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Gwaikolo C, Bodo B, Nabawanuka D, Mukiibi M, Seremba E, Muyinda P, Bakainaga A, Woldemariam YT, Moore CC, Ssekitoleko R. Impact of supportive supervision visits on the availability of World Health Organization infection prevention and control core components in health facilities in Southwestern Uganda. Infect Prev Pract 2024; 6:100355. [PMID: 38854705 PMCID: PMC11156696 DOI: 10.1016/j.infpip.2024.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/19/2024] [Accepted: 02/15/2024] [Indexed: 06/11/2024] Open
Abstract
Background In sub-Saharan Africa, the provision of infection prevention and control (IPC) measures are often limited by resource constraints. Aim To determine the association of supportive supervision activities with the availability of the WHO core components for IPC at health facilities in Southwestern Uganda. Methods We employed a before and after quality improvement study design. We conducted a baseline assessment of the availability of the WHO IPC core components and provided supportive supervision activities, which was followed by a second IPC assessment. We included health centers II-IV, which have increasing clinical care capacity, and regional hospitals. Findings Of 244 regional health facilities, baseline assessment occurred at 111 (45%) of which 23 (21%) were reassessed. The number of facilities in the Red (<70%) category for each core component stayed the same or decreased at each facility type, but there was an increase from five to six health center III facilities scoring Red (<70%) for PPE. The number of facilities in the Green (>85%) category for each core component stayed the same or was increased at each facility type, but there was a decrease from four to two health center III facilities scoring Green (>85%) for instrument processing. There was an increase in the median (interquartile range [IQR]) overall score for all facilities (65 [54-72] vs 75 [68-83], P=0.0001). Conclusion Supportive supervision activities were associated with improved availability of the core components of IPC at health facilities in Southwestern Uganda. PPE should be prioritized in health care facilities in Southwestern Uganda.
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Affiliation(s)
- Cozie Gwaikolo
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
| | | | | | | | - Emmanuel Seremba
- College of Health Sciences, Makerere University, Kampala, Uganda
- Kiruddu National Hospital, Kampala, Uganda
| | - Paul Muyinda
- College of Education and External Studies, Makerere University, Kampala, Uganda
| | | | | | - Christopher C. Moore
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Douno M, Rocha C, Borchert M, Nabe I, Müller SA. Qualitative assessment of hand hygiene knowledge, attitudes and practices among healthcare workers prior to the implementation of the WHO Hand Hygiene Improvement Strategy at Faranah Regional Hospital, Guinea. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001581. [PMID: 36963021 PMCID: PMC10021640 DOI: 10.1371/journal.pgph.0001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
Healthcare-associated infections are a serious burden globally. Few qualitative studies have explored healthcare workers' knowledge, attitudes and practices of hand hygiene. Prior to the implementation of the World Health Organization's Hand Hygiene Improvement Strategy at Faranah Regional Hospital in the Upper Region of Guinea in December 2018, we conducted a qualitative baseline assessment of knowledge, attitudes and practices of hand hygiene among healthcare workers to guide future hand hygiene interventions. The qualitative study consisted of direct observations, In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). We found that the 2013-16 Ebola outbreak had had a pivotal impact on healthcare workers' knowledge, attitudes and practices. The severity of the disease and the training provided for infection control were responsible for their knowledge acquisition and adoption of good attitudes and practices. However, negligence, resulting in poor hand hygiene practices, rose after the outbreak, once the "cue of fear" that had motivated workers for their own self-protection had waned. Our results suggest that local capacity building through training and availability of hand hygiene materials would be a sustainable approach to enhance hand hygiene culture at the hospital. Our study suggests that there is a need for a high and long-term commitment of authorities and healthcare workers at all levels for a sustainable hand hygiene culture.
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Affiliation(s)
- Moussa Douno
- Projet des Fièvres Hémorragiques en Guinée, Centre de Recherche en Virologie, Université Gamal Abdel Nasser de Conakry, Conakry, Guinée
| | - Carlos Rocha
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Matthias Borchert
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
| | | | - Sophie Alice Müller
- Center for International Health Protection, Robert Koch Institute, Berlin, Germany
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Balde T, Oyugi B, Karamagi H, Okeibunor JC, Conteh IN, Ejiofor NE, Atuhebwe P, Nanyunja M, Diallo AB, Mihigo R, Yoti Z, Braka F, Gueye AS. Framing the future of the COVID-19 response operations in 2022 in the WHO African region. Glob Health Action 2022; 15:2130528. [PMID: 36314610 PMCID: PMC9629107 DOI: 10.1080/16549716.2022.2130528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND With the evolving epidemiological parameters of COVID-19 in Africa, the response actions and lessons learnt during the pandemic's past two years, SARS-COV 2 will certainly continue to circulate in African countries in 2022 and beyond. As countries in the African continent need to be more prepared and plan to 'live with the virus' for the upcoming two years and after and at the same time mitigate risks by protecting the future most vulnerable and those responsible for maintaining essential services, WHO AFRO is anticipating four interim scenarios of the evolution of the pandemic in 2022 and beyond in the region. OBJECTIVE In preparation for the rollout of response actions given the predicted scenarios, WHO AFRO has identified ten strategic orientations and areas of focus for supporting member states and partners in responding to the COVID-19 pandemic in Africa in 2022 and beyond. METHODS WHO analysed trends of the transmissions since the first case in the African continent and reviewed lessons learnt over the past months. RESULTS Establishing a core and agile team solely dedicated to the COVID-19 response at the WHO AFRO, the emergency hubs, and WCOs will improve the effectiveness of the response and address identified challenges. The team will collaborate with the various clusters of the regional office, and other units and subunits in the WCOs supported with good epidemics intelligence. COVID-19 pandemic has afflicted global humanity at unprecedented levels. CONCLUSION Two years later and while starting the third year of the COVID-19 response, we now need to change and adapt our strategies, tools and approaches in responding timely and effectively to the pandemic in Africa and save more lives.
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Affiliation(s)
- Thierno Balde
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Boniface Oyugi
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo,Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, CanterburyUK
| | - Humphrey Karamagi
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Joseph Chukwudi Okeibunor
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo,CONTACT Joseph Chukwudi Okeibunor World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Ishata Nannie Conteh
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Nonso Ephraim Ejiofor
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Phionah Atuhebwe
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Miriam Nanyunja
- Emergency Preparedness and Response Hub, World Health Organisation Emergency Hub for East and Southern Africa, Nairobi, Kenya
| | - Amadou Bailo Diallo
- Emergency Preparedness and Response Hub, World Health Organisation Emergency Hub for East and Southern Africa, Nairobi, Kenya,World Health Organisation Emergency Hub for West and Central Africa, Dakar, Senegal
| | - Richard Mihigo
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Zabulon Yoti
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Fiona Braka
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Abdou Salam Gueye
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
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Ousman K, Thumath M, McKay G, Niyukuri D, Mwesha Ombeni D, Kabego L, Banzua B, Mangala S, Tatabod R, Mirindi N. P, Talisuna A, Houndjo B, Kieta M, Baller A. Evaluation of a health systems strengthening intervention to improve Ebola Virus Disease infection prevention and control in the Democratic Republic of the Congo. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.36558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background The Democratic Republic of Congo declared their tenth outbreak of Ebola in North Kivu in 2018, which was the second-largest in the world and took place in an active conflict zone. Transmission of Ebola occurs by direct contact with infected bodily fluids and can occur within facilities when infection prevention and control (IPC) precautions are not strictly practised. Methods To develop infection prevention and control (IPC) standards in health facilities, 45 medical students were trained and placed in 101 health facilities to mentor healthcare workers and support IPC practices between February and October 2019. A mixed-methods retrospective evaluation of quality improvement in North Kivu was conducted in October and November 2019 to capture key lessons from such a pilot IPC project. Five focus groups (N=49) and 42 key-informant interviews were conducted in addition to a secondary analysis of surveillance and programmatic data collected during the intervention. Results The intervention contributed 1.83 times (95% confidence interval, CI=1.10-3.06) to increased the likelihood of health facilities achieving an IPC score of 80% or above compared with facilities that did not receive the intervention. Overall, we found the odds of Ebola cases declining three times more likely in Butembo and Katwa (odds ratio, OR=3.00, 95% CI=1.87-5.62) relative to ten health zones in the region that were not reached by the intervention. Conclusions The results are difficult to attribute to any one type of intervention, given the number of other interventions implemented concurrently during the outbreak response. Further evaluations should be conducted to assess the cost-effectiveness of using medical students in conflict resolution and IPC, and to assess the suitability of scaling these approaches to other settings and diseases.
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O’Brien N, Shaw A, Flott K, Leatherman S, Durkin M. Safety in fragile, conflict-affected, and vulnerable settings: An evidence scanning approach for identifying patient safety interventions. J Glob Health 2022; 12:04018. [PMID: 35265329 PMCID: PMC8876158 DOI: 10.7189/jogh.12.04018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The number of people living in fragile, conflict-affected, and vulnerable (FCV) settings is growing rapidly and attention to achieving universal health coverage must be accompanied by sufficient focus on the safety of care for universal access to be meaningful. Healthcare workers in these settings are working under extreme conditions, often with insufficient contextualized evidence to support decision-making. Recognising the relative paucity of, and methodological issues in gathering evidence from these settings, the evidence scanning described in this paper considered which patient safety interventions might offer the ‘better bet’, eg, the most effective and appropriate intervention in FCV settings. Methods An evidence scanning approach was used to examine the literature. The search was limited to FCV settings and low-income settings as defined by the World Bank, but if a systematic review included a mix of evidence from FCV/low income settings, as well as low-middle income settings, it was included. The search was conducted in English and limited to studies published from 2003 onwards, utilising Google Scholar as a publicly accessible database and further review of the grey literature, with specific attention to the outputs of non-governmental organisations. The search and subsequent analysis were completed between April and June 2020. Results The majority of studies identified related to strengthening infection prevention and control which was also found to be the ‘better bet’ intervention that could generalise to other settings, be most feasible to implement, and most effective for improving patient care and associated outcomes. Other prioritized interventions include risk management, with contributing elements such as reporting, audits, and death review processes. Conclusions Infection prevention and control interventions dominate in the literature for multiple reasons including strength of evidence, acceptability, feasibility, and impact on patient and health worker well-being. However, there is an urgent need to further develop the evidence base, specialist knowledge, and field guidance on a range of other patient safety interventions such as education and training, patient identification, subject specific safety actions, and risk management.
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Affiliation(s)
- Niki O’Brien
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alexandra Shaw
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Kelsey Flott
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Sheila Leatherman
- UNC Gillings School of Global Public Health, University of North Carolina, North Carolina, USA
| | - Mike Durkin
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
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Cénat JM, Noorishad PG, Dalexis RD, Rousseau C, Derivois D, Kokou-Kpolou CK, Bukaka J, Balayulu-Makila O, Guerrier M. Prevalence and risk factors of depression symptoms among rural and urban populations affected by Ebola virus disease in the Democratic Republic of the Congo: a representative cross-sectional study. BMJ Open 2022; 12:e053375. [PMID: 35017247 PMCID: PMC8753092 DOI: 10.1136/bmjopen-2021-053375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES High mortality rates, anxiety and distress associated with Ebola virus disease (EVD) are risk factors for mood disorders in affected communities. This study aims to document the prevalence and risk factors associated with depressive symptoms among a representative sample of individuals affected by EVD. DESIGN Cross-sectional study. SETTING The current study was conducted 7 months (March 11, 2019 to April 23, 2019) after the end of the ninth outbreak of EVD in the province of Equateur in the Democratic Republic of the Congo (DRC). PARTICIPANTS A large population-based sample of 1614 adults (50% women, Mage=34.05; SD=12.55) in health zones affected by the ninth outbreak in DRC. PRIMARY AND SECONDARY OUTCOME MEASURES Participants completed questionnaires assessing EVD exposure level, stigmatisation related to EVD and depressive symptoms. The ORs associated with sociodemographic data, EVD exposure level and stigmatisation were analysed through logistic regressions. RESULTS Overall, 62.03% (95% CI 59.66% to 64.40%) of individuals living in areas affected by EVD were categorised as having severe depressive symptoms. The multivariable logistic regression analyses showed that adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms (respectively, OR 1.94 (95% CI 1.22 to 3.09); OR 2.34 (95% CI 1.26 to 4.34)). Individuals in the two higher categories of stigmatisation were two to four times more at risk (respectively, OR 2.42 (95% CI 1.53 to 3.83); OR 4.73 (95% CI 2.34 to 9.56)). Living in rural areas (OR 0.19 (95% CI 0.09 to 0.38)) and being unemployed (OR 0.68 (95% CI 0.50 to 0.93)) increased the likelihood of having severe depressive symptoms. CONCLUSIONS Results indicate that depressive symptoms in EVD affected populations is a major public health problem that must be addressed through culturally adapted mental health programs.
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Affiliation(s)
| | | | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Daniel Derivois
- Department of Psychology, Université Bourgogne Franche-Comté, Dijon, Franche-Comté, France
| | | | - Jacqueline Bukaka
- Department of Psychology, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Oléa Balayulu-Makila
- Department of Psychology, Université Bourgogne Franche-Comté, Dijon, Franche-Comté, France
- Department of Psychology, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
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Baller A, Padoveze MC, Mirindi P, Hazim CE, Lotemo J, Pfaffmann J, Ndiaye A, Carter S, Chabrat MAD, Mangala S, Banzua B, Umutoni C, Niang NR, Kabego L, Ouedraogo A, Houdjo B, Mwesha D, Ousman KB, Kolwaite A, Blaney DD, Choi MJ, Pallawo R, Legand A, Park B, Formenty P, Montgomery JM, Gueye AS, Allegranzi B, Yao NKM, Fall IS. Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018-2020 outbreak. Int J Infect Dis 2021; 115:126-133. [PMID: 34883237 PMCID: PMC8755545 DOI: 10.1016/j.ijid.2021.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/03/2022] Open
Abstract
Health workers were among those most affected by nosocomial Ebola virus disease (EVD) in this outbreak. Children had a higher case fatality rate compared with other patients with nosocomial EVD. Referral health facilities and privately owned health facilities had the highest number of nosocomial infections (NI). Clear case definition of NI is required to prompt transmission chain interruption.
Objectives To describe the characteristics of nosocomial cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo between July 2018 and May 2020 in order to inform future interventions. Methods Nosocomial cases of EVD were identified during outbreak response surveillance, and a retrospective analysis of cases was conducted according to demographic characteristics and type of health facility (HF). Results Of 3481 cases of EVD, 579 (16.6%) were nosocomial. Of these, 332 cases occurred in women (57.3%). Patients and visitors accounted for 419 cases (72.4%), of which 79 (18.9%) were aged 6–≤18 years and 108 (25.8%) were aged ≤5 years. Health workers (HWs) accounted for the remaining 160 (27.6%) nosocomial cases. The case fatality rate (CFR) for HWs (66/160, 41.3%) was significantly lower than the CFR for patients and visitors (292/419, 69.7%) (P<0.001). The CFR was higher among cases aged 6–≤18 years (54/79, 68.4%) and ≤5 years (89/108, 82.4%). Referral HFs (>39 beds) had the highest prevalence of nosocomial EVD (148/579, 25.6%). Among HFs with at least one case of nosocomial infection, 50.0% (98/196) were privately owned. Conclusions Nurses and traditional healers should be targeted for infection prevention and control training, and supportive supervision should be provided to HFs to mitigate EVD transmission.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Berthe Banzua
- Ministry of Health, Democratic Republic of the Congo
| | | | | | | | | | | | | | | | - Amy Kolwaite
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David D Blaney
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary J Choi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Benjamin Park
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tomczyk S, Storr J, Kilpatrick C, Allegranzi B. Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis. Antimicrob Resist Infect Control 2021; 10:113. [PMID: 34332622 PMCID: PMC8325287 DOI: 10.1186/s13756-021-00962-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings. METHODS Semi-structured interviews were conducted with IPC experts from low-resource settings, guided by a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and finally reviewed to ensure validity. Sub-themes appearing ≥ 3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively. RESULTS Interviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes including the related critical actions to achieve the WHO IPC core components included: (1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; (2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; (3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; (4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and "data for action"; (5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; (6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and "data for action"; (7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and (8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy. CONCLUSIONS These IPC implementation themes offer important qualitative evidence for IPC professionals to consider.
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Affiliation(s)
- Sara Tomczyk
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Julie Storr
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Claire Kilpatrick
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Kinyenje E, Hokororo J, Eliakimu E, Yahya T, Mbwele B, Mohamed M, Kwesigabo G. Status of Infection Prevention and Control in Tanzanian Primary Health Care Facilities: Learning From Star Rating Assessment. Infect Prev Pract 2020; 2:100071. [PMID: 34316561 PMCID: PMC7311348 DOI: 10.1016/j.infpip.2020.100071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background The WHO estimates 10–30% of hospital admissions are associated with poor infection prevention and control (IPC). There are no reliable data on IPC status in Tanzanian healthcare facilities; hence the Star Rating Assessment (SRA) was established to address this. This study compared the health facility performances on adherence to IPC principles using baseline and reassessment data of SRA. Methods A retrospective analysis of data from eight randomly selected regions across Tanzania. Data was gathered from an SRA database in which records of baseline assessments (2015/16) and reassessments (2017/18) were documented. Each healthcare facility's ownership and service level were investigated as independent variables. Results A total of 2,131 healthcare facilities at baseline and 2,185 at reassessment were analysed. Median adherence to IPC principles increased from 31% (IQR: 20%, 46%) to 57% (IQR: 41.4%, 73.2%) after interventions (p<0.001). Privately-owned facilities had higher adherence to IPC principles compared to publicly-owned facilities during baseline (p<0.001) however, the difference was not significant after intervention (p=0.751). On average, hospitals scored highest followed by health centres and then dispensaries during both assessments. Being a privately-owned facility was a predictor of attaining a recommended IPC score of 80% at baseline (POR=1.92 CI=1.06–3.48) but not after the intervention. Facility level was not a predictor during baseline assessment; however after intervention hospitals were twice as likely to attain the recommended score compared to dispensaries (POR=2.27 CI=1.15–4.45). Conclusion Assessment and rating of quality and organization of health services plus management support to healthcare facilities, leads to improved adherence to IPC principles.
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Affiliation(s)
- Erick Kinyenje
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania
- Corresponding author. Address: School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania.
| | - Joseph Hokororo
- Health Quality Assurance Unit, Ministry of Health, Community Development, Gender, Elderly and Children—MoHCDGEC, Dodoma, Tanzania
| | - Eliudi Eliakimu
- Health Quality Assurance Unit, Ministry of Health, Community Development, Gender, Elderly and Children—MoHCDGEC, Dodoma, Tanzania
| | - Talhiya Yahya
- Health Quality Assurance Unit, Ministry of Health, Community Development, Gender, Elderly and Children—MoHCDGEC, Dodoma, Tanzania
| | - Bernard Mbwele
- Department of Epidemiology and Biostatistics, University of Dar es Salaam - Mbeya College of Health and Allied Sciences (UDSM-MCHAS), P.O Box 608, Mbeya, Tanzania
| | - Mohamed Mohamed
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
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Raab M, Pfadenhauer LM, Millimouno TJ, Hoelscher M, Froeschl G. Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N'zérékoré prefecture, Guinea: a cross-sectional study. BMC Public Health 2020; 20:296. [PMID: 32138720 PMCID: PMC7059383 DOI: 10.1186/s12889-020-8433-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The 2013-2016 Ebola epidemic in West Africa began in Guinea's Forest region, a region now considered to be at high risk for future epidemics of viral haemorrhagic fevers (VHF). Good knowledge, attitudes and practices towards VHF amongst healthcare workers in such regions are a central pillar of infection prevention and control (IPC). To inform future training in IPC, this study assesses the knowledge, attitudes and practices (KAP) towards VHF amongst healthcare workers in public healthcare facilities in the most populated prefecture in Forest Guinea, and compares results from urban and rural areas. METHODS In June and July 2019, we interviewed 102 healthcare workers in the main urban and rural public healthcare facilities in the N'zérékoré prefecture in Forest Guinea. We used an interviewer-administered questionnaire adapted from validated KAP surveys. RESULTS The great majority of respondents demonstrated good knowledge and favourable attitudes towards VHF. However, respondents reported some gaps in preventive practices such as VHF suspect case detection. They also reported a shortage of protective medical equipment used in everyday clinical work in both urban and rural healthcare facilities and a lack of training in IPC, especially in rural healthcare facilities. However, whether or not healthcare workers had been trained in IPC did not seem to influence their level of KAP towards VHF. CONCLUSIONS Three years after the end of the Ebola epidemic, our findings suggest that public healthcare facilities in the N'zérékoré prefecture in Forest Guinea still lack essential protective equipment and some practical training in VHF suspect case detection. To minimize the risk of future VHF epidemics and improve management of outbreaks of infectious diseases in the region, current efforts to strengthen the public healthcare system in Guinea should encompass questions of supply and IPC training.
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Affiliation(s)
- Manuel Raab
- Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Leopoldstr. 5, 80802 Munich, Germany
| | - Lisa M. Pfadenhauer
- Institute of Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig Maximilian University Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Tamba Jacques Millimouno
- Department of Disease Surveillance, Agence Nationale de Sécurité Sanitaire (ANSS), Conakry, Guinea
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Leopoldstr. 5, 80802 Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital (LMU), Leopoldstr. 5, 80802 Munich, Germany
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Shears P, Garavan C. The 2018/19 Ebola epidemic the Democratic Republic of the Congo (DRC): epidemiology, outbreak control, and conflict. Infect Prev Pract 2020; 2:100038. [PMID: 34368690 PMCID: PMC8336035 DOI: 10.1016/j.infpip.2020.100038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022] Open
Abstract
The Democratic Republic of Congo (DRC) (formerly Zaire) was the location of the first Ebola outbreak, in 1976, and since then there have been a total of ten outbreaks in different parts of the country. The current outbreak, the first in eastern DRC (North Kivu and Ituri provinces), began in July 2018, and by December 2019, there had been 3262 cases and 2232 deaths. Within weeks of the first reported cases, the World Health Organisation (WHO) and the DRC Ministry of Health (MOH) initiated a major response programme, with laboratory support, international agencies providing personnel, and material resources. Unlike previous Ebola outbreaks, including the west Africa epidemic, a proven vaccine, and trial therapeutic agents have been available as part of the outbreak response. Two therapeutic agents, mAb114 and REGN-EB3, both monoclonal antibody derived, have shown case fatality rates (CFR) of around 30%, compared to the overall of 66%. Despite these positive interventions, the outbreak has continued for eighteen months. Underlying the outbreak response has been a high number of violent incidents by local militias, and community mistrust and lack of involvement that has hampered many aspects of the response programme. As a result, many cases are not reported early and not transferred to treatment centres, deaths and increased transmission occur in the community, and the response programme is reaching only a proportion of the cases. New strategies to improve community participation, and integrate the Ebola response into the existing health structure are planned to improve the programme effectiveness.
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Affiliation(s)
- Paul Shears
- Wirral University Teaching Hospital, Wirral, Merseyside UK
| | - Carrie Garavan
- WHO Ebola Case Management Team, Butembo DRC & Medicines Sans Frontiers' Ebola Emergency Response Team DRC, Ireland
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