Patients' perceived quality of care and their satisfaction with care given for MDR-TB at referral hospitals in Ethiopia.

BACKGROUND: There is presently dearth of evidence in Ethiopia on patients' perception on quality of care given for multi-drug resistant tuberculosis (MDR-TB) and their satisfaction with the care and services they receive for the disease. Moreover, there is no evidence on the experiences and practices of caregivers for MDR-TB regarding the functionality of the programmatic management of MDR-TB at referral hospitals in Ethiopia. Thus, this study was conducted to address these gaps. Evidence in these areas would help to institute interventions that could enhance patient satisfaction and their adherence to the treatment given for MDR-TB. DESIGN AND METHODS: This study employed an inductive phenomenological approach to investigate patients' perception of the quality of care given for MDR-TB, level of their satisfaction with the care they received for MDR-TB and the experiences and practices of caregivers for MDR-TB on the functionality of the programmatic management of MDR-TB at referral hospitals in Ethiopia. The data were analysed manually, and that helped to get more control over the data. RESULTS: The majority of the patients were satisfied with the compassionate communication and clinical care they received at hospitals. However, as no doctor was dedicated exclusively for the MDR-TB centre of the hospitals, patients could not get timely medical attention during emergent medical conditions. Patients were dissatisfied with the poor communication and uncaring practice of caregivers found at treatment follow-up centres (TFCs). Patients perceived that socio-economic difficulties are both the cause of MDR-TB and it has also challenged their ability to cope-up with the disease and its treatment. Patients were dissatisfied with the poor quality and inadequate quantity of the socio-economic support they got from the programme. Despite the high MDR-TB and HIV/AIDS co-infection, services for both diseases were not available under one roof. CONCLUSIONS: Socio-economic challenges, inadequate socio-economic support, absence of integrated care for MDR-TB and HIV/AIDS, and the uncaring practice of caregivers at treatment follow-up centres are found to negatively affect patients' perceived quality of care and their satisfaction with the care given for MDR-TB. Addressing these challenges is recommended to assist patients' coping ability with MDR-TB and its treatment.

Treatment outcomes of patients with MDR-TB and its determinants at referral hospitals in Ethiopia.

BACKGROUND: There is limited empirical evidence in Ethiopia on the determinants of treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) who were enrolled to second-line anti-tuberculosis drugs. Thus, this study investigated the determinants of treatment outcomes in patients with MDR-TB at referral hospitals in Ethiopia. DESIGN AND METHODS: This study was underpinned by a cross-sectional quantitative research design that guided both data collection and analysis. Data is collected using structured questionnaire and data analyses was performed using the Statistical Package for Social Sciences. Multi-variable logistic regression was used to control for confounders in determining the association between treatment outcomes of patients with MDR-TB and selected predictor variables, such as co-morbidity with MDR-TB and body mass index. RESULTS: From the total of 136 patients with MDR-TB included in this study, 31% had some co-morbidity with MDR-TB at baseline, and 64% of the patients had a body mass index of less than 18.5 kg/m2. At 24 months after commencing treatment, 76 (69%), n = 110), of the patients had successfully completed treatment, while 30 (27%) died of the disease. The odds of death was significantly higher among patients with low body mass index (AOR = 2.734, 95% CI: 1.01-7.395; P<0.048) and those with some co-morbidity at baseline (AOR = 4.260, 95%CI: 1.607-11.29; p<0.004). CONCLUSION: The higher proportion of mortality among patients treated for MDR-TB at Adama and Nekemte Hospitals, central Ethiopia, is attributable to co-morbidities with MDR-TB, including HIV/AIDS and malnutrition. Improving socio-economic and nutritional support and provision of integrated care for MDR-TB and HIV/AIDS is recommended to mitigate the higher level of death among patients treated for MDR-TB.

Paramedic students' confidence and satisfaction with clinical simulations of an emergency medical care programme in South Africa: A cross-sectional study.

BACKGROUND: There has been an increase in the use of clinical simulations as instructional tools in healthcare education. This is because of their role in ensuring patients' safety and quality-care provision. AIM: This study investigated the paramedic students' satisfaction and self-confidence in the clinical simulation of an emergency medical care programme. SETTING: The study was conducted at the Durban University of Technology in the KwaZulu-Natal Province of South Africa. The paramedic students' satisfaction and self-confidence in the clinical simulation of an emergency medical care programme were the focus of the study. METHODS: The study used a cross-sectional research design. A convenience sampling method was used to select the 83-paramedic students who participated in the study. Data were collected between July and September 2017 using a structured questionnaire. Descriptive statistics (frequencies and percentages and Spearman's rank-order correlation coefficient) and an inferential test, ordinal logistic regression analysis, were used for data analysis. RESULTS: High levels of paramedic students' satisfaction and self-confidence in simulation activities were reported. Generally, the paramedic students' demographics were associated with the satisfaction and self-confidence variables with p-values ≤ 0.04. Emergency medical care training undertaken by the paramedic students was significantly associated with self-confidence (p = 0.00). CONCLUSION: Clinical simulation can bridge the theory-practice gap for paramedic students. It is a hands-on approach that promotes students learning of clinical skills through reflection.

Sexual behaviour among adolescents living with the human immunodeficiency virus in Zimbabwe: educational implications.

The incidence of HIV infection is increasing among adolescents in Zimbabwe. This rise in incidence is partly due to risky sexual behaviours yet there are no published research studies on sexual behaviours of HIV-positive adolescents in Zimbabwe. Hence, this study, which examined the sexual behaviours of HIV-positive adolescents. This study utilised a cross-sectional design with a conveniently selected sample of 341 HIV-positive adolescents. Data were collected through a questionnaire. Data were analysed using descriptive and analytical statistics. The study revealed that approximately 37 (11%) of the adolescents had engaged in sexual intercourse, and approximately 14 (60%) of these did not use condoms. Approximately 11 (30%) of the sexually active adolescents had multiple sexual partners, and only 9 (24.3%) of them had disclosed their HIV serostatus to their partners before sexual intercourse. A bivariate analysis revealed factors that were associated with being sexually activity. Examples of these include age (OR = 1.56, p < 0.001) and being treated by a psychiatrist (OR = 47.9, p < 0.001). A multivariate logistic regression analysis was carried out, revealing factors that were independently associated with being sexually active. Examples of these include age (AOR = 1.91, p < 0.01) and exposure to erotic television programmes (AOR = 3.9, p < 0.04). The results of the study indicate that the sexual risk behaviours of HIV-positive adolescents contributes to the increase in incidence and prevalence of HIV/AIDS in Zimbabwe. The development and rolling out of a health education programme will help health care workers to address this concern.