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Galson SW, Pesambili M, Vissoci JRN, Manavalan P, Hertz JT, Temu G, Staton CA, Stanifer JW. Hypertension in an Emergency Department Population in Moshi, Tanzania; A Qualitative Study of Barriers to Hypertension Control. PLoS One 2023; 18:e0279377. [PMID: 36608026 PMCID: PMC9821488 DOI: 10.1371/journal.pone.0279377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa has a high prevalence of hypertension with a low rate of awareness, treatment adherence, and control. The emergency department (ED) may represent a unique opportunity to improve hypertension screening, awareness, and linkage to care. We conducted a qualitative study among hypertensive patients presenting to the ED and their healthcare providers to determine barriers to hypertension care and control. METHODS In northern Tanzania, between November and December 2017, we conducted three focus group discussions among patients with hypertension presenting to the emergency department and three in-depth interviews among emergency department physicians. In our study, hypertension was defined as a single blood pressure of ≥160/100 mm Hg or a two-time average of ≥140/90 mm Hg. Barriers to care were identified by thematic analysis applying an inductive approach within the framework method. RESULTS We enrolled 24 total patients into three focus groups and performed three in-depth interviews with individual providers. Thematic analysis identified two major domains: 1) patient knowledge, attitudes, and practices, and 2) structural barriers to hypertension care. Four major themes emerged within the knowledge, attitudes, and practices domain, including disease chronicity, provider communication, family support, and fear-based attitudes. Within the structural domain, several themes emerged that identified barriers that impeded hypertension follow-up care and self-management, including cost, access to care, and transportation and wait time. CONCLUSION Patients and physicians identified multiple barriers and facilitators to hypertension care. These perspectives may be helpful to design emergency department-based interventions that target blood pressure control and linkage to outpatient care.
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Affiliation(s)
- Sophie W. Galson
- Duke Emergency Medicine, Duke Global Health Institute, Durham, NC, United States of America
- * E-mail:
| | | | | | - Preeti Manavalan
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Julian T. Hertz
- Duke Emergency Medicine, Duke Global Health Institute, Durham, NC, United States of America
| | - Gloria Temu
- Kilimanjaro Christian Medical Center, Kilimanjaro, Tanzania
| | - Catherine A. Staton
- Duke University Medical Center, Duke Global Health Institute, Durham, NC, United States of America
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Staton CA, Minnig MC, Phillips AJ, Kozhumam AS, Pesambili M, Suffoletto B, Mmbaga BT, Ngowi K, Vissoci JRN. Feasibility of SMS booster for alcohol reduction in injury patients in Tanzania. PLOS Glob Public Health 2022; 2:e0000410. [PMID: 36962731 PMCID: PMC10022354 DOI: 10.1371/journal.pgph.0000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 10/29/2022] [Indexed: 12/02/2022]
Abstract
Alcohol use is associated with 3 million annual deaths globally. Harmful alcohol use, which is associated with a high burden of disease in low- and middle-income countries (LMICs), often increases the probability of traumatic injury. Treatments for harmful alcohol use in LMICs, such as Tanzania, lack trained personnel and adequate infrastructure. The aim of this study was to assess the feasibility of using SMS boosters to augment a hospital based brief negotiational intervention (BNI) in this low resourced setting. We conducted a three stage, four arm feasibility trial of a culturally adapted BNI for injury patients with harmful and hazardous drinking admitted to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Post hospital discharge, two of the four arms included patients receiving either a standard or personalized short message service (SMS) booster to enhance and or perpetuate the effect of the in-hospital BNI. Text messages were sent weekly throughout a 3-month follow-up period. SMS feasibility was assessed according to the TIDier checklist evaluating what, when, how much, tailoring processes, modifications and how well (intervention fidelity). Data was collected with SMS logs and short answer surveys to participants. A total of 41 study participants were assigned to each receive 12 SMS over a three-month period; 38 received messages correctly, 3 did not receive intended messages, and 1 received a message who was not intended to. Of the 258 attempted texts, 73% were successfully sent through the messaging system. Of the messages that failed delivery, the majority were not able to be sent due to participants traveling out of cellular service range or turning off their phones. Participants interviewed in both booster arms reported that messages were appropriate, and that they would appreciate the continuation of such reminders. At 6-month follow-up, 100% (n = 11) of participants interviewed believed that the boosters had a positive impact on their behavior, with 90% reporting a large impact. This study demonstrated feasibility and acceptability of the integration of SMS mobile health technology to supplement this type of nurse-led BNI. SMS booster is a practical tool that can potentially prolong the impact of a brief hospital based intervention to enact behavioral change in injury patients with AUD.
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Affiliation(s)
- Catherine A. Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Mary Catherine Minnig
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Ashley J. Phillips
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Arthi S. Kozhumam
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University, California, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Gafaar TO, Pesambili M, Henke O, Vissoci JRN, Mmbaga BT, Staton C. Good death: An exploratory study on perceptions and attitudes of patients, relatives, and healthcare providers, in northern Tanzania. PLoS One 2020; 15:e0233494. [PMID: 32649715 PMCID: PMC7351142 DOI: 10.1371/journal.pone.0233494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE In the Kilimanjaro region of Tanzania, there are no advance care planning (ACP) protocols being used to document patient preferences for end-of-life (EoL) care. There is a general avoidance of the topic and contemplating ACP in healthcare-limited regions can be an ethically complex subject. Nonetheless, evidence from similar settings indicate that an appropriate quality of life is valued, even as one is dying. What differs amongst cultures is the definition of a 'good death'. OBJECTIVE Evaluate perceptions of quality of death and advance EoL preparation in Moshi, Tanzania. DESIGN 13 focus group discussions (FGDs) were conducted in Swahili using a semi-structured guide. These discussions were audio-recorded, transcribed, translated, and coded using an inductive approach. SETTING Kilimanjaro Christian Medical Centre (KCMC), referral hospital for northern Tanzania. PARTICIPANTS A total of 122 participants, including patients with life-threatening illnesses (34), their relatives/friends (29), healthcare professionals (29; HCPs; doctors and nurses), and allied HCPs (30; community health workers, religious leaders, and social workers) from KCMC, or nearby within Moshi, participated in this study. FINDINGS In characterizing Good Death, 7 first-order themes emerged, and, of these themes, Religious & Spiritual Wellness, Family & Interpersonal Wellness, Grief Coping & Emotional Wellness, and Optimal Timing comprised the second-order theme, EoL Preparation and Life Completion. The other first-order themes for Good Death were Minimal Suffering & Burden, Quality of Care by Formal Caregivers, and Quality of Care by Informal Caregivers. INTERPRETATION The results of this study provide a robust thematic description of Good Death in northern Tanzania and they lay the groundwork for future clinical and research endeavors to improve the quality of EoL care at KCMC.
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Affiliation(s)
- Temitope O. Gafaar
- Duke University School of Medicine, Duke University, Durham, NC, United States of America
| | - Msafiri Pesambili
- Duke University Research Collaboration, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Oliver Henke
- Cancer Care Center, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
| | - Blandina Theophil Mmbaga
- Cancer Care Center, Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
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Nguyen T, Vissoci JRN, Joelson T, Pesambili M, Haglund M, Gerardo CJ, Mvungi M, Staton CA. Injury prevalence and safety habits of boda boda drivers in Moshi, Tanzania: A mixed methods study. PLoS One 2018; 13:e0207570. [PMID: 30481196 PMCID: PMC6258469 DOI: 10.1371/journal.pone.0207570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Traffic crashes are a major cause of global morbidity and mortality disproportionately affecting low- and middle-income countries (LMICs). Motorcycle taxi (boda boda) drivers are particularly vulnerable because they are exposed to traffic risks with limited safety equipment. This study aims to characterize injury prevalence and safety habits among boda boda drivers, as well as ways to improve road traffic safety in LMICs. METHODS A cross-sectional mixed methods study was conducted with 300 boda boda drivers between 24 March and 3 April 2014 in urban Moshi, Tanzania. A convenience sample of participants was drawn from 25 of 58 registered boda boda stands and 2 of 31 unregistered stands. Data were analyzed using R, and content thematic analysis was performed and agreed upon by three investigators. Logistic regression models were used to evaluate the association between boda boda characteristics and injury risk. RESULTS In total, 300 drivers participated, of whom 148 (49.3%) had experienced a crash during their lifetime, and 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalized. Of all participants, 220 (73.3%) reported consistent helmet usage, despite 285 participants (95.0%) agreeing that helmet usage reduces injury severity. From the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. Having a cracked helmet was associated with higher risk of being involved in a traffic crash. Owning a helmet with a proper fit was associated with reduced risk for a traffic crash (OR = 0.06) and road traffic injuries (OR = 0.07). A thematic analysis of boda boda drivers' suggestions to increase road safety identified four intervention areas: 1) roadway infrastructure and traffic regulation, 2) road user attitudes and safe driving behaviors, 3) education and training, and 4) law enforcement. CONCLUSION Our study demonstrates boda boda drivers' safety behaviors and identifies four intervention areas that can be leveraged to increase overall road traffic safety. Unfortunately, while boda boda drivers are aware of ways to improve safety, adherence to safety habits remains low. Successful multi-sectoral interventions are needed to improve road safety for boda boda drivers in Tanzania.
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Affiliation(s)
- TuanDat Nguyen
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
| | | | | | - Michael Haglund
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
| | - Charles J. Gerardo
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
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Reardon JM, Andrade L, Hertz J, Kiwango G, Teu A, Pesambili M, El-Gabri D, Hocker M, Mvungi M, Vissoci JRN, Staton CA. The epidemiology and hotspots of road traffic injuries in Moshi, Tanzania: An observational study. Injury 2017; 48:1363-1370. [PMID: 28529012 PMCID: PMC5545685 DOI: 10.1016/j.injury.2017.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/02/2017] [Indexed: 02/02/2023]
Abstract
Road traffic injuries (RTIs) continue to increase with the proliferation of motor vehicles, especially in low-income countries where safe road infrastructure is lacking. Knowing where and why RTIs occur would allow for increased safety and prevention planning. In this study, police records of 300 motor vehicle collisions which occurred between February 2013 and January 2014 in Moshi, Tanzania were reviewed. Analysis of variables including victim age, gender, type of collision, conditions, and use of safety equipment were analyzed. Geographic information system (GIS) analysis was performed to identify areas with the most collisions. Most injuries occurred at four intersections on two main corridor. Car crashes represented 48% of reports while motorcycle collisions were 35% of reports. Victims were predominantly male. The majority (64%) of RTI victims in cars used seatbelts while only 43% of motorcyclists wore helmets; none of those who used the helmet or seatbelt suffered a grievous injury. These data demonstrate that RTIs in Moshi occur in predictable high traffic locations. RTIs injure victims of all backgrounds and safety equipment is not universally utilized. More investment is needed in improved data collection methods, and a greater emphasis on intersection safety is needed to reduce these preventable injuries.
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Affiliation(s)
- Joseph M Reardon
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Luciano Andrade
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Julian Hertz
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | | | - Anneth Teu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Deena El-Gabri
- Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States
| | - Michael Hocker
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Mark Mvungi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - João Ricardo N Vissoci
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States; Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States; Duke Global Health Institute, Duke University, Durham, NC, United States.
| | - Catherine A Staton
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States; Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States; Duke Global Health Institute, Duke University, Durham, NC, United States
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Nguyen TDV, Joelson T, Vissoci J, Pesambili M, Haglund M, Mvungi M, Staton CA. 519 Injury prevalence and safety habits of motorcycle taxi drivers in urban Moshi, Tanzania. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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