An analysis of the policy participation of field response nurses in South Korea: COVID-19 response guidelines and the infectious disease act revision.

INTRODUCTION: The Republic of Korea's response to Coronavirus disease 2019 was divided before and after global vaccine development at the end of 2020. It also varied according to the size of confirmed patients in the non-pharmaceutical intervention. Therefore, this study aimed to analyze the contribution of frontline nurses to the policy and law revision on infectious diseases and suggest health and nursing policies for emerging infectious diseases in the future. DESIGN: This case evaluation study analyzed the significant policy decisions that nurses' roles brought on changes in the infectious disease response system in the Republic of Korea and applying the health system model and those capacities on resilience under emerging infectious diseases. METHODS: Objective data that contributed directly to the revision of infectious disease-related Acts and policies in 2020 were collected and analyzed through literature search and information disclosure claims from the first to third waves of Coronavirus disease 2019 in one city. RESULTS: With the rapid outbreak of COVID-19 confirmed cases at the end of February 2020, a pan-government support group was formed and dispatched to D City. In addition, central quarantine officials worked with local quarantine officials to share real-time situations and find out on-site difficulties and support requests. As a result, inquiry of opinions to working staff before changing the "response guidelines to Coronavirus disease 2019" was reflected in major contents on the revision of "policy on infectious disease response" and "Infectious Disease Prevention and Management Act." With the establishment of an epidemiological investigation team in September 2020, the number of new nurses in 17 cities and provinces increased by 19.1% compared to the previous year, the most significant increase compared to doctors (-2.3), dentists (-1.6), and health workers (3.7). CONCLUSION: The experience of responding to Coronavirus was a reminder that the curriculum needed to be improved so that nurses will be recognized to have leadership competencies and as field experts regarding social determinants of health for population groups in the decision-making process. In the initial COVID-19 response process, nurses showed excellence in analyzing patient interviews and various information as field epidemiological investigation response personnel, making comprehensive judgments, and solving problems in cooperation with related agencies and severe patients' bedside nursing care. Continuous primary care and management of infectious diseases for the vulnerable should be prepared on an ongoing basis to assure the quality of care. CLINICAL RELEVANCE: Action strategies for developing leadership to enable nurses to have participated in the social determinants of health and the nursing policy formation for health equity should be applied in nursing education and practice, and global monitoring efforts were accelerated.

Development and application of survey-based artificial intelligence for clinical decision support in managing infectious diseases: A pilot study on a hospital in central Vietnam.

Introduction: In this study, we developed a simplified artificial intelligence to support the clinical decision-making of medical personnel in a resource-limited setting. Methods: We selected seven infectious disease categories that impose a heavy disease burden in the central Vietnam region: mosquito-borne disease, acute gastroenteritis, respiratory tract infection, pulmonary tuberculosis, sepsis, primary nervous system infection, and viral hepatitis. We developed a set of questionnaires to collect information on the current symptoms and history of patients suspected to have infectious diseases. We used data collected from 1,129 patients to develop and test a diagnostic model. We used XGBoost, LightGBM, and CatBoost algorithms to create artificial intelligence for clinical decision support. We used a 4-fold cross-validation method to validate the artificial intelligence model. After 4-fold cross-validation, we tested artificial intelligence models on a separate test dataset and estimated diagnostic accuracy for each model. Results: We recruited 1,129 patients for final analyses. Artificial intelligence developed by the CatBoost algorithm showed the best performance, with 87.61% accuracy and an F1-score of 87.71. The F1-score of the CatBoost model by disease entity ranged from 0.80 to 0.97. Diagnostic accuracy was the lowest for sepsis and the highest for central nervous system infection. Conclusion: Simplified artificial intelligence could be helpful in clinical decision support in settings with limited resources.

A retrospective review of vaccine wastage and associated risk factors in the Littoral region of Cameroon during 2016-2017.

BACKGROUND: Immunization is an effective preventive health intervention. In Cameroon, the Expanded Program on Immunization (EPI) aims to vaccinate children under 5 years of age for free, but vaccination coverage has consistently remained below the national target. Vaccines are distributed based on the target population size, factoring in wastage norms. However, the vaccine wastage rate (VWR) may differ among various settings. Our study aimed to assess vaccine wastage for different site settings, seasonality, and vaccine types in comparison to vaccination coverage in order to provide comprehensive insights on vaccine wastage. METHODS: A retrospective data collection and analysis were conducted on immunization and vaccine wastage data in the Littoral Region of Cameroon during 2016 and 2017. Health districts were classified as urban or rural, seasonality was categorized as rainy or dry season, and vaccine types were grouped into liquid, lyophilized, oral, and injectable vaccines. VWRs and vaccination coverage rates (VCRs) were calculated, and the vaccine waste factor was investigated. RESULTS: The VWR of Bacillus Calmette-Guérin (BCG; 32.19%) was the highest, followed by measles and rubella (MR; 19.05%) and yellow fever (YF; 18.34%) among all EPI vaccines in the Littoral Region of Cameroon during 2016 and 2017. Single-dose vaccine vials exhibited lower VWRs than multi-dose vials. Dry season was associated with higher VWRs for most vaccines, although more lyophilized vaccines (BCG, MR, YF vaccines) were wasted in rainy season in 2016. The VWR was persistently higher in rural than urban health districts. The months of February and November saw a decrease in VCRs. The study found an overall negative correlation between VCR and VWR. CONCLUSIONS: Multiple factors may cause wastage of EPI vaccines in Cameroon. Vaccination area characteristics, seasonality, types of vaccines such as multi- or single-dose, lyophilized or injectable vaccines are related to VWRs in Littoral Region. Further research on vaccine wastage and vaccination coverage across Cameroon is needed to better understand the socio-behavioral aspect of vaccine in-take that may affect the level of vaccination and vaccine wastage. Public health system strengthening is warranted to adapt more real-time monitoring of the VWR and VCR for each vaccine in the government's immunization programs.

Infectious Disease Control and Management in Ethiopia: A Case Study of Cholera.

Cholera remains a significant public health problem among the vulnerable populations living in many resource-limited settings with poor access to safe and clean water and hygiene practice. Around 2.86 million cholera cases and 95,000 deaths are estimated to occur in endemic countries. In Ethiopia, cholera has been one of the major epidemic diseases since 1634 when the first cholera outbreak was recorded in-country. Several cholera epidemics occurred with recent outbreaks in 2019-2021. Cholera has been often reported as acute watery diarrhea due to limited diagnostic capacity in remote areas in Ethiopia and sensitivities around cholera outbreaks. The government of Ethiopia has been executing several phases of multi-year health sector development plan in the past decades and has recently developed a national cholera control plan. Here, we aim to present the existing cholera control guidelines and health system in Ethiopia, including case detection and reporting, outbreak declaration, case management, and transmission control. Challenges and way forward on further research and public health interventions are also discussed to address the knowledge and health service gaps related to cholera control in Ethiopia.

Factors Associated with the Implementation of an Improved Community Health Fund in the Ubungo Municipality Area, Dar es Salaam Region, Tanzania.

Community-based health insurance schemes help households to afford healthcare services. This paper describes healthcare facilities and community factors that are associated with the Improved Community Health Fund (iCHF) scheme in the Ubungo district of Tanzania. A cross-sectional descriptive study was conducted using online questionnaires that were completed by healthcare providers and community members in public-owned healthcare facilities in the Ubungo Municipal Council district of Dar es Salaam, Tanzania, between October and November 2021. The data were analyzed using descriptive statistics and the chi-squared test of association. We found a statistically significant relationship between income level and satisfaction with the iCHF scheme. For community-related factors, income level was statistically significant in the level of involvement in iCHF implementation among local leaders. Further, income level was statistically significant in relation to community behavior/culture toward the iCHF. Occupation was statistically significant in iCHF implementation, iCHF premiums, and iCHF membership size. A statistically significant relationship was also found between income, iCHF membership size, and iCHF premiums. Moreover, people would be willing to pay the required premiums if the quality of the healthcare services under the iCHF scheme improves. Therefore, the government should allocate resources to reduce the challenges that are facing iCHF implementation, such as the preference for a user fee scheme over the iCHF, the issues that are faced by enrollment officers, and inadequate iCHF premiums and membership size.

Isoniazid Preventive Therapy for Tuberculosis in People Living with HIV: A Cross Sectional Study in Butebo, Uganda.

BACKGROUND: Despite evidence that isoniazid preventive therapy (IPT) can reduce the risk of tuberculosis (TB) disease among People Living with Human Immunodeficiency Virus (PLHIV), uptake of IPT is low in many resource-limited settings. This study determined the level of IPT uptake and its associated factors amongst PLHIV. MATERIALS AND METHODS: This was a retrospective quantitative study amongst PLHIV who do not have active TB and enrolled in 2019 - 2020 for anti-retroviral therapy (ART) in Butebo district, Uganda. Data related to demographic factors (age, sex, religion, marital status, employment status, education level, area of residence, household density), health facility factors (pre-IPT counseling), community factors [distance from Health Center (H/C), incurred costs to reach H/C], and IPT drug-related factors [frequency of Isoniazid (INH) refill, INH stock-outs] were collected from four health facilities using a checklist. The data was analyzed into descriptive statistics and relationships determined using Chi-square tests. RESULTS: Among eligible PLHIV (272), 34.2% achieved IPT uptake. The mean duration between HIV diagnosis and the start of IPT was 4.31 years, with IPT Uptake among males (37.0%), females (32.8%), married (39.5%), and Christians (35.4%). Factors that affect the rate of IPT uptake include employment, education, residence, costs to reach H/C, and pre-IPT counseling. The IPT completion rate was 97.8%. All the cases who had regular INH refill completed IPT compared to 60.0% with the irregular refill, while 97.8% did not experience INH stock-outs and completed IPT. CONCLUSION: Pre-IPT counseling was the most significant contributing factor for IPT uptake. IPT uptake may be scaled up by integrating IPT services in routine HIV care, enhancing counseling for IPT and supervision and monitoring, training of health workers, and improving logistical supplies at the health centers.

Working Experience of Managers Who Are Responsible for Promoting and Monitoring Patient Safety in South Korea: Focusing on Small- and Medium-Sized Hospitals.

OBJECTIVES: This study explored the working experience of patient safety managers (PSMs) in small- and medium-sized hospitals (SMHs). METHODS: A qualitative study comprising 3 focus group discussions (6 people each) was conducted. Patient safety managers working in SMHs-hospitals with 100 to 300 beds-were included. Researchers analyzed the transcribed script, and a conventional content analysis was performed to describe PSMs' working experience. RESULTS: All the PSMs were nurses and with an average (SD) work experience of 1.51 (1.02) years. Five core themes and 17 subthemes were derived. The PSMs reported that it was difficult to perform patient safety tasks alone and cooperate with other departments. Because of members who did not acknowledge PSMs' authority as experts, PSMs experienced identity confusion. Lack of an established patient safety culture in SMHs hindered the PSMs from performing patient safety-related duties. The government continues to train PSMs and provide materials; however, they are not suitable for SMHs and thus cannot be used. The PSMs hoped to overcome the system's initial phase and become professionals. CONCLUSIONS: Patient safety managers faced difficulties because of the lack of guidelines, training, and systems. Nevertheless, they have attempted to overcome these problems themselves, so they can be recognized as professionals. This study's findings can be used as basic data to provide differentiated support for PSMs, based on hospital size.

School-Based Participatory Response for Reopening During the COVID-19 Pandemic: A Case Study of a Metropolitan High School Implementing the Health Promoting School.

Purpose: This study aimed to analyze how a private high school in Seoul developed and executed a "school disinfection strategy" to ensure the students' right to study in a safe environment, and also to analyze the lessons learned from this process. Methods: This was a case study of school health in a community-based school reopening during the COVID-19 pandemic. The study target was a 64-year-old private high school with 12 classes for each grade with a total of 1,100 students. Results: A "school disinfection strategy" was set up at individual and class environment levels to protect students from the risk of infection. In addition, school health activities were carried out with a "personal protection safety belt" and "community protection safety belt" for effective implementation. To ensure a safe educational environment for high school students and to ensure smooth execution of face-to-face classes (in-person teaching), the "prevention safety belt strategy" was introduced in accordance with governmental guidelines to sequentially implement various preventive measures necessary to guarantee environmental safety of schools. Activating personal prevention safety belts by checking the symptoms of students when entering the school and during each class, and providing self-made disinfectants by spraying alcohol on wet-wipes were cost-effective and sustainable methods used in this school to prevent the spread of infection. Conclusions: The experience of developing a prevention safety belt strategy to adapt the guidelines of the local education office to the school situation was presented. Focusing on the school community, as well as individual students and teachers, the concept of prevention safety belts helped to unite and stimulate voluntary participation of students in health promotion activities.

School Health Needs Assessment in Chanchamayo, Peru: A Health Promoting School Project.

Background: School-based health promotion can be particularly valuable in developing countries. However, there is a lack of information about the health needs of Peruvian school students. The purpose of this study was to conduct a health needs assessment to develop strategies for a school health promotion program in a jungle and indigent region in Chanchamayo, Peru. Methods: This study was conducted using a mixed method approach that included a literature review, national and local statistics, stakeholder interviews, and a survey. Participants of the survey were 210 teachers, 2,504 elementary school students, and 2,834 secondary school students from six 'schools in two planned project implementation regions. A self-administered questionnaire for students was developed based on WHO's Global School-based Student Health Survey. Collected data were analyzed using descriptive statistics, chi-square tests, and t-tests for the survey data and content analysis for the interviews. Results: Weak school health systems were identified, including school health policies, curriculum, trained health care personnel, and health-related facilities and equipment. Common health problems of students were anemia, nutritional deficiency, infectious diseases, tuberculosis, drug abuse, poor hygiene, and sex-related problems. High absence rates from school due to family problems and high dropout rates due to pregnancy were also critical issues. Teachers identified personal hygiene, nutrition, reproductive health, and sex education as high priorities for school health education, while students identified prevention of infectious diseases, nutrition education, psychological health, and healthy lifestyles as priorities. Identified strategies included: establishment of school health policies, curriculum-based interventions, increasing community participation and raising school health awareness, capacity building for health care promotors, training of trainers, and partnership between schools and communities. Conclusions: Findings from this study will help guide the development and implementation of a school-based health promotion program in Chanchamayo. Multicomponent school-based interventions that consider feasibility and sustainability will be developed and evaluated based on WHO's Health Promoting School concepts.

Comparative Studies on Patient Safety Culture to Strengthen Health Systems Among Southeast Asian Countries.

Patient safety is an important issue in health systems worldwide. A systematic review of previous studies on patient safety culture in Southeast Asian countries is necessary for South Korea's partnership with these countries, especially given South Korea's assistance in strengthening the health systems of these developing countries. Studies on patient safety culture in Southeast Asian countries, published in English and Thai languages, were retrieved from computerized databases using keywords through a manual search. Data extraction, quality assessment, and analyses were performed using several tools. The review included 21 studies conducted in Indonesia (n = 8), Thailand (n = 5), Malaysia (n = 3), Vietnam (n = 2), Singapore (n = 1), and the Philippines (n = 1). They were analyzed and categorized into 12 dimensions of safety culture, and differences in response rate or scores were identified compared to the mean of the dimensions. The heterogeneous of safety culture's situation among Southeast Asian countries, both in practice and in research, can be explained since patient safety policy and its application are not prioritized as much as they are in developed countries in the priority compared to the developed countries. However, Vietnam, Cambodia, Myanmar, and Laos are the priority countries for South Korea's official healthcare development assistance in the Southeast Asia region. Vietnam, for instance, is an economically transitioning country; therefore, consolidated patient safety improvement by inducing patient safety culture in the provincial and central health system as well as strengthening project formulation to contribute to health policy formation are needed for sustainable development of the partner countries' health systems. It is recommended that more evidence-based proactive project planning and implementation be conducted to integrate patient safety culture into the health systems of developing countries, toward health policy on patient safety and quality service for the attainment of sustainable development goals in South Korea's development cooperation.

Identification of New Isolates of Phytophthora sojae and the Reactions of Korean Soybean Cultivars Following Hypocotyl Inoculation.

Phytophthora root and stem rot (PRSR) caused by Phytophthora sojae is one of the most destructive diseases of soybean. PRSR recently became an issue as soybean cultivation in paddy fields increased in South Korea. The management of PRSR mainly involves R-gene-mediated resistance, however, little is known about the resistance in Korean cultivars. Major Korean soybean cultivars were investigated for the presence or absence of R-gene-mediated resistance to four P. sojae isolates, two of which were new isolates. Isolate-specific reactions were observed following P. sojae inoculation. Of 21 cultivars, 15-20 cultivars (71.4-95.2%) showed susceptible reaction for each isolate. Ten cultivars were susceptible to all the isolates, and six cultivars were identified to have R-gene-mediated resistance to one or two isolates. The results of this study would provide a framework for the discovery of resistant cultivars, development of new cultivars resistant to P. sojae, and investigation of pathogenic diversity of P. sojae population in South Korea.

Factors influencing nutritional practices among mothers in Dakar, Senegal.

BACKGROUND: Maternal undernutrition is a leading cause of maternal mortality. Furthermore, health statuses and habits of mothers influence health statuses of newborns as well as healthy habits and mortality of children. The Senegal government is aware of the severity of these issues and has devised a national policy goal of reducing maternal, infant, and adolescent mortality rates by the end of 2018. This study aimed to identify nutritional knowledge, attitudes, and practices of lactating women in Senegal, and determine factors related to nutritional practices to obtain basic data for developing a maternal and child nutrition project. METHOD: This study used a mixed-method approach, collecting data via structured questionnaires administered to lactating women in Senegal and semistructured interviews with seven stake-holders. Questions for stuctured questionnaires were about nutritional knowledge, attitudes, and practices. For the quantitative analysis of the structured questionnaires, data from 171 participants analyzed using independent t-tests, Pearson's correlation coefficients, and multiple linear regression analysis. Interview data were analyzed using an inductive thematic analysis approach. The questions for the interviews concerned maternal and child nutritional status, causes of undernutrition, and restrictions. RESULTS: Factors significantly related to healthy nutritional practices(explaining 27.1% of variance) included having a household (B = 1.03, p = .015) and a mother (B = 0.96, p = .017) with an above primary school education, and being in the 5th quintile of income level (B = 1.24, p = .014). The interviews with seven stakeholders revealed obstructive factors of nutritional management were insufficient nutritional programs within health centers, incomplete national policy on nutrition, lack of general interest in undernutrition-related topics, inadequate economic environment, and the absence of partnerships to produce sustainable solutions. CONCLUSION: Education and income levels, rather than knowledge and attitudes, had a strong relationship with healthy nutritional practices. Therefore, economic factors and educational background must be considered to succeed in Senegalese nutrition projects.

Capacity Development in an Undergraduate Nursing Program in Vietnam.

Background: Nurses are an essential human resource to ensure a healthy population and support the socio-economic development. However, little research has focused on the capacity development of nurses. Objective: The performance of a capacity development project for an undergraduate nursing program in Vietnam was reviewed to share lessons. Design: A descriptive case report. Setting: A baccalaureate nursing program in Vietnam from June 2014 to June 2016. Methods: A case report was analyzed in terms of the project's process, and the outcomes of 2 years' activities were evaluated. Results: Practice-based curriculum redesign and two basic nursing subjects were developed after five rounds of curriculum workshops. To improve application efficiency, two nursing experts were dispatched to provide instructions regarding the application of the new subjects. Three candidates were invited to complete their master's and doctoral studies in Korea. An advanced nursing education environment was supported with simulation labs equipped within a ubiquitous network. The result of experts' evaluation was excellent by every criterion of the Organization for Economic Co-operation and Development-Development Assistance Committee. Conclusions: The capacity development of a nursing program was possible through ownership, accountability, and results-based management. Gradual improvement in nursing academic and clinical capacity building based on research evidence can empower partner countries' nursing leadership.

Implementation of a Sustainable Training System for Emergency in Vietnam.

PURPOSE: This study analyzed the project outcomes to share lessons regarding the development of an emergency medicine education system in Vietnam. METHODS: Retrospective evaluation was implemented using project outcome indicators. RESULTS: A total of 13 training courses were administered, with the collaboration of international experts in Korea and Vietnam. A total of 23 kinds of emergency medicine education equipment were purchased, and a basic life support (BLS) and two advanced cardiac life support labs were remodeled to provide appropriate simulation training. Throughout the 2 years of the project, nine Vietnamese BLS instructors were approved by the Korea Association of Cardiopulmonary Resuscitation under American Heart Association. Results of evaluation by Korean international development experts were based on five criteria, provided by the Development Assistance Committee of the Organization for Economic Co-operation and Development, were excellent. Success factors were identified as partnership, ownership, commitment, government support, and global networking. CONCLUSION: Project indicators were all accomplished and received an excellent evaluation by external experts. For sustainable success, healthcare policy and legal regulation to promote high quality and safe service to the Vietnamese people are recommended.

An Effective Model for Improving Global Health Nursing Competence.

This paper proposed an effective model for improving global health nursing competence among undergraduate students. A descriptive case study was conducted by evaluation of four implemented programs by the author. All programs were conducted with students majoring in nursing and healthcare, where the researcher was a program director, professor, or facilitator. These programs were analyzed in terms of students' needs assessment, program design, and implementation and evaluation factors. The concept and composition of global nursing competence, identified within previous studies, were deemed appropriate in all of our programs. Program composition varied from curricular to extracurricular domains. During the implementation phase, some of the programs included non-Korean students to improve cultural diversity and overcome language barriers. Qualitative and quantitative surveys were conducted to assess program efficacy. Data triangulation from students' reflective journals was examined. Additionally, students' awareness regarding changes within global health nursing, improved critical thinking, cultural understanding, and global leadership skills were investigated pre- and post-program implementation. The importance of identifying students' needs regarding global nursing competence when developing appropriate curricula is discussed.