Contribution of plastic bags to the retention of child immunization cards in Gambella Region and Assosa Zone, Benishangul-Gumuz Region, Ethiopia

Background: Many vaccines are given more than once, at different ages, and in combinations. Parents are expected to retain immunization cardsfor their children, however in Ethiopia,the retention of child immunization cardsis minimal. For example,the 2005 and 2011 Ethiopian Demographic and Health Surveysshowed that 37% and 29% of immunization cards, respectively, were retained. The CORE Group Polio Project developed an innovative approach to keeping home vaccination records for a long time and safely,in the form of a plastic bag designed to hold the immunization card. The pilot project for this innovation was held in Gambella Region and Assosa Zone, Benishangul-Gumuz Region since 2015. Objective: Evaluate the contribution of plastic bags for holding and retaining child immunization cards in Gambella Region and Assosa Zone, Benishangul-Gumuz Region. Methods: The study was a household-based cross-sectional survey and the target population was households with at least one child aged under 2years who had received at least one vaccination dose. A sample of 239 households (120 from Gambella Region and 119 from Assosa Z one in Benishangul-Gumuz Region) were selected randomly from immunization registration records. Up to 12 kebeles were included from each region, with at least 10 children per kebele. Data were collected using an Amharic language questionnaire and analyzed with STATA version 13.0. Results: Of all 239 respondents, 139 (58.2%) received the plastic bag for retaining immunization cards, while 100 (41.8%) did not receive the bag. Of the 139 respondents who received immunization cards, 125 (89.9%) utilized the plastic bag. Of those that utilized the bags to hold immunization cards, 50.4% were from Gambella Region and 49.6% were from Benishangul-Gumuz Region. A total of 125 (58.7%) respondents were presented with the immunization card inside the plastic bag, and 88 (41.3%) respondents received the immunization card with no accompanying plastic bag. However, of all respondents who received the plastic bag, 14 (10%) did not put the card inside it. The reasons given by respondents were that it was difficult to put the card inside the plastic bag(seven cases, (58.3%))and that it was lost/damaged or used for some other purpose (five cases, (41.7%)).A total of 145(70%)respondents reported that they placed the plastic bag that contains the immunization card in a secure place, such as in a box, and 53 (25.6%) hung it on a wall.Conclusion:In general, there was89.5% card retention;90% of respondents utilized the plastic bag,and 88% of mothers said they would advise others to use the plastic bag

In search of an effective teaching approach for skill acquisition and retention: teaching manual defibrillation to junior medical students

Introduction: Although overloaded curricula; the increasing student to educator ratio; limited resources; insufficient curriculum alignment and the unpredictable clinical learning environment contribute to the decay of clinical skill competency; the problem of poor skill retention often lies in inadequate skill acquisition which is associated with the quality of the instruction. The aim of the study was to investigate the influence of three different instructional approaches on the acquisition and retention of skills in order to determine which method would be best suited for teaching in simulation in a resource-constrained environment. Methods : A randomised controlled trial design was used to compare the efficacy of the traditional; Peyton's four-stage; and a modified five-step method. Regarding the latter; George and Doto's five-step method was altered to include peer teaching and feedback with a tutor in a supervisory role. Groups of first year students were taught 'manual defibrillation'. Subsequent to the teaching session as well as at two months later; students' skills were tested. Additional qualitative data regarding students' perceptions of the different teaching strategies they were exposed to were obtained by means of questionnaires. Results: None of the three instructional approaches proved to be superior in acquisition or retention. Previous studies reported similar findings. The lack of differentiation between the three teaching methods might be attributed to the fact that all three methods included practice with feedback in one form or another. Numerous studies have identified these as critical components leading to effective learning in a simulation-based learning environment. Conclusion: Considering that the three instructional approaches were similar in terms of skill acquisition and retention; incorporating peer teaching and feedback is a feasible strategy in a resource-limited environment

Factors Influencing the Retention of Registered Nurses in the Gauteng Province of South Africa

Background: South Africa is a source country for many destination countries that recruit registered nurses who emigrate for personal and/or professional reasons. A large number of South African nurses belong to the baby boomer generation (born between 1943 and 1964) who will retire within the foreseeable future. Statistics from the South African Nursing Council show a decline of 42.0in the number of nurses who completed their training in South Africa from 1996 to 2005. These aspects combine to predict a potential dire shortage of nurses in South Africa within the foreseeable future. Objectives: Retention of registered nurses should be the focus of health-care planners to avoid crises in South Africa's health-care services. This study attempted to identify factorsthat would influence registered nurses' decisions to stay with their current employers in the Gauteng Province of South Africa. Methods: An exploratory descriptive quantitative design was adopted and questionnaires were sent to a sample of nurses; registered with the South African Nursing Council (SANC); with addresses in the Gauteng Province. A total of 108 nurses completed and returnedquestionnaires; of whom 77 (73.1) had considered leaving their current employers. Results: The most important factors that would influence more than 90.0of these nurses' decisions to stay with their current employers related to finances; safety and security; equipment and/or supplies; management; staff and patients. Conclusions: In terms of Maslow's Hierarchy of Needs Theory; deficiency needs (physiological; safety and social needs) should be met by improved salaries revised on an annual basis; paying long-service and outstanding-service bonuses; and improving the safety and security; as well the available equipment and supplies; at institutions. Sufficient numbers of nurses should be employed and vacancies should be filled rapidly. However; not all changes required to enhance nurses' retention rates involve increased costs. Managers should lead by example and respect nurses; and encourage doctors as well as patients to do so; to meet nurses' self-esteem needs. Recognising and rewarding outstanding service would meet nurses' self-actualisation needs; as well as opportunities to further their education

Retaining Professional Nurses in South Africa: Nurse Managers' Perspectives

South Africa is experiencing a serious shortage of nurses; which has to be addressed to prevent crises in health care services. Previous studies (Fletcher 2001:324; Oosthuizen 2005:117) found that nurses change their work environment due to dissatisfaction with their job situations. This implies that creating a favourable environment in the workplace situation could help retain professional nurses in their posts; implying that retention strategies should be effective. An exploratory; descriptive; contextual and qualitative design was used to describe nurse managers' views on factors which could influence professional nurse retention; as well as their views regarding attributes that were required to enable them to contribute towards enhancing professional nurse retention. A purposive sample of nurse managers employed in public and private hospitals in the Gauteng province was selected. Semi-structured interviews were conducted with 21 nurse managers. The results were analysed qualitatively and contextualised within Vogt; Cox; Velthouse and Thames's Cork-Top (Bottleneck) Theory of Nurse Retention (1983) and Lewin's Force-Field Analysis Theory (1952). Factors pertaining to individual nurses; the organisation and nurse managers could influence the retention of professional nurses. Poor working conditions; long and inconvenient working hours; uncompetitive salaries and professional development of nurses have to be addressed to enhance professional nurses' retention. Unsafe working environments and a lack of resources threaten the safety and well-being of nurses and patients and contribute to high turnover rates. Nurse managers have to address shortcomings in their managerial and leadership skills and implement changes within a multigenerational nursing workforce and challenging working environments

Factors and Outcomes in Primary Care Physician Retention in Rural Areas

Background: This paper examines factors influencing physicians' decisions to practise in rural communities as well as the results of a programme focused on rural recruitment and retention. Methods: Data from two sources were analysed and discussed: 1) telephone interviews with 20 of 33 (61) recently located rural physicians regarding practice and community factors influencing their practice decisions and 2) a database of 107 graduates of a rural medical education programme who have been in practice for at least three years to examine specialty choice and practice location(s); including moves from their original practice sites. Results: Most rural physicians in this study decided to practise in rural areas because of family ties. Eighty per cent of the physicians participating in the interviews mentioned no negative personal or family factors related to their community of practice. Outcome data on graduates from the rural medical education programme are encouraging. Over 70opt for primary care and rural practice. Over 80have remained in their original rural practice location. Conclusion: Keys to success in rural physician retention seem to include identifying and recruiting medical students ofrural origin and focusing on a healthy practice environment. Policy makers need to work with local government; schools and employers to offer programmes that provide information on health careers in rural areas and begin to identify local youth for induction in rural health care

Retention of Knowledge of and Skills in Cardiopulmonary Resuscitation among Healthcare Providers after Training

This study assesses the retention of core knowledge and skills among healthcare providers (HCPs) who attended a Basic Life Support (BLS) course. The format for teaching this course changed in 2006 and a review of the effectiveness and acceptability of the new course was considered vital. Studies indicate that early and effective cardiopulmonary resuscitation improves the chances of survival in cardiac arrest victims; however; the knowledge and skills of HCPs in basic life support vary. International recommendations on the BLS course were that HCPs repeat the course every two years. However; no studies have been conducted in South Africa to determine the ideal time when HCPs should be re-evaluated to ensure that they retain adequate knowledge and skills. This study was conducted at a training centre in a hospital in KwaZulu-Natal; where a new format for training was introduced in 2006. Participants were HCPs who had completed a BLS course. The sample was taken sequentially from half of the annual intake of a BLS course three months after completion of the course. Data were collected using the accredited American Heart Association written test and the Critical Skills Checklist; and a further questionnaire was developed to collect variables such as demography and profession. Results indicate that skills retention was good and; although there was some fall-off in skills and knowledge; there was no significant difference between the scores at the end of the course and retest scores. Staff working in accident and emergency departments had more practical experience and their knowledge and skills retention was better than that of staff working in other areas of the hospital. Nurses performed nearly as well as doctors and are an important skills resource in the management of patients who need to be resuscitated. All participants were satisfied with the new format and had no suggestions on how to improve it

Enrolment and Retention of African Women in Biomedical Research: the Challenges

Background : In Africa; women have had minimal participation in biomedical research especially in clinical trials despite the epidemiologic realities of the trends andburden of diseases in the continent. The purpose of this paper is to critically examine the challenges as well as suggesting ways of over-coming them in recruiting andretaining African women in biomedical research. Methods:Relevant biomedical research literatures on Human Research Participants from Scirus; Pubmed and Medline computerized search were critically evaluated and highlighted. Information was also obtained from research ethics training as well as texts and journals in the medical libraries of the research ethics departments of the Universities of Pretoria; Kwazulu-Natal; Johns Hopkins Berman Institute of Bioethics Baltimore and Kennedy Institute of Bioethics Georgetown University; Washington DC. Results: Studies reviewed have shown that African women have an unfair participation in biomedical research. Efforts in enrolling and retaining women in biomedical research are hampered by chain reactions of events viz: gender perception; cultural barriers; ignorance and fear of adverse event; limited autonomy to give consent; lack of confidentiality especially in sensitive trials; and improper research design. Conclusion:Women need to participate in clinical trials because of their different biological and physiological make-up which require proper information about the effects of drugs on their bodies. A variety of harm may therefore ensue from failure to include adequate numbers of women in biomedical research such as exposure to ineffective treatment; occurrence of unexpected sideeffects and delayed diagnosis and early treatment of disease

The Retention of Community Service Officers at District Hospitals in KwaZulu Natal; Eastern Cape and Limpopo Provinces

Background: Community service (CS) is an effective recruitment strategy for underserved areas; using legislation as the driver; however it is not a retention strategy. By the end of each year; most CS officers working in district hospitals (DH) are skilled; valued and valuable members of the health team; able to cope with the demands of working in the public health service within the resources available at DHs. Their exodus at the end of each annual cycle represents a net loss of valuable skills and experience by the public service; measured by the time and effort required to orientate and induct the following cohort of CS officers. This in turn has a negative effect on the level of service delivery and the quality of patient care. This study sought to understand the motivations of CS officers to continue working at the same DH for a subsequent year after their obligatory year was over. The objectives were to determine the number of CS officers who actually remained at the same DH after completing their CS in 2002; the major factors that influenced them to remain; and factors that would encourage the 2003 cohort of CS officers to remain for an additional year at the same DH. Methods: A descriptive cross- sectional study design was employed using qualitative methods with the cohort of CS officers who had completed their compulsory CS year in 2002 and who were still working at the same DH in July 2003. This was followed by a quantitative survey of CS officers doing their CS at DHs in KwaZulu-Natal (KZN); Eastern Cape (EC) and Limpopo Province (LP) in November 2003. Results: 22/278 (8) of the 2002 cohort of CS officers in KZN; EC and LP remained at the same DH in the year following their CS. The reasons given; in order of decreasing priority; were that they were close to home; had been allocated as part of their CS; were personally recruited; had bursary commitments; had heard about the hospital from friends; had visited the hospital prior to starting community service; and had visited as a medical student. Four others did not specify reasons. In the larger quantitative study 150 / 221 questionnaires were returned. More than 80of the respondents felt that there had been opportunities to develop confidence in their own ability to make independent decisions; that they had had good relations with the hospital staff; and that they had been able to make a difference in health care delivery. Between 67and 76of respondents felt that they were providing a good standard of care; that there were learning opportunities; that they were doing worthwhile work and saw CS as excellent work experience. However only 52of respondents felt that there had been opportunities for personal growth; 38felt that appropriate equipment was available; 37had a supportive mentor figure and 29felt that there were adequate levels of staffing at the hospital. In total 24 (16) of the 150 who responded to the questionnaire indicated a willingness to remain at the same DH after completion of their year of CS. The intention to continue for a further year was statistically significantly associated with the following factors: ethnic group; province; rural origin; allocation priority and bursary commitment. Conclusions: The retention in the same DH of only 8of the CS officer cohort in 3 rural provinces indicates a serious loss of skills on a recurrent annual basis. Local hospital management can do much to strengthen the factors that would attract CS officers to stay on by improving orientation; mentoring; teamwork; professional development opportunities; medical equipment and accommodation