Authors:Stephen Ojiambo Wandera, Edward Duncan, Monica Maria Diaz, David Otundo Ayuku Abstract: Background: Cognitive Stimulation Therapy (CST) is a non-pharmacological intervention developed for dementia that is useful in Africa but has not been studied widely. We reviewed the existing evidence regarding CST among older people living with dementia in Africa. Methods: A systematic literature search on CST among older people with dementia in Africa from 2000-2021 was done in MEDLINE (PubMed), CINAHL (EBSCOhost), and PsycINFO. A narrative approach was taken to chart, synthesize and interpret the data using Microsoft Excel. Results: After removing duplicates using Endnote, a total of 122 studies were retained and screened first by title, then abstract, and finally by full text. Seven articles matched the inclusion/exclusion criteria. CST has been adapted and piloted in two African countries (Nigeria and Tanzania). CST studies in Africa indicate improvements in clinical outcomes including cognition and quality of life. Although there are some barriers to overcome, CST has significant facilitators in an African context. Conclusions: CST is feasible, adaptable, and acceptable in the African countries it has been implemented in. Some cultural barriers, such as religious affiliation and respect for older people, should be overcome. Further research is needed to further evaluate the efficacy of CST in various African contexts. PubDate: 2023-06-13T14:38:13Z DOI: 10.12688/openresafrica.14092.1 Issue No:Vol. 6 (2023)
Authors:Imelda Namagembe, Jolly Beyeza-Kashesya, Joseph Rujumba, Dan K.Kaye, Moses Mukuru, Noah Kiwanuka, Ashley Moffett, Annettee Nakimuli, Josaphat Byamugisha Abstract: Background: Preventable maternal and newborn deaths remain a global concern, particularly in low- and- middle-income countries (LMICs) Timely maternal death surveillance and response (MDSR) is a recommended strategy to account for such deaths through identifying contextual factors that contributed to the deaths to inform recommendations to implement in order to reduce future deaths. Implementation of MDSR is still suboptimal due to barriers such as inadequate skills and leadership to support MDSR. With the leadership of WHO and UNFPA, there is momentum to roll out MDSR, however, the barriers and enablers for implementation have received limited attention. These have implications for successful implementation. The aim of this study was: To assess barriers and facilitators to implementation of MDSR at a busy urban National Referral Hospital as perceived by health workers, administrators, and other partners in Reproductive Health. Methods: Qualitative study using in-depth interviews (24), 4 focus-group discussions with health workers, 15 key-informant interviews with health sector managers and implementing partners in Reproductive-Health. We conducted thematic analysis drawing on the Theory of Planned Behaviour (TPB). Results: The major barriers to implementation of MDSR were: inadequate knowledge and skills; fear of blame / litigation; failure to implement recommendations; burn out because of workload and inadequate leadership- to support health workers. Major facilitators were involving all health workers in the MDSR process, eliminate blame, strengthen leadership, implement recommendations from MDSR and functionalize lower health facilities (especially Health Centre -IVs). Conclusions: The barriers of MDSR include knowledge and skills gaps, fear of blame and litigation, and other health system factors such as erratic emergency supplies, and leadership/governance challenges. Recommendation: Efforts to strengthen MDSR for impact should use health system responsiveness approach to address the barriers identified, constructive participation of health workers to harness the facilitators and addressing the required legal framework. PubDate: 2023-05-30T14:28:14Z DOI: 10.12688/openresafrica.13438.2 Issue No:Vol. 5 (2023)
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