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Finn M, Walsh A, Rafter N, Mellon L, Chong HY, Naji A, O'Brien N, Williams DJ, McCarthy SE. Effect of interventions to improve safety culture on healthcare workers in hospital settings: a systematic review of the international literature. BMJ Open Qual 2024; 13:e002506. [PMID: 38719514 PMCID: PMC11086522 DOI: 10.1136/bmjoq-2023-002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND In an era of safety systems, hospital interventions to build a culture of safety deliver organisational learning methodologies for staff. Their benefits to hospital staff are unknown. We examined the literature for evidence of staff outcomes. Research questions were: (1) how is safety culture defined in studies with interventions that aim to enhance it?; (2) what effects do interventions to improve safety culture have on hospital staff?; (3) what intervention features explain these effects? and (4) what staff outcomes and experiences are identified? METHODS AND ANALYSIS We conducted a mixed-methods systematic review of published literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was conducted in MEDLINE, EMBASE, CINAHL, Health Business Elite and Scopus. We adopted a convergent approach to synthesis and integration. Identified intervention and staff outcomes were categorised thematically and combined with available data on measures and effects. RESULTS We identified 42 articles for inclusion. Safety culture outcomes were most prominent under the themes of leadership and teamwork. Specific benefits for staff included increased stress recognition and job satisfaction, reduced emotional exhaustion, burnout and turnover, and improvements to working conditions. Effects were documented for interventions with longer time scales, strong institutional support and comprehensive theory-informed designs situated within specific units. DISCUSSION This review contributes to international evidence on how interventions to improve safety culture may benefit hospital staff and how they can be designed and implemented. A focus on staff outcomes includes staff perceptions and behaviours as part of a safety culture and staff experiences resulting from a safety culture. The results generated by a small number of articles varied in quality and effect, and the review focused only on hospital staff. There is merit in using the concept of safety culture as a lens to understand staff experience in a complex healthcare system.
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Affiliation(s)
- Mairead Finn
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Natasha Rafter
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lisa Mellon
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Hui Yi Chong
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Abdullah Naji
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niall O'Brien
- Library Services, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Siobhan Eithne McCarthy
- Graduate School of Healthcare Management, Royal College of Surgeons in Ireland, Dublin, Ireland
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Dougherty L, Mathur S, Gul X, Spielman K, Tripathi V, Wakefield C, Silva M. Methods and Measures to Assess Health Care Provider Behavior and Behavioral Determinants in Reproductive, Maternal, Newborn, and Child Health: A Rapid Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200407. [PMID: 38035722 PMCID: PMC10698233 DOI: 10.9745/ghsp-d-22-00407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/23/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Health care provider behavior is the outcome of a complex set of factors that are both internal and external to the provider. Social and behavior change (SBC) programs are increasingly engaging providers and introducing strategies to improve their service delivery. However, there is limited understanding of methods and measures applied to assess provider behavioral outcomes and strengthen provider behavior change programming. METHODS Using PubMed, we conducted a rapid review of published research on behaviors of health workers providing reproductive, maternal, newborn, and child health services in low- and middle-income countries (2010-2021). Information on study identifiers (e.g., type of provider), select domains from Green and Kreuter's PRECEDE-PROCEED framework (e.g., predisposing factors such as attitudes), study characteristics (e.g., study type and design), and evidence of theory-driven research were extracted from a final sample of articles (N=89) and summarized. RESULTS More than 80% of articles were descriptive/formative and examined knowledge, attitudes, and practice, mostly related to family planning. Among the few evaluation studies, training-focused interventions to increase provider knowledge or improve competency in providing a health service were dominant. Research driven by behavioral theory was observed in only 3 studies. Most articles (75%) focused on the quality of client-provider interaction, though topics and modes of measurement varied widely. Very few studies incorporated a validated scale to measure underlying constructs, such as attitudes and beliefs, and how these may be associated with provider behaviors. CONCLUSION A need exists for (1) theory-driven approaches to designing and measuring provider behavior change interventions and (2) measurement that addresses important internal and structural factors related to a provider's behavior (beyond knowledge-enhancing training approaches). Additional investment in implementation research is also needed to better understand which SBC approaches are shifting provider behavior and improving client-provider interactions. Finally, theory-driven approaches could help develop empirically measurable and comparable outcomes.
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Affiliation(s)
| | | | - Xaher Gul
- Pathfinder International, Karachi, Pakistan
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Basu S, Dwivedy S, Sharma J, Mohan N, Negandhi P, Goel S, Gupta M, Zodpey S. Perceived Gaps in Academic Training and Expectations From Refresher Training in Primary Care Nurses at an Urban Metropolis in Northern India: A Qualitative Study. Cureus 2023; 15:e46855. [PMID: 37954811 PMCID: PMC10636498 DOI: 10.7759/cureus.46855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Background Nursing professionals, comprising the largest workforce engaged in the primary healthcare system, play a pivotal role in addressing population health needs. However, gaps in the training of nurses and midwives in lower-middle-income countries may undermine their performance and necessary skill development for fulfilling key population health needs. Substantial challenges exist in improving the regular curricular and refresher training of diplomate nurses and midwives working in primary care facilities and supporting both clinical care and health promotion functions. The study objective was to conduct a gap analysis in the present nursing curriculum and training profile of general duty midwives working in urban primary health facilities and understand their expectations and preferences from the planned refresher training course. Methods We conducted a qualitative explorative study among General Nursing midwives (GNMs) working in urban primary health facilities in the Gurugram district of Haryana, India to conduct a gap analysis in their present curriculum and training preferences. Results A total of 17 nurses with a mean (SD) age of 33.52 (4.75) years and an average nursing work experience of 5.35 (0.56) years were interviewed in-depth. Lack of practical applicability, complex study material, inexperienced tutors, and weak English language comprehension were key barriers in the existing nursing curriculum. The nurses expressed willingness to participate in refresher training with varied expectations, although there existed a distinct preference for short, flexible, and blended online-offline modes of training. Conclusions Strengthening GNM nursing education should be prioritized in Indian health settings with the focus on improving student comprehension through vernacular instruction when feasible, and capacity building of tutors, with avenues for continued training and education. There is also a need for strengthening the curriculum related to key emergent public health challenges related to non-communicable diseases and mental health, as also skills for client and patient counseling and communication.
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Affiliation(s)
- Saurav Basu
- Community Medicine, Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, IND
| | - Subhralaxmi Dwivedy
- Public Health, Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, IND
| | - Jyoti Sharma
- Nutrition, Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, IND
| | - Neha Mohan
- Public Health, Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, IND
| | - Preeti Negandhi
- Public Health, Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, IND
| | - Shalini Goel
- Public Health, National Health Mission, Gurugram, IND
| | - Mehak Gupta
- Public Health, Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, IND
| | - Sanjay Zodpey
- Community Medicine, Public Health Foundation of India, New Delhi, IND
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Adeyemi O, Phorbee O, Samuel F, Sanusi R, Afolabi W, Covic N, Onabolu A, Ajieroh V. Training to Build Nutrition Capacity in the Nigerian Agricultural Sector: Initial Assessment and Future Directions. Food Nutr Bull 2023; 44:S85-S91. [PMID: 36127833 DOI: 10.1177/03795721221123870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In response to calls to increase nutrition-sensitive agriculture (NSA), the Federal Ministry of Agriculture and Rural Development developed the Nigeria Agricultural Sector Food Security and Nutrition Strategy 2016-2025 (AFSNS). Capacity development activities to facilitate the AFSNS implementation subsequently commenced. OBJECTIVE This study analyzed the processes and outputs of initial capacity development efforts, examined findings from the analysis using existing literature, and identified critical next steps for nutrition capacity development in the Nigerian agriculture sector. METHODS The study reviewed documents including a proposal for nutrition training of agriculture sector actors, reports of meetings held among 6 resource persons who designed and/or delivered training, training reports, participants' pre- and posttraining assessments, and participants' training evaluation. Interviews were conducted with 2 resource persons involved in training design and delivery. Documents and interviews were coded and analyzed to identify emergent themes. Participants' pre- and posttests results were compared using paired t test in Stata 12.0. RESULTS Knowledge and practice gaps were more extensive than had been anticipated. Training had some but limited effects on knowledge scores at the federal level. Modules addressing implementation practices had to be scaled down for participants to keep up with the learning pace. Existing literature indicates that such training would have been better planned as part of a broader sectoral nutrition workforce strategy, to facilitate greater tailoring of training to participants' job roles. CONCLUSION Effective AFSNS implementation requires developing and operationalizing a comprehensive short-, medium- and long-term Agriculture Sector Nutrition Capacity Development Strategy for Nigeria.
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Affiliation(s)
- Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- Formerly of Food and Agriculture Organization of the United Nations, Abuja, Nigeria
| | - Olapeju Phorbee
- International Institute of Tropical Agriculture, Ibadan, Nigeria
- Food Agriculture Nutrition Network, Abuja, Nigeria
| | - Folake Samuel
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Rasaki Sanusi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Wasiu Afolabi
- Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
| | - Namukolo Covic
- International Livestock Research Institute, Addis Ababa, Ethiopia
| | - Adeyinka Onabolu
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
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Bosongo S, Belrhiti Z, Ekofo J, Kabanga C, Chenge F, Criel B, Marchal B. How capacity building of district health managers has been designed, delivered and evaluated in sub-Saharan Africa: a scoping review and best fit framework analysis. BMJ Open 2023; 13:e071344. [PMID: 37532484 PMCID: PMC10401232 DOI: 10.1136/bmjopen-2022-071344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES We aimed to understand how capacity building programmes (CBPs) of district health managers (DHMs) have been designed, delivered and evaluated in sub-Saharan Africa. We focused on identifying the underlying assumptions behind leadership and management CBPs at the district level. DESIGN Scoping review. DATA SOURCES We searched five electronic databases (MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library and Google Scholar) on 6 April 2021 and 13 October 2022. We also searched for grey literature and used citation tracking. ELIGIBILITY CRITERIA We included all primary studies (1) reporting leadership or management capacity building of DHMs, (2) in sub-Saharan Africa, (3) written in English or French and (4) published between 1 January 1987 and 13 October 2022. DATA EXTRACTION AND SYNTHESIS Three independent reviewers extracted data from included articles. We used the best fit framework synthesis approach to identify an a priori framework that guided data coding, analysis and synthesis. We also conducted an inductive analysis of data that could not be coded against the a priori framework. RESULTS We identified 2523 papers and ultimately included 44 papers after screening and assessment for eligibility. Key findings included (1) a scarcity of explicit theories underlying CBPs, (2) a diversity of learning approaches with increasing use of the action learning approach, (3) a diversity of content with a focus on management rather than leadership functions and (4) a diversity of evaluation methods with limited use of theory-driven designs to evaluate leadership and management capacity building interventions. CONCLUSION This review highlights the need for explicit and well-articulated programme theories for leadership and management development interventions and the need for strengthening their evaluation using theory-driven designs that fit the complexity of health systems.
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Affiliation(s)
- Samuel Bosongo
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Zakaria Belrhiti
- Département santé publique and management, Ecole Internationale de Santé Publique, Université Mohammed VI des Sciences de la Santé, Casablanca, Morocco
- Centre Mohammed VI de la recherche et Innovation (CM6), Rabat, Morocco
| | - Joël Ekofo
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Chrispin Kabanga
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Faustin Chenge
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Congo (the Democratic Republic of the)
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Bosongo S, Belrhiti Z, Chenge F, Criel B, Marchal B. Capacity building of district health management teams in the era of provincial health administration reform in the Democratic Republic of Congo: a realist evaluation protocol. BMJ Open 2023; 13:e073508. [PMID: 37463816 PMCID: PMC10357782 DOI: 10.1136/bmjopen-2023-073508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION In 2006, the Congolese Ministry of Health developed a health system strengthening strategy focusing on health district development. This strategy called for reforming the provincial health administration in order to better support the health district development through leadership and management capacity building of district health management teams. The implementation is currently underway, yet, more evidence on how, for whom and under what conditions this capacity building works is needed. The proposed research aims to address this gap using a realist evaluation approach. METHODS AND ANALYSIS We will follow the cycle of the realist evaluation. First, we will elicit the initial programme theory through a scoping review (completed in December 2022, using MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library, Google Scholar and grey literature), a review of health policy documents (completed in March 2023), and interviews with key stakeholders (by June 2023). Second, we will empirically test the initial programme theory using a multiple-embedded case study design in two provincial health administrations and four health districts (by March 2024). Data will be collected through document reviews, in-depth interviews, non-participant observations, a questionnaire, routine data from the health information management system and a context mapping tool. We will analyse data using the Intervention-Context-Actor-Mechanism-Outcome configuration heuristic. Last, we will refine the initial programme theory based on the results of the empirical studies and develop recommendations for policymakers (by June 2024). ETHICS AND DISSEMINATION The Institutional Review Board of the Institute of Tropical Medicine and the Medical Ethics Committee of the University of Lubumbashi approved this study. We will also seek approvals from provincial-level and district-level health authorities before data collection in their jurisdictions. We will disseminate the study findings through the publication of articles in peer-reviewed academic journals, policy briefs for national policymakers and presentations at national and international conferences.
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Affiliation(s)
- Samuel Bosongo
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Zakaria Belrhiti
- Ecole Internationale de Santé Publique, Université Mohammed VI des sciences de la santé (UM6SS), Casablanca, Morocco
- Centre Mohammed VI de la recherche et innovation (CM6), Rabat, Morocco
| | - Faustin Chenge
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Congo (the Democratic Republic of the)
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Salehi R, de Young S, Asamoah A, Aryee SE, Eli R, Couper B, Smith B, Djokoto C, Agyeman YN, Zakaria AFS, Butt N, Boadu A, Nyante F, Merdiemah G, Oliver-Commey J, Ofori-Boadu L, Akoriyea SK, Parry M, Fiore C, Okae F, Adams A, Acquah H. Evaluation of a continuing professional development strategy on COVID-19 for 10 000 health workers in Ghana: a two-pronged approach. HUMAN RESOURCES FOR HEALTH 2023; 21:18. [PMID: 36879262 PMCID: PMC9987385 DOI: 10.1186/s12960-023-00804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND COVID-19 has created unprecedented challenges for health systems worldwide. Since the confirmation of the first COVID-19 case in Ghana in March 2020 Ghanian health workers have reported fear, stress, and low perceived preparedness to respond to COVID-19, with those who had not received adequate training at highest risk. Accordingly, the Paediatric Nursing Education Partnership COVID-19 Response project designed, implemented, and evaluated four open-access continuing professional development courses related to the pandemic, delivered through a two-pronged approach: e-learning and in-person. METHODS This manuscript presents an evaluation of the project's implementation and outcomes using data for a subset of Ghanaian health workers (n = 9966) who have taken the courses. Two questions were answered: first, the extent to which the design and implementation of this two-pronged strategy was successful and, second, outcomes associated with strengthening the capacity of health workers to respond to COVID-19. The methodology involved quantitative and qualitative survey data analysis and ongoing stakeholder consultation to interpret the results. RESULTS Judged against the success criteria (reach, relevance, and efficiency) the implementation of the strategy was successful. The e-learning component reached 9250 health workers in 6 months. The in-person component took considerably more resources than e-learning but provided hands-on learning to 716 health workers who were more likely to experience barriers to accessing e-learning due to challenges around internet connectivity, or institutional capacity to offer training. After taking the courses, health workers' capacities (addressing misinformation, supporting individuals experiencing effects of the virus, recommending the vaccine, course-specific knowledge, and comfort with e-learning) improved. The effect size, however, varied depending on the course and the variable measured. Overall, participants were satisfied with the courses and found them relevant to their well-being and profession. An area for improvement was refining the content-to-delivery time ratio of the in-person course. Unstable internet connectivity and the high upfront cost of data to access and complete the course online were identified as barriers to e-learning. CONCLUSIONS A two-pronged delivery approach leveraged distinct strengths of respective e-learning and in-person strategies to contribute to a successful continuing professional development initiative in the context of COVID-19.
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Affiliation(s)
- Roxana Salehi
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Stephanie de Young
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | | | - Raymond Eli
- Ghana College of Nurses and Midwives, Accra, Ghana
| | - Barbara Couper
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Brian Smith
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | | | | | - Nancy Butt
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Felix Nyante
- Nursing and Midwifery Council of Ghana, Accra, Ghana
| | | | | | | | | | - Megan Parry
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Cindy Fiore
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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Gachohi J, Bett B, Otieno F, Mogoa E, Njoki P, Muturi M, Mwatondo A, Osoro E, Ngere I, Dawa J, Nasimiyu C, Oyas H, Njagi O, Canfield S, Blackburn J, Njenga K. Anthrax hotspot mapping in Kenya support establishing a sustainable two-phase elimination program targeting less than 6% of the country landmass. Sci Rep 2022; 12:21670. [PMID: 36522381 PMCID: PMC9755300 DOI: 10.1038/s41598-022-24000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
Using data collected from previous (n = 86) and prospective (n = 132) anthrax outbreaks, we enhanced prior ecological niche models (ENM) and added kernel density estimation (KDE) approaches to identify anthrax hotspots in Kenya. Local indicators of spatial autocorrelation (LISA) identified clusters of administrative wards with a relatively high or low anthrax reporting rate to determine areas of greatest outbreak intensity. Subsequently, we modeled the impact of vaccinating livestock in the identified hotspots as a national control measure. Anthrax suitable areas included high agriculture zones concentrated in the western, southwestern and central highland regions, consisting of 1043 of 1450 administrative wards, covering 18.5% country landmass, and hosting 30% of the approximately 13 million cattle population in the country. Of these, 79 wards covering 5.5% landmass and hosting 9% of the cattle population fell in identified anthrax hotspots. The rest of the 407 administrative wards covering 81.5% of the country landmass, were classified as low anthrax risk areas and consisted of the expansive low agricultural arid and semi-arid regions of the country that hosted 70% of the cattle population, reared under the nomadic pastoralism. Modelling targeted annual vaccination of 90% cattle population in hotspot administrative wards reduced > 23,000 human exposures. These findings support an economically viable first phase of anthrax control program in low-income countries where the disease is endemic, that is focused on enhanced animal and human surveillance in burden hotspots, followed by rapid response to outbreaks anchored on public education, detection and treatment of infected humans, and ring vaccination of livestock. Subsequently, the global anthrax elimination program focused on sustained vaccination and surveillance in livestock in the remaining few hotspots for a prolonged period (> 10 years) may be implemented.
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Affiliation(s)
- John Gachohi
- grid.411943.a0000 0000 9146 7108School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya ,Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Bernard Bett
- grid.419369.00000 0000 9378 4481International Livestock Research Institute, Nairobi, Kenya
| | - Fredrick Otieno
- grid.419369.00000 0000 9378 4481International Livestock Research Institute, Nairobi, Kenya
| | - Eddy Mogoa
- grid.10604.330000 0001 2019 0495Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
| | - Peris Njoki
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya
| | - Mathew Muturi
- grid.419369.00000 0000 9378 4481International Livestock Research Institute, Nairobi, Kenya ,Kenya Zoonotic Disease Unit, Nairobi, Kenya ,grid.463427.0Kenya Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Athman Mwatondo
- grid.419369.00000 0000 9378 4481International Livestock Research Institute, Nairobi, Kenya ,Kenya Zoonotic Disease Unit, Nairobi, Kenya ,grid.415727.2Ministry of Health, Nairobi, Kenya
| | - Eric Osoro
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Isaac Ngere
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Jeanette Dawa
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Carolyne Nasimiyu
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
| | - Harry Oyas
- grid.463427.0Kenya Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Obadiah Njagi
- grid.463427.0Kenya Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Samuel Canfield
- grid.15276.370000 0004 1936 8091Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL 32611 USA
| | - Jason Blackburn
- grid.15276.370000 0004 1936 8091Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, University of Florida, Gainesville, FL 32611 USA ,grid.15276.370000 0004 1936 8091Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL 32611 USA
| | - Kariuki Njenga
- Washington State University Global Health Program, Washington State University, P. O. Box 72938, Nairobi, 00200 Kenya ,grid.30064.310000 0001 2157 6568Paul G, Allen School of Global Health, Washington State University, Pullman, WA99164 USA
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An evaluation of mental health capacity building among Community Rehabilitation Officers in Malawi: A mixed-methods case study. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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