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Ramadany S, Djaharuddin I, Zainuddin AA, Aras I, Madjid I, Delima AA. Knowledge and attitudes of patients’ family toward efforts in preventing tuberculosis in Tamalanrea Health Center. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ehrlich R, Spiegel JM, Adu P, Yassi A. Current Guidelines for Protecting Health Workers from Occupational Tuberculosis Are Necessary, but Not Sufficient: Towards a Comprehensive Occupational Health Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3957. [PMID: 32503223 PMCID: PMC7313452 DOI: 10.3390/ijerph17113957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 12/16/2022]
Abstract
Health workers globally are at elevated occupational risk of tuberculosis infection and disease. While a raft of guidelines have been published over the past 25 years on infection prevention and control (IPC) in healthcare, studies in different settings continue to show inadequate implementation and persistence of risk. The aim of this commentary is to argue, based on the literature and our own research, that a comprehensive occupational health approach is an essential complement to IPC guidelines. Such an approach includes a health system framework focusing on upstream or mediating components, such as a statutory regulation, leadership, an information system, and staff trained in protective disciplines. Within the classical prevention framework, primary prevention needs to be complemented by occupational health services (secondary prevention) and worker's compensation (tertiary prevention). A worker-centric approach recognises the ethical implications of screening health workers, as well as the stigma perceived by those diagnosed with tuberculosis. It also provides for the voiced experience of health workers and their participation in decision-making. We argue that such a comprehensive approach will contribute to both the prevention of occupational tuberculosis and to the ability of a health system to withstand other crises of infectious hazards to its workforce.
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Affiliation(s)
- Rodney Ehrlich
- Division of Occupational Medicine, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town 8001, South Africa
| | - Jerry M. Spiegel
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; (J.M.S.); (P.A.); (A.Y.)
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; (J.M.S.); (P.A.); (A.Y.)
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada; (J.M.S.); (P.A.); (A.Y.)
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Adu PA, Yassi A, Ehrlich R, Spiegel JM. Perceived Health System Barriers to Tuberculosis Control Among Health Workers in South Africa. Ann Glob Health 2020; 86:15. [PMID: 32090022 PMCID: PMC7019201 DOI: 10.5334/aogh.2692] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The healthcare workforce in high tuberculosis burden countries such as South Africa is at elevated risk of tuberculosis infection and disease with adverse consequences for their well-being and productivity. Despite the availability of international guidelines on protection of health workers from tuberculosis, research globally has focused on proximal deficiencies in practice rather than on health system barriers. Objective This study sought to elicit perceptions of informed persons within the health system regarding health system barriers to protecting health workers from tuberculosis. Methods Semi-structured interviews were conducted with 18 informants active in spheres related to workplace tuberculosis prevention and management in South Africa. Interviews were audio recorded and transcribed verbatim, validated and analysed to derive emergent themes. Responses were analysed using the World Health Organization building blocks as core elements of a health system bearing on protection of its health workforce. Findings The following health system barriers were identified by informants: leadership and governance were "top-down" and fragmented; lack of funding was a major barrier; there were insufficient numbers of staff trained in infection prevention and control and occupational health; occupational health services were not comprehensively available and the ability to sustain protective technologies was questioned. A cross-cutting barrier was lack of priority afforded to workforce occupational health associated with lack of accurate information on cases of TB among health workers. Conclusions We conclude that deficiencies in implementation of recommended infection control and tuberculosis management practices are unlikely to be corrected until health system barriers are addressed. More committed leadership from senior health system management and greater funding are needed. The process could be assisted by the development of indicators to characterise such barriers and monitor progress.
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Affiliation(s)
- Prince A. Adu
- School of Population and Public Health, University of British Columbia, Vancouver, CA
- British Columbia Centre for Disease Control, Vancouver, CA
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, CA
| | - Rodney Ehrlich
- School of Public Health and Family Medicine, University of Cape Town, South Africa, ZA
| | - Jerry M. Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, CA
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Nuzzo JB, Meyer D, Snyder M, Ravi SJ, Lapascu A, Souleles J, Andrada CI, Bishai D. What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review. BMC Public Health 2019; 19:1310. [PMID: 31623594 PMCID: PMC6798426 DOI: 10.1186/s12889-019-7707-z] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/30/2019] [Indexed: 11/24/2022] Open
Abstract
Background The 2014–2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency. Methods We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization’s Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations. Results We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings. Conclusions An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.
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Affiliation(s)
- Jennifer B Nuzzo
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA
| | - Diane Meyer
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA.
| | - Michael Snyder
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA
| | - Sanjana J Ravi
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA
| | - Ana Lapascu
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jon Souleles
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Carolina I Andrada
- Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD, 21202, USA
| | - David Bishai
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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van der Westhuizen HM, Nathavitharana RR, Pillay C, Schoeman I, Ehrlich R. The high-quality health system 'revolution': Re-imagining tuberculosis infection prevention and control. J Clin Tuberc Other Mycobact Dis 2019; 17:100118. [PMID: 31788560 PMCID: PMC6880133 DOI: 10.1016/j.jctube.2019.100118] [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] [Indexed: 12/26/2022] Open
Abstract
The Lancet Commission on High-Quality Health Systems called for a 'revolution' in the quality of care provided in low- and middle-income countries. We argue that this provides a helpful framework to demonstrate how effective tuberculosis infection prevention and control (TB IPC) implementation should be linked with health system strengthening, moving it from the silo of the national TB programmes. Using this framework, we identify and discuss links between TB IPC implementation and patient safety, human resources for health, prioritising person-centred care, building trust in health systems and refining the tools used to measure TB IPC implementation. Prioritising patient experience has been a recent addition to the definition of high-quality care. In high TB burden settings, the encounter with TB IPC measures may be a TB patient's initial contact with the healthcare system and may cause feelings of stigmatisation. We advocate for re-imagining the way we implement TB IPC, by drawing on the principles of person-centred care through incorporating the experiences of people using healthcare services. Health workers who developed occupational TB also offer a unique perspective: they have both experienced TB IPC and have played a role in implementing it in their workplace. They can be powerful advocates for person-centred TB IPC implementation. Through framing TB IPC as part of health system strengthening and consciously including person-centred perspectives in TB IPC design, measurement and guidelines, we hope to influence future TB IPC research and practice.
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Affiliation(s)
- Helene-Mari van der Westhuizen
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care building, Oxford University, OX2 6GG, United Kingdom.,TB Proof, South Africa
| | - Ruvandhi R Nathavitharana
- TB Proof, South Africa.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, 110 Francis Street, Suite GB, Boston MA 02215, USA
| | - Clio Pillay
- TB Proof, South Africa.,Department of Public Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom
| | | | - Rodney Ehrlich
- Department of Public Health and Family Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town 7925, South Africa
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Squire JS, Hann K, Denisiuk O, Zachariah R. Staffing in public health facilities after the Ebola outbreak in rural Sierra Leone: How much has changed? F1000Res 2019; 8:793. [PMID: 32148756 PMCID: PMC7047906 DOI: 10.12688/f1000research.18566.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The 2014-2015 Ebola outbreak in Sierra Leone led the Ministry of Health and Sanitation to set minimum standards of staffing (medical/non-medical) at the district level for the provision of basic essential health services (BPEHS). In one of the worst Ebola affected districts in Sierra Leone, we assessed staffing levels measured against these stipulated standards before, during, and 16 months after the Ebola outbreak. Methods: The study population included all health workers in 83 health facilities. We assessed staffing levels at three points in time: pre-Ebola (April 2014); the end of the outbreak (November 2015); and 16 months post-Ebola (March 2017). April 2014 was immediately prior to the Ebola outbreak and thus representative of the human resource situation before the outbreak. November 2015 was the month when Sierra Leone was declared Ebola-free, and thus reflects the end-situation after Ebola. March 2017 was two years since the launch of the BPEHS, and some progress should be expected. Results: Against recommended medical staff numbers during pre-, intra- and post-Ebola periods, deficits were 67%, 65% and 60% respectively. Similarly, against recommended non-medical staff numbers during pre-, intra- and post-Ebola periods, the deficit remained at 92% throughout. In the post-Ebola period, there was a deficit of 73% against 1,389 recommended health worker positions. Conclusions:Nothing has really changed in the state of human resources for health, and urgent measures are needed to rectify the situation and prevent a
déjà vu in the advent of a new Ebola outbreak.
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Affiliation(s)
- James Sylvester Squire
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Katrina Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | | | - Rony Zachariah
- TDR, The Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
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Engelbrecht M, Rau A, Kigozi G, Janse van Rensburg A, Wouters E, Sommerland N, Masquillier C, Uebel K. Waiting to inhale: factors associated with healthcare workers' fears of occupationally-acquired tuberculosis (TB). BMC Infect Dis 2019; 19:475. [PMID: 31138140 PMCID: PMC6540445 DOI: 10.1186/s12879-019-4115-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/21/2019] [Indexed: 12/19/2022] Open
Abstract
Background Fear of TB infection is rooted in historical and social memories of the disease, marked by stigma, segregation and exclusion. Healthcare workers (HCWs) face these same fears today, and even seek to hide their TB status when infected. This study sought to investigate factors associated with HCWs fears of acquiring TB while at work, including selected biographic characteristics, TB knowledge, infection control and perceptions that their colleagues stigmatise co-workers with TB/ presumed to have TB. Methods In the Free State Province, South Africa, a representative sample of 882 HCWs from eight hospitals completed self-administered questionnaires on issues related to fear of occupationally acquired TB, infection control, TB knowledge and workplace TB stigma. The data were analysed using descriptive statistics as well as binomial logistic regression. Results Most of the HCWs (67.2%) were concerned about contracting TB at work. Support staff were less likely to worry about acquiring TB than clinical staff (OR = 0.657, P = 0.041). Respondents who indicated that there were inadequate numbers of disposable respirators at work, were 1.6 times more likely to be afraid of contracting TB at work (P = 0.040). With every unit increase on the TB stigma scale, respondents were 1.1 times more likely to fear acquiring TB at work (P = 0.000). Conclusions Being a professional clinical HCW, not having adequate disposable respirators available and seeing/perceiving co-workers stigmatise colleagues with (presumptive) TB were all significantly associated with the fear of occupationally-acquired TB. It is recommended that campaigns to destigmatise TB, as well as appropriate TB infection control education and measures, are necessary to alleviate HCWs fears of acquiring the disease in the workplace. Ultimately this should create a health-enabling working environment, where HCWs are not afraid to function and are free to seek treatment and support when necessary.
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Affiliation(s)
- Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa.
| | - Asta Rau
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
| | - Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
| | - André Janse van Rensburg
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
| | - Edwin Wouters
- Research Centre for Longitudinal & Life Course Studies (CELLO), University of Antwerp, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium
| | - Nina Sommerland
- Research Centre for Longitudinal & Life Course Studies (CELLO), University of Antwerp, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium
| | - Caroline Masquillier
- Research Centre for Longitudinal & Life Course Studies (CELLO), University of Antwerp, Sint-Jacobstraat 2, BE-2000, Antwerp, Belgium
| | - Kerry Uebel
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
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Ehrlich R, Spiegel J, Yassi A. Diverse approaches to preventing occupational tuberculosis in health workers: cross-disciplinary or cross purposes? Public Health Action 2019; 9:11-14. [PMID: 30963037 DOI: 10.5588/pha.18.0086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/19/2018] [Indexed: 12/29/2022] Open
Affiliation(s)
- R Ehrlich
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Zhang ZN, Zhang XP, Lai XQ. Model of Healthcare-Associated Infection Control in Primary Health Care Institutions: A Structural Equation Modeling. Curr Med Sci 2019; 39:153-158. [PMID: 30868506 DOI: 10.1007/s11596-019-1967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 01/09/2019] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to construct the model of organization system, management, training and surveillance in healthcare-associated infection prevention and control (IC) of primary health care institutions and identify its effect on patient safety and decreasing economic burden by standardizing IC. A cross-sectional survey was conducted with questionnaires. Data were collected from 268 primary health care institutions in Hubei province, China. Hypotheses on the model of IC were analyzed by means of confirmatory factor analysis and structural equation modeling. The results showed that the fit indices of the hypothesized model of IC satisfied recommended levels: root mean square error of approximation (RMSEA)=0.071; comparative fit index (CFI)=0.965; tucker-lewis index (TLI)=0.956; weighted root mean square residual (WRMR)=1.014. The model showed that organization system had a direct effect on management (β=0.311, P<0.01), and training (β=0.365, P<0.01). Management and training played an intermediary role that partially promoted organization system impact on surveillance. Results also showed that institutional factors such as the number of physicians, the number of nurses, the designated capacity of beds, the actual number of open beds and surgery trips had positive impacts on management (β=0.050, P<0.01; β=0.181, P<0.01; β=0.111, P<0.01; β=0.064, P<0.01; β=0.084, P=0.04) and training (β=0.21, P=0.03; β=0.050, P=0.02; β=0.586, P=0.01; β=-0.995, P=0.02; β=-0.223, P=0.03). In conclusion, the model of organization system, management, training and surveillance in IC of primary health care institutions is valuable for guiding IC practice.
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Affiliation(s)
- Zi-Nan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xin-Ping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xiao-Quan Lai
- Department of Nosocomial Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Engelbrecht MC, Kigozi G, Janse van Rensburg AP, Van Rensburg DHCJ. Tuberculosis infection control practices in a high-burden metro in South Africa: A perpetual bane for efficient primary health care service delivery. Afr J Prim Health Care Fam Med 2018; 10:e1-e6. [PMID: 29943601 PMCID: PMC6018120 DOI: 10.4102/phcfm.v10i1.1628] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background Tuberculosis (TB) prevention, including infection control, is a key element in the strategy to end the global TB epidemic. While effective infection control requires all health system components to function well, this is an area that has not received sufficient attention in South Africa despite the availability of policy and guidelines. Aim To describe the state of implementation of TB infection control measures in a high-burden metro in South Africa. Setting The research was undertaken in a high TB- and HIV-burdened metropolitan area of South Africa. More specifically, the study sites were primary health care facilities (PHC), that among other services also diagnosed TB. Methods A cross-sectional survey, focusing on the World Health Organization levels of infection control, which included structured interviews with nurses providing TB diagnosis and treatment services as well as observations, at all 41 PHC facilities in a high TB-burdened and HIV-burdened metro of South Africa. Results Tuberculosis infection control was poorly implemented, with few facilities scoring 80% and above on compliance with infection control measures. Facility controls: 26 facilities (63.4%) had an infection control committee and 12 (29.3%) had a written infection control plan. Administrative controls: 26 facilities (63.4%) reported separating coughing and non-coughing patients, while observations revealed that only 11 facilities (26.8%) had separate waiting areas for (presumptive) TB patients. Environmental controls: most facilities used open windows for ventilation (n = 30; 73.2%); however, on the day of the visit, only 12 facilities (30.3%) had open windows in consulting rooms. Personal protective equipment: 9 facilities (22%) did not have any disposable respirators in stock and only 9 respondents (22%) had undergone fit testing. The most frequently reported barrier to implementing good TB infection control practices was lack of equipment (n = 22; 40%) such as masks and disposable respirators, as well as the structure or layout of the PHC facilities. The main recommendation to improve TB infection control was education for patients and health care workers (n = 18; 33.3%). Conclusion All levels of the health care system should be engaged to address TB prevention and infection control in PHC facilities. Improved infection control will address the nosocomial spread of TB in health facilities and keep health care workers and patients safe from infection.
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Kigozi NG, Heunis JC, Engelbrecht MC, Janse van Rensburg AP, van Rensburg HCJD. Tuberculosis knowledge, attitudes and practices of patients at primary health care facilities in a South African metropolitan: research towards improved health education. BMC Public Health 2017; 17:795. [PMID: 29017526 PMCID: PMC5633895 DOI: 10.1186/s12889-017-4825-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 10/04/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Health education is important to empower patients and encourage their contribution towards tuberculosis (TB) control. In South Africa, health education activities are integrated into services provided at the primary health care (PHC) level. This study was conducted in a high TB burden metropolitan area in South Africa. The objective was to assess TB-related knowledge, attitudes and infection control practices of patients attending PHC facilities. METHODS In September and October 2015, a cross-sectional survey using fieldworker-administered questionnaires was conducted among patients older than 17 years attending 40 PHC facilities in the Mangaung Metropolitan. Convenience sampling was used to select patients. Participation in the study was voluntary. Descriptive, inferential and multivariate logistic regression analyses were performed. Statistical significance was considered at alpha <0.05 and 95% confidence interval. RESULTS A total of 507 patients' data were included in the analysis. Most of the patients knew that TB transmission is facilitated by crowded conditions (84.6%) and that pulmonary TB is contagious (73.0%). Surprisingly, the majority of patients also believed that one can get TB from sharing toothbrushes (85.0%) or kissing (65.0%). An overwhelming majority of patients perceived TB to be serious (89.7%), and concurred that taking treatment (97.2%) and opening windows to prevent transmission in PHC facilities (97.0%) are important. Being employed (AOR: 11.5; CI: 4.8-27.6), having received TB infection control information from a PHC facility (AOR: 2.2; CI: 1.5-3.4), and being a TB patient (AOR: 1.6; CI: 1.02-2.46) increased the likelihood of adopting good infection control practices. CONCLUSION These findings highlight the need for health education efforts to strengthen accurate information dissemination to promote sound TB knowledge and attitudes among patients attending PHC facilities. Health education efforts should also capitalise on the positive finding of this study that information dissemination at PHC facilities increases good infection control practices.
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Affiliation(s)
- N. Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300 South Africa
| | - J. Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300 South Africa
| | - Michelle C. Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300 South Africa
| | - André P. Janse van Rensburg
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300 South Africa
| | - H. C. J. Dingie van Rensburg
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300 South Africa
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12
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Sylvester Squire J, Hann K, Denisiuk O, Kamara M, Tamang D, Zachariah R. The Ebola outbreak and staffing in public health facilities in rural Sierra Leone: who is left to do the job? Public Health Action 2017; 7:S47-S54. [PMID: 28744439 DOI: 10.5588/pha.16.0089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: The 82 public health facilities of rural Kailahun District, Sierra Leone. Objective: The 2014-2015 Ebola virus disease outbreak in Sierra Leone led the Ministry of Health and Sanitation and stakeholders to set minimum standards of staffing (medical/non-medical) for a basic package of essential health services (BPEHS). No district-level information exists on staffing levels in relation to the Ebola outbreak. We examined the staffing levels before the Ebola outbreak, during the last month of the outbreak and 4 months after the outbreak, as well as Ebola-related deaths among health care workers (HCWs). Design: This was a retrospective cross-sectional study. Results: Of 805 recommended medical staff (the minimum requirement for 82 health facilities), there were deficits of 539 (67%) pre-Ebola, 528 (65%) during the Ebola outbreak and 501 (62%) post-Ebola, hovering at staff shortages of >50% at all levels of health facilities. Of the 569 requisite non-medical staff, the gap remained consistent, at 92%, in the three time periods. Of the 1374 overall HCWs recommended by the BPEHS, the current staff shortage is 1026 (75%). Of 321 facility-based HCWs present during Ebola, there were 15 (14 medical and one non-medical staff) Ebola-related and three non-Ebola related deaths among HCWs. Conclusion: The post-Ebola health-related human resource deficit is alarmingly high, with very few staff available to work. We call for urgent political will, resources and international collaboration to address this situation.
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Affiliation(s)
- J Sylvester Squire
- District Health Management Team, Ministry of Health and Sanitation, Kailahun District, Sierra Leone
| | - K Hann
- Partners in Health, Freetown, Sierra Leone
| | - O Denisiuk
- Alliance for Public Health, Kiev, Ukraine
| | - M Kamara
- District Health Management Team, Ministry of Health and Sanitation, Kailahun District, Sierra Leone
| | - D Tamang
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - R Zachariah
- Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre (LuxOR), Luxembourg
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Hermans V, Zachariah R, Woldeyohannes D, Saffa G, Kamara D, Ortuno-Gutierrez N, Kizito W, Manzi M, Alders P, Maikere J. Offering general pediatric care during the hard times of the 2014 Ebola outbreak: looking back at how many came and how well they fared at a Médecins Sans Frontières referral hospital in rural Sierra Leone. BMC Pediatr 2017; 17:34. [PMID: 28122533 PMCID: PMC5264448 DOI: 10.1186/s12887-017-0786-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 01/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Bo district, rural Sierra Leone, we assessed the burden of the 2014 Ebola outbreak on under-five consultations at a primary health center and the quality of care for under-15 children at a Médecins Sans Frontières (MSF) referral hospital. METHODS Retrospective cohort study, comparing a period before (May-October 2013) and during the same period of the Ebola outbreak (2014). Health worker infections occurred at the outbreak peak (October 2014), resulting in hospital closure due to fear of occupational-risk of contracting Ebola. Standardized hospital exit outcomes and case fatality were used to assess quality of care until closure. RESULTS A total of 13,658 children under-five, were seen at the primary health center during 2013 compared to 8761 in 2014; a consultation decline of 36%. Of 6497 children seen in the hospital emergency room, during the outbreak, patients coming from within hospital catchment area declined with 38% and there were significantly more self-referrals (80% vs. 61%, P < 0.001). During Ebola, 23 children were dead on arrival and the proportion of children in severe clinical status (requiring urgent attention) was higher (74% during Ebola vs. 65% before, P < 0.001). Of 5,223 children with available hospital outcomes, unfavorable outcomes (combination of deaths and abandoned) were less than 15% during both periods, which is within the maximum acceptable in-house threshold set by MSF. Case fatality for severe malaria and lower respiratory tract infections (n = 3752) were similar (≤15%). CONCLUSIONS Valuable and good quality pediatric care was being provided in the pediatric hospital during the 2014 Ebola outbreak, but could not be sustained because of hospital closure. Health facility and health worker safety should be tackled as a universal requirement to try to avoid a déjà-vu.
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Affiliation(s)
- Veerle Hermans
- Médecins Sans Frontières, Brussels Operational Centre, Bo, Sierra Leone
- Vogelzang 41, 2980 Zoersel, Halle Belgium
| | - Rony Zachariah
- Médecins Sans Frontières, Brussels Operational Centre Brussels, Brussels, Belgium
- Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium
| | | | | | - Dauda Kamara
- Médecins Sans Frontières, Brussels Operational Centre, Bo, Sierra Leone
| | | | | | - Marcel Manzi
- Médecins Sans Frontières, Brussels Operational Centre Brussels, Brussels, Belgium
- Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium
| | - Petra Alders
- Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium
| | - Jacob Maikere
- Médecins Sans Frontières, Brussels Operational Centre, Bo, Sierra Leone
- Médecins Sans Frontières, Brussels Operational Centre, Brussels, Belgium
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Topp SM, Chipukuma JM. How did rapid scale-up of HIV services impact on workplace and interpersonal trust in Zambian primary health centres: a case-based health systems analysis. BMJ Glob Health 2016; 1:e000179. [PMID: 28588985 PMCID: PMC5321392 DOI: 10.1136/bmjgh-2016-000179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/07/2016] [Accepted: 11/24/2016] [Indexed: 11/09/2022] Open
Abstract
Background In sub-Saharan Africa, large amounts of funding continue to be directed towards HIV-specific care and treatment, often with claims of ‘health system strengthening’ effect. Such claims rarely account for the impact on human relationships and decisions that are core to functional health systems. This research examined how establishment of externally funded HIV services influenced trusting relationships in Zambian health centres. Methods An in-depth, multicase study included four health centres selected for urban, peri-urban and rural characteristics. Case data included healthcare worker (HCW) interviews (60); patient interviews (180); direct observation of facility operations (2 weeks/centre) and key informant interviews (14) which were recorded and transcribed verbatim. Thematic analysis adopted inductive and deductive coding guided by a framework incorporating concepts of workplace trust, patient–provider trust, intrinsic and extrinsic motivation. Results HIV service scale-up impacted trust in positive and negative ways. Investment in HIV-specific infrastructure, supplies and quality assurance mechanisms strengthened workplace trust, HCW motivation and patient–provider trust in HIV departments in the short-term. In the health centres more broadly and over time, however, non-governmental organisation-led investment and support of HIV departments reinforced HCW's perceptions of the government as uninterested or unable to provide a quality work environment. Exacerbating existing perceptions of systemic workplace inequity and nepotism, uneven distribution of personal and professional opportunities related to HIV service establishment contributed to interdepartmental antagonism and reinforced workplace practices designed to protect individual HCW's interests. Conclusions Findings illustrate long-term negative effects of the vertical HIV resourcing and support structures which failed to address and sometimes exacerbated HCW (dis)trust with their own government and supervisors. The short-term and long-term effects of weakened workplace trust on HCWs' motivation and performance signal the importance of understanding how such relationships play a role in generating virtuous or perverse cycles of actor interactions, with implications for service outcomes.
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Affiliation(s)
- Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Engelbrecht M, Janse van Rensburg A, Kigozi G, van Rensburg HD. Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa. BMC Infect Dis 2016; 16:633. [PMID: 27814757 PMCID: PMC5097379 DOI: 10.1186/s12879-016-1984-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/27/2016] [Indexed: 11/25/2022] Open
Abstract
Background Despite the availability of TB infection control guidelines, and good levels of healthcare worker knowledge about infection control, often these measures are not well implemented. This study sought to determine the factors associated with healthcare workers’ good TB infection control practices in primary health care facilities in the Free State Province, South Africa. Methods A cross-sectional self-administered survey among nurses (n = 202) and facility-based community healthcare workers (n = 34) as well as facility observations were undertaken at all 41 primary health care facilities in a selected district of the Free State Province. Results The majority of respondents were female (n = 200; 87.7 %) and the average age was 44.19 years (standard deviation ±10.82). Good levels of knowledge were recorded, with 42.8 % (n = 101) having an average score (i.e. 65–79 %) and 31.8 % (n = 75) a good score (i.e. ≥ 80 %). Most respondents (n = 189; 80.4 %) had positive attitudes towards TB infection control practices (i.e. ≥ 80 %). While good TB infection control practices were reported by 72.9 % (n = 161) of the respondents (i.e. ≥75 %), observations revealed this to not necessarily be the case. For every unit increase in attitudes, good practices increased 1.090 times (CI:1.016–1.169). Respondents with high levels of knowledge (≥80 %) were 4.029 (CI: 1.550–10.469) times more likely to have good practices when compared to respondents with poor levels of knowledge (<65 %). The study did not find TB/HIV-related training to be a predictor of good practices. Conclusions Positive attitudes and good levels of knowledge regarding TB infection control were the main factors associated with good infection control practices. Although many respondents reported good infection control practices - which was somewhat countered by the observations - there are areas that require attention, particularly those related to administrative controls and the use of personal protective equipment.
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Affiliation(s)
- Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa.
| | - André Janse van Rensburg
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa.,Health and Demographic Research Unit, Department of Sociology, Ghent University, Korte Meer 5, Ghent, 9000, Belgium.,Department of Political Science, Stellenbosch University, Corner Merriman and Ryneveld Street, Stellenbosch, 7602, South Africa
| | - Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
| | - Hcj Dingie van Rensburg
- Centre for Health Systems Research & Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
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Ortuno-Gutierrez N, Zachariah R, Woldeyohannes D, Bangoura A, Chérif GF, Loua F, Hermans V, Tayler-Smith K, Sikhondze W, Camara LM. Upholding Tuberculosis Services during the 2014 Ebola Storm: An Encouraging Experience from Conakry, Guinea. PLoS One 2016; 11:e0157296. [PMID: 27533499 PMCID: PMC4988783 DOI: 10.1371/journal.pone.0157296] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/26/2016] [Indexed: 01/03/2023] Open
Abstract
Setting Ten targeted health facilities supported by Damien Foundation (a Belgian Non Governmental Organization) and the National Tuberculosis (TB) Program in Conakry, Guinea. Objectives To uphold TB program performance during the Ebola outbreak in the presence of a package of pre-emptive additional measures geared at reinforcing the routine TB program, and ensuring Ebola infection control, health-workers safety and motivation. Design A retrospective comparative cohort study of a TB program assessing the performance before (2013) and during the (2014) Ebola outbreak. Results During the Ebola outbreak, all health facilities were maintained opened, there were no reported health-worker Ebola infections, drug stockouts or health staff absences. Of 2,475 presumptive pulmonary TB cases, 13% were diagnosed with TB in both periods (160/1203 in 2013 and 163/1272 in 2014). For new TB, treatment success improved from 84% before to 87% during the Ebola outbreak (P = 0.03). Adjusted Hazard-ratios (AHR) for an unfavorable outcome was alwo lower during the Ebola outbreak, AHR = 0.8, 95% CI:0.7–0.9, P = 0.04). Treatment success improved for HIV co-infected patients (72% to 80%, P<0.01). For retreatment patients, the proportion achieving treatment success was maintained (68% to 72%, P = 0.05). Uptake of HIV-testing and Cotrimoxazole Preventive Treatment was maintained over 85%, and Anti-Retroviral Therapy uptake increased from 77% in 2013 to 86% in 2014 (P<0.01). Conclusion Contingency planning and health system and worker support during the 2014 Ebola outbreak was associated with encouraging and sustained TB program performance. This is of relevance to future outbreaks.
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Affiliation(s)
| | - Rony Zachariah
- Medecins Sans Frontières, Medical department (Operational Research), Brussels Operational Center, Luxembourg, Luxembourg
| | | | | | | | | | | | - Katie Tayler-Smith
- Medecins Sans Frontières, Medical department (Operational Research), Brussels Operational Center, Luxembourg, Luxembourg
| | - Welile Sikhondze
- National Tuberculosis Control Program (NTCP), Ministry of Health, Manzini, Swaziland
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Storr J, Kilpatrick C, Allegranzi B, Syed SB. Redefining infection prevention and control in the new era of quality universal health coverage. J Res Nurs 2016. [DOI: 10.1177/1744987116628328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Universal health coverage (UHC) is a concept that is deeply rooted in the Development Agenda and is receiving increasing attention at the global level. The interconnection of infection prevention and control (IPC), UHC and quality has not been well described. We aim to present a novel and compelling case for considering IPC as a critical part of quality UHC and develop a preliminary theory of change model, informed by existing literature and emerging thinking on this evolving field. A review of published and grey literature on UHC, quality and IPC was undertaken with a view to triangulating common goals and informing a theory of change. A preliminary theory of change framework describing the potential synergy between UHC, quality and IPC in catalysing concerted action at every level of the health system has been developed. A table outlining key considerations at the policy, practice and research levels is also presented. This paper considers the extent to which the global IPC community in its widest form should better position IPC as a fundamental component of quality within the context of rapidly advancing UHC-driven health system reforms. The theory of change will be of value to the many organisations involved in supporting countries and facilities as they move towards a true focus on UHC.
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Affiliation(s)
- Julie Storr
- Consultant to WHO Department of Service Delivery and Safety; Director S3 Global
| | - Claire Kilpatrick
- Consultant to WHO Department of Service Delivery and Safety, Faculty of Medicine, Imperial College London, UK; Director S3 Global
| | - Benedetta Allegranzi
- Coordinator (ad interim), Infection Prevention and Control Global Unit, Department of Service Delivery & Safety (SDS), Health Systems & Innovations Cluster (HIS), World Health Organization (WHO); Adjunct Professor, Institute of Global Health, University of Geneva, Switzerland
| | - Shamsuzzoha B Syed
- Coordinator (ad interim), Universal Health Coverage & Quality Unit (QHC), Department of Service Delivery & Safety (SDS), Health Systems & Innovations Cluster (HIS), World Health Organization (WHO)
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18
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Gokah T, Chiotcha A. Is Kamuzu central hospital management system a weak virus: Identifying and isolating free radicals in the fight against hospital (theatre) Infections in Malawi? INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2015. [DOI: 10.1179/2047971914y.0000000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Topp SM, Black J, Morrow M, Chipukuma JM, Van Damme W. The impact of human immunodeficiency virus (HIV) service scale-up on mechanisms of accountability in Zambian primary health centres: a case-based health systems analysis. BMC Health Serv Res 2015; 15:67. [PMID: 25889803 PMCID: PMC4347932 DOI: 10.1186/s12913-015-0703-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/13/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Questions about the impact of large donor-funded HIV interventions on low- and middle-income countries' health systems have been the subject of a number of expert commentaries, but comparatively few empirical research studies. Aimed at addressing a particular evidence gap vis-à-vis the influence of HIV service scale-up on micro-level health systems, this article examines the impact of HIV scale-up on mechanisms of accountability in Zambian primary health facilities. METHODS Guided by the Mechanisms of Effect framework and Brinkerhoff's work on accountability, we conducted an in-depth multi-case study to examine how HIV services influenced mechanisms of administrative and social accountability in four Zambian primary health centres. Sites were selected for established (over 3 yrs) antiretroviral therapy (ART) services and urban, peri-urban and rural characteristics. Case data included provider interviews (60); patient interviews (180); direct observation of facility operations (2 wks/centre) and key informant interviews (14). RESULTS Resource-intensive investment in HIV services contributed to some early gains in administrative answerability within the four ART departments, helping to establish the material capabilities necessary to deliver and monitor service delivery. Simultaneous investment in external supervision and professional development helped to promote transparency around individual and team performance and also strengthened positive work norms in the ART departments. In the wider health centres, however, mechanisms of administrative accountability remained weak, hindered by poor data collection and under capacitated leadership. Substantive gains in social accountability were also elusive as HIV scale-up did little to address deeply rooted information and power asymmetries in the wider facilities. CONCLUSIONS Short terms gains in primary-level service accountability may arise from investment in health system hardware. However, sustained improvements in service quality and responsiveness arising from genuine improvements in social and administrative accountability require greater understanding of, and investment in changing, the power relations, work norms, leadership and disciplinary mechanisms that shape these micro-level health systems.
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Affiliation(s)
- Stephanie M Topp
- Schools of Public Health and Medicine, University of Alabama, Birmingham, USA.
- Centre for Infectious Disease Research in Zambia, PO Box 30338, Lusaka, Zambia.
- Nossal Institute for Global Health, University of Melbourne, Level 4, 161 Barry Street, Alan Gilbert Building, Carlton, 3010, VIC, Australia.
| | - Jim Black
- Nossal Institute for Global Health, University of Melbourne, Level 4, 161 Barry Street, Alan Gilbert Building, Carlton, 3010, VIC, Australia.
| | - Martha Morrow
- Nossal Institute for Global Health, University of Melbourne, Level 4, 161 Barry Street, Alan Gilbert Building, Carlton, 3010, VIC, Australia.
| | - Julien M Chipukuma
- University of Lusaka, Plot No 37413, Mass Media, Lusaka, 101010, Zambia.
| | - Wim Van Damme
- Public Health and Health Policy Unit, ITM-Antwerp, Sint-Rochusstraat 2, 2000, Antwerpen, Belgium.
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, Republic of South Africa.
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20
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Promoting the Safety of Healthcare Workers in Africa: From HIV Pandemic to Ebola Epidemic. Infect Control Hosp Epidemiol 2015; 36:361-2. [DOI: 10.1017/ice.2014.68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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21
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Controlling healthcare-associated infections in the international research setting. J Acquir Immune Defic Syndr 2013; 62:e115-8. [PMID: 24135735 DOI: 10.1097/qai.0b013e3182845b95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Mansoor GF, Rahmani AM, Kakar MA, Hashimy P, Abrahimi P, Scott PT, Peel SA, Rentas FJ, Todd CS. Blood supply safety in Afghanistan: a national assessment of high-volume facilities. Transfusion 2013; 53:2061-8. [PMID: 23216410 DOI: 10.1111/trf.12005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/09/2012] [Accepted: 10/12/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little information is available regarding blood supply safety in Afghanistan. The purpose of this study was to assess blood safety through serologic and observational measures in Afghanistan. STUDY DESIGN AND METHODS This cross-sectional assessment included the 40 highest-volume facilities collecting and transfusing blood nationally identified in a previous survey. At each facility, study representatives completed a standardized instrument assessing staff performance of transfusion-related activities and performed rapid testing for human immunodeficiency virus, syphilis, and hepatitis B and C with rapid diagnostic tests on clinically discarded specimens. Reactive samples received confirmatory testing. Descriptive statistics were generated, with differences analyzed using chi-square or Fisher's exact tests. RESULTS Between November 2010 and May 2011, a total of 332 blood donor collection procedures were observed. Only 52.4% of observed encounters correctly screened and deferred donors by international criteria. Public and private facilities demonstrated glove use, proper sharps disposal, and patient counseling and relayed screening test results in less than 75% of observed events, significantly less likely than military facilities (p < 0.01). Of 1612 specimens assessed, confirmed cases of hepatitis B (n = 6), hepatitis C (n = 1), and syphilis (n = 3) were detected among units already prescreened and accepted for transfusion. CONCLUSION Lapses in proper donor screening contributed to the presence of confirmed-positive units available for transfusion, as detected in this study. Steps must be taken to ensure standardization of testing kits requirements, documentation, and mandatory training and continuing education for blood bank staff with regard to counseling, drawing, processing, and transfusion of blood products.
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Affiliation(s)
- G Farooq Mansoor
- Health Protection and Research Organisation, Afghan National Blood Safety and Transfusions Services, Ministry of Public Health, Islamic Republic of Afghanistan; School of Medicine, Yale University, New Haven, Connecticut; United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland; Armed Services Blood Program Office, United States Department of Defense, Washington, DC; Department of Obstetrics & Gynecology, Columbia University, New York, New York
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Abdelrahman I, Lohiniva AL, Kandeel A, Benkirane M, Atta H, Saleh H, El Sayed N, Talaat M. Learning about Barriers to Care for People Living with HIV in Egypt: A Qualitative Exploratory Study. J Int Assoc Provid AIDS Care 2013; 14:141-7. [PMID: 23792709 DOI: 10.1177/2325957413488180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to identify obstacles health care workers face in providing care for people living with HIV and AIDS (PLWHA). Based on these findings, health authorities can design interventions to support health care workers in providing better medical care for PLWHA. Thirty in-depth interviews were conducted with physicians and nurses in one 300-bed tertiary care public hospital in Giza, Egypt. Thematic analysis was conducted by 2 investigators. Five main themes were identified (1) fear of infection; (2) disbelief in effectiveness of infection control measures to protect against HIV; (3) misconceptions regarding medical care for PLWHA; (4) fear of secondary stigma; and (5) moral judgments toward PLWHA and negative connotations related to HIV. Interventions targeting health care workers should be multidimensional, including knowledge and skills building as well as value and attitude change. Reducing stigma among health care workers will improve access to care for PLWHA.
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Affiliation(s)
| | - Anna Leena Lohiniva
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | | | - Manal Benkirane
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Hossam Atta
- Ouem El Masreyn General Hospital, Ministry of Health in Egypt, Cairo, Egypt
| | - Hanan Saleh
- Ouem El Masreyn General Hospital, Ministry of Health in Egypt, Cairo, Egypt
| | | | - Maha Talaat
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
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A national mapping assessment of blood collection and transfusion service facilities in Afghanistan. Transfusion 2012; 53:69-75. [DOI: 10.1111/j.1537-2995.2012.03674.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shapiro AE, Variava E, Rakgokong MH, Moodley N, Luke B, Salimi S, Chaisson RE, Golub JE, Martinson NA. Community-based targeted case finding for tuberculosis and HIV in household contacts of patients with tuberculosis in South Africa. Am J Respir Crit Care Med 2012; 185:1110-6. [PMID: 22427532 DOI: 10.1164/rccm.201111-1941oc] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE South Africa has a high prevalence of tuberculosis (TB) and HIV-coinfected adults in whom TB is often diagnosed late in the course of disease. OBJECTIVES Improved case-finding approaches for TB and HIV are needed to reduce mortality and prevent transmission. METHODS We identified newly diagnosed index TB cases in a rural district and enrolled their households in a TB-HIV contact-tracing study. A group of randomly selected control households were enrolled to determine community prevalence of undetected TB and HIV. Field teams screened participants for TB symptoms, collected sputum specimens for smear microscopy and culture, provided HIV counseling and testing, and collected blood for CD4 testing. Participants were referred to public clinics for TB treatment and antiretroviral therapy. MEASUREMENTS AND MAIN RESULTS We evaluated 2,843 household contacts of 727 index patients with TB and 983 randomly selected control household members. The prevalence of TB in household contacts was 6,075 per 100,000 (95% confidence interval, 5,789-6,360 per 100,000), whereas the prevalence detected in randomly selected households was 407 per 100,000 (95% confidence interval, 0-912 per 100,000; prevalence difference, 5,668 per 100,000; P < 0.001). TB detected among contacts was less likely to be smear-positive than in the index patients (6% vs. 22%; P < 0.001). Most contacts with culture-confirmed TB were asymptomatic. At least one case of undiagnosed TB was found in 141 (19%) of 727 contact versus 4 (1%) of 312 control households. HIV testing was positive in 166 (11%) of 1,568 contacts tested versus 76 (14%) of 521 control participants tested (odds ratio, 1.48; P = 0.02). CONCLUSIONS Active case finding in TB contact households should be considered to improve TB and HIV case detection in high-prevalence settings, but sensitive diagnostic tools are necessary.
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Affiliation(s)
- Adrienne E Shapiro
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21231, USA
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MacPherson P, Lalloo DG, Choko AT, Mann GH, Squire SB, Mwale D, Manda E, Makombe SD, Desmond N, Heyderman R, Corbett EL. Suboptimal patterns of provider initiated HIV testing and counselling, antiretroviral therapy eligibility assessment and referral in primary health clinic attendees in Blantyre, Malawi. Trop Med Int Health 2012; 17:507-17. [PMID: 22296187 PMCID: PMC3378506 DOI: 10.1111/j.1365-3156.2011.02946.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To understand reasons for suboptimal and delayed uptake of antiretroviral therapy (ART) by describing the patterns of HIV testing and counselling (HTC) and outcomes of ART eligibility assessments in primary clinic attendees. Methods All clinic attendances and episodes of HTC were recorded at two clinics in Blantyre. A cohort of newly diagnosed HIV-positive adults (>15 years) was recruited and exit interviews undertaken. Logistic regression models were constructed to investigate factors associated with referral to start ART. Qualitative interviews were conducted with providers and patients. Results There were 2398 episodes of HTC during 18 021 clinic attendances (13.3%) between January and April 2011. The proportion of clinic attendees undergoing HTC was lowest in non-pregnant women (6.3%) and men (8.5%), compared with pregnant women (47.2%). Men had more advanced HIV infection than women (79.7% WHO stage 3 or 4 vs. 56.4%). Problems with WHO staging and access to CD4 counts affected ART eligibility assessments; only 48% completed ART eligibility assessment, and 54% of those reporting WHO stage 3/4 illnesses were not referred to start ART promptly. On multivariate analysis, HIV-positive pregnant women were significantly less likely to be referred directly for ART initiation (adjusted OR: 0.29, 95% CI: 0.13–0.63). Conclusions These data show that provider-initiated testing and counselling (PITC) has not yet been fully implemented at primary care clinics. Suboptimal ART eligibility assessments and referral (reflecting the difficulties of WHO staging in primary care) mean that simplified eligibility assessment tools are required to reduce unnecessary delay and attrition in the pre-ART period. Simplified initiation criteria for pregnant women, as being introduced in Malawi, should improve linkage to ART.
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Zachariah R, Van Damme W, Arendt V, Schmit JC, Harries AD. The HIV/AIDS epidemic in sub-Saharan Africa: thinking ahead on programmatic tasks and related operational research. J Int AIDS Soc 2011; 14 Suppl 1:S7. [PMID: 21967983 PMCID: PMC3194152 DOI: 10.1186/1758-2652-14-s1-s7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Until now, we have all been desperately trying to run behind the HIV/AIDS epidemic and catch up with it, but despite all our efforts, the epidemic remains well ahead of us. In 2010, the antiretroviral treatment (ART) gap was about 60%, AIDS-related deaths were almost two million a year, and on top of these figures, for every one person started on ART, there were two new HIV infections. What is needed to change this situation is to think ahead of the epidemic in terms of the programmatic tasks we will be faced with and try to act boldly in trying to implement those tasks. From a programmatic perspective, we: a) highlight what needs to fundamentally change in our thinking and overall approach to the epidemic; and b) outline a number of key task areas for implementation and related operational research.
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Affiliation(s)
- Rony Zachariah
- Médecins sans Frontières, Operational Centre Brussels, Medical Department, MSF- Luxemburg, Luxemburg.
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Niang MK, Syed SB. Safety - an entry point to strengthening health systems in Africa. Trop Med Int Health 2011; 16:902-3. [DOI: 10.1111/j.1365-3156.2011.02802.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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