Essential health services delivery status during COVID-19 pandemic in Ethiopia: A national mixed-methods survey of primary healthcare units

BACKGROUND: Essential health services are a package of services critical to improve health outcomes. COVID-19 pandemic disrupts essential health services. However, the level of essential health service disruption due to COVID-19 in Ethiopia is not clear. This study aimed at measuring the status of delivery of essential health services in Ethiopia during COVID-19. METHODS: A national mixed-methods cross-sectional survey was conducted. It was undertaken in Amhara (10 districts), Oromia (eight districts), Sidama (six districts), Southern Nations, Nationalities, and People's Region (16 districts), and Dire Dawa City Administration. A total of 452 health facilities were surveyed. Data were collected using face-to-face interview. Descriptive analysis was undertaken. Qualitative data was analyzed thematically. RESULTS: The woredas (districts) and health facilities which adopted essential health services before the COVID-19 pandemic were 81.4% and 51.2%, respectively. Nearly all health centers provided antenatal care services. Blood pressure measuring apparatus and delivery set were available in all health centers. However, only 50% of health centers had radiant warmer. Malnutrition services were provided by 47% of rural health centers. Moreover, a functional incinerator was available in only 41% of health centers. The provision of cardiovascular disease management was at 27.2%. Furthermore, HIV/AIDS treatment was provided by 43.5% of health facilities. CONCLUSION: The adoption of lists of essential health services was optimal. The status of delivery of essential health services was high for maternal healthcare. Neonatal care at birth, malnutrition treatment, and cardiovascular disease management were low. The district health system should strive more to maintain essential health services.

A comparative analysis of two national tuberculosis reporting systems and their impact on tuberculosis case notification in Uganda

Background: Before 2018, the use of parallel tuberculosis (TB) reporting systems was resource intensive with duplication of efforts and hence the need to select one that contributed to better TB case notification at the National TB and Leprosy Program (NLTP) in Uganda. We sought to analyse the difference in reporting rates between the two systems in order to improve NTLP TB case notification rates, logistics management, and planning for better health service delivery initiatives. Methods: We conducted a comparative study to assess TB case notification between the web-based DHIS2 and the district TB supervisor-led health management information system between January 2016 to December 2017. We used Poisson regression analysis to assess the statistical differences in reporting rates between the two reporting systems. Results: The association between TB case notification and the type of reporting system was statistically significant (Prob > chi2 = 0.0000). The Incident Rate Ratio (IRR) for the web-enabled DHIS2 system versus the district TB supervisor-led health management information system was 1.106625. Conclusion: The web-based integrated DHIS2 system was more effective in reporting missing TB cases. It presents an opportunity for better planning and allocation of resources for improved service delivery in a low-income setting.

Neural tube defect diagnosis and outcomes at a tertiary South African hospital with intensive case ascertainment

Background. Neural tube defects (NTDs) are an important category of birth defect, but surveillance remains inadequate in South Africa.Objectives. To assess the identification of NTDs at a tertiary hospital using a range of prenatal, perinatal and postnatal data sources, and to estimate the impact of prenatal diagnosis and birth prevalence for the referral area.Methods. Cases of anencephaly, encephalocele and spina bifida (SB) in a 6-year period were retrospectively identified from 5 data sources covering prenatal, perinatal and postnatal care. These were cross-correlated to avoid duplicate entries and to determine the contribution of different data sources. Details of prenatal diagnosis and termination of pregnancy (TOP) were obtained for 10 years, and birth prevalence over 2 years.Results. During a 6-year period 195 NTDs were identified at a Western Cape Province tertiary hospital. These included 59 (30%) cases of anencephaly, 28 (14%) of encephalocele and 108 (55%) of SB. The majority of NTDs (71%) were detected prenatally, although SB was less commonly diagnosed prenatally than cranial defects (56% v. 88%; p<0.001). Of SB cases ascertained pre- or postnatally, 57% of patients were born alive and 50% discharged alive, but 72% of survivors had not been diagnosed prenatally. Women receiving prenatal diagnosis of any type of NTD before 24 weeks' gestation were nearly always offered TOP, and the majority accepted termination after non-directive counselling. For SB, later prenatal diagnosis was associated with much lower termination rates because the option was less often offered (51% v. 100%; p<0.001), and perhaps less often accepted (57% v. 78%; p=0.06). The estimated NTD birth prevalence for the referral area was 0.76 - 0.80 per 1 000 live births, but perhaps up to 1.18 per 1 000 when considering under-referral of lethal cranial lesions from rural areas.Conclusions. A substantial number of NTDs can be ascertained from a tertiary hospital environment if multiple data sources are used, even though adding data from the Perinatal Problem Identification Program for outlying health facilities increases detection of lethal defects. Hospital-based surveillance can be considered, especially for SB. Prenatal diagnosis was fairly common and pregnancy termination was often offered and accepted if detected before 24 weeks' gestation. A regional prenatal ultrasound programme, predominantly based in primary care but with ready access to a tertiary centre, can be quite effective, although limited or delayed access to prenatal diagnosis must be addressed

Research supervision: perceptions of postgraduate nursing students at a higher education institution in KwaZulu-Natal, South Africa

Background. Scientific advancement; particularly in the area of information communication technology (ICT); challenges the mode of knowledge advancement at universities. Such challenges are especially evident in the area of postgraduate (PG) research supervision; particularly in the light of the changing students' demography; whereby there is a radical shift from full-time campus-based students to part-time students. This challenge is compounded by many countries not considering research competency as a requirement for PG supervision - the result of static and outdated curricula. Objective. To explore the perceptions of PG nursing students with regard to the research supervision process. Methods. A quantitative research study was conducted at the University of KwaZulu-Natal (UKZN); Durban; South Africa using non-convenience sampling. The PG Research Experience Survey questionnaire was adapted for the current study. Ethical clearance was obtained from UKZN's Ethics Committee.The population consisted of the PG coursework Master's nursing students who were registered for the research project module during 2012. A total of 56 students participated; with a response rate of 70%. Data were analysed using the Statistical Package for the Social Sciences 19 (SPSS 19) (IBM Corp.; USA). Results. The findings revealed that more than half of the respondents (66.2%; n=37) rated the level of support from research supervisors as moderate on a scale of low to high. The period of research supervision; mode of attendance and status within the university were identified as factors influencing the perceptions of support from research supervisors. Conclusion. This study recommends that; to improve the quality of research supervision; there is a need to include a research supervision module in the curriculum of nurse educators and to adopt online research supervision; underpinned by the extensive use of ICT to accommodate both part-timeand full-time PG students

Evaluation of Inhaler Techniques among Asthma Patients Seen in Nigeria: An Observational Cross Sectional Study

Background: An Adequate and an effective dose of inhalation drugs can be administered only if the correct inhaler-specific technique is followed by asthma patients. There is paucity of data on this subject among Nigerians and Africans. Aims: This observational study was to assess the inhaler techniques among asthma patients in Nigeria and also to identify the factors related to an inaccurate or poor inhaler use. Subjects and Methods: Consenting asthma patients on inhalers; who attended medical out-patients clinic; of two university hospitals in Nigeria were asked to use their inhalers while an inhaler-administration checklist was used to assess each patients inhaler technique. Information on demographics; asthma symptoms history and history of technique education were obtained. Data was analyzed using standard statistical methods. Results: A total of 140 asthma patients participated out of which 75 were females. All the patients used pressurized metered dose inhalers (pMDI) type; 51 of them used dry powder inhalers (DPI) in addition. For pMDI; 22.1 (31/140) completed all required steps while 37.3 (19/51) did so for DPI (P = 0.04). Patients with higher educational qualification (P 0.01) and those with less frequent asthma symptoms (P 0.01) are more likely to use the pMDI inhalers more accurately while patients who have been taught previously by a Doctor were more likely to use the DPI better. Conclusion: Majority of asthma patients use their inhalers inaccurately. Patient-dependent factors were identified as the cause of incorrect technique of inhaler use. Asthma patients on inhalation medications should have routine assessment of their inhaler technique at every visit and corrected if found to be poor

On the Horizon : New Oral Therapies for Type 2 Diabetes Mellitus : Review

The first documented case of diabetes mellitus occurred earlier than 4000 BC. Since then; many of the brightest minds in medicine have dedicated their time and effort toward developing treatments that can reverse the course of this deadly disease. As our understanding of the pathogenesis of diabetes increases; so does the availability of treatment options. The fight against diabetes once only had metformin and sulfonylureas as the cornerstone of oral treatment; but now; multiple classes have been added to this armamentarium including thiazolidenediones (TZDs) and dipeptidyl peptidase IV (DDP IV) inhibitors. These therapies provide reasonable durable glycemic control but are unable to arrest the natural progression of diabetes or the eventual need for insulin. By utilizing our growing knowledge on the pathogenesis of diabetes; a number of new therapeutic agents are in development to overcome the shortcomings of current therapies. Promising options on the horizon include sodium-coupled glucose co-transport 2 (SGLT2) inhibitors; ranolazine; salicylates; second-generation peroxisome proliferator-activator receptor agonists (PPARs); and 11-beta hydroxysteroid dehydrogenase type 1 inhibitors (11-beta HSD1 inhibitors). Various molecules; including some enzymes; are also in development; particularly to address beta-cell preservation and its sensitivity to glucose; while minimising hypoglycaemia. Most of these new classes of drugs consist of daily administration; simplifying the regimen for patients and likely increasing medication compliance. This article reviews the new agents that are advancing through clinical trials; their mechanism of actions; glucose lowering effect and possible side effects and limitations

An Assessment of the Functionality of a Community Health Committee in an Oil Bearing Community in South-South Nigeria

BACKGROUND.Primary health care has been identified as the most cost-effective way of realizing health for all; and the health-related millennium development goals; while community participation in the running of health services is recognized as the key to unlocking the potentials of primary health care. This study assessed the effectiveness of a community health committee (CHC) in an oil bearing community in Rivers State; south-south Nigeria.METHOD.The study was carried out using a pre- intervention/ post-intervention study design. The CHC was constituted; and its performance assessed after six months; using five qualitative indicators: needs assessment; leadership; resource mobilization; management and organization that were previously established by Rifkin and coworkers. The data for the study were collected through document analysis; personal observations; and interviews.RESULTS.Members of the CHC had an average age of 47.54 +/- 7.5 years; with at least secondary school education; and were mainly either self-employed or civil servants. The CHC was therefore found to be well constituted. The capacity of the committee for resource mobilization was graded as good; because it was able to make contacts for additional resources for the health center. The committee was however rated poor in the areas of needs assessment; leadership; and management. Most members of the committee did not understand their expected role in the committee. The committee was only able to implement 2 out of the 7 interventions identified during the community needs assessment; and was able to hold just 2 out of the 6 scheduled meetings; with only 6 (42.86%); out of the 14 members of the committee attending all the meetings. The poor performance was attributed to the committee's lack of control over the health center and its staff.CONCLUSION.The constitution of a CHC does not guarantee the expected level of community participation. Effective leadership and full community control of health centers and their staff are therefore recommended

Problems with Administration of International Prostate Symptom Score in a Developing Community

Background: The IPSS form has been found useful for assessing symptom severity; which assists in treatment choice and in monitoring patients on therapy. The form should be self-administered and requires some level of literacy. We assessed the problems associated with its administration in a developing community.Materials and Methods: The IPSS form was administered to patients with benign prostatic hyperplasia at the Urology Clinic of the Jos University Teaching Hospital from November 2004 to October 2005. Those who did not understand the questions or who could not read eng required explanations.Result: There were a total of 70 patients who agreed to fill out the forms. Their ages ranged from 40 to 104 years with a mean of 63.6. The IPSS scores ranged from 3 to 35 with a mean of 18.3. About 56.7 of the patients had quality of life scores of ? 5. Only 2 (2.9) patients were initially uncooperative in filling out the forms. Twenty-four (34.3) did not understand eng. Of the 46 (65.7) that understood eng; 28 (40.0) could speak but could not read eng; thus 52 (74.3) could not read eng. Ten (14.3) patients thought the questions were either not comprehensive or clear enough.Conclusion: Illiteracy is a major drawback with the administration of the IPSS form; with 74.3 of patients unable to read eng. Attempts should be made to draft the forms in the main language(s) spoken or read in a particular locality so as to gain maximally from the benefits of the IPSS. Relevant bodies should improve on the education of the populace

Impact of Praziquantel Mass Drug Administration Campaign on Prevalence and Intensity of Schistosoma haemamtobium Check for this Species in other Resources among Schoolchildren in Bahi District; Tanzania

As part of the Tanzania National Schistosomiasis Control Programme; Bahi district in central Tanzania; received two annual rounds of praziquantel mass drug administration (MDA) to control urinary schistosomiasis in schoolchildren. The objectives of this study were to assess the impact of the two rounds of MDA on prevalence and intensity of Schistosoma haemamtobium and the impact of MDA campaigns on knowledge of urinary schistosomiasis; safe water use and contact with potentially unsafe water bodies. A quantitative crosssectional study was carried out among schoolchildren in March and April; 2013. A structured questionnaire was used to collect information on MDA uptake; knowledge of schistosomiasis; sources of water for domestic and other uses. Urine samples were collected from each pupil to examine prevalence and intensity of S. haematobium. Transmission of schistosomiasis was assessed by sampling Bulinus spp snails for cercarial shedding. Uptake of MDA was 39.5 in 2011 and 43.6 in 2012. Prevalence of S. haematobium significantly dropped by 50.0 from 26 in 2011 to 15 in 2012 (p = 0.000). Prevalence of S. haematobium was significantly low in MDA participating (3.1) than non-participating (28.5) schoolchildren (p = 0.000). MDA campaigns had significant impact on knowledge of the disease (p = 0.02) and borderline impact on safe water use (p = 0.04) but had no impact on avoidance of contact with unsafe water bodies (p = 0.06). Bulinus spp. snails were found shedding schistosome cercariae indicating environmental contamination with viable S. haematobium eggs. In conclusion; though MDA significantly reduced prevalence of S. haematobium; uptake was below 50.0 and below the World Health Assembly resolution 54.19 target of 75.0 for 2010. Non-participation in MDA was the likely source of S. haematobium eggs in the environment hence the observed 15.0 prevalence of S. haematobium infection; and cercarial shedding Bulinus spp. snails indicating continuity of transmission hence the need for further health promotion campaigns

Current State of Public Cemeteries in River State; Nigeria

Cemeteries or 'sleeping places' are where bodies or cremated remains are buried. Dead bodies are essentially 'wastes' and their improper disposal in the form of burial may come with health implications. This is particularly apt in Nigeria and indeed Rivers State where unsupervised burials are carried out in homes (houses); compounds and community-based cemeteries. A walk through survey of five functional public cemeteries in Rivers State appraised their current state and their possible health implications. This on-the-spot site visit revealed infrastructural; operational and maintenance challenges which have further stressed the need for better managed public cemeteries and more objective studies on the subject

Socioeconomic Factors Associated with Compliance with Mass Drug Administration for Lymphatic Filariasis Elimination in Kenya: Descriptive Study Results

Background: Annual Mass Drug Administration (MDA) to at least 65 - 80of the population at risk is necessary for Lymphatic Filariasis (LF) elimination. In Kenya; MDA based on diethylcarbamazine and albendazole; using the community-directed treatment (ComDT) approach has been implemented thrice in the Kwale and Malindi districts. To identify the socioeconomic factors influencing compliance with MDA; a retrospective cross-sectional study was conducted in the two districts after the 2008 MDA. Materials and Methods: In Kwale; the Tsimba location was selected for high and Gadini for low coverage; while in Malindi; the Goshi location represented high and Gongoni; low coverage. Using systematic sampling; nine villages were selected from the four locations. Quantitative data was collected from 965 systematically selected household heads and analyzed using SPSS v. 15. For qualitative data; which was analyzed manually according to core themes of the study; 80 opinion leaders and 80 LF patients with clinical signs were purposively selected and interviewed; and 16 focus group discussions (FGDs) conducted with adult and youth male and female groups. Results: Christians were slightly more (49.1) in the high compliance areas compared to Muslims (34.3); while Muslims prevailed (40.6) in the low compliance areas compared to Christians (29). On the income level; 27from the low compared to 12.2from the high compliance areas had a main occupation; indicative of a higher income; and 95from the low compared to 78from high compliance areas owned land; also an indicator of higher economic status. Accurate knowledge of the cause of swollen limbs was higher (37) in the high compared to 25.8in the low compliance areas; and so was accurate knowledge about the cause of swollen genitals (26.8in high compared to 14in low). Risk perception was higher in the high compliance areas (52compared to 45) and access to MDA information seemed to have been better in the high compared to low compliance areas. Patients from the high compliance areas had a higher mean number of years with chronic disease (15.2 compared to 9.7). Conclusions: There is a need for more investment in reaching out to groups that are often missed during MDAs. Different strategies have to be devised to reach those in specific religious groupings and those in casual employment. This could include prolonging the duration of MDA to capture those who are out during the week seeking for casual and other forms of employment

Comparative Study of the Primary Healthcare Systems in China and Mali

"Background: Community health centres (CHCs) are an important component of the health system in Mali and China. Despite patient support and commitment from the authorities; the management and the quality of care of these structures need to be improved. This research aimed to compare the management style of the relevant boards with users' satisfaction pertaining to CHC services in Mali and China. Method: Between September 2009-January 2010; a study was conducted in eight CHCs in Mali and in 16 CHCs in China. A total of 480 householders; [60 (Mali) and 320 (China)]; and 24 management committee members (Mali) and 48 management committee members (China) were interviewed. An in-depth interview technique was used on members of the management committee; while a structured interview was carried out to ollect data during face-to-face contact with householders in their residences. In residences in which there were two or more households; the first willing householder was interviewed. Questions about the level of satisfaction were coded from 1-5 and ranged from ""excellent"" to ""very bad"" respectively. Results: The CHCs in China were managed by the government; whereas in Mali; they were overseen by the local population. The most satisfied people in both countries were those living in the poorest socioeconomic conditions; the elderly; and those who attended the healthcare meetings. Chinese households were more satisfied with the quality of the CHC services than those in Mali. The Chinese management boards proposed standardisation of rules and more funding; whereas those in Mali advocated that government provide more funding and human resources allocation. Conclusion: A high level of satisfaction regarding the CHC services was observed. However; users reported on deficits in the quality of care; whereas management suggested a need for greater resource allocation."

Prostatic Fossa Gauze-Packing in the Prevention of Blood Clot Obstruction of the Bladder after Transvesical Prostatectomy

BACKGROUND: Clot obstruction often complicates transvesical prostatectomy. Any measure that prevents this will be a great relief to both surgeon and patient. OBJECTIVE: To demonstrate that packing the prostatic fossa with roller gauze bandage after transvesical prostatectomy can prevent post-operative clot blockage of bladder drainage. METHODS: Charts of all patients who had transvesical prostatectomy at Jasman Hospital Udo by me from 1988 to 1997 were sorted into two groups ; Group A; not packed and Group B; packed. Information sought included patient's age; type of prostatectomy performed; whether the prostatic fossa was packed or not ; average duration of catheter drainage; and complications. RESULTS: There were 68 patients who had no fossa packing and 72 in Group B with fossa packing. The age range of the two groups A and B were respective 45-85year-old and 50-83 years. In both groups the highest number of patients was in the 60 t0 79 age bracket (48 in group A ; 70; and 56 in group B (78). Bladder blockage occurred in 32(47) patients without packing and none (0) in group B with packing. Average duration of bladder drainage was 14 days in each group. There was no persisting vesico-cutaneous fistula. Temporary urinary incontinence occurred in three (3) patients who had no packing and in five (7) with packing. CONCLUSION: Gauze-packing of the prostatic fossa during transvesical prostatectomy can prevent bladder obstruction from clot retention without undue complications

School Managers' Understanding of HIV/AIDS in Gauteng; South Africa

This paper presents the diverse understandings of HIV/AIDS and people living with HIV (PLHIV) revealed by school managers in a selection of public schools in Gauteng Province; South Africa. Discussions with school managers emerged as part of a larger investigation into the interplay of culture and gender in people's experience of HIV. The respondents from five public schools comprised head teachers; school board members; educators and adult learners. The data were assembled from semi-structured interviews; focus group discussions; comments on rumours and gossip; and informal conversations. Mary Douglas's (1966) analysis of the theory of cultural risk has provided the main approach for explaining the prevailing understandings of HIV and AIDS among the South African educators. Despite good knowledge of HIV and AIDS; the respondents' understanding of the disease and the experiences of PLHIV were commonly drawn from six categories of meaning: biomedical; cultural; religious; witchcraft; race; and eschatology. Social constructs were strong in terms of the ways HIV/AIDS and PLHIV were understood in these South African education workplaces. The findings imply that new strategies are required from the government and agencies that are involved in developing responses to the HIV epidemic; especially in the education sector

The Impact of Organisational Culture on the Adaptation of Newly Employed Nurses to Work Environment

Usually newly employed nurses find adjusting to a work setting a challenging experience.Their successful adaptation to their work situation is greatly influenced by the socialisation process inherent in the organisational culture. The newly employed nurse often finds that the norms are unclear; confusing and restrictive. The purpose of the study was to examine the impact of organisational culture on the adaptation of newly employed nurses to the work environment. A descriptive quantitative survey was employed to explore the constructs of organisational culture that have a positive or a negative impact on the adaptation of newly employed nurses to the work setting. Constructs such as conflict resolution; employee participation; human resource orientation; goal clarity; identification with the organisation; locus of control and management style were examined. Participants expressed their views as to what constructs of organisational culture had a positive or a negative impact on their adjustment to the work settings. For the culture to serve its function it must be perceived as correct and valid and if it is perceived that way; it automatically follows that it must be taught to newcomers

Development and in-vitro Evaluation of a Topical Drug Delivery System Containing Betamethazone Loaded Ethyl Cellulose Nanospheres

PURPOSE : Lipid nanospheres are used for the passive targeting of cosmetic agents to skin; thereby achieving major benefits such as reduction of total dose and avoidance of systemic absorption. The present study was carried out to exploit the feasibility of using polymeric nanospheres as an alternative and cheaper carrier for targeting corticosteroids to the skin. METHODS: Nanospheres were prepared from ethyl cellulose by a modified method of desolvation and cross linking. The drug betamethazone was incorporated into nanospheres and the drug : polymer ratio was evaluated to determine the carrier capacity of the polymer. In vitro release studies of drug-loaded nanospheres were carried out by the centrifugal ultrafiltration method. The kinetics of release was determined and fitted to an empirical equation. The release of drug from drug-loaded nanospheres dispersing in a conventional cream was evaluated. A comparative in vitro diffusion study was carried out between a commercial brand of cream and the cream incorporating nanospheres. RESULTS: Formulation of nanospheres of betamethazone by a modified method produced discrete particles. Studies on drug : polymer ratio showed a linear relationship between drug concentration and percentage of loading. The in vitro release of drug-loaded nanospheres was found to be first order. The comparative in vitro diffusion study between the commercial cream and the formulated cream showed a marked reduction in release rate from nanospheres-bound cream. CONCLUSION : Formulated topical cream containing nanospheres of betamethazone was found to be a potential dermal delivery system for sustaining the release of the drug