The long-term impact of providing nursing education in a low-income country.

OBJECTIVE: To measure long-term knowledge gain after provision of nursing education in a low-income country. DESIGN AND SAMPLE: Global health education research has often focused on the short- term effects of providing education and direct patient care. Assessment of long-term knowledge gain is key for determining whether education knowledge transfer is sustainable. MEASUREMENTS: This prospective cohort study of educational training for nurses in Haiti tested knowledge gain before, immediately after, and 6 months after education. INTERVENTION: Quantitative assessments were obtained through multiple choice tests at 3 time points. Qualitative data were obtained through focus groups and self-assessments. RESULTS: Knowledge gain was significant from pretest to immediate posttest, and knowledge retention was assessed at 6 months after the education. Qualitative data showed improvement in reported confidence levels and patient care activities. Short-term knowledge gain was statistically significant for improvement; however, long-term knowledge gain was statistically significant in only 4 of 19 lectures. CONCLUSIONS: Reported qualitative improvements in patient care indicated added value of providing education to the nursing staff. Hands-on learning techniques were important to long-term retention, and building trust was vital to the completion of our study.

Prevalence, risk factors and associated complications of postpartum hypertension in rural Haiti.

BACKGROUND: The prevalence of hypertensive disorders during pregnancy is high in developing countries such as Haiti, however little is known about postpartum hypertension (PPHTN). METHODS: This is a prospective study done at Hospital Albert Schweitzer in rural Haiti among pregnant women age 18 or older who were admitted for labor. Blood pressures were collected before and after delivery and medical charts were reviewed to gather delivery characteristics and fetal/neonatal outcomes. Differences between groups are presented based on postpartum blood pressures (BP) as mild PPHTN (systolic BP≥140 or diastolic BP≥90) and severe PPHTN (systolic BP≥160 or diastolic BP≥110). RESULTS: Of 175 women, the prevalence of PPHTN during the two-month study period was 57.1% (97/172) and included 56 parturients with mild and 41 with severe PPHTN. Severe PPHTN was associated with a higher proportion of complications including abruption (14.6%), fetal (14.6%) and neonatal death (7.3%). Thirty-nine (69.6%) patients with mild PPHTN and 9 (21.9%) patients with severe PPHTN did not receive any antihypertensive medications postpartum. Patients with severe PPHTN had prolonged hospitalization compared to the normal group (3.5 vs. 2.0days, p=0.0003). There was a strong correlation between antepartum and postpartum systolic and diastolic BP's (r=0.62 and 0.54, p<0.0001, respectively). CONCLUSION: In this study, we identified a high prevalence of PPHTN in rural Haiti. Severe PPHTN was associated with adverse outcomes and treatment is not universal. This data is a starting point to develop region-specific protocols to treat and control PPHTN.

Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti.

INTRODUCTION: In the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program. MATERIALS AND METHODS: Patient navigators were trained to guide subjects from a mountain population through the entire hospital process for elective surgery. We compared the rate of elective operations before and after the patient navigation intervention between three groups: a control group from a mountainous area, a control group from the plains and an intervention group from a mountainous area. RESULTS: The baseline elective operation rate differed significantly between the plains control group, the mountain control group and the mountain intervention group (361 vs. 57 vs. 68 operations per 100,000 population per year). The rate of elective surgery between the two mountain groups was not statistically different prior to the intervention. After the intervention, the elective operation rate in the mountain group that received patient navigation increased from 68 to 131 operations per 100,000 population per year (p = 0.017). DISCUSSION: Patient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.

Prevalence and risk factors for chronic kidney disease in a rural region of Haiti.

BACKGROUND: In the Caribbean region chronic kidney disease (CKD) is an increasing challenge. High rates of non-communicable and infectious diseases and the rise in people suffering from diabetes and hypertension explain the observed and further expected increase of CKD. However, data about the magnitude of the problem are rare and in some countries such as Haiti completely lacking. The aim of our study was to generate data about the prevalence and risk factors for CKD in a rural region in Haiti. METHODS: In this prospective cross-sectional study, adult patients visiting the medical outpatient clinic of the Hôpital Albert Schweitzer (HAS) in Deschapelles Haiti were included. CKD was assessed by estimated glomerular filtration rate (eGFR) and measurement of proteinuria by dipstick test. Risk factors for CKD were assessed by clinical examinations and questionnaires. RESULTS: Overall 608 patients were screened for CKD, of whom 27% had CKD. CKD stages 1 to 2 were found in 15.3% and stages 3 to 5 in 11.7%. The prevalence of hypertension and diabetes mellitus was 49.2% and 36.3%, respectively. Risk factors independently associated with CKD were hypertension (p = 0.0002) and HIV infection (p = 0.019) and age >60 years (p = 0.0052), whereas diabetes mellitus was not independently associated (p = 0.72). CONCLUSION: Our data show a high prevalence of CKD and traditional risk factors, and their association with CKD in Haiti. These findings have now to be confirmed in other regions in longitudinal analyses as a basic step to build up screening and prevention programmes for CKD.

Recovery from severe heart failure following peripartum cardiomyopathy.

OBJECTIVES: Traditional concepts surrounding peripartum cardiomyopathy (PPCM) hold that if recovery does not occur within 6 months of diagnosis, it is unlikely to happen. The purpose of the study was to determine the length of time required for recovery of left ventricular systolic function. METHODS: Patients were identified from the Hôpital Albert Schweitzer PPCM Registry over the period 2000-2008. Echocardiography was carried out at diagnosis and every 6 months thereafter. Recovery of systolic heart function was defined as left ventricular ejection fraction greater than 0.50. RESULTS: Thirty-two out of 116 (27.6%) PPCM patients reached recovery levels, with 75% of patients taking over 12 months to recover. Shortest time to recovery was 3 months and longest time to recovery was 48 months. CONCLUSION: Recovery of left ventricular systolic function in PPCM patients often requires longer than 6-12 months following diagnosis. It is important to continue effective treatment and follow-up for a sufficient period to assure maximum benefit.