Care-recipient perspectives on the responsiveness of Orthopedic surgical services in a tertiary center in Nigeria

Responsiveness optimisesthe system-based approach to meeting legitimate demands by healthcare recipients. This study assessed the responsiveness of orthopaedic services at the University of Port Harcourt Teaching Hospital (UPTH) from the perspectives of the care recipients. Methods:Descriptive cross-sectional study among 442 consecutively recruited recipients of orthopaedic services at UPTH from March to June 2020. Close-ended questionnaire with responsiveness conceptualised by five constructs: dignity, autonomy, confidentiality, quality of basic amenities and choice of care provider, each measured along 4-point response scale. The internal consistency reliability of the responsiveness scale was determined by the Cronbach's alpha coefficient. Descriptive (frequency, percentages, bar charts) and inferential (ordinal logistic regression) statistics were conducted and p-values ≤ 0.05 were considered statistically significant. Results: Response rate was 97.3% and the Cronbach's alpha coefficient for the responsiveness scale was 0.83. Participants' mean age was 38.5±14.8years with more being males (55.8%), privately employed (34.9%) and completed secondary education (82.5%). Proportion of respondents who gave excellent ratings across responsiveness domains were dignity (32.8%), autonomy (34.2%), confidentiality (26.3%), amenities (25.8%) and no excellent rating for choice of provider. Marital, employment and visit status were the most consistent factors associated with feedback on autonomy, choice of providers, confidentiality domains.Conclusion: More orthopaedic patients were pleased with the level of autonomy and dignity than choice of providers and quality of basic amenities. There is the need for enhanced responsiveness of orthopedic services to meeting the unique needs of patients and achieving improved quality of care and patient outcomes

Perceived accessibility, and adequacy of COVID-19 related information in Nigeria

Information on COVID-19 has evolved and blended with fake news, which the public, unfortunately, has to make an individual decision on how to use. As a result, access to authentic and adequate health information on COVID-19 is crucial for curbing the ongoing pandemic. The study was aimed at identifying sources of information on COVID-19 commonly used by adult Nigerian residents; determine the adequacy of information received; determine the accessibility of information on COVID-19 among Nigerians, and explore the relationship between location and access to information. An adapted version of the World Health Organization's (WHO) COVID-19 behavioral insight questionnaire was used to collect data from 1,039 adult residents in Nigeria across the geopolitical zones through an online survey. Analysis was done using SPSS version 24. Logistic regression was used to examine if location predicts access to information. Social media was identified as the major source of information among Nigerians. The top three accessible sources included social media 807(77.7%), television 546 (52.6%), and WHO websites 340 (32.7%). It was also found that they perceived information received on COVID-19 as adequate. The logistic regression model of the location did not predict access to COVID-19 information (p<0.05; 95% CI). Health authorities like the WHO, the ministry of health, CDC should optimize social media for better health information coverage.

Contexts, beliefs and health behaviour: Are individuals who engage in risky sexual behaviour likely to wear face-masks against COVID-19?

and availability of sanitation facilities, individual health beliefs and behaviour are critical in combating the sustained prevalence of Covid-19. Behaviour has, however, been shown to be consistent but could be context-dependent based on the individual's beliefs. To investigate whether or not individuals' protective behaviour against coronavirus is associated with their behaviour in a previous health context. Facemask usage and engagement in risky sexual behaviour (RSB) were employed as corollaries of Covid-19 protective behaviour and a previous health context respectively. Data on them and other sociodemographic correlates of health behaviour were collected on 522 Nigerians via a web-based survey. The data were analyzed using frequency, Chi Square and Binary Logistics Regression. About 31% of the population wore facemasks in public, 48.1% believed Covid existed and was severe, and 31.6% had engaged in RSB. Individuals who engaged in RSB had lower odds of wearing facemasks in public in both the general population and across the rural-urban divide. The relationship was, however, only statistically significant (OR:0.642, p<0.05) in the adjusted regression model. Other significant determinants of facemask use were gender, place of residence, employment status and beliefs about Covid. The similarity of individual beliefs and behaviours in different health contexts provides an opportunity to model behaviour change communication policies for preventing and combating the spread of coronavirus and other infectious diseases

COVID-19 and patient-doctor confidentiality

Given the increasing numbers of ethical and legal issues arising from the COVID-19 epidemic, particularly in respect of patient-doctor confidentiality, doctors must explain to patients how the measures taken to combat the spread of the virus impact on their confidentiality. Patients must be reassured that doctors are ethically bound to continue to respect such confidentiality, but it should be made clear to them that doctors must also comply with the demands of the law. While the Constitution, statutory law and the common law all recognise a person's right to privacy, during extraordinary times such as the COVID-19 pandemic, confidentiality must be breached to a degree to halt the spread of the virus

Statut de travailleur tuberculeux et environnement professionnel, Cotonou, Bénin / NA

Le partage du statut de tuberculose (TB) peut être pour le patient une source de conflit en milieu professionnel en raison de la stigmatisation liée à la maladie. L'objectif de la présente étude était d'évaluer les raisons et les réactions de partage ou non du statut de patient TB en milieu professionnel.Il s'agissait d'une étude transversale descriptive ayant inclus lestravailleurs TB du Centre National Hospitalier de Pneumo-Phtisiologie de Cotonou. Sur les 107 travailleurs inclus, 50% provenaient des petites entreprises privées et 30% du secteur informel. Parmi ceux qui avaient des supérieurs (43/107) ou des collègues (68/107) de service, respectivement 65,1% et 41,2% n'ont pas informé leur supérieur hiérarchique ou au moins un collègue. Les raisons évoquées étaient : crainte d'une perte de l'emploi (40%), peur du rejet (68%).La majorité de ceux qui avait partagé leur statut avaiteu en retour une réaction d'acceptation de la part de leur employeur (86,7 %) et collègues (85%).

Sharing tuberculosis status can be a source of conflict for the patient in the workplace due to the stigma associated with the disease. The objective of this study was to assess the reasons and reactions for and against sharing TB patient status in the workplace. This was a descriptive cross-sectional study that included tuberculosis workers at the National Tuberculosis Center at Cotonou. Of the 107 workers included, 50% came from small private companies and 30% from the informal sector. Of those who had supervisors (43/107) or colleagues (68/107) on duty, 65.1% and 41.2% respectively did not inform their supervisor or at least one colleague. The reasons given were: fear of job loss (40%), fear of rejection (68%). The majority of those who had shared their status had in turn received an acceptance reaction from their employer (86.7%) and colleagues (85%).

Legal responses to HIV and AIDS: lessons from Swaziland

Since 1999, the HIV and AIDS epidemic in Swaziland has been declared a national disaster, and today HIV and AIDS still pose a great threat to the survival and development of Swaziland and its people. The impact of the pandemic necessitated a multi-faceted response from the government. This paper critically evaluates the Swaziland legal response to HIV and AIDS. The objective is to assess whether and to what extent Swazi law addresses human rights issues related to HIV and AIDS. Through the application of a human rights based theory, the paper analyses the domestication of Swaziland's treaty commitments, and the constitutional and the statutory frameworks. The paper advances the importance of "law" as a tool that can create an enabling environment for a national response to HIV and AIDS. It analyses how the government has successfully crafted the normative framework so as to make it responsive to the fight against HIV and AIDS, and the shortcomings of the Swaziland legal system in this fight. The paper argues that even though a credible legal and policy environment is in place, some laws still need to be supplemented, reviewed and amended so that the legal system adequately addresses the human rights issues related to HIV and AIDS. The paper suggests improvements to the legal system which mainly relate to aligning the legal framework with the Constitution of Swaziland and international conventions to which Swaziland is party

Client Confidentiality: Perspectives of Students in a Healthcare Training Programme

Background. Confidentiality is an important ethical principle for all health professionals and also has a legal bearing on duty. One of the most difficult issues health professionals face in their daily fieldwork practice is a conflict between their professional duties; as illustrated in keeping a patient's medical information confidential; and having empathy with a family member's need to know. This moral dilemma is difficult for students to circumvent and therefore this paper presents healthcare students' perspectives of confidentiality.Methods. We aimed to explore healthcare students' views and experiences of confidentiality as an ethical principle by adopting a qualitative explorative approach. Purposeful sampling was undertaken where specific individuals with specific experiences were identified. Data were collected by means of written responses from two open-ended questions and analysed thematically. Two themes emerged.Conclusion. Confidentiality; as with other ethical principles; is an important obligation of a good client-therapist relationship as identified by students. However; the students' responses illustrate that it cannot be absolute; and cognisance must be taken as to when it is acceptable; and even desirable; to override confidentiality because of conflicting; greater duties

Social Media in the Healthcare Context: Ethical Challenges and Recommendations

The popularity of social media has grown rapidly and healthcare practitioners and students commonly use sites such as Facebook. The ethical and professional implications and their benefits and hazards must be considered. Concerns include blurring of boundaries between an individual's public and professional lives; maintaining privacy and confidentiality of patient information; damaging the public image of the profession and inter-professional relationships. The same laws that apply to conduct in the real world also apply in cyberspace. Harmful or derogatory posts may result in a defamation lawsuit. The internet may also provide opportunities for patient education through peerreviewed websites and to build professional networks. Institutions should have policies on the uses of social media. Emerging technology will continue to change the landscape of social media and social networking and the way patients and practitioners use websites will continue to evolve. Practitioners should proactively manage digital identity by reviewing publicly available material and maintaining strict privacy settings about their information

Value and Importance of Informed Consent to Researchers at Makerere University

Background: Respect for persons requires that research participants be given the opportunity to make choices about what should be done to them. Many times; the process of informed consent is abused to the benefit of researchers while exploitation and harm to the research participants may occur. In Uganda; issues of questionable research ethics have been highlighted in the past. Objective: To determine the Value and importance of the informed consent process among researchers at Makerere University. Materials and Methods: This was a qualitative descriptive study design involving faculty and graduate students in the faculties of Medicine and Social Sciences. Results: Of the 37 respondents 68were faculty while 32were graduate students in the fields of social sciences; clinical and basic sciences. Mean research experience was 8.5 years. More than 70of the respondents have had no formal training in research ethics. Only 22of the respondents appreciated the need for research participants to comprehend the informed consent; 38thought it is not always the case and in many cases their subjects do not have to comprehend; while the remaining 40believe that research subjects' understanding of the informed consent process may not be necessary. All respondents appreciated the importance of confidentiality although data management procedures were lacking by many. Conclusion: Most researchers appreciate the importance of confidentiality; but have limited understanding of the process of informed consent; information handling and the importance of feedback

Disclosure in Times of ART: A Relational Analysis of Social Practices

The reach of HIV counseling and testing has grown rapidly since the 2000s; particularly since 2007 when provider-initiated counseling and testing was implemented alongside voluntary counseling and testing and testing for the prevention of motherto- child transmission. Nevertheless; we still know little about the attendant practices of disclosing HIV-positive status. Persistently high rates of non-disclosure raise difficult ethical; public health and human rights issues. The articles in this special issue show that disclosure practices in Africa not only follow the public health rationality but are shaped by fears of stigma that favor secrecy. They show how practices of disclosure are embedded in social relationships. More specifically; they present disclosure practices at the intersection of five social spaces: international norms; national legislation and public health recommendations; household and family settings; couples' relationships; parental relationships; and relationships between health workers and PLWHA. The authors describe how people pursue strategies of disclosure in one or more of these social spaces; which sometimes allows them to avoid barriers (for instance when they choose to disclose only partially to certain 'significant others' in the household). One important finding is that counselors often do not support PLWHA to disclose their HIV status. Counselors themselves may be influenced by divergent logics and experience conflicts in values; they may also lack sufficient knowledge and skills to discuss sensitive issues based on rapidly changing medical data and public health recommendations

The Duty to Disclose in Kenyan Health Facilities: a Qualitative Investigation of HIV Disclosure in Everyday Practice

Disclosure of HIV status is routinely promoted as a public health measure to prevent transmission and enhance treatment adherence support. While studies show a range of positive and negative outcomes associated with disclosure; it has also been documented that disclosing is a challenging and ongoing process. This article aims to describe the role of health-care workers in Central and Nairobi provinces in Kenya in facilitating disclosure in the contexts of voluntary counselling and testing and provider-initiated testing and counselling and includes a discussion on how participants perceive and experience disclosure as a result. We draw on in-depth qualitative research carried out in 2008-2009 among people living with HIV (PLHIV) and the health workers who provide care to them. Our findings suggest that in everyday practice; there are three models of disclosure at work: (1) voluntary-consented disclosure; in alignment with international guidelines; (2) involuntary; non-consensual disclosure; which may be either intentional or accidental; and (3) obligatory disclosure; which occurs when PLHIV are forced to disclose to access services at health facilities. Health-care workers were often caught between the three models and struggled with the competing demands of promoting prevention; adherence; and confidentiality. Findings indicate that as national and global policies shift to normalize HIV testing as routine in a range of clinical settings; greater effort must be made to define suitable best practices that balance the human rights and the public health perspectives in relation to disclosure

Data-Protection Standards and Confidentiality of HIV/AIDS Status in the Workplace : a South African Case Study

The article contextualises an emerging new regime for information privacy in South Africa (i.e. the draft Protection of Personal Information Bill). Subsequently; it discusses the possibility of successful implementation of international data-protection standards in an environment where there is an urgent need to balance HIV/AIDS confidentiality rights with public health requirements. Also; the article presents a preliminary assessment of the possible impact of professionalisation (and outsourcing) of workplace HIV/AIDS management on workplace data-protection practices; and it identifies some spaces for social dialogue on HIV/AIDS-data treatment in South Africa. The study methods comprise an analysis of legal documents (concerning international data-protection standards and the development of law governing data protection and HIV/AIDS confidentiality in South Africa) and interviews conducted with workplace health managers and trade union representatives; in Johannesburg; in 2007

Communicable diseases control unit; part 1: the control of sexually transmitted diseases

Confidentiality concerning HIV/AIDS should be taken very seriously by all health services workers; especially in a country as small as Seychelles. One way of grasping the importance of confidentiality is to imagine for a while that the HIV positive person is one's close relative; one's child or oneself. Positivity is disclosed to other medical professionals only if it is the interest of the patient's health

AIDS home care : a baseline survey in Zimbabwe

The research was undertaken during the first half of 1992; and data sought from 150 organisations throughout Zimbabwe. Of these; 125 nationwide were visited by the research team and the rest were sent questionnaires. 24 are providing AIDS home care services; and a further 30 or more have investigated developing home care; have trained nursing and other staff in home care; and/or are just beginning to implement a programme. Organisations with AIDS home care programmes included AIDS service organisations and NGOs; mission hospitals and clinics and district hospitals. By the end of 1992 over 50 AIDS home care programmes should be operational in Zimbabwe. In addition to visiting agencies; the researchers made 21 home visits with various home care teams; and were able to interview relatives or patients in 15 homes. This provided valuable opportunities for seeing the teams in action; and gaining first hand insights from the families themselves about their needs and how the services had assisted them. The organisational base and structure of the programmes vary considerably. Some programmes are community based and others are institution (hospital) based outreach programmes; and programmes exist in rural and urban areas. Some are staffed entirely by professional health workers; and others utilise volunteers with varying levels of training. Home care for AIDS; usually part of a wider home care programme for the chronically sick and others; but there are also vertical programmes only catering for patients with AIDS. A common finding on most schemes was that poverty is often the primary concern of the patient and family; and that home care must involve the provision of basic food; medication and; perhaps; money for essentials. Large amounts of money have been spent on training workshops for home care staff; but in most cases little finance is available for these basic welfare needs of patients and their families; and in some cases the training does not appear to be utilised. This raised the question of whether too much has been spent on training staff; and too little on programme implementation and follow up; and meeting basic welfare needs. The types of care provided through home care services include: medical care; the provision of food and other material goods; counselling and spiritual care; and training for care-givers in the family. The frequency of visits varies considerably; with some schemes normally making only one; or at most two; visits per family; and one or two providing an intensive service with daily (or more frequent) visits and needs demand to a small number of patients and families. Occasionally the service includes transporting patients home from hospital but in most cases this in so offered and a follow up may only be made weeks; or even months later when the patient may already be dead. The schemes that are operating most effectively tend to be ones in which the home care providers were involved in the planning and establishment of the service itself. Those that appear to have most difficulty are those in which existing staff; such as hospital nurses; have been coopted into counselling and home care on top of their other duties; and fell unable to make time for home care; or hold equivocal views about its value. Interestingly; certain rural home care services; operating under greater constraints than their urban counterparts; are among the most well developed. A particular problem observed with several schemes is that of coordination and communication between the various agencies involved; including problems to do with patient referral where the home care service is not provided by the hospital itself. Confidentially was cited as a problem in many programmes; with staff ensure how to work with patients' demands for strict confidentiality; and their own uncertainty about criteria for passing the information to others