Abstract
Malnutrition is the major cause of mortality and morbidity globally with undernutrition contributing about 45% of all deaths of under five children. Besides the direct effects of protracted conflicts, the macroeconomic crisis that has greatly increased the national inflation rate hence devastating the purchasing power, the COVID-19 outbreak, flooding, and the Desert Locusts have contributed to a food security emergency. Besides being among the most under resourced states, South Kordofan has experienced years of conflict resulting in displacement of people and extensive infrastructure destruction with high rates of malnutrition. The state currently has 230 health facilities and out of these, only 140 are providing outpatient therapeutic programme centres with 28.6% (40) of these being operated by the state ministry of health and the rest by the international non-governmental organizations. Limited resources leading to donor dependence, limited accessibility due to insecurity and floods, poor referral system and gaps in continuity of care, lack of operational and implementation research data and limited integration of management of malnutrition in other health services have negatively affected effective implementation. Ensuring effective and efficient community based management of acute malnutrition, implementation needs action beyond the health sector with a multi-sectoral and integration approach. Federal and state development frameworks should ensure a comprehensive multi-sectoral nutrition policy with strong political commitment and allocation of adequate resources to ensure integrated and quality implementation.
Abstract
Background
The increasing physical violence against doctors in the health sector has become an alarming global problem and a key concern for the health system in Bangladesh. This study aimed to determine the prevalence and associated factors of physical violence against doctors in Bangladeshi tertiary care hospitals.
Methods
A cross-sectional survey was performed among 406 doctors working in tertiary care hospitals. Data were collected using a self-administered questionnaire and the binary logistic regression model was employed for predicting physical violence against doctors.
Results
Of the participants, 50 (12.3%) doctors reported being exposed to physical violence in 12 months prior to the survey. According to logistic regression analysis, aged less than 30 years or younger, male and never-married doctors were prone to physical violence. Similarly, doctors from public hospitals and those worked in emergency departments were at higher risk of physical violence. More than 70% of victims reported that patients’ relatives were the main perpetrators. Two-thirds of the victims referred to violence in the hospitals as a grave concern.
Conclusions
Physical violence against doctors is relatively common in the emergency departments and public hospitals in Bangladesh. This study found that male and younger doctors were at high risk of exposing physical violence. To prevent hospital violence, authorities must develop human resources, bolster patient protocol and offer physician training.
BACKGROUND: Despite having one of the largest human resources for health in Africa, the delivery of neglected tropical disease (NTD) health interventions in Nigeria has been hampered by health worker shortages. This study assessed factors associated with job satisfaction among community drug distributors (CDDs) supporting the Nigerian NTD programme, with the goal of identifying opportunities to improve job satisfaction in support of NTD control and elimination efforts in Nigeria. METHODS: A health facility-based cross-sectional survey was conducted in 2019 among CDDs in two states with sharply contrasting NTD programme support, Kaduna and Ogun. A multivariate logistic regression model was used to determine the association between respondent characteristics, programme delivery modalities and job satisfaction. RESULTS: Overall, 75.3% and 74.0% of CDDs were categorised as being satisfied with their job in Kaduna and Ogun states, respectively. The component with the highest reported satisfaction was motivation, where 98.9% and 98.6% of CDDs were satisfied, in Kaduna and Ogun, respectively. Participants were least satisfied with remuneration, communication, supplies and materials, as well as workload. Location (rural/urban) and state, years of experience, who delivers training and reimbursement of transport fare during medicine distribution were significantly associated with job satisfaction. CONCLUSIONS: Including multiple health staff and NTD programme cadres in CDD training and providing remuneration to cover transport fares spent during MDA delivery may improve CDDs' job satisfaction both in Ogun and Kaduna states. Given these two states are at opposite ends of the programme support spectrum, such adaptative measures might help improve CDD job satisfaction in the wider Nigerian NTD programme context.
Abstract
Introduction
In sub-Saharan Africa, there is limited evidence on the COVID-19 health-related effect from front-line health provision settings. Therefore, this study aimed to analyse the effect of the COVID-19 pandemic on routine maternal and neonatal health services in three referral hospitals.
Materials and methods
We conducted an observational study using aggregate monthly maternal and neonatal health services routine data for two years (March 2019–February 2021) in three referral hospitals including two maternities: Hôpital National Ignace Deen (HNID) in Conakry and Hôpital Regional de Mamou (HRM) in Mamou and one neonatology ward: Institut de Nutrition et de Santé de l’Enfant (INSE) in Conakry. We compared indicators of health service utilisation, provision and health outcomes before and during the COVID-19 pandemic periods. An interrupted time-series analysis (ITSA) was performed to assess the relationship between changes in maternal and neonatal health indicators and COVID-19 through cross-correlation.
Results
During COVID-19, the mean monthly number (MMN) of deliveries decreased significantly in HNID (p = 0.039) and slightly increased in HRM. In the two maternities, the change in the MMN of deliveries were significantly associated with COVID-19. The ITSA confirmed the association between the increase in the MMN of deliveries and COVID-19 in HRM (bootstrapped F-value = 1.46, 95%CI [0.036–8.047], p < 0.01). We observed an increasing trend in obstetric complications in HNID, while the trend declined in HRM. The MMN of maternal deaths increased significantly (p = 0.011) in HNID, while it slightly increased in HRM. In INSE, the MMN of neonatal admissions significantly declined (p < 0.001) and this decline was associated with COVID-19. The MMN of neonatal deaths significantly decreased (p = 0.009) in INSE and this decrease was related to COVID-19.
Conclusion
The pandemic negatively affected the maternal and neonatal care provision, health service utilisation and health outcomes in two referral hospitals located in Conakry, the COVID-19 most-affected region.
Um dos campos de atuação dos profissionais de saúde é a Atenção Básica (AB). A presença de diferentes formações profissionais dentro da AB e a articulação entre esses profissionais é fundamental para a integralidade da assistência prestada à população. As práticas colaborativas e a integralidade do cuidado são habilidades essenciais e comuns a to-dos os profissionais que atuam na AB e na Estratégia de Saúde da Família. Para a Organização Mundial de Saúde (OMS) a Educação Interprofissional em Saúde ocorre quando estudantes e/ou profissionais de duas ou mais áreas aprendem com o outro, sobre o trabalho do outro, e entre si, visando trazer benefícios aos pacientes. Dessa forma, este relato de experiência tem como objetivo relatar a experiência oriunda das atividades de ensino realizadas no estágio acadêmico dos alunos do 7º e 8º períodos do curso de Fisioterapia da Universidade de Ribeirão Preto (UNAERP). As atividades foram desenvolvidas em parceria com as Equipes de Saúde da Família da Unidade Dr. Vinício Plastino, na cidade de Ribeirão Preto, no período de fevereiro de 2018 a dezembro de 2019. Tais atividades são resultantes da implementação de um estágio que tem como foco a atuação do profissional de fisioterapia na AB. Dentro dessa unidade atuaram conjuntamente estudantes dos cursos de Medicina, Farmácia e Fisioterapia. Após o reconhecimen-to do território e da dinâmica da Equipe de Saúde da Família local, o grupo de estagiários iniciou um trabalho de educação em saúde com ações planejadas de forma interprofissional e colaborativa. A partir da percepção das ne-cessidades de saúde da população, foram alinhadas às práticas da disciplina aquelas ações que a equipe realiza no território - cadastramento individual e familiar, territorialização, visita domiciliar e grupos de educação em saúde; acrescidas por aquelas de promoção da saúde específicas da fisioterapia. A experiência no território permitiu: ampliar a vivência dos discentes na ESF, possibilitando a observação e a reflexão sobre o trabalho em equipe nesse contexto; e sensibilizar os acadêmicos para as necessidades em saúde da população e discutir essas necessidades a partir da educação em saúde. Através da vivência, os estudantes da fisioterapia, juntamente com a equipe e alunos de outros cursos da área da saúde puderam redimensionar a importância e a complexidade do trabalho interprofissional na APS e, juntos, desenvolver ou aprimorar habilidades essenciais à sua profissão. (AU) One of the fields of action of health professionals is Primary Health Care (PHC). The presence of different professional formations within PHC and the articulation between these professionals is fundamental for the integrality of the assistance provided to the population. Collaborative practices and comprehensive care are essential skills common to all professionals working in PHC and the Family Health Strategy. For the World Health Organization (WHO), Interprofessional Health Learning occurs when students and/or professionals from two or more areas learn from each other, about the work of the other, and from each other, aiming to bring benefits to patients. Thus, this expe-rience report aims to report the experience arising from teaching activities carried out in the academic internship of students from the 7th and 8th terms of the Physiotherapy course at Universidade de Ribeirão Preto (UNAERP). The activities were developed in partnership with the Family Health Team of Unit Dr. Vinício Plastino, in Ribeirão Preto, from February 2018 to December 2019. Such activities result from the implementation of an internship that focuses on the professional's performance of physiotherapy at PHC. Within this unit, students from the Medicine, Pharmacy, and Physiotherapy courses worked together. After recognizing the territory and the dynamics of the local Family Health Team, the group of interns started a health education work with actions planned in an interprofessional and collaborative way. Based on the perception of the population's health needs, those actions that the team performs in the territory were aligned to the discipline practices - individual and family registration, territorialization, home visits, and health education groups; added by those of health promotion specific to physical therapy. The experience in the territory allowed: expanding the students' experience in the FHS, enabling observa-tion and reflection on teamwork in this context; and sensitizing academics to the health needs of the population and discussing these needs through health education. Through experience, physiotherapy students, along with the team and students from other courses in the health area, could resize the importance and complexity of interprofessional work in PHC and, together, develop or improve skills essential to their profession. (AU)
COVID-19, the novel coronavirus, has posed a major threat to low- and middle-income countries (LMICs) due to inadequate health infrastructure and human resources. Ethiopia, a low-income country with the second largest population in Africa, has coordinated a strategic response, leveraging existing infrastructure and health systems and mobilizing public health professionals and specialist expert physicians for a multifaceted, unified government approach and adaptive response. Resource limitations, particularly in critical care, have still posed challenges, but the public health and clinical interventions thus far have prevented the catastrophic toll that many predicted. As the pandemic continues, Ethiopia expects to use a triple care model integrated at all levels, consisting of COVID-19 care, isolation care for suspected cases, and essential health services, and urges intensified non-pharmaceutical interventions alongside equitable global vaccine distribution as the ultimate answers to pandemic control. This paper draws on existing data, national planning and guidelines, and expertise from health leadership to describe this response in hopes of providing an example of how future large-scale health challenges might be faced in LMICs, using Ethiopia's successes and challenges in facing the pandemic. COVID-19, le nouveau coronavirus, a représenté une menace majeure pour les pays à revenu faible et intermédiaire (LMIC) en raison de l'insuffisance des infrastructures de santé et des ressources humaines. L'Éthiopie, un pays à faible revenu dont la population est la deuxième plus importante d'Afrique, a coordonné une réponse stratégique, en tirant parti des infrastructures et des systèmes de santé existants et en mobilisant des professionnels de la santé publique et des médecins experts spécialisés pour une approche gouvernementale unifiée à multiples facettes et une réponse adaptative. Les ressources limitées, notamment en matière de soins intensifs, ont encore posé des problèmes, mais les interventions cliniques et de santé publique menées jusqu'à présent ont permis d'éviter le bilan catastrophique que beaucoup prédisaient. Alors que la pandémie se poursuit, l'Éthiopie prévoit d'utiliser un modèle de soins triple intégré à tous les niveaux, composé de soins COVID-19, de soins d'isolement pour les cas suspects et de services de santé essentiels, et préconise l'intensification des interventions non pharmaceutiques parallèlement à une distribution équitable des vaccins à l'échelle mondiale comme réponses ultimes au contrôle de la pandémie. Cet article s'appuie sur les données existantes, la planification et les directives nationales, et l'expertise des responsables de la santé pour décrire cette réponse dans l'espoir de fournir un exemple de la manière dont les futurs défis sanitaires à grande échelle pourraient être relevés dans les LMIC, en utilisant les succès et les défis de l'Éthiopie face à la pandémie.
Abstract
Background
Northwest Syria (NWS) is a complex and extremely fragile operating environment, with more than 2.8 million people needing humanitarian assistance. To support a common standard of care delivery and enable coordination among the multiple providers in NWS, WHO developed an Essential Health Services package (EHSP) in 2016-17 and subsequently supported a facility network model to deliver the EHSP. This article provides an evaluation of the network to date, aiming to inform further development of the network and draw wider lessons for application of similar approaches in complex emergency settings.
Methods
This mixed method study included document review, participatory, qualitative and quantitative data, gathered in the first half of 2021. Participatory data came from two group model building workshops with 21 funders and implementers. Semi-structured interviews with 81 funders, health professionals and community members were also conducted. Analyses of the workshops and interviews was inductive, however a deductive approach was used for synthesising insights across this and the document review. The final component was a survey of health providers (59 health care professionals) and service users (233 pregnant women and 214 persons living with NCDs) across network and other comparable facilities, analysed using routine descriptive and inferential statistics. Findings across all methods were triangulated.
Results
The study finds that the network and its accompanying essential service package were relevant to the dynamic and challenging context, with high but shifting population needs and multiple uncoordinated providers. Judged in relation to its original goals of comprehensive, coordinated services, equitable access and efficient service delivery, the data indicate that gains have been made in all three areas through the network, although attribution is challenging, given the complex environment. The context remains challenging, with shifting boundaries and populations displaced by conflict, difficulties in retaining staff, the need to import medicines and supplies across borders, and governance gaps.
Conclusion
This study adds to a very limited literature on coordinated network approaches used to raise care quality and improve referrals and efficiency in a complex emergency setting. Although areas of ongoing challenge, including for sustainability, are noted, the network demonstrated some resilience strategies and can provide lessons for other similar contexts.
BACKGROUND: An inter-professional education (IPE) workshop centred around newly approved COVID-19 vaccination was attended by 77 nursing and pharmacy students. AIM: To embed and evaluate the implementation of a virtual IPE workshop, and to upskill undergraduate nursing and pharmacy students about the COVID-19 vaccination. METHODS: The workshop was evaluated using a questionnaire completed by participants from both disciplines. A focus group was conducted with the IPE facilitators. RESULTS: 77 students out of a potential 400 attended the workshop (19% attendance). Of the 77 participants, 44 (23 nursing, 21 pharmacy) completed the questionnaire (57%), rating the content highly. There was overall positivity toward working interprofessionally, and there was no evidence of significant differences between how the two groups of students rated the workshop. Qualitative findings from students and facilitators corroborated the supposition that the workshop would enhance professional development. Thus, the workshop was successful in facilitating interprofessional interactions, with students all working collaboratively toward the same goal, the ultimate purpose of IPE. It was agreed that such an event should be included as part of the student curricula. CONCLUSION: Implementing an IPE event that includes real-time healthcare priorities can contribute to optimising students' healthcare education. More high-quality longitudinal research is needed to understand the impact of such sessions on students' competence and confidence.
INTRODUCTION: Interprofessional education is a relatively new addition to health professional education curricula in the Arab world. To understand current practice in this area, a scoping review will enable reporting of essential elements for the implementation of interprofessional education. The objective of this scoping review is to report on the implementation components, including presage, process and product, of interprofessional education in prelicensure health professions education programmes in the Arab world. METHODS AND ANALYSIS: A comprehensive and systematic search for literature will be conducted using eight electronic databases from their inception to September 2022. A presearch was devised in PubMed, Scopus and CINAHL using a combination of terms related to population, context and concept. The Covidence Systematic Review tool will be used for blind screening, selection and conflict resolution. Data will be presented in tabular format and as a narrative synthesis and will include elements that support the implementation of interprofessional education. This review will be presented according to the Joanna Briggs Institute methodology.Studies conducted with students and/or faculty in prelicensure health professions education programmes will be included. The concept to be explored is interprofessional education. The context is the region commonly known as the Arab world, which includes 18 countries, sharing many common social and cultural traditions and where Arabic is the first language.Excluded will be studies conducted on collaborative practice of health professionals and postlicensure interprofessional education. ETHICS AND DISSEMINATION: No ethical approval was required. Findings will be disseminated in conference presentations and peer-reviewed articles.
Interprofessional student placements can not only cater to the added pressures on student placement numbers but can also enhance the work readiness of new graduates. For rural areas, there is a potential for interprofessional student placements to attract the future healthcare workforce. However, tried and tested models of interprofessional placements in rural areas backed up by rigorous evaluation, remain scarce. The Rural Interprofessional Education and Supervision (RIPES) model was developed, implemented, and evaluated across four rural health services in Queensland to address this gap. Students from two or more professions undertook concurrent placements at RIPES sites, with a placement overlap period of at least five weeks. Eleven focus groups (n = 58) with clinical educators (CEs) and students were conducted to explore student and clinical educator experiences and perspectives. Content analysis of focus group data resulted in the development of the following categories: value of the RIPES placement model, unintended benefits to CEs, work units and rural areas, tension between uni-professional and IPE components, and sustainability considerations. Students and CEs alike valued the learning which arose from participation in the model and the positive flow-on effects to both patient care and work units. This unique study was undertaken in response to previous calls to address a gap in interprofessional education models in rural areas. It involved students from multiple professions and universities, explored perspectives and experiences from multiple stakeholders, and followed international best practice interprofessional education research recommendations. Findings can inform the future use and sustainability of the RIPES model.
The current article provides an overview of an interprofessional service-learning course that became virtual in the setting of the coronavirus disease 2019 pandemic. Telehealth video technologies were used to build an intergenerational, virtual classroom and increase engagement of older adults with interdisciplinary health professional students. The virtual classroom involved group health education sessions, individualized Medicare wellness visits, and a clinical huddle. The course addressed the public health need for reliable health information during the early days of the pandemic, social connection, and meeting the educational goals for health care students and older adults in a novel virtual setting. Lessons learned for the interdisciplinary team and for engaging older adults included the need for preparation reading, team building exercises, training videos, and telehealth competency checklists. Beyond the pandemic, adoption of virtual methods enables hybrid approaches to interprofessional education and builds competencies for delivery of telehealth and computer-based visits in professional practice settings. [Journal of Gerontological Nursing, 48(8), 52-56.].
In the wake of local initiatives and developmental funding programs, interprofessionality is now included in national curricula in the German-speaking countries. Based on the 3P model (presage, process, product), this position paper presents the development of interprofessional education in recent years in Germany, Austria and Switzerland and places it in an international context. Core aspects as legal frameworks, including amendments to occupational regulations as well as the formation of networks and faculty development are basic requirements for interprofessional education. New topics and educational settings take shape in the process of interprofessional education: patient perspectives and teaching formats, such as online courses, become more important or are newly established. The influence of the COVID-19 pandemic on interprofessional education is explored as well. Among many new interprofessional courses, particularly the implementation of interprofessional training wards in Germany and Switzerland are positive examples of successful interprofessional education. The objective of interprofessional education continues to be the acquisition of interprofessional competencies. The main focus is now centered on evaluating this educational format and testing for the corresponding competencies. In the future, more capacities will be required for interprofessional continuing education and post-graduate education. Structured research programs are essential to ascertain the effects of interprofessional education in the German-speaking countries. In this position paper the GMA committee on interprofessional education encourages further advancement of this topic and expresses the aim to continue cooperating with other networks to strengthen and intensify interprofessional education and collaboration in healthcare.
BACKGROUND: Improving interprofessional communication and collaboration is necessary to facilitate the early identification and treatment of patients with sepsis. Preparing undergraduate medical and nursing students for the knowledge and skills required to assess, escalate, and manage patients with sepsis is crucial for their entry into clinical practice. However, the COVID-19 pandemic and social distancing measures have created the need for interactive distance learning to support collaborative learning. OBJECTIVE: This study aimed to evaluate the effect of sepsis interprofessional education on medical and nursing students' sepsis knowledge, team communication skills, and skill use in clinical practice. METHODS: A mixed methods design using a 1-group pretest-posttest design and focus group discussions was used. This study involved 415 undergraduate medical and nursing students from a university in Singapore. After a baseline evaluation of the participants' sepsis knowledge and team communication skills, they underwent didactic e-learning followed by virtual telesimulation on early recognition and management of sepsis and team communication strategies. The participants' sepsis knowledge and team communication skills were evaluated immediately and 2 months after the telesimulation. In total, 4 focus group discussions were conducted using a purposive sample of 18 medical and nursing students to explore their transfer of learning to clinical practice. RESULTS: Compared with the baseline scores, both the medical and nursing students demonstrated a significant improvement in sepsis knowledge (P<.001) and team communication skills (P<.001) in immediate posttest scores. At the 2-month follow-up, the nursing students continued to have statistically significantly higher sepsis knowledge (P<.001) and communication scores (P<.001) than the pretest scores, whereas the medical students had no significant changes in test scores between the 2-month follow-up and pretest time points (P=.99). A total of three themes emerged from the qualitative findings: greater understanding of each other's roles, application of mental models in clinical practice, and theory-practice gaps. The sepsis interprofessional education-particularly the use of virtual telesimulation-fostered participants' understanding and appreciation of each other's interprofessional roles when caring for patients with sepsis. Despite noting some incongruities with the real-world clinical practice and not encountering many sepsis scenarios in clinical settings, participants shared the application of mental models using interprofessional communication strategies and the patient assessment framework in their daily clinical practice. CONCLUSIONS: Although the study did not show long-term knowledge retention, the use of virtual telesimulation played a critical role in facilitating the application of mental models for learning transfer and therefore could serve as a promising education modality for sepsis training. For a greater clinical effect, future studies could complement virtual telesimulation with a mannequin-based simulation and provide more evidence on the long-term retention of sepsis knowledge and clinical skills performance.
This article aims to share the online collaborative experience of interprofessional teamwork among healthcare undergraduate students based on community learning during the coronavirus disease 2019 (COVID-19) pandemic in Chile. This experience took place in 48 different communities in Chile from November 10, 2020 to January 12, 2021. It was a way of responding to the health education needs of the community when the entire Chilean population was in confinement. Students managed to adapt to the COVID-19 pandemic despite the challenges, including internet connectivity problems and the limited time available to do the work. The educational programs and videos shared in this article will be helpful for other interprofessional health educators to implement the same kind of program.
Vikki Park, Programme Lead/Senior Lecturer, University of Sunderland, formerly IPE Lead, Northumbria University, and CAIPE National Board Member (contactme@drvikkipark.com).
SUMMARY STATEMENT: On-site interprofessional education (IPE) simulation is primarily used to teach students teamwork, communication, and crisis resource management. Participants view it as an educational environment in which to acquire and consolidate skills. Virtual IPE simulation is traditionally seen as an opportunity to supplement, complement, and reinforce on-site IPE (OI). We used VI as the sole simulation method during the COVID-19 pandemic to provide IPE because of constraints of social distancing. The VI resulted in substantially achieving similar learning outcomes to OI. This suggests that VI, which has the advantage of being cheaper and more easily scalable than OI, may be an effective remote learning modality for IPE.
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