Barriers to routine screening for intimate partner violence during pregnancy in Nigeria.

Background: The benefits of routine screening for intimate partner violence (IPV) among pregnant women include early identification, prompt management, referral of IPV victims, and creating awareness about IPV. Despite these benefits, the practice of routine screening of IPV remains limited in midwifery settings in low-income countries. The purpose of this study is to identify and describe midwives' perspectives of the barriers in conducting routine screening of IPV for pregnant women in northern Nigeria. Methods: A case study qualitative descriptive design was used to collect data from ten midwives in the antenatal clinic of a tertiary hospital. Non-participant observation and individual face-to-face semi-structured interviews were used as data collection methods. Thematic data analysis was carried out using Yin's five stage analytical cycle. Findings: Three themes, with related subthemes, emerged from the data: (i) The theme of "Internal" barriers to IPV screening has four subthemes; midwives' personal discomfort in asking IPV- related questions, perceived mistrust of midwives by pregnant women, midwives' own perceptions of IPV as a personal matter, and midwives' lack of skills to screen for IPV. (ii) "External" barriers to IPV screening subsumes three subthemes: antenatal card related barriers, workload related barriers, and protocol barriers. (iii) "Structural" barriers to IPV screening have two subthemes: lack of space for privacy and lack of resources for managing pregnant women who have experienced IPV. Conclusion: Knowing the barriers to midwives' screening practices is important because it may help in the development of contextually relevant and acceptable screening guidelines for midwives in Nigeria. Education and training of midwives will eliminate the internal barriers while the external barriers will need the intervention of hospital authorities and government to eliminate their effects on screening.

Barriers to nurses health advocacy role.

BACKGROUND: Speaking up to safeguard patients is a crucial ethical and moral obligation for nurses, but it is also a difficult and potentially dangerous component of nursing work. Health advocacy is gaining impetus in the medical literature, despite being hampered by barriers resulting in many nurses in Ghana remaining mute when faced with advocacy-required situations. We explored situations that thwart nurses from performing their health advocacy role. RESEARCH QUESTION: What would cause nurses to take no action when they witness situations that require them to act as health advocates for their clients or communities? RESEARCH DESIGN: An inductive, descriptive qualitative design was used to collect and analyse data on barriers that prevent nurses from practising their health advocacy role in Ghana. Individual one-on-one in-depth interviews were conducted using a semi-structured interview guide. The data were analysed using qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Twenty-four professional nurses and midwives registered with the Nursing and Midwifery Council were recruited from three regional hospitals in Ghana. These public hospitals were chosen from the upper, middle and coastal regions. ETHICAL CONSIDERATIONS: The UKZN Ethics Review Committee in South Africa and the GHS Ethics Review Committee in Ghana both gave their approval for this study. FINDINGS: Intrapersonal barriers, interpersonal barriers, and structural barriers emerged as major obstacles that nurses experience when performing their health advocacy role. CONCLUSIONS: Barriers to health advocacy have undermined nurses' ability to function as health advocates and are preventing them from utilising their health advocacy position in nursing practise. Giving nursing students positive role models in the classroom and in the clinic can help them become more effective health advocates.

Barriers to implementing National Action Plans on antimicrobial resistance using a One Health Approach: policymakers' perspectives from South Africa and Eswatini.

OBJECTIVES: Antimicrobial resistance poses a global public health concern that threatens human, animal, and environmental health. If it is not addressed, it is estimated to cost the global economy between USD 90 trillion and USD 210 trillion, and the death burden could balloon to 10 million lives per year by 2050. This study aimed to explore policymakers experiences on barriers to implementing National Action Plans on antimicrobial resistance using a One Health approach in South Africa and Eswatini. METHODS: Thirty-six policy makers were recruited using purposive and snowballing sampling in South Africa and Eswatini. Data were collected between November 2018 and January 2019 in South Africa, and February to March 2019 in Eswatini. Data was then analysed based on Creswell methods. RESULTS: Three themes and five subthemes emerged from our findings. The themes were resource barriers, political barriers, and regulation barriers to the implementation of National Action Plans on antimicrobial resistance in South Africa and Eswatini. CONCLUSION: South African and Eswatini governments should commit funds to their One Health sector budgets to enable the implementation of National Action Plans on antimicrobial resistance. Specialized human resources issues need to be prioritized to unlock barriers of implementation. A renewed political commitment is needed to combat antimicrobial resistance in a One Health approach, as it plays a significant role in resource mobilization from regional and international organizations to support the resource-constrained countries to successfully implement policies.

Factors motivating female sex workers to initiate pre- exposure prophylaxis for HIV prevention in Zimbabwe.

BACKGROUND: Female sex workers (FSWs) have a 26 times greater chance of HIV infection compared to the women in the general population. The World Health Organization recommends pre-exposure prophylaxis (PrEP) for population groups with an HIV incidence of 3% or higher and FSWs in southern Africa fit this criteria. This study sought to understand factors that motivate FSWs to initiate PrEP, in Harare, Zimbabwe. METHODS: We purposively selected and recruited 20 FSWs to participate in the study in-order to gain an in-depth understanding of factors that motivate FSWs to initiate PrEP in Harare, Zimbabwe. We identified FSW who had been initiated on PrEP at a specialized clinic providing comprehensive sexual reproductive health (SRH) services for sex workers including HIV prevention options. We used a descriptive phenomenological approach to collect and analyze the data. Data was analyzed using Colaizzi's seven steps to analyze data. FINDINGS: Two broad themes were identified as intrinsic and extrinsic motivators. The two broad themes each have several sub-themes. The sub-themes under intrinsic motivation were (i) Self- protection from HIV infection and (ii) condoms bursting. Six sub-themes were identified as external motivators for initiating PrEP, these included (i) occupational risk associated with sex work, (ii) increased chance of offering unprotected sex as a motivator to initiate PrEP, (iii) positive encouragement from others (iv) need to take care of the children and (v) prior participation in HIV prevention research studies and (vi) Gender Based Violence. CONCLUSIONS: Understanding the factors that motivate FSWs to initiate PrEP is critical in developing contextually appropriate strategies to promote PrEP initiation and adherence strategies within specific and eligible populations for receiving PrEP according to the WHO guidelines (2015).

Conditions Influencing Effective Nurse Nonverbal Communication With Hospitalized Older Adults in Cameroon.

Effective communication between nurses and patients is an important factor to quality nursing care but ineffective nonverbal communication could take a toll on health care. Therefore, understanding the factors that influence nonverbal communication between nurses and hospitalized older adults could help solve communication problems, thus improve nursing care. A sample of 13 nurses and 4 student nurses from two hospitals in Cameroon participated in the study. Data were collected using participant observations and semi-structured interviews, and analyzed using open coding and constant comparative analysis. Three categories were identified as influencing factors: nurse views of hospitalized older adults, hospitalized older adult-related factors, and nurse intrinsic factors. Effective nurses' nonverbal communication with hospitalized older adults relies mostly on nurses' intrinsic factors. Identification and nurturing of the positive nurse intrinsic factors are important to develop effective nonverbal communication skills among nurses.

La communication efficace entre les infirmières et les patients est un facteur important pour des soins infirmiers de qualité, mais une communication non verbale inefficace pourrait nuire aux soins de santé. Par conséquent, comprendre les facteurs qui influencent la communication non verbale entre les infirmières et les personnes âgées hospitalisées pourrait aider à résoudre les problèmes de communication et ainsi améliorer les soins infirmiers. Un échantillon de 13 infirmières et 4 élèves infirmières de deux hôpitaux du Cameroun ont participé à l'étude. Les données ont été recueillies à l'aide d'observations des participants et d'entretiens semi-structurés, et analysées à l'aide d'un codage ouvert et d'une analyse comparative constante. Trois catégories ont été identifiées comme facteurs influençant la communication non verbale des infirmiers avec les personnes âgées hospitalisées : les points de vue des infirmiers sur les personnes âgées hospitalisées, les facteurs liés aux personnes âgées hospitalisées et les facteurs liés aux infirmiers. La communication non verbale efficace des infirmiers avec les personnes âgées hospitalisées repose principalement sur les facteurs propres aux infirmiers. L'identification et le développement des facteurs positifs lis aux infirmiers sont importants pour développer des compétences de communication non verbale efficaces chez les infirmiers.

Scoping review of food safety at transport stations in Africa.

OBJECTIVE: The WHO has declared food safety as a public health concern. Transport hubs such as taxi ranks, bus stations and other transport exchange sites are major food trading/purchasing sites, particularly in Africa. Research evidence is needed to improve food safety policies and ensure consumption of safe food, owing to the increasing burden of foodborne diseases, particularly in the WHO Africa Region. We systematically mapped and described research evidence on food safety at transport stations in Africa. DESIGN: A scoping review guided by the Arksey and O'Malley framework. DATA SOURCES: We searched for original research articles in PubMed, Web of Science, and EBSCOhost (Academic search complete, CINAHL with Full-text and Health Source), SCOPUS, and Google Scholar from their inception to 25 October 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies that focused on food safety, involved transport stations, involved African countries and were published in English. DATA EXTRACTION AND SYNTHESIS: Data extraction was performed by two reviewers using a piloted-tested form. Thematic analysis was used to organise the data into themes and subthemes, and a narrative summary of the findings is presented. RESULTS: Of the total 23 852 articles obtained from the database searches, 16 studies published in 6 countries met the inclusion criteria. These 16 studies were published between 1997 and 2019, with the most (5) in 2014. Of the 16 studies, 43.8% (7) were conducted in South Africa, 3 studies in Ghana, 2 in Ethiopia and 1 study each in Nigeria, Kenya, Lesotho and Zambia. Most (44.4%) of the included studies focused on microbial safety of food; few studies (22.2%) focused on hygienic practices, and one study investigated the perspective of consumers or buyers. Microbes detected in the foods samples were Salmonella spp, Escherichia coli, Shigella spp, Bacillus sp, Staphylococcus aureus, which resulted mainly from poor hygiene practices. CONCLUSIONS: There is limited research that focused on food safety at transport stations in Africa, especially on aspects such as hygiene practices, food storage and occupational health and food safety. Therefore, we recommend more research in these areas, using various primary study designs, to inform and improve food safety policies and practices for transport stations in African countries alongside improving access to clean water/handwashing facilities, and undertaking structural changes to facilitate behaviours and monitoring for unintended consequences such as livelihoods of vulnerable populations.

Nurses' perspectives of an environment of optimum mental health: a grounded theory study.

Background: The Government's aspiration to make Kenya a middle-income country and achieve the United Nations' sustainable development goal 3, 'good health and well-being', are threatened by poor quality of mental health services. Environment and lack of a conceptual model of nursing to guide care were some of the reasons that were attributed to poor quality of mental health services. The purpose of the study was to discover and describe an appropriate conceptual model of mental health nursing practice. This paper describes the environment which is one of the metaparadigms of a conceptual model grounded on data collected from Kenyan mental health nurses. Methods: A grounded theory study was conducted with 33 mental health nurses selected by purposive, open and theoretical sampling procedures. The study sites were level 5 and 6 mental health facilities across the country. Data were collected over a period of 11 months through audio-recorded in-depth interviews and field notes. Analysis was performed using Straussian Grounded Theory steps of open, axial and selective coding processes aided by NVivo version 10. Dimensions and properties of environment metaparadigm grounded on nurses' views were discovered. The study was conducted within the dictates of the institutional and national ethics and research review boards. Results: Environment evolved as an intervening condition and a supra-system for mental health nursing. A homely environment emerged as a space with properties that nurture optimum mental health contrary to a hostile environment that precipitates mental disorders and prolongs recovery. Conclusion: Grounded theory methodology was useful in discovering an environment metaparadigm as the context that influences mental health while nursing practice is the central phenomenon for optimum mental health. Nurses can ensure homely environments from diverse cultures and conduct comparative studies on the recovery of patients in the two environments.

Mapping evidence of food safety at transport stations in Africa: a scoping review protocol.

INTRODUCTION: In Africa, travels, urbanisation and changing consumer habits are increasing the number of people buying and eating food prepared/sold at public spaces including transport stations, particularly in the urban and periurban areas. Although food trading in such public spaces serves as a source of livelihood for many people, unsafe food can have a negative impact on health. We, therefore, aim to systematically explore and examine the literature, and describe the evidence on food safety (food handling, storage, preparation and sale, packaging of food when sold, hygiene of sale venue and quality (nutrition) of food sold/purchased/eaten) at transport stations to inform policy, as well as identify research gaps for future studies in Africa. METHODS AND ANALYSIS: We will employ the Arksey & O'Malley framework, Levac et al recommendations and the Joanna Briggs Institute guidelines to guide this study. We will conduct a comprehensive search in PubMed, SCOPUS, Web of Science, Google Scholar and EBSCOhost (Academic search complete, CINAHL with Full-text and Health Source) from inception to December 2019 for relevant peer-review articles using a combination of keywords/search terms with no limitations. We will also search for relevant literature from the reference list of all included articles. Two investigators will independently screen the articles in parallel at the abstract and full-text phases using the eligibility criteria as a guide. Data extraction will be done using a piloted data extraction form designed in a Microsoft Word tabular format. Afterward, the extracted data will be collated into themes and subthemes, summarised, and the results reported using a narrative approach. We will the Preferred Reporting Items for Systematic Reviews and Meta-analyses: Extension for scoping reviews checklist to report this study results. ETHICS AND DISSEMINATION: Ethics approval is not required. All sources of data will be adequately cited and added to the reference list. We will present the final scoping review results at the appropriate workshops, meetings, conferences, as well as submit for peer-review and publication in a scientific journal.

Factors contributing to primary caregiver delay in presenting children with chronic kidney disease for medical care in Ghana.

BACKGROUND: Conforming to the 2016 World Kidney Day focus on raising awareness of the early detection of kidney diseases in children, we report on factors that contribute to primary caregiver delay in presenting their children with chronic kidney disease (CKD) for medical care in Kumasi, Ghana. AIM: The objective of the study was to explore and describe the factors that contribute to primary caregiver delay in presenting children with CKD for medical care in Kumasi, Ghana. SETTING: The study was conducted in the Paediatric Renal Unit in Kumasi, Ghana. METHODS: A qualitative study was conducted in January 2017. Semi-structured interviews were used to collect data from a convenience sample of 10 primary caregivers whose children were admitted for CKD, but were not too ill. The primary caregivers had to respond to the research question: What factors contribute to your delay in presenting your child with CKD for medical care? Thematic data analysis and the ecological model of Schneider (2017) were used to organise the findings. RESULTS: Four themes and related subthemes, including intrapersonal-related factors, interpersonal-related factors, community-related factors and infrastructural factors were identified as those that contribute to delay in presenting children with CKD for medical care. CONCLUSION: The findings show that primary prevention strategies for CKD in children should not only focus on personal-related factors but also cut across all levels of the socio-ecological model in order for them to be effective.

Nurses' practice of integration of HIV prevention and sexual and reproductive health services in Ntcheu District, Malawi.

BACKGROUND:  Nurses play a critical role in their practice of integrating human immunodeficiency virus (HIV) prevention and sexual and reproductive services to combat the spread of HIV and promote family planning in resource-constrained countries like Malawi. OBJECTIVES:  The purpose of this study was to determine and describe the nurses' practice of integration of HIV prevention and sexual and reproductive health (SRH) services as a strategy to effectively combat the spread of HIV and promote family planning in Malawi. METHODS:  A descriptive qualitative case study was used. The research question was: How do nurses practise the integration of family planning and HIV prevention services in Ntcheu District, Malawi? Qualitative data were collected using semi-structured interviews from a sample of 10 participants. Manual data analysis, using the five steps for interpretive content analysis, was used to analyse data. RESULTS:  Five themes were identified as (1) facilitation of access and acceptability of comprehensive HIV and family planning services, (2) educating and counselling patients, (3) early detection of HIV among women of child-bearing age, (4) professional benefits of integrating family planning and HIV prevention services and (5) resentment of integration of family planning and HIV prevention services. CONCLUSION:  The nurses' practice of integration of HIV prevention and SRH services has more benefits for both nurses and patients as a strategy to combat the spread of HIV and promote family planning in a resource-constrained country like Malawi.

Factors contributing to primary caregiver delay in presenting children with chronic kidney disease for medical care in Ghana

Background: Conforming to the 2016 World Kidney Day focus on raising awareness of the early detection of kidney diseases in children, we report on factors that contribute to primary caregiver delay in presenting their children with chronic kidney disease (CKD) for medical care in Kumasi, Ghana.Aim: The objective of the study was to explore and describe the factors that contribute to primary caregiver delay in presenting children with CKD for medical care in Kumasi, Ghana.Setting: The study was conducted in the Paediatric Renal Unit in Kumasi, Ghana.Methods: A qualitative study was conducted in January 2017. Semi-structured interviews were used to collect data from a convenience sample of 10 primary caregivers whose children were admitted for CKD, but were not too ill. The primary caregivers had to respond to the research question: What factors contribute to your delay in presenting your child with CKD for medical care? Thematic data analysis and the ecological model of Schneider (2017) were used to organise the findings.Results: Four themes and related subthemes, including intrapersonal-related factors, interpersonal-related factors, community-related factors and infrastructural factors were identified as those that contribute to delay in presenting children with CKD for medical care.Conclusion: The findings show that primary prevention strategies for CKD in children should not only focus on personal-related factors but also cut across all levels of the socio-ecological model in order for them to be effective

Factors contributing to primary caregiver delay in presenting children with chronic kidney disease for medical care in Ghana

Background: Conforming to the 2016 World Kidney Day focus on raising awareness of the early detection of kidney diseases in children, we report on factors that contribute to primary caregiver delay in presenting their children with chronic kidney disease (CKD) for medical care in Kumasi, Ghana. Aim: The objective of the study was to explore and describe the factors that contribute to primary caregiver delay in presenting children with CKD for medical care in Kumasi, Ghana. Setting: The study was conducted in the Paediatric Renal Unit in Kumasi, Ghana. Methods: A qualitative study was conducted in January 2017. Semi-structured interviews were used to collect data from a convenience sample of 10 primary caregivers whose children were admitted for CKD, but were not too ill. The primary caregivers had to respond to the research question: What factors contribute to your delay in presenting your child with CKD for medical care? Thematic data analysis and the ecological model of Schneider (2017) were used to organise the findings. Results: Four themes and related subthemes, including intrapersonal-related factors, interpersonal-related factors, community-related factors and infrastructural factors were identified as those that contribute to delay in presenting children with CKD for medical care. Conclusion: The findings show that primary prevention strategies for CKD in children should not only focus on personal-related factors but also cut across all levels of the socio-ecological model in order for them to be effective

Characteristics and critical success factors for implementing problem-based learning in a human resource-constrained country.

BACKGROUND: Problem-based learning (PBL) was introduced in Malawi in 2002 in order to improve the nursing education system and respond to the acute nursing human resources shortage. However, its implementation has been very slow throughout the country. OBJECTIVES: The objectives of the study were to explore and describe the goals that were identified by the college to facilitate the implementation of PBL, the resources of the organisation that facilitated the implementation of PBL, the factors related to sources of students that facilitated the implementation of PBL, and the influence of the external system of the organisation on facilitating the implementation of PBL, and to identify critical success factors that could guide the implementation of PBL in nursing education in Malawi. METHOD: This is an ethnographic, exploratory and descriptive qualitative case study. Purposive sampling was employed to select the nursing college, participants and documents for review.Three data collection methods, including semi-structured interviews, participant observation and document reviews, were used to collect data. The four steps of thematic analysis were used to analyse data from all three sources. RESULTS: Four themes and related subthemes emerged from the triangulated data sources. The first three themes and their subthemes are related to the characteristics related to successful implementation of PBL in a human resource-constrained nursing college, whilst the last theme is related to critical success factors that contribute to successful implementation of PBL in a human resource-constrained country like Malawi. CONCLUSION: This article shows that implementation of PBL is possible in a human resource-constrained country if there is political commitment and support.

Factors contributing to late breast cancer presentation for health care amongst women in Kumasi, Ghana.

BACKGROUND: Delay in presenting breast cancer for health care is dangerous because it can increase the mortality rate amongst affected women. Delaying health care and treatment makes it difficult to manage advanced breast cancer successfully. Understanding the factors that contribute to delays in presentation for health care can save lives. OBJECTIVES: The purpose of the study was to describe the factors which contribute to the late presentation of Ghanaian women with breast cancer for health care at a tertiary hospital in Kumasi, Ghana. METHOD: A descriptive qualitative research design was utilised to answer the research question: 'What factors contribute to presenting with late breast cancer for health care amongst Ghanaian women who were treated for breast cancer at a tertiary hospital in Kumasi, Ghana?' A sample of 30 women diagnosed with breast cancer and presented with Stage II and Stage III participated in the study. Semi-structured interviews and field notes were conducted for data collection. Content data analysis was used in line with the research question. FINDINGS: Five themes were discovered as findings. These were: lack of knowledge about breast cancer; fear of cancer treatment and its outcomes; poverty; traditional and spiritual beliefs and treatments and caring for others. CONCLUSIONS: We recommend the development of breast cancer awareness programmes and health education at primary health care level.

Lived experiences of male intimate partners of female rape victims in Cape Town, South Africa.

BACKGROUND: Sexual violence in South Africa is a major public health and social problem. Sexual assault or rape is a traumatic event which disrupts not only the life of the female rape victim, but also that of her male intimate partner (MIP), irrespective of whether he witnessed or was informed of the incident. OBJECTIVES: The study aimed to explore the lived experiences of MIPs of female rape victims and the meaning of these experiences in the six months following the partner's rape. METHOD: We conducted a longitudinal hermeneutic phenomenological study. Nine purposively sampled adult MIPs were interviewed over a period of six months. The participants were in an intimate relationship with a female rape victim prior to and immediately after the rape; their partners had been treated at a specialised centre for victims of rape and sexual assault. Four interviews were conducted with each of the nine intimate partners of female rape victims: (1) within 14 days of, (2) a month after, (3) three months after, and (4) six months after the rape. RESULTS: Two major themes emerged: being-in-the-world as a secondary victim of rape, and living in multiple worlds, those of their female partners, family, friends, society, employers or colleagues, professionals and the justice system. The participant's familiar world became strange and even threatening, and his relationship with his partner became uncertain. CONCLUSION: Early supportive intervention for intimate partners of female rape victims is required to prevent on-going emotional trauma and alleviate the effects of chronic post-traumatic stress disorder and suffering at intra- and interpersonal levels.

The costs and benefits of nurse migration on families: A Lesotho experience.

The present day migration of nurses from developing countries, to more developed countries,depletes these countries of this vital human resource, which is necessary to provide optimum quality nursing care to their populations. If nurse migration persists, the health systems of these countries face collapse.It is important that a nurse understands the costs and benefits of migration to their families, whom they leave behind. This is not only to curb the problems that may occur, but to help the migrant nurses to realise how migration affects their families, especially their children and spouses, before they decide to leave their home countries to work in foreign lands.The purpose of this study, which was exploratory, descriptive and qualitative, was to investigate and describe the experiences of family members, of migrant nurses, from the Maseru district of Lesotho, about the costs and benefits of nurse migration. The objectives were to explore and describe the disadvantageous costs and the benefits gained by the families of migrant nurses. These were explored through the research question 'What are the experiences of family members of migrating nurses with regard to the costs and benefits of nurse migration?'The target population of the study was families of migrant nurses from Lesotho. Using purposive sampling the families of two migrant nurses, who were colleagues of the researcher, were identified and approached to participate in the study. Snowball sampling was next utilised to recruit the remainder of the participants. In total, six families were identified and included in the study.The semi-structured interviews and field notes were the two data collection methods that were implemented. The Giorgi's (1970) steps for data analysis, as outlined in (Burns & Grove 2001:610), were followed and seven themes were discovered as findings. The themes that relate to the costs of nurse migration are: emotional instability, weaker family connections and increased responsibility. The themes that relate to the benefits of nurse migration for their families are: better household income, improved quality of life, essential skills development and travelling opportunities.The use of communication technology is recommended to increase contact across borders in order to reduce the emotional costs of nurse migration on the families of migrant nurses. The article provides a balanced view of the costs and benefits of nurse migration on their families.