Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi-experimental pre-post study (The PartoMa study). BJOG 2017; 125:235-245. [PMID: 28892306 DOI: 10.1111/1471-0528.14933] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia. DESIGN Quasi-experimental pre-post study investigating the causal pathway through changes in clinical practice. SETTING Tanzanian low-resource referral hospital, Mnazi Mmoja Hospital. POPULATION Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention
month (1 October 2015 until 31 January 2016) [corrected]. METHODS Birth outcome was extracted from all cases of labouring women during baseline (n = 3690) and intervention months (n = 3087). Background characteristics and quality of care were assessed in quasi-randomly selected subgroups (n = 283 and n = 264, respectively). MAIN OUTCOME MEASURES Stillbirths and neonates with 5-minute Apgar score ≤5. RESULTS Stillbirth rate fell from 59 to 39 per 1000 total births (RR 0.66, 95% CI 0.53-0.82), and subanalyses suggest that this was primarily due to reduction in intrahospital stillbirths. Apgar scores between 1 and 5 fell from 52 to 28 per 1000 live births (RR 0.53, 95% CI 0.41-0.69). Median time from last fetal heart assessment till delivery (or fetal death diagnosis) fell from 120 minutes (IQR 60-240) to 74 minutes (IQR 30-130) (Mann-Whitney test for difference, P < 0.01). Oxytocin augmentation declined from 22% to 12% (RR 0.54, 95% CI 0.37-0.81) and timely use improved. CONCLUSION Although low human resources and substandard care remain major challenges, PartoMa guidelines were associated with improvements in care, leading to reductions in stillbirths and birth asphyxia. Findings furthermore emphasise the central role of improved fetal surveillance and restricted intrapartum oxytocin use in safety at birth. TWEETABLE ABSTRACT: #PartoMa guidelines aided in reducing stillbirths and birth asphyxia at a Tanzanian low-resource hospital PLAIN LANGUAGE SUMMARY: PartoMa guidelines help birth attendants in Tanzania to save lives Every year, 3 million babies die on the day of birth. The vast majority of these deaths occur in the poorest countries. If their mothers had received better care during birth, most babies would have survived. At Mnazi Mmoja Hospital, an East African referral hospital, the PartoMa study shows that use of locally developed guidelines helps birth attendants to deliver better quality of care, which has led to improved survival at birth. At the hospital studied, resources are scarce. Each birth attendant assists four to six birthing women simultaneously, and many have less than 1 year of professional experience. International guidelines are available, but they are often unachievable and seldom applied. The PartoMa guidelines were developed in close collaboration with the birth attendants and approved by seven international experts. The result is an 8-page pocket booklet providing locally achievable and simple decision support for care during birth. Use of the PartoMa guidelines began in February 2015. As the staff group frequently changes, quarterly seminars are conducted where birth attendants are welcomed after working hours to learn about the guidelines. The guidelines have been positively received, and seminar attendance remains high. Use of the PartoMa guidelines is associated with: A decrease by one-third in stillbirths (59 to 39 per 1000 total births) A nearly halving in the number of babies born in immediate poor medical condition (52 to 28 per 1000 live births) The results presented here derive from a comparison of births before using the PartoMa guidelines and during the 9th-12th month of use. Such a 'before-after' study cannot exclude the possibility of other causes of better survival at birth. However, the improved survival is consistent with improved care during birth, which is in line with the PartoMa guidelines.
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Affiliation(s)
- N Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - N Housseine
- Mnazi Mmoja Hospital, Zanzibar, Tanzania.,Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T Meguid
- Mnazi Mmoja Hospital, Zanzibar, Tanzania.,School of Health & Medical Sciences, State University of Zanzibar, Zanzibar, Tanzania
| | - B B Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Akg Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - R S Khamis
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | | | - M M Ali
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - S M Said
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - J van Roosmalen
- Athena Institute, VU University of Amsterdam, Amsterdam, the Netherlands
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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99
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Effective nutrition education and communication for sustainable maternal and child health. Proc Nutr Soc 2017; 76:504-515. [PMID: 28662730 DOI: 10.1017/s0029665117001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Maternal and child health (MCH) consists of an interdependent reproductive system that collectively determines the survival of the mother during childbirth, and determines the health and survival of the child. This interdependency underscores the importance of appropriate and timely interventions during pregnancy through the first 1000 d at the minimum. The Millennium Development Goals (MDG) recommended the use of the continuum of care for the development of interventions by addressing all the stages of MCH. The purpose of the present paper is to review the factors that contributed to the attainment of the MDG 4 and MDG 5 by analysing the interventions conducted by the countries that achieved at least 5·0 and 5·5 %, respectively, and determine the level of their intervention based on the MCH conceptual framework. Out of the eighteen selected countries discussed, fifteen countries achieved their target for either MDG 4 or MDG 5 or both, while three countries did not achieve their target. The countries that were more likely to achieve their targets addressed the societal, underlying and direct causes, and implemented country wide policies. In contrast, the countries that did not succeed were more likely to address the direct causes with poor policy implementation. Understanding the motivation and limitations of the target population, including nutrition education and targeting behaviour change has the potential to result in sustainable MCH. This information has the potential to enlighten the policymakers as we progress to the sustainable development goals, specifically goals 2 and 3.
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100
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Maaløe N, Housseine N, van Roosmalen J, Bygbjerg IC, Tersbøl BP, Khamis RS, Nielsen BB, Meguid T. Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants' perceptions. BMC Pregnancy Childbirth 2017; 17:175. [PMID: 28592237 PMCID: PMC5463375 DOI: 10.1186/s12884-017-1360-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While international guidelines for intrapartum care appear to have increased rapidly since 2000, literature suggests that it has only in few instances been matched with reviews of local modifications, use, and impact at the targeted low resource facilities. At a Tanzanian referral hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants' perceptions. METHODS Part 1: Modification of evidence-based international guidelines through repeated evaluation cycles by local staff and seven external specialists in midwifery/obstetrics. Part 2: Questionnaire evaluation 12 months post-implementation of perceptions and use among professional birth attendants. RESULTS Part 1: After the development process, including three rounds of evaluation by staff and two external peer-review cycles, there were no major concerns with the guidelines internally nor externally. Thereby, international recommendations were condensed to the eight-paged 'PartoMa guidelines ©'. This pocket booklet includes routine assessments, supportive care, and management of common abnormalities in foetal heart rate, labour progress, and maternal condition. It uses colour codes indicating urgency. Compared to international guidelines, reductions were made in frequency of assessments, information load, and ambiguity. Part 2: Response rate of 84% (n = 84). The majority of staff (93%) agreed that the guidelines helped to improve care. They found the guidelines achievable (89%), and the graphics worked well (90%). Doctors more often than nurse-midwives (89% versus 74%) responded to use the guidelines daily. CONCLUSIONS The PartoMa guidelines ensure readily available, locally achievable, and acceptable support for intrapartum surveillance, triage, and management. This is a crucial example of adapting evidence-based international recommendations to local reality. TRIAL REGISTRATION This paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org ( NCT02318420 , 4th November 2014).
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Natasha Housseine
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Jos van Roosmalen
- Athena Institute, VU University of Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Rashid Saleh Khamis
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Birgitte Bruun Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health & Medical Sciences, State University of Zanzibar, P.O.Box:146, Zanzibar, Tanzania
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