Perspectives and experiences of healthcare providers on the response to the COVID-19 pandemic in three maternal and neonatal referral hospitals in Guinea in 2020: a qualitative study

BACKGROUND

The COVID-19 pandemic has adversely affected access to essential healthcare services. This study aimed to explore healthcare providers' perceptions and experiences of the response to the COVID-19 pandemic in three referral maternal and neonatal hospitals in Guinea.

METHODS

We conducted a longitudinal qualitative study between June and December 2020 in two maternities and one neonatology referral ward in Conakry and Mamou. Participants were purposively recruited to capture diversity of professional cadres, seniority, and gender. Four rounds of in-depth interviews (46 in-depth interviews with 18 respondents) were conducted in each study site, using a semi-structured interview guide that was iteratively adapted. We used both deductive and inductive approaches and an iterative process for content analysis.

RESULTS

We identified four themes and related sub-themes presented according to whether they were common or specific to the study sites, namely: 1) coping strategies & care reorganization, which include reducing staffing levels, maintaining essential healthcare services, suspension of staff daily meetings, insertion of a new information system for providers, and co-management with COVID-19 treatment center for caesarean section cases among women who tested positive for COVID-19; 2) healthcare providers' behavior adaptations during the response, including infection prevention and control measures on the wards and how COVID-19-related information influenced providers' daily work; 3) difficulties encountered by providers, in particular unavailability of personal protective equipment (PPE), lack of financial motivation, and difficulties reducing crowding in the wards; 4) providers perceptions of healthcare service use, for instance their fear during COVID-19 response and perceived increase in severity of complications received and COVID-19 cases among providers and parents of newborns.

CONCLUSION

This study provides insights needed to be considered to improve the preparedness and response of healthcare facilities and care providers to future health emergencies in similar contexts.

Factors facilitating the use of contraceptive methods among urban adolescents and youth in Guinea: a qualitative study

BACKGROUND

The use of modern contraceptive methods among adolescents and youth is a public health priority to prevent unintended pregnancies. To our knowledge, no study has ever explored and documented factors promoting contraceptive use among urban adolescents and youth in Guinea. The objective of this study was to explore the factors that promote the use of contraceptive methods at the personal, interpersonal, community, and health system levels among urban adolescents and youth in Guinea.

METHODS

We conducted a qualitative research study including twenty-six individual in-depth interviews among adolescents and youth, and 10 group interviews with an additional eighty individuals, for a total of 106 participants. The socio-ecological model was used to orient both data collection and analysis. Data were collected from June to October 2019. Both individual and group interviews were audio-recorded, and transcribed verbatims afterwards. Data was analyzed thematically, using deductive codes.

RESULTS

The individual factors favoring contraceptive use among adolescents and youth pertained to perceived benefits of the methods (e.g., discretion, absence of side effects, duration of action, ease of use), knowledge of the family planning service channels, and means to afford the cost of the method. The interpersonal factors were spouse/sexual partner approval, and peer suggestions about contraceptive methods. The community factors included socio-cultural beliefs about the methods, and community expectation not to get pregnant before marriage. The health system factors included access to free contraceptive methods, availability of methods, clinical competence and attitude of the health care provider to advise or administer methods, and proximity of family planning services to users' place of residence.

CONCLUSIONS

This qualitative research shows that many adolescents and youth living in Conakry use a variety of contraceptive methods, whether modern, traditional Access to free or affordable methods, discretion of method use, proximity and availability of methods, and suggestions of methods by peers are factors that motivate adolescents and youth to use contraception. In order to optimally facilitate the use of modern contraception among adolescent and young urban Guineans, we recommend that: (1) adolescents and youth have access to public health strategies enabling them to learn about, obtain, and use methods in a way that allows them to remain discreet; (2) the use of modern contraceptive methods be promoted by peers; and (3) health care providers and peers be adequately trained to have accurate and up-to-date knowledge about the different contraceptive methods available, demonstrate clinical skills for teaching and for method placement (if applicable), and show appropriate attitudes toward this population. This knowledge can inform policies and programs to improve the use of effective contraceptive methods by adolescents and youth living in urban Guinea.

Effect of the COVID-19 pandemic on maternal and neonatal health services in three referral hospitals in Guinea: an interrupted time-series analysis

INTRODUCTION

In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals.

MATERIALS AND METHODS

We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019-February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l'Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation.

RESULTS

During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID (p = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036-8.047], p < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly (p = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined (p < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased (p = 0.009) in INSE and this decrease was related to COVID-19.

CONCLUSION

The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region.

How has Guinea learnt from the response to outbreaks? A learning health system analysis

INTRODUCTION

Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea's health system has learnt from the response to outbreaks between 2014 and 2021.

METHODS

We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022.

RESULTS

The 70 reports included in the evidence synthesis were about the 2014-2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts' opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents' commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system.

CONCLUSION

Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.

Evaluation of Three Blended Learning Courses to Strengthen Health Professionals' Capacity in Primary Health Care, Management of Sexual and Reproductive Health Services and Research Methods in Guinea

Background

Three blended courses on Primary Health Care (eSSP), Management of Sexual and Reproductive Health Services (eSSR), and Research Methods (eMR) were developed and implemented between 2017 and 2021 by the Maferinyah National Training and Research Center in Rural Health, a training and research institution of the Ministry of Health in Guinea. The study objectives were to evaluate the reasons for dropout and abstention, the learners' work behavior following the training, and the impact of the behavior change on the achievements of learners' organizations or services.

Methods

We evaluated the three implemented courses in 2021, focusing on levels 3 and 4 of the Kirkpatrick training evaluation model. Quantitative and qualitative data were collected through an open learning platform (Moodle), via an electronic questionnaire, during the face-to-face component of the courses (workshops), and at learners' workplaces. Descriptive statistics and thematic analysis were performed for quantitative and qualitative data, respectively.

Results

Out of 1,016 applicants, 543 including 137 (25%) women were enrolled in the three courses. Over the three courses, the completion rates were similar (67–69%) along with 20–29% dropout rates. Successful completion rates were 72% for eSSP, 83% for eMR and 85% for eSSR. Overall success rate (among all enrollees) ranged from 50% (eSSP) to 58% (eSSR). The majority (87%) of the learners reported applying the knowledge and skills they acquired during the courses through activities such as supervision (22%), service delivery (20%), and training workshops (14%). A positive impact of the training on utilization/coverage of services and increased revenues for their health facilities were also reported by some trainees.

Conclusion

These findings showed fair success rates and a positive impact of the training on learners' work behavior and the achievements of their organizations.

Effect of COVID-19 on maternal and neonatal healthcare services in Guinea: a hospital based study

Objective

The objective of this study was to analyze the effect of COVID-19 on routine maternal and newborn health services in three referral facilities in Guinea.

Methods

This was a cross-sectional study using routine facility data covering two years (2019-2021). COVID-19 effects were quantified using interrupted time series models. The use of services (intra-hospital deliveries and neonatal admissions) and outcomes (obstetric complications and neonatal deaths) were analyzed for the periods before (March 2019-February 2020), and during (March 2020-February 2021) the COVID-19.

Results

The mean number of monthly deliveries did not vary significantly before and during COVID-19 but that of induced labor increased significantly during COVID-19 (p < 0.001). Also, the monthly mean of neonatal admissions significantly decreased during COVID-19 (167 versus 124; p < 0.001). The mean number of monthly hospitalizations significantly decreased (123 before COVID-19 versus 87 during; p = 0.001). The mean number of monthly neonatal admissions in the pre-COVID-19 period significantly increased. Immediately after the start of the epidemic in Guinea (March 12, 2020), admissions declined significantly (64 admissions, 95%CI 102-27; p = 0.001). The mean number of monthly maternal deaths increased significantly during the pandemic (p = 0.002), as did the number of babies with low birth weight (p = 0.04). In the pre-COVID-19 period, there was a monthly increase of three neonatal deaths (95%CI 1.5 - 4; p = 0.001) but from the start of COVID-19, the monthly trend declined significantly and continued throughout the COVID-19 period (5 deaths/month, 95%CI 7-3).

Conclusions

The ongoing COVID-19 pandemic is jeopardizing efforts to achieve Millennium Development Goals for maternal and child health in urban settings in Guinea. For the country's health system to be resilient to crises such as COVID-19, there is a need for interventions to ensure the continuity of maternal and neonatal care.

Key messages

COVID-19 decreased monthly hospitalizations but increased maternal deaths in big urban maternities in Guinea.

COVID-19 decreased neonatal admissions and deaths but increased low birth weight in referral neonatal units in Conakry, Guinea.

Mobilizing health district management teams through digital tools: Lessons from the District.Team initiative in Benin and Guinea using an action research methodology

BACKGROUND

Improving capacities of health systems to quickly respond to emerging health issues, requires a health information system (HIS) that facilitates evidence-informed decision-making at the operational level. In many sub-Saharan African countries, HIS are mostly designed to feed decision-making purposes at the central level with limited feedback and capabilities to take action from data at the operational level. This article presents the case of an eHealth innovation designed to capacitate health district management teams (HDMTs) through participatory evidence production and peer-to-peer exchange.

METHODS

We used an action research design to develop the eHealth initiative called "District.Team," a web-based and facilitated platform targeting HDMTs that was tested in Benin and Guinea from January 2016 to September 2017. On District.Team, rounds of knowledge sharing processes were organized into cycles of five steps. Quantitative and qualitative data were collected to assess the participation of HDMTs and identify enablers and barriers of using District.Team.

RESULTS

Participation of HDMTs in District.Team varied between cycles and steps. In Benin, 79% to 94% of HDMTs filled in the online questionnaire per cycle compared to 61% to 100% in Guinea per cycle. In Benin, 26% to 41% of HDMTs shared a commentary on the results published on the platform while 21% to 47% participated in the online discussion forum. In Guinea, only 3% to 8% of HDMTs shared a commentary on the results published on the platform while 8% to 74% participated in the online discussion forum. Five groups of factors affected the participation: characteristics of the digital tools, the quality of the facilitation, profile of participants, shared content and data, and finally support from health authorities.

CONCLUSION

District.Team has shown that knowledge management platforms and processes valuing horizontal knowledge sharing among peers at the decentralized level of health systems are feasible in limited resource settings.

Outcomes of blended learning for capacity strengthening of health professionals in Guinea

BACKGROUND

Quality human resources constitute an essential pillar of an effective health system. This paper analyzes the outcomes of blended learning for post-Ebola capacity strengthening of health professionals in Guinea.

METHODS

Two courses lasting 3 months each (7-8 modules) were developed and implemented: one in Primary Health Care (eSSP) and the other in Sexual and Reproductive Health Services Management (eSSR). Both eSSP and eSSR courses were offered online on the Moodle platform, followed by a face-to-face capacity-building workshop. A cross-sectional study using a mixed-methods approach was conducted in 2018-19. As outcomes, we described learners' sociodemographic characteristics, course completion and success, and perceptions of the courses and support from the instructors, analyzed the factors associated with learners' successful completion and reported on learners' feedback on their blended learning experience. Quantitative data were analyzed using the STATA 15 software, and qualitative data were analyzed through content analysis.

RESULTS

Overall, 282 health professionals were enrolled for both eSSP and eSSR courses. The completion rate was 69.5% (196/282). The success rate for learners who completed the courses was 80% (156/196), and the overall success rate for enrollees was 55% (156/282). The dropout and abstention rates were 22 and 9%, respectively. On both eSSP and eSSR courses, the success rate of women enrolled was higher than or equal to men's. The success rate of medical doctors enrolled (53% for eSSP and 67% for eSSR) was higher than for other health professionals, in particular nurses (9% for eSSP) and midwives (40% for eSSR). Course type was associated with success (AOR = 1.93; 95% CI = 1.15-3.24). Most learners strongly agreed that the courses are relevant for targeted health professionals (81 to 150/150), pdf course materials are well-structured and useful (105/150), the content of the modules is relevant, comprehensible, and clear (90/150), self-assessment quizzes are helpful (105/150), summative assessment assignments are relevant (90/150), the course administrators and IT manager were responsive to learners' concerns (90/150), they will recommend the courses to colleagues and friends (120/150).

CONCLUSION

Two blended courses for capacity strengthening of health professionals were successfully developed and implemented in Guinea.

[eLearning approach for capacity strengthening of health professionals in Guinea: A post-Ebola experience]

INTRODUCTION

The development of quality human resources for health is an essential pillar of an effective health system. The objective of this study was to describe the implementation process and the results of an eLearning approach for capacity strengthening of health professionals in Guinea.

METHOD

A descriptive cross-sectional study using a mixed research method was conducted from January 15, 2018 to January 15, 2019.

RESULTS

A team from the National Training and Research Centre in Rural Health of Maferinyah in Guinea has been trained in the development of online courses. Two courses lasting three months each (7 to 8 modules), entirely offered online on the Moodle platform, have been developed, one on Primary Health Care (eSSP) and the other on the Management of Sexual and Reproductive Health Services (eSSR). Overall, 282 health professionals have been enrolled for both courses, with a completion rate of 69.5%. The success rate for learners who completed the courses was 79.6% and the success rate for enrollees was 55.3%. The dropout and abstention rates were 21.6% and 8.9%, respectively. The strengths, weaknesses and challenges of the organization and the success of such a training were reported.

CONCLUSIONS

The eLearning approach for capacity strengthening of health professionals is feasible and gives good findings in low-income contexts like that of Guinea.

[Frequency of pregnancies within school environment and profile of adolescent girls who have had the experience in Conakry city, Guinea]

INTRODUCTION

Pregnancy in schools is an obstacle to the development and education of young girls, especially in developing countries. The purpose of this study was to assess the frequency of pregnancies within a school setting and the profile of adolescent girls who have had the experience in Conakry, Guinea.

METHOD

We conducted a cross-sectional study covering the period from January 1 to June 30, 2017 in 16 schools.

RESULTS

A total of 2,419 adolescent girls consented to participate in the study. The mean age was 16.48±0.04 years with extremes of 10 and 19 years. Students aged 15 to 19 (93.0%), those in college (53.3%) and single (69.8%) were the most likely to have been pregnant in school (P&lt;0.05). The factors statistically significantly associated with the occurrence of teenage pregnancies in a school environment were age (Adjusted odds ratio (AOR)=1.5; 95%CI=1.3-1.7; P&lt;0.001), school level (AOR=0.6; 95%CI=0.4-0.8; P=0.003 for Lycée), the place of residence (AOR=0.5; 95%CI=0.4-0.9; P=0.002 for Matam, AOR=0.4; 95%CI=0.3-0.8; P&lt;0.001 for Dixinn, AOR=0,3; 95%CI=0.2-0.8; P=0.010 for Ratoma), marital status (AOR=8.7; 95%CI=3.4-7.0; P&lt;0.001), information on reproductive health (AOR=2.4; 95%CI=1.1-3.0; P=0.015), knowledge of the benefits of family planning (AOR=2.2; 95%CI=1.0-2.2; P=0.030) and the difficulty of accessing sexual and reproductive health services (AOR=3.4; 95%CI=1.4-3,7; P&lt;0.01).

CONCLUSIONS

The occurrence of school pregnancies remains a worrying reality among adolescent girls in Guinea. Factors associated with the occurrence of pregnancy in the school are age, school level, place of residence, marital status, knowledge of sexual health information, knowledge of the benefits of family planning, and related difficulties access to sexual and reproductive health services.

Learning for Universal Health Coverage

The journey to universal health coverage (UHC) is full of challenges, which to a great extent are specific to each country. 'Learning for UHC' is a central component of countries' health system strengthening agendas. Our group has been engaged for a decade in facilitating collective learning for UHC through a range of modalities at global, regional and national levels. We present some of our experience and draw lessons for countries and international actors interested in strengthening national systemic learning capacities for UHC. The main lesson is that with appropriate collective intelligence processes, digital tools and facilitation capacities, countries and international agencies can mobilise the many actors with knowledge relevant to the design, implementation and evaluation of UHC policies. However, really building learning health systems will take more time and commitment. Each country will have to invest substantively in developing its specific learning systemic capacities, with an active programme of work addressing supportive leadership, organisational culture and knowledge management processes.

Evaluation of the maternal deaths surveillance and response system at the health district level in Guinea in 2017 through digital communication tools

BACKGROUND

Reducing maternal mortality still remains a major challenge in low-income countries. This study aims to explore how digital communication tools can be used to evaluate the maternal deaths surveillance and response (MDSR) system at the health district level in Guinea.

METHODS

A descriptive cross-sectional study was conducted, using an innovative digital approach called District.Team, from April to September 2017. This study targeted all 38 district medical officers in Guinea. In addition to district medical officers, the participation of health actors from regional and central levels were also expected in the online discussion forum. Data collected through the questionnaire were mixed and those from the online discussion forum were entirely qualitative.

RESULTS

In total, 23 (61%) district medical officers (DMOs) participated in the study. Out of health districts (87%) which had updated guidelines and standards for the MDSR, 4 (20%) did not apply the content. In two health districts (8.7%), not all health facilities had maternal deaths notification forms. Three districts (13%) did not have maternal death review committees. In 2016, only half (50.2%) of reported maternal deaths were reviewed. The main recommendation formulated was related to quality of care. Other needs were also highlighted including continuous training of health care providers on emergency obstetric and neonatal care. Less than half (45%) of the review committee's recommendations were implemented. Six health districts (26.1%) did not have a response plan to reported maternal deaths and no district annual report on the MDSR was published in 2016. The weaknesses identified were, among others, insufficiency of human resources and lack of financial resources. Fifty-eight messages related to MDSR weaknesses and improvement solutions were posted in the online discussion forum by 28 participants (23 DMOs and 5 health actors from regional and central levels).

CONCLUSION

Digital tools can be used to assess the functioning of a system like maternal deaths surveillance and response. Moreover, the findings of the evaluation conducted will help stakeholders (starting from the health districts themselves) to design strategies and interventions for an effective MDSR.