Authors:
C. Norman Coleman; John E. Wong, Eugenia Wendling, Mary Gospodarowicz, Donna O’Brien, Taofeeq Abdallah Ige, Simeon Chinedu Aruah, David A. Pistenmaa, Ugo Amaldi, Onyi–Onyinye Balogun, Harmar D. Brereton, Silvia Formenti, Kristen Schroeder, Nelson Chao, Surbhi Grover, Stephen M. Hahn, James Metz, Lawrence Roth, Manȷit Dosanȷh Pages: 626 - 637 PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00108 Issue No:Vol. 8, No. 4 (2020)
Authors:
Kasereka M. Claude; Muyisa Sahika Serge, Kahindo Kahatane Alexis, Michael T. Hawkes Pages: 638 - 653 Abstract: ABSTRACTBackground:The coronavirus disease (COVID-19) pandemic poses a grave threat to refugees and internally displaced persons (IDPs). We examined knowledge, attitudes, and practices with respect to COVID-19 prevention among IDPs in war-torn Eastern Democratic Republic of the Congo (DRC).Methods:Mixed-methods study with qualitative (focus group discussions, [FGDs]) and quantitative (52-item survey questionnaire) data collection and synthesis.Results:FGDs (N=23) and survey questionnaires (N=164 IDPs; N=143 comparison group) were conducted in May 2020. FGD participants provided narratives of violence that they had fled. IDPs were statistically more likely to have larger household size, experience more extreme poverty, have lower educational attainment, and have less access to information through media and internet versus the comparison group (P PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00272 Issue No:Vol. 8, No. 4 (2020)
Authors:
Md. Mehedi Hasan; Ricardo J. Soares Magalhaes, Saifuddin Ahmed, Sayem Ahmed, Tuhin Biswas, Yaqoot Fatima, Md. Saimul Islam, Md. Shahadut Hossain, Abdullah A. Mamun Pages: 654 - 665 Abstract: ABSTRACTIntroduction:Improving reproductive, maternal, newborn, and child health (RMNCH) care services is imperative for reducing maternal and child mortality. Many low- and middle-income countries (LMICs) are striving to achieve RMNCH-related Sustainable Development Goals (SDGs). We monitored progress, made projections, and calculated the average annual rate of change needed to achieve universal (100%) access of RMNCH service indicators by 2030.Methods:We extracted Demographic and Health Survey (DHS) data of 75 LMICs to estimate the coverage of RMNCH indicators and composite coverage index (CCI) to measure health system strengths. Bayesian linear regression models were fitted to predict the coverage of indicators and the probability of achieving targets.Results:The projection analysis included 64 countries with available information for at least 2 DHS rounds. No countries are projected to reach universal CCI by 2030; only Brazil, Cambodia, Colombia, Honduras, Morocco, and Sierra Leone will have more than 90% CCI. None of the LMICs will achieve universal coverage of all RMNCH indicators by 2030, although some may achieve universal coverage for specific services. To meet targets for universal service access by 2030, most LMICs must attain a 2-fold increase in the coverage of indicators from 2019 to 2030. Coverage of RMNCH indicators, the probability of target attainments, and the required rate of increase vary significantly across the spectrum of sociodemographic disadvantages. Most countries with poor historical and current trends for RMNCH coverage are likely to experience a similar scenario in 2030. Countries with lower coverage had higher disparities across the subgroups of wealth, place of residence, and women’s/mother’s education and age; these disparities are projected to persist in 2030.Conclusion:None of the LMICs will meet the SDG RMNCH 2030 targets without scaling up essential RMNCH interventions, reducing gaps in coverage, and reaching marginalized and disadvantaged populations. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00097 Issue No:Vol. 8, No. 4 (2020)
Authors:
Jane T. Bertrand; John Ross, Tara M. Sullivan, Karen Hardee, James D. Shelton Pages: 666 - 679 Abstract: ABSTRACTContext:Improving contraceptive method choice is a goal of international family planning. Method mix—the percentage distribution of total contraceptive use across various methods—reflects both supply (availability of affordable methods) and demand (client preferences). We analyze changes in method mix, regional contrasts, and the relationship of the mix to contraceptive prevalence.Methods:We use 789 national surveys from the 1960s through 2019, from 113 developing countries with at least 1 million people and with data on use of 8 contraceptive methods. Two measures assess the “evenness” of the mix: method skew (more than 50% use is by 1 method), and the average deviation (AD) of the 8 methods’ shares from their mean value. Population weighted and unweighted results are compared because they can differ substantially.Results:Use of traditional methods has declined but still represents 11% of all use (population weighted) or 17% (unweighted country average). Vasectomy’s share was historically low with the exception of a few countries but is now even lower. The previous trend toward greater overall evenness in the mix has slowed recently. Sub-Saharan Africa shows a hormonal method progression from oral contraceptives to injectables to implants in a substantial number of countries. In some countries with high HIV prevalence, the condom share has increased. The leading method’s share differs by region: female sterilization in Asia (39%) and in Latin America (31%), the pill in the Middle East/North Africa (32%), and the injectable in sub-Saharan Africa (36%). Method skew persists in 30% of countries. “Evenness” of mix is not related to contraceptive prevalence.Conclusion:The marked diversity in predominant methods underscores the conclusion that no single method mix is ideal or appropriate everywhere. But that diversity across countries, coupled with the persisting high degree of extreme skewness in many of them, argues for continued concerted efforts for programs to increase method choice. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00229 Issue No:Vol. 8, No. 4 (2020)
Authors:
Natasha Kanagat; Kirstin Krudwig, Karen A. Wilkins, Sydney Kaweme, Guissimon Phiri, Frances D. Mwansa, Mercy Mvundura, Joanie Robertson, Debra Kristensen, Abdoulaye Gueye, Sang D. Dao, Pham Q. Thai, Huyen T. Nguyen, Thang C. Tran Pages: 680 - 688 Abstract: ABSTRACTIntroduction:Limited information exists on health care workers’ (HCWs) perceptions about use of multidose vaccine vials and their preferences about doses per container (DPC). We present findings from qualitative studies conducted in Senegal, Vietnam, and Zambia to explore HCWs’ behavior regarding opening vials and their perceptions and preferences for the number of doses in vials of BCG and measles-containing vaccine (MCV). Zambia and Senegal currently offer MCV in 10-dose vials and BCG in 20-dose vials; 10-dose vials are used for both vaccines in Vietnam. Unused doses in vials of these reconstituted vaccines must be discarded within 6 hours.Methods:Key informant interviews (KIIs) were conducted with frontline HCWs in Senegal, Vietnam, and Zambia. In Senegal and Vietnam, the KIIs were conducted as part of broader formative research; in Zambia, KIIs were conducted in control districts using 10-dose MCV vials only and in intervention districts that switched from 10- to 5-dose vials during the study. During analysis, themes common to all 3 countries were synthesized. Critical themes relevant to country contexts were also examined.Results:HCWs in all 3 countries preferred containers with fewer doses for BCG and MCV to reduce wastage and increase the likelihood of vaccinating every eligible child. HCWs in Senegal and HCWs using 10-dose vials in Zambia reported sending unvaccinated children away because not enough children were present to warrant opening a new vial. In Vietnam, where sessions are typically held monthly, and in Zambia when the 5-dose vials were used, almost all HCWs reported opening a vial of MCV for even 1 child.Discussion:HCWs prefer vials with fewer DPC. Their concerns about balancing coverage and wastage influence their decisions to vaccinate every eligible child; and their perspectives are crucial to ensuring that all target populations are reached with vaccines in a timely manner. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00112 Issue No:Vol. 8, No. 4 (2020)
Authors:
Grant Donovan; Siew Kim Ong, Sophanna Song, Nayah Ndefru, Chhayheng Leang, Sophat Sek, Lucy A. Perrone Pages: 689 - 698 Abstract: ABSTRACTBackground:Providing professional development opportunities to staff working in clinical laboratories undergoing quality improvement programs can be challenged by limited funding, particularly in resource-limited countries such as Cambodia. Using innovative approaches such as video conferencing can connect mentors with practitioners regardless of location. This study describes and evaluates the methods, outputs, and outcomes of a quality improvement program implemented in 12 public hospital laboratories in Cambodia between January 2018 and April 2019. The program used mixed intervention methods including both in-person and remote-access training and mentorship.Methods:Training outputs were quantified from the activity reports of program trainers and mentors. Program outcomes were measured by pre- and postimplementation audits of laboratory quality management system conformity to international standards. Variations in improved outcomes were assessed in relation to the time spent by laboratory personnel in video conference training and mentoring activity. An additional cross-sectional comparison described the difference in final audit scores between participating and nonparticipating laboratories.Results:Laboratories significantly improved their audit scores over the project period, showing significant improvement in all sections of the ISO 15189 standard. Pre- and postaudit score differences and laboratory personnel participation time in remote mentoring activities showed a strong monotonic relationship. Average input per laboratory was 6,027±2,454 minutes of participation in video conference activities with mentors. Audit scores of participating laboratories were significantly higher than those of laboratories with no quality improvement program.Conclusion:Laboratories improved significantly in ISO 15189 conformity following structured laboratory quality management systems training supported by remote and on-site mentoring. The correlation of laboratory participation in video conference activities highlights the utility of remote video conferencing technology to strengthen laboratories in resource-limited settings and to build communities of practice to address quality improvement issues in health care. These findings are particularly relevant in light of the COVID-19 pandemic. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00128 Issue No:Vol. 8, No. 4 (2020)
Authors:
Sean Duffy; Derek Norton, Mark Kelly, Aleȷandro Chavez, Rafael Tun, Mariana Nino de Guzman Ramirez, Guanhua Chen, Paul Wise, Jim Svenson Pages: 699 - 720 Abstract: ABSTRACTBackground:The global prevalence of diabetes has nearly doubled since 1980. Seventy-five percent of patients with diabetes live in low- and middle-income countries, such as Guatemala, where health care systems are often poorly equipped for chronic disease management. Community health workers (CHWs) and mobile health technology have increasingly been applied to the diabetes epidemic in these settings, although mostly in supportive rather than primary roles in diabetes management. We sought to improve diabetes care in rural Guatemala through the development of a CHW-led diabetes program and a smartphone application to provide CHWs with clinical decision support.Methods:We worked with our local partners to develop a program model and the smartphone application (using the CommCare platform) and to train CHWs. We recruited patients with type 2 diabetes living in rural communities. Program evaluation used a single-group, pre-post design. Primary outcomes were hemoglobin A1c and the percentage of patients meeting A1c goals compared with baseline. We also followed a variety of process metrics, including application reliability.Results:Eighty-nine patients enrolled during the study period. The hemoglobin A1c percentage decreased significantly at 3 months (-1.0; 95% CI=-1.7, -0.6), 6 months (-1.5; 95% CI=-2.2, -0.8), 9 months (-1.3; 95% CI=-2.0, -0.6), and 12 months (-1.0; 95% CI=-1.7, -0.4). The percentage of patients with A1c ≤ 8% increased significantly at 3 months (23.6% to 44.4%, P=.007), 6 months (22.0% to 44.0%, P=.015), and 9 months (23.9% to 45.7%, P=.03). CHWs and supervising physicians agreed with application medication recommendations>90% of the time.Conclusion:Our results suggest that CHWs can safely and effectively manage diabetes with the assistance of a smartphone application and remote physician supervision. This model should be evaluated versus other standards of care and could be adapted to other low-resource settings and chronic diseases. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00076 Issue No:Vol. 8, No. 4 (2020)
Authors:
Jessica D. Brewer; Julianna Shinnick, Karina Roman, Maria P. Santos, Valerie A. Paz–Soldan, Alison M. Buttenheim Pages: 721 - 731 Abstract: ABSTRACTChildhood anemia remains a significant driver of morbidity in low- and middle-income countries, including Peru. To identify behavioral challenges to using micronutrient powder (MNP) that is given to supplement children’s diets and prevent anemia, we applied a behavioral design approach to interviews and focus groups with 129 caregivers in Arequipa, Peru. We examined 3 key points in the decision-making process: accessing MNP through the health system; forming intentions to use MNP; and MNP use at the time of child feeding. Using the NUDGE (Narrow, Understand, Discover, Generate, Evaluate) approach, we identified the following behavioral barriers and facilitators: (1) caregivers’ experiences with health care providers shaped their motivation to access MNP; (2) caregivers felt accessing MNP at clinics was inconvenient and created hassle factors; (3) caregivers’ mental models about anemia prevention shaped MNP intentions and use; (4) caregivers’ salient negative experiences could have caused them to stop giving MNP; (5) caregivers forgot to give MNP if they did not have cues to remind them but could be prompted with salient cues; and (6) caregivers were affected by emotional, cognitive, and attentional factors during feeding that were difficult to anticipate. Our results, based on a behavioral design approach, suggest opportunities to adapt current messaging, counseling, and education around MNP use. Adaptations include providing culturally relevant messages, leveraging caregivers’ emotional and cognitive states, and encouraging small but impactful changes to feeding routines to address barriers to MNP use. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00078 Issue No:Vol. 8, No. 4 (2020)
Authors:
Laura C. Altobelli; Jose Cabreȷos–Pita, Mary Penny, Stan Becker Pages: 732 - 758 Abstract: ABSTRACTBackground:Community health workers (CHWs) are increasingly deployed to support mothers’ adoption of healthy home practices in low- and middle-income countries. However, little is known regarding how best to train them for the capabilities and cultural competencies needed to support maternal health behavior change. We tested a CHW training method, Sharing Histories (SH), in which CHWs recount their own childbearing and childrearing experiences on which to build new learning.Methods:We conducted an embedded cluster-randomized trial in rural Peru in 18 matched clusters. Each cluster was a primary health facility catchment area. Government health staff trained female CHWs using SH (experimental clusters) or standard training methods (control clusters). All other training and system-strengthening interventions were equal between study arms. All CHWs conducted home visits with pregnant women and children aged 0–23 months to teach, monitor health practices and danger signs, and refer. The primary outcome was height-for-age (HAZ) PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-19-00332 Issue No:Vol. 8, No. 4 (2020)
Authors:
Michael Krautmann; Mariam Zameer, Dorothy Thomas, Nora Phillips-White, Ana Costache, Pascale R. Leroueil Pages: 759 - 770 Abstract: ABSTRACTEffective and efficient health supply chains play a vital role in achieving health outcomes by ensuring supplies are available for people to access quality health services. However, supplying health commodities to service delivery points is complex and costly in many low- and middle-income countries. Thus, governments and partner organizations are often interested in understanding how to design their health supply chains more cost efficiently.Several modeling tools exist in the public and private market that can help assess supply chain efficiency and identify supply chain design improvements. These tools are generally capable of providing users with very precise cost estimates, but they often use proprietary software and require detailed data inputs. This can result in a somewhat lengthy and expensive analysis process, which may be prohibitive for many decision makers, especially in the early stages of a supply chain design process. For many use cases, such as advocacy, informing workshop and technical meetings, and narrowing down initial design options, decision makers may often be willing to trade some detail and accuracy in exchange for quicker and lower-cost analysis results. To our knowledge, there are no publicly available tools focused on generating quick, high-level estimates of the cost and efficiency of different supply chain designs.To address this gap, we designed and tested an Excel-based Rapid Supply Chain Modeling (RSCM) Tool. Our assessment indicated that, despite requiring significantly less data, the RSCM Tool can generate cost estimates that are similar to other common analysis and modeling methods. Furthermore, to better understand how the RSCM Tool aligns with real-world processes and decision-making timelines, we used it to inform an ongoing immunization supply chain redesign in Angola. For the use cases described above we believe that the RSCM Tool addresses an important need for quicker and less expensive ways to identify more cost-efficient supply chain designs. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00227 Issue No:Vol. 8, No. 4 (2020)
Authors:
Emily Carnahan; Nikki Gurley, Gilbert Asiimwe, Baltazar Chilundo, Herbert C. Duber, Adama Faye, Carol Kamya, Godefroid Mpanya, Shakilah Nagasha, David Phillips, Nicole Salisbury, Jessica Shearer, Katharine Shelley, for the Gavi Full Country Evaluations Consortium; Global Fund Prospective Country Evaluation Consortium Pages: 771 - 782 Abstract: ABSTRACTIntroduction:As global health programs have become increasingly complex, corresponding evaluations must be designed to assess the full complexity of these programs. Gavi and the Global Fund have commissioned 2 such evaluations to assess the full spectrum of their investments using a prospective mixed-methods approach. We aim to describe lessons learned from implementing these evaluations.Methods:This article presents a synthesis of lessons learned based on the Gavi and Global Fund prospective mixed-methods evaluations, with each evaluation considered a case study. The lessons are based on the evaluation team’s experience from over 7 years (2013–2020) implementing these evaluations. The Centers for Disease Control and Prevention Framework for Evaluation in Public Health was used to ground the identification of lessons learned.Results:We identified 5 lessons learned that build on existing evaluation best practices and include a mix of practical and conceptual considerations. The lessons cover the importance of (1) including an inception phase to engage stakeholders and inform a relevant, useful evaluation design; (2) aligning on the degree to which the evaluation is embedded in the program implementation; (3) monitoring programmatic, organizational, or contextual changes and adapting the evaluation accordingly; (4) hiring evaluators with mixed-methods expertise and using tools and approaches that facilitate mixing methods; and (5) contextualizing recommendations and clearly communicating their underlying strength of evidence.Conclusion:Global health initiatives, particularly those leveraging complex interventions, should consider embedding evaluations to understand how and why the programs are working. These initiatives can learn from the lessons presented here to inform the design and implementation of such evaluations. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00126 Issue No:Vol. 8, No. 4 (2020)
Authors:
Gwendolyn Morgan; Anjala Kanesathasan, Akinsewa Akiode Pages: 783 - 798 Abstract: ABSTRACTBackground:Reproductive health programs for youth have largely overlooked first-time parents (FTPs)—defined as young women younger than 25 years old who are pregnant or already have 1 child, and their partners. To address this gap, we implemented and evaluated a program to improve child spacing, modern contraceptive use, and related gender outcomes among FTPs in Cross River State (CRS), Nigeria. This paper examines the effectiveness of FTP interventions in improving voluntary uptake of contraception.Methods:We conducted small group sessions and home visits with FTPs from May to August 2018 in 2 local government areas of CRS. A pretest–posttest study examined the effectiveness of these interventions regarding healthy timing and spacing of pregnancy/family planning knowledge, attitudes, intentions, communication, decision making, and contraceptive use. We performed a bivariate analysis and logistic binomial regression to confirm change over time in the primary study outcome, current use of a modern method of contraception. We also performed analysis of demographic characteristics and secondary outcomes (e.g., birth spacing intentions and couple communication).Results:We interviewed 338 participating first-time mothers (FTMs) and 224 participating partners at baseline and endline. Important indicators of contraceptive awareness, attitudes, and couples’ communication increased significantly from baseline to endline. Voluntary current modern contraceptive use increased from 26% to 79% among nonpregnant FTMs (P PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00111 Issue No:Vol. 8, No. 4 (2020)
Authors:
Bridgit Adamou; Janine Barden–O’Fallon, Katie Williams, Amani Selim Pages: 799 - 812 Abstract: ABSTRACTHealth information systems rely on high-quality data to measure, track, and inform decision making. Currently, the quality, uptake, and use of family planning data in routine health information systems is limited, presenting an opportunity for improvement on many levels. The current synthesis assessed findings from 17 small grants that MEASURE Evaluation issued to low- and middle-income country research teams between 2015 and 2019. Main findings from that research were collaboratively categorized in 4 major themes: (1) the enabling environment for managing and using family planning information; (2) barriers to integration of family planning in routine health information systems; (3) gaps in the analysis, interpretation, and use of routine family planning data; and (4) family planning data use in management, programmatic, and budgetary decisions. Data quality at the systemic, organizational, technical, and output levels was a crosscutting theme. Collectively, the findings outline barriers to and opportunities for improved integration of family planning data and subsequent strengthening of routine health information systems. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00122 Issue No:Vol. 8, No. 4 (2020)
Authors:
Banyar Aung; Jason W. Mitchell, Kathryn L. Braun Pages: 813 - 826 Abstract: ABSTRACTBackground:mHealth interventions are being tested to improve contraceptive uptake in low- and middle-income countries (LMICs); however, the effectiveness of these interventions has not been systematically reviewed.Objectives:The primary objective of this systematic review was to assess the effectiveness of mHealth interventions to improve contraceptive uptake and adherence in LMICs. A second objective was to identify mHealth features and behavior change communication components used in these mHealth interventions.Methods:A systematic search was conducted of online databases for peer-reviewed articles that reported on intervention studies with men and women from LMICs and measured mHealth intervention impact on contraceptive uptake and/or adherence. Key search terms included “mHealth” or “mobile health,” “contraception” or “family planning,” and “low- and middle-income countries.” PRISMA guidelines were followed for reporting review methods and findings. The Cochrane risk-of-bias 2 tool for randomized trials was used to assess the risk of bias of the included studies. The GRADE approach was used to determine the quality of evidence.Results:Eight randomized controlled trial studies met the inclusion criteria. Four studies experienced implementation challenges (e.g., intervention components were not utilized fully by participants, intervention participants did not receive the full intervention content, contamination, low response rate, and/or missing data). Only 3 interventions were found to be effective, and these included a “push” approach, interactive communication, information tailored to participants, motivational messaging, and male partner involvement.Conclusion:To date, the delivery of mHealth interventions for improving family planning in LMICs has met with implementation challenges that have reduced the researcher’s ability to test intervention effectiveness. Although 3 of 8 studies found improved contraceptive use in the intervention group, the review cannot draw concrete conclusions on the overall effectiveness of mHealth interventions to increase contraceptive use in LMICs. Further research with robust program fidelity is recommended. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00069 Issue No:Vol. 8, No. 4 (2020)
Authors:
Giorgia Gon; Said M. Ali, Robert Aunger, Oona M. Campbell, Micheal de Barra, Mariȷn de Bruin, Mohammed Juma, Stephen Nash, Amour Taȷo, Johanna Westbrook, Susannah Woodd, Wendy J. Graham Pages: 827 - 837 Abstract: ABSTRACTBackground:Good-quality evidence on hand hygiene compliance among birth attendants in low-resource labor wards is limited. The World Health Organization Hand Hygiene Observation Form is widely used for directly observing behaviors, but it does not support capturing complex patterns of behavior. We developed the HANDS at Birth tool for direct observational studies of complex patterns of hand rubbing/washing, glove use, recontamination, and their determinants among birth attendants. Understanding these behaviors is particularly critical in wards with variable patient volumes or unpredictable patient complications, such as emergency departments, operating wards, or triage and isolation wards during epidemics. Here we provide detailed information on the design and implementation of the HANDS at Birth tool, with a particular focus on low-resource settings. We developed the HANDS at Birth tool from available guidelines, unstructured observation, and iterative refinement based on consultation with collaborators and pilot results. We designed the tool with WOMBAT software, which supports collecting multidimensional time-and-motion data. Our analysis of the tool’s performance centered on interobserver agreement and convergent validity and the implications of the data structure for data analysis. The HANDS at Birth tool encompasses various hand actions and context-relevant information. Hand actions include procedures relevant during labor and delivery; hand hygiene or glove actions; and other types of touch. During field implementation, we used the tool for continuous observation of the birth attendant. Interobserver agreement was good (kappa range: 0.7–0.9), and the tool showed convergent validity. Using the HANDS at Birth tool is a feasible way to obtain useful information about compliance with hand hygiene procedures. The tool could be used after simple training and allows for collection of reliable information about the complex pattern of hygiene behaviors. Future studies should explore using this tool to observe behavior in labor wards in other settings and in other types of wards. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00221 Issue No:Vol. 8, No. 4 (2020)
Authors:
Shela Sridhar; Alexis Schmid, Francois Biziyaremye, Samantha Hodge, Ngamika Patient, Kim Wilson Pages: 838 - 845 Abstract: ABSTRACTBackground:Pediatric early warning (PEW) scores represent a “track-and-trigger system” that identifies clinical deterioration in a patient’s condition in the hours preceding a sentinel event. Before implementation, nurses reported feeling unprepared to identify and advocate for acutely ill patients owing to a lack of skills, vocabulary, and agency. We implemented a Pediatric Early Warning Score for Resource-Limited Settings (PEWS-RL) with nurses in a rural district hospital in Rwanda. Although PEW scores can improve clinical outcomes, empowering nurses in resource-limited settings to discuss patient acuity with physicians is a critical first step. Our primary aims were to train nurses to obtain more accurate vital signs and assess their importance as early warning signs of clinical deterioration and use PEW scores to improve communication between nurses and physicians.Implementation:The PEWS-RL tool implementation began with a training program that was created through discussions with nurses, physicians, and the medical director of the hospital. The program included lectures and application of learned skills through direct clinical mentorship of nurses, as well as training of physicians regarding PEWS-RL as a communication tool.Evaluation:The PEWS-RL protocol was evaluated based on pre- and post-tests to assess improvement in nurses’ knowledge and skill, as well as skills assessments of accurate recognition of clinical deterioration. All 6 nurses passed skill testing with>80% accuracy. Nurses’ feelings of empowerment to advocate for patients and to escalate care were assessed through pre- and post-training interviews. Nurses described increased confidence in calling for physician support.Discussion:Implementation of PEW scores increased nurses’ technical skills and feelings of confidence and empowerment; however, the low-resource setting presented major challenges. Barriers to sustainable implementation include the rapid ward staff turnover as well as limited physician buy-in. Nevertheless, the PEWS-RL tool has the potential to empower nurses and improve patient outcomes if fully embraced by staff. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00075 Issue No:Vol. 8, No. 4 (2020)
Authors:
Antony Duttine; Tracey Smythe, Miriam Ribeiro Calheiros de Sa, Silvia Ferrite, Maria Elisabeth Moreira, Hannah Kuper Pages: 846 - 857 Abstract: ABSTRACTBackground:The 2015–2016 Zika virus outbreak in Brazil was unprecedented and resulted in the birth of more than 3,000 children with congenital Zika syndrome (CZS). These children experience multiple complex health conditions and have limited services to support them and their family’s needs.Program Development and Piloting:An existing family support program for children with cerebral palsy (Getting to Know Cerebral Palsy) was adapted to the Zika context in Brazil through expert consultation. The program was pilot tested at 2 sites among 6 groups of caregivers (total of 48 families) from August 2017 to June 2018. Group observation and focus group discussions with facilitators and participants at the end of each session informed fast-track learning, which was used to tailor the program for future groups. Fast-track learning—adjusting the intervention in real time based on gathered feedback—was found to be a helpful process to inform and hone the program from its initial concept.Program Description:The intervention, Juntos, is a facilitated participatory group program for caregivers of children who have CZS. The group sessions are cofacilitated by a parent of a child who has CZS and an allied health professional. The group meets for 10 sessions that last 4 hours. Each session includes an icebreaker, activities, and group discussions. Content covers practical information on caring for a child with a developmental disability including that caused by Zika. Psychosocial support forms an important component, and families are guided from the first week to define and develop their own communities of support. Six pilot groups were successfully run in Rio de Janeiro and Greater Salvador, Bahia. The groups gave positive feedback on acceptability and demand.Conclusions:The program has the potential to be an important tool for community health and social support services in South America in response to Zika. The program can also be applied to children with neurodevelopmental disabilities other than those caused by the Zika virus, which could be important in ensuring families of children with CZS are less isolated. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00018 Issue No:Vol. 8, No. 4 (2020)
Authors:
Hamish R. Graham; Sheillah M. Bagayana, Ayobami A. Bakare, Bernard O. Olayo, Stefan S. Peterson, Trevor Duke, Adegoke G. Falade Pages: 858 - 862 Abstract: ABSTRACTOxygen therapy is an essential medicine and core component of effective hospital systems. However, many hospitals in low- and middle-income countries lack reliable oxygen access—a deficiency highlighted and exacerbated by the coronavirus disease (COVID-19) pandemic. Oxygen access can be challenged by equipment that is low quality and poorly maintained, lack of clinical and technical training and protocols, and deficiencies in local infrastructure and policy environment. We share learnings from 2 decades of oxygen systems work with hospitals in Africa and the Asia-Pacific regions, highlighting practical actions that hospitals can take to immediately expand oxygen access. These include strategies to: (1) improve pulse oximetry and oxygen use, (2) support biomedical engineers to optimize existing oxygen supplies, and (3) expand on existing oxygen systems with robust equipment and smart design. We make all our resources freely available for use and local adaptation. PubDate: 2020-12-23T10:57:01-08:00 DOI: 10.9745/GHSP-D-20-00224 Issue No:Vol. 8, No. 4 (2020)
Open Access journal
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