Bench, bed and beyond: communication and responsibility in decentralised tuberculosis care

Background: South Africa faces one of the world's worst drug-resistant tuberculosis epidemics. Implementing successful care in this context has proven challenging for a number of reasons. Communication is an essential yet neglected feature of care and research in the field of tuberculosis. Aim: The primary aim of this qualitative study was to explore communication facilitators and barriers at several tuberculosis care sites. In this article, we focus on communication practices across the chain of diagnosis, treatment, discharge and follow-up in decentralised care approaches and present evidence of gaps in communication. Setting: The study was conducted at three tuberculosis care sites in two South African provinces. Methods: Participants included healthcare workers, patients, community members and home-based carers. Data included 79 interviews, 4 video-recorded interactions between patients and healthcare workers, and ethnographic observations at each site. We analysed the data using thematic analysis and a qualitative sociolinguistic framework. Results: Communication in decentralised care contexts is complex because of multiple sites and role players. Responsibility for communication seems to be unduly placed on patients, treatment guidelines are not implemented consistently across sites and assumptions are made about the role of others in the chain. Patient and healthcare worker reports suggest confusion and frustration. Conclusion: Communication in the South African tuberculosis care context appears fragile and current mechanisms for detecting flaws in the care chain are not sensitive to communication issues. We make recommendations for strengthening home-based care resources, providing team training and focusing on communication processes in monitoring and evaluating systems

Social Marketing of Insecticide-Treated Bed Net for Malaria Control : an Experience in a Semi-urban Community in South-South Nigeria

Background: The effectiveness of the insecticide- treated bed net in reducing the morbidity and mortality associated with malaria has been proved at all levels of malaria transmission. Several models on how to achieve massive coverage have been suggested; but social marketing of the nets is highly favoured for its sustainability.Aim: To report the experience of a small- scale social marketing project for insecticide-treated bed net in a semi-urban community in south-south Nigeria.Methods: The social marketing project was established in 2003 in Egbema; a semi-urban community in Rivers State; with a population of 47;000. A descriptive cross-sectional study design was used for the study; with the sales records of the project and a structured; interviewer-administered questionnaire as study tools. The sales records were analysed to assess the performance of the project; while the questionnaire was used to collect data on the socio-economic characteristics of buyers of the net.Results: In six months; the project achieved an uptake rate of 1.10 ITN per month; per 1000 population; and a 6.5 coverage of the target population. Most; 208 (67); of the paid up sales were achieved at the well-child clinic and the antenatal clinic of the health facilities that serve the community. Buyers in the two lower socio- economic quartiles bought only about one third of the nets. Members of the community were predominantly farmers/fishermen; but only 19 (10) of the buyers of the nets identified themselves as such.Conclusion: The study shows that the use of social marketing for promoting the use of ITN for malaria control is slow in a poor community

Effect of Use of Insecticide Treated Nets on Birth Outcomes Among Primips in a Peri-Urban Slum Settlement in South-East; Nigeria

Introduction : Each year in sub-Saharan Africa; where 80 to 90 of the world's malaria cases occur; approximately 19 to 24 million women are at risk for malaria and its adverse consequences during pregnancy. The major impact of malaria during pregnancy in these regions is caused by persistent or recurrent; predominantly low-grade; sometimes sub-patent; parasitaemia. In Nigeria; malaria has severe negative effects on maternal health and birth outcomes; resulting in maternal anaemia; a high incidence of miscarriages and low birth weight. Primigravidae and secundigravidae are most at risk. Resistance to first-line antimalarials has increased in sub-Saharan Africa; and the available arsenal of alternative tools for malaria control in pregnancy is very limited. One of the most promising of these tools is insecticide-treated bed nets (ITNs); which have been shown to reduce the number of infective mosquito bites by 70 to 90 in a variety of ecologic settings. In Nigeria; the current use of ITNs by the at-risk groups; pregnant women and children under five years; is just 1; according to the latest report of the Nigeria Demographic and Health Survey (NDHS).Aim : This study aimed at examining the effects of the use of ITNs on pregnancy outcomes among 208 primigravidae. Methodology : The study design was an analytical case control. One hundred and four subjects; the intervention group; received ITNs between August 2003 and January 2004The other 104 subjects were the control. Data were obtained using the new World Health Organization antenatal care classifying form and the basic component checklist; and a self-structured; 30-item pre-tested questionnaire. The Apgar scores of the babies and their birth weights were observed and recorded for both the intervention and the control groups.Results : The results showed that 83 of babies of mothers in the intervention group had a good condition at birth; while 87 of babies of mothers in the control group had a good condition at birth (p larger than 0.07; X2=1.69). A small increase in mean birth weight (0.001kg) of the babies of mothers in the intervention group was observed over those of mothers in the control group (p larger than 0.90). This showed that there were no significant beneficial impacts of the use of ITNs on foetal condition at birth; mean birth weight and low birth weight.Conclusion : The use of ITNs by primigravidae in Okpoko; a peri-urban slum in south-eastern Nigeria; showed no significant impact on pregnancy outcome

Nurses' Accuracy in Estimating Backrest Elevation

Background. The Centers for Disease Control and Prevention (CDC) have recommended that the head of the bed of mechanically ventilated patients be elevated to between 30o and 45o to decrease the risk of ventilator associated pneumonia (VAP) Compliance with this recommendation may be affected by nurses' knowledge of the recommendation and their accuracy in estimating the backrest elevation. Objectives. To determine the difference between nurses' estimation of backrest angle and the actual measured angle; to determine the relationship between nurses' demographic characteristics and the accuracy of estimation; to determine nurses' knowledge of why this recommendation has been made. Methods. A convenience sample of 39 nurses working in the selected ICUs of the study hospital was used. The angles of elevation were preselected in each area. Estimated angles were correlated with measured angles and this was correlated with demographic characteristics. Results. Forty-two per cent of the nurses were accurate in their estimation of bedrest angle (correlation 0.6232). Demographic characteristics had little effect on accuracy. Conclusion. Nurses could benefit from assistance in accurately estimating backrest elevation angle; as well as from education regarding strategies to decrease the incidence of ventilator-associated pneumonia