Effectiveness of an educational intervention in improving healthcare workers' knowledge of early recognition, diagnosis and management of rheumatic fever and rheumatic heart disease in rural far-western Nepal: a pre/post-intervention study

Challenges and possible improvements for healthcare teams at outreach clinics in Nepal - a qualitative study

BACKGROUND

All Nepalese citizens have the right to high-quality healthcare services free of charge. To achieve this, healthcare services for the rural population in Nepal need to be improved in terms of personnel, medicines, and medical equipment.

OBJECTIVES

To explore challenges and possible improvements healthcare personnel experience when travelling to rural parts of Nepal to provide healthcare.

METHOD

Data was collected from various health professionals using focus group discussions at Dhulikhel Hospital in Nepal. The data were transcribed and analysed using Systematic text condensation.

RESULTS

Twenty-two professional healthcare personnel participated in five group discussions. Four categories emerged from the collected material: Finding ORC services being underutilised, Wanting to fulfil tasks and do a good job, Facing inadequate resources, and Seeing the need for improved organisation and cooperation. There was consensus that rural clinics are important to maintaining health for the rural population of Nepal. However, there was frustration that the rural population was not benefitting from all available healthcare services due to underutilisation.

CONCLUSION

Rural healthcare clinics are not utilised appropriately, according to healthcare workers at the rural outreach clinics. Potential ways of overcoming the perceived challenges of underutilising available healthcare services include financial and human resources. The rural population´s health awareness needs to be increased, and the work environment for rural healthcare workers needs to be improved. These issues need to be prioritised by the government and policymakers.

Assessing the knowledge, attitude, and practice of frontline physicians in Egyptian university hospitals regarding pharyngitis and acute rheumatic fever: a cross-sectional study that calls for action

BACKGROUND

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major public health issues. Although the primary and secondary prevention of RHD through appropriate management of bacterial pharyngitis and ARF are well-described in the literature, few studies address the knowledge, attitude, and practice (KAP) of developing countries. We aimed to evaluate the KAP of the frontline physicians in Egyptian university hospitals regarding pharyngitis and ARF.

METHODS

We employed a cross-sectional design between September 1st, 2022, and January 31st, 2023 using a self-administered questionnaire in 21 Egyptian universities. The questionnaire was developed based on previous studies and recent guidelines and included four domains: sociodemographic data, knowledge, attitude, and practice regarding pharyngitis and ARF. We utilized both online (Google Forms) and paper surveys. Frontline physicians, including interns, residents, and assistant lecturers, were conveniently invited to participate. Furthermore, with the help of participating phycisians in recruiting their colleagues, we utilized the snowball method. Data were analyzed using IBM SPSS version 27 software.

RESULTS

The final analysis included 629 participants, of whom 372 (59.1%) were males and 257 (40.9%) had direct contact with ARF patients. Most participants (61.5%) had a fair knowledge level while 69.5% had a fair level of practice regarding ARF and pharyngitis. Higher satisfactory knowledge levels were noted regarding pharyngitis (17.1% vs. 11.3%; p-value: 0.036) and ARF (26.8% vs. 18%; p-value: 0.008) among physicians dealing directly with ARF cases compared to physicians in departments not dealing directly with ARF cases. Physicians in Cairo region universities had significantly higher levels of satisfactory knowledge about ARF compared to Delta and Upper Egypt region universities (p = 0.014). Delta region universities showed significantly lower levels of practice compared to Cairo and Upper Egypt region universities (p = 0.027). The most frequently recognized barriers against health promotion were low socioeconomic status (90.3%) and lack of adequate public education (85.8%).

CONCLUSIONS

Despite the fair knowledge and practice levels towards bacterial pharyngitis and ARF among participants, many gaps were still identified that might contribute to RHD prevalence. Educational interventions should be implemented by updating the local guidelines in Egypt for diagnosis and management based on the most recent guidelines.

Diagnosis and management of acute pharyngotonsillitis among pediatric patients at Ribat Teaching Hospital: a prospective audit (2021-2022)

Diagnosis of pharyngotonsillitis is challenging due to the wide range of symptoms and signs. Sudan Federal Ministry of Health and Sudanese Association of Paediatricians, along with Sudan Heart Society reached a consensus about the clinical prediction rule which aids in diagnosing and managing bacterial pharyngotonsillitis. This audit aimed to assess doctors' knowledge and practice regarding diagnosis and management of bacterial pharyngotonsillitis at Ribat Teaching Hospital, Khartoum, Sudan. This audit was done at Pediatric Department, Ribat Teaching Hospital, and data collection was done over 2 weeks either in the first or the second cycle. Inclusion criteria were children who presented at the emergency room and were diagnosed with acute pharyngotonsillitis. The criteria used in this audit were from Sudan guidelines for prevention, diagnosis and management of rheumatic heart disease. Regular training sessions were done between the first and second cycles. There were 19 patients in the first cycle, 17 of them (89.4%) were diagnosed clinically with bacterial pharyngotonsillitis, and 8 of these 17 (47%) were fitting the criteria. Regarding the management of bacterial pharyngotonsillitis, no patient was given the recommended antibiotics in the guidelines (0.00%). In the second cycle, there were 21 patients, of whom 11 patients were diagnosed clinically with bacterial pharyngotonsillitis (52%). Of those 11, 8 patients were fitting the criteria (72.7%), and the recommended antibiotics were given in 9 of them (82%). The current practice toward acute pharyngotonsillitis management revealed a lack of doctors' knowledge about local guidelines which can be improved by simple ways such as posters, lectures, and focused group discussions.

Rheumatic heart disease prevalence in Namibia: a retrospective review of surveillance registers

BACKGROUND

Rheumatic heart disease (RHD) is the most commonly acquired heart disease in children and young people in low and middle-income settings. Fragile health systems and scarcity of data persist to limit the understanding of the relative burden of this disease. The aims of this study were to estimate the prevalence of RHD and to assess the RHD-related health care systems in Namibia.

METHODS

Data was retrieved from outpatient and inpatient registers for all patients diagnosed and treated for RHD between January 2010 to December 2020. We used descriptive statistics to estimate the prevalence of RHD. Key observations and engagement with local cardiac clinicians and patients helped to identify key areas of improvement in the systems.

RESULTS

The outpatient register covered 0.032% of the adult Namibian population and combined with the cumulative incidence from the inpatient register we predict the prevalence of clinically diagnosed RHD to be between 0.05% and 0.10% in Namibia. Young people (< 18 years old) are most affected (72%), and most cases are from the north-eastern regions. Mitral heart valve impairment (58%) was the most common among patients. We identified weaknesses in care systems i.e., lack of patient unique identifiers, missing data, and clinic-based prevention activities.

CONCLUSION

The prevalence of RHD is expected to be lower than previously reported. It will be valuable to investigate latent RHD and patient follow-ups for better estimates of the true burden of disease. Surveillance systems needs improvements to enhance data quality. Plans for expansions of the clinic-based interventions must adopt the "Awareness Surveillance Advocacy Prevention" framework supported by relevant resolutions by the WHO.