Medical laboratory practice in Malawi ­ Current status

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Health librarians making a difference in a health care setting: the Chitambo emergency care communications project

Health librarians in the role of a knowledge broker can encourage health care workers to use evidence based health information. The knowledge broker role is an intervention dedicated to translating knowledge into action originating from the evidence-based medicine campaign. The Chitambo Emergency Care Communications Project through its knowledge component work strand has visualisations of converting knowledge into action to improve emergency care response by health workers, through the implementation of the knowledge broker role for health care workers in Chitambo district, Central Zambia. Implementation of the knowledge broker activity for Chitambo adopted a framework purposefully designed to build capacity for health librarians by the National Health Service Education for Scotland. The knowledge to action model can be useful in providing the relevant information to improve patient outcomes for healthcare workers. These knowledge gaps can be alleviated by knowledge brokering as it straddles through any knowledge gaps between the health workers' knowledge and their service delivery practice.

A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province

Background: Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy. Aim: This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). Setting: The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu. Methods: A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin's approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. Results: This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases. Conclusion: The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science

Family physicians' experience and understanding of evidence-based practice and guideline implementation in primary care practice, Cape Town, South Africa

Background: In primary care, patients present with multimorbidity and a wide spectrum of undifferentiated illnesses, which makes the application of evidence-based practice (EBP) principles more challenging than in other practice contexts. Aim: The goal of this study was to explore the experiences and understanding of family physicians (FP) in primary care with regard to EBP and the implementation of evidence-based guidelines.Setting: The study was conducted in Cape Town primary care facilities and South African university departments of Family Medicine. Methods: For this phenomenological, qualitative study, 27 purposefully selected FPs from three groups were interviewed: senior academic FPs; local FPs in public-sector practice; and local FPs in private-sector practice. Data were analysed using the framework method with the assistance of ATLAS.ti, version 6.1. Results: Guideline development should be a more inclusive process that incorporates more evidence from primary care. Contextualisation should happen at an organisational level and may include adaptation as well as the development of practical or integrated tools. Organisations should ensure synergy between corporate and clinical governance activities. Dissemination should ensure that all practitioners are aware of and know how to access guidelines. Implementation should include training that is interactive and recognises individual practitioners' readiness to change, as well as local barriers. Quality improvement cycles may reinforce implementation and provide feedback on the process. Conclusion: Evidence-based practice is currently limited in its capacity to inform primary care. The conceptual framework provided illustrates the key steps in guideline development, contextualisation, dissemination, implementation and evaluation, as well as the interconnections between steps and barriers or enablers to progress. The framework may be useful for policymakers, health care managers and practitioners in similar settings

Cochrane, evidence-based medicine and associated factors: A cross-sectional study of the experiences and knowledge of Ethiopian specialists in training

Introduction: Evidence-based healthcare is a core competency for practicing healthcare practitioners and those in speciality training. In sub-Saharan Africa, little is known about the teaching of evidence-based medicine (EBM) in residency program. This survey evaluated the experiences and knowledge of Cochrane, EBM and associated factors among Ethiopian specialists in training.Methods: A convenient sample of trainee specialists completed a pretested self-administered survey. The majority (93%) were ≤30 years old, males (63%) and 41% in paediatrics speciality. The associations of categorical variables with EBM knowledge was assessed by Fisher's exact or Chi-Square tests. Covariates contributing to EBM knowledge were identified using multivariate logistic regression analysis.Results: Eighty-three trainees participated in the survey (response rate 88.2%). About 75% have heard aboutCochrane but no one recognized Cochrane South Africa. Only 25% of the trainees knew the Cochrane Library but none used it in clinical practice. Most (78%) have heard of EBM, 15% had attended EBM course, 96% wanted to attend EBM course and 81% had positive attitudes to EBM. Trainees EBM knowledge was associated withawareness of Cochrane [Adjusted odds ratio (AOR) = 8.5, 95% Confidence interval (CI) 1.3­54.6, P = 0.02], EBM (AOR = 51.2, 95% CI 2.7­960.8, P = 0.009), and being in third year training (AOR = 28.4, 95% CI 1.9­427.2, P = 0.02). The promotion of EBM in residency hospital (AOR = 22.2, 95% CI 2.2­223.8, P = 0.008) and being aware of Cochrane (AOR = 4.8, 95% CI 1.1­21.7, P = 0.04) were predictors of positive attitude. Familiarity with Cochrane Library was influenced by EBM knowledge (AOR = 6.6, 95% CI 1.4­31.5, P = 0.02) and perceived organization barrier to accessing the resource (AOR = 3.2, 95% CI 1.03­10.1, P = 0.04). Conclusion: Ethiopian trainee specialists lacked formal EBM training, awareness and use of the Cochrane Library. To improve the healthcare quality and patient outcomes, EBM education should be integrated into residency curricula

Nurses' knowledge, attitudes and practices regarding evidence-based practice in the prevention of mother-to-child transmission of HIV programme in Malawi

Background: HIV continues to be a global public health concern with Malawi being among the worst affected countries. The prevalence of HIV among pregnant women is also very high, thereby raising concerns of mother-to-child transmission of the virus. Prevention of mother-to-child transmission (PMTCT) of HIV is therefore a priority in the efforts to curb the HIV pandemic. Keeping in mind that the area of HIV management is rapidly evolving, underpinning nursing care with evidence-based practice is essential and has been reported to reduce mother-to-child transmission.Objectives: The aim of the study was to explore and describe the knowledge, attitudes and practices of nurses regarding evidence-based practice in PMTCT at a selected hospital in Malawi.Methods: An exploratory descriptive quantitative design was used, and 81 nurses working in paediatric, obstetrics and gynaecology departments completed a self-administered questionnaire. Data were analysed using Predictive Analytics Software.Results: The results showed that nurses had average knowledge of evidence-based practice and although their attitudes were favourable, their practice was very low. Certain sociodemographic variables had an influence on the respondent's knowledge, attitudes and practices. Furthermore, the results have indicated that evidence-based practice was mainly hampered by insufficient resources and difficulties in accessing research articles. It emerged from the study that mentoring, training and access to literature could facilitate evidence-based practice in PMTCT among nurses.Conclusion: Nurses need to be provided with the necessary support including education and resources if evidence-based practice in PMTCT is to be promoted

Impact of Health Education Intervention on Malaria Prevention Practices among Nursing Mothers in Rural Communities in Nigeria

Malaria is the most prevalent parasitic endemic disease in Africa; which is preventable; treatable and curable. This study aims to assess the effect of health education intervention on the knowledge; attitude; and prevention practices amongst mothers of under-five children in a rural area of Ogun State; Nigeria. Materials and Methods: The study design was a quasi-experimental study carried out in Ijebu North Local Government Area of Ogun State. A multistage random sampling technique was used in choosing the required samples and a semi-structured questionnaire was used to collect relevant information. A total of 400 respondents were recruited into the study with 200 each in both the experimental and control groups and were followed up for a period of 3 months. Results: There was no statistically significant differences observed between the experimental and control groups. Knowledge of indoor spraying increased from 14.7 to 58.2 (P 0.001) and window and door nets increased from 48.3 to 74.8 (P 0.001). The proportion of those with ITN use increased from 50.8 to 87.4 (P 0.001) while those with practice of maintaining clean environment also increased from 40.4 to 54.5 (P 0.001). There were no significant changes in all the practice of malaria prevention methods in the control group. Conclusion: This suggests that malaria control can be significantly improved in rural areas; if the caregivers are adequately empowered through appropriate health education intervention though change in attitude and belief may require a longer and persistent effort

Assessment of Oral Health Problems among the Elderly Populace of Ikibiri Community; Yenagoa Local Government Area of Bayelsa State and Possible Solutions

Background: This research work was aimed at assessing the oral health problems of the elderly populace of Ikibiri community; Bayelsa State as well as determining possible solutions to these problems.Method: A descriptive study design was carried out on 100 respondents comprising of elderly individuals of Ikibiri community; Yenagoa Local Government Area of Bayelsa State between the ages of 60 - 110 years. Interviewer - based questionnaires assessing the presence of specific oral health problems as well as delivery of oral health services were used as our instrument for data collection.Results: Bleeding gums (52); toothache (44); and oral sores (42) were found to be the major oral health problems being experienced by the population under study and these were mostly attributed to the absence of a dentist (95); absence of a dental clinic (94) as well as the absence of oral health education to the community (87).Conclusion: Oral health problems are undoubtedly present among the elderly individuals of Ikibiri community; Yenagoa LGA; Bayelsa State which was attributed to the absence of dental personnel; dental facilities and oral health education. It was however recommended that Ikibiri community be provided with dental personnel and facilities as well as the provision of oral health education to the entire populace of Ikibiri; which would indeed reduce the burden of oral health problems among the elderly in this community

Most Influential Medical Publications of the Last 20 Years (1990-2012): a Collection from Journals with the Highest Impact Factor

As the performance of the clinical medicine relies on evidence-based facts as well as particular landmark researches; this collection of influential medical articles that changed and/or guided most current recommendations used in the daily basis of clinical medicine gives the top spotlight of new trends of management and treatment. The compilation is made from a search into MEDLINE; PubMed; DynaMed; CINAHL; and Academic Search Premier as well as systematically from reference lists of studies and relevant reviews. The inclusion criterion was based on the impact factor of publishing journals that were mostly renowned magazines; which expresses a measurement of the frequency that an article has been cited during a period of time. 478 articles classified according to specialties and sub-specialties were collected from 103 medical journals published approximately in a period of 20 years (1990-2012). In fact; referral materials (Books et Encyclopedias; on-line links; etc) sustained the selecting process that; although we assume exhaustive in the methodology used; but exiguous considered how challengeable and quickly-progressing clinical researches are; gave the most eventful recent researches that had influenced the clinical Medicine. However; opinions expressed within articles compiled are not necessary gold standards or landmarking facts; though they open the perspective on multiple interchangeable evidence-based factors that guide the universal tendency upon the medical management. Thus; regarded how fast medical researches and new facts progress; we recommend checking furthermore on diagnostic and treatment new approaches

An Evaluation of a Refresher Training Intervention for HIV Lay Counsellors in Chongwe District; Zambia

To address a severe shortage of human resources for health; the Zambian Ministry of Health has begun to make use of lay counsellors for HIV counselling and testing. However; their skills and knowledge rarely have been reviewed or refreshed. We conducted a two-day refresher workshop for lay counsellors to review their performance and refresh their skills and knowledge. The objective of this study was to evaluate the refresher training intervention for HIV lay counsellors in the rural district of Chongwe in Zambia. The two-day refreshertraining workshop was held in November 2009. Twenty-five lay counsellors were selected by District Health Office and participated in the workshop. The workshop included: the opening; a pre-training exercise; lectures on quality assurance with regard to testing and safety precautions; lectures on counselling; filling the gap/QetA session; and a post-training exercise. In both the pre- and post-trainingexercise; participants answered 25 true/false questions and tested 10 blood panel samples to demonstrate their knowledge and skill on HIV counselling and testing. The average overall knowledge test score increased from 79 to 95 (p0.001). At the baseline; knowledge test scores in topic of standard precaution and post-exposure prophylaxis were relatively low (58) but rose to 95 after the training (p0.001). The per cent agreement of HIV testing by lay counsellors with reference laboratory was 99.2. Participants' knowledge was improved during the workshop and skill at HIV testing was found to remain at a high level of accuracy. Relatively weak knowledge of standard precautions and post-exposure prophylaxis suggests that lay counsellors are at risk of nosocomial infections; particularly in the absence of refresher training interventions. We conclude that the refresher training was effective for improving the knowledge and skills of lay counsellors and provided an opportunity to monitor their performance