Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study

BACKGROUND: Bloodstream infections caused by Enterobacterales show high frequency of antimicrobial resistance (AMR) in many Low- and Middle-Income Countries. We aimed to describe the variation in circumstances for management of such resistant infections in a group of African public-sector hospitals participating in a major research study. METHODS: We gathered data from eight hospitals across sub-Saharan Africa to describe hospital services, infection prevention and antibiotic stewardship activities, using two WHO-generated tools. We collected monthly cross-sectional data on availability of antibiotics in the hospital pharmacies for bloodstream infections caused by Enterobacterales. We compared the availability of these antibiotics to actual patient-level use of antibiotics in confirmed Enterobacterales bloodstream infections (BSI). RESULTS: Hospital circumstances for institutional management of resistant BSI varied markedly. This included self-evaluated infection prevention level (WHO-IPCAF score: median 428, range 155 to 687.5) and antibiotic stewardship activities (WHO stewardship toolkit questions: median 14.5, range 2 to 23). These results did not correlate with national income levels. Across all sites, ceftriaxone and ciprofloxacin were the most consistently available antibiotic agents, followed by amoxicillin, co-amoxiclav, gentamicin and co-trimoxazole. There was substantial variation in the availability of some antibiotics, especially carbapenems, amikacin and piperacillin-tazobactam with degree of access linked to national income level. Investigators described out-of-pocket payments for access to additional antibiotics at 7/8 sites. The in-pharmacy availability of antibiotics correlated well with actual use of antibiotics for treating BSI patients. CONCLUSIONS: There was wide variation between these African hospitals for a range of important circumstances relating to treatment and control of severe bacterial infections, though these did not all correspond to national income level. For most antibiotics, patient-level use reflected in-hospital drug availability, suggesting external antibiotics supply was infrequent. Antimicrobial resistant bacterial infections could plausibly show different clinical impacts across sub-Saharan Africa due to this contextual variation

Investigating the determinants of brain drain of healthcare professionals in developing countries: the case of registered nurses in Malawi health sector

Brain drain is one of the most serious challenges that health systems face in many developing countries. Malawi is not an exception. The determinants of brain drain phenomenon vary across regions and the brain drain of nurses is assuming an increasingly important role in the developing world. This issue has received great attention in recent years. Brain drain studies mostly in developing countries have fallen short of investigating determinants of brain drain from a source country perspective because the focus is mainly on the nurses who have already migrated. In this regard, this research fills the gap by adding to the understanding of major determinants of brain drain among registered nurses in the Malawi health sector. The problem with the knowledge gap is that it makes various stakeholders and experts fail to come up with strategies and measures in an informed, well-focused and systematic manner. The study employed a qualitative approach and implemented in six public hospitals in rural and urban settings in Malawi to determine the factors of brain drain of registered nurses. The qualitative data were elicited from registered nurses and key informants using semi-structured interviews and focus group discussions. 18 nurses, 9 key informants and 3 focus group discussions of nurses were targeted to provide empirical evidence of determinants of brain drain in the Malawi health sector. The data were analysed using content analysis. Content analysis involved transcribing and reading thoroughly all interviews before identifying themes that were more recurring than others. This allowed compressing many words of text into fewer categories. The findings of the study reveal the determinants of brain drain among nurses in the Malawi health sector. These factors are low salaries, delays in paying salaries, delays in adjustment salaries, high tax, regionalism, nepotism and tribalism, diseases, heavy workload, long working hours, non-provision of nurse uniform, non-provision of meals and non-provision of medical cover. Furthermore, the findings show that the lack of equipment, lack of medication, small and congested wards, the lack of training opportunities, the lack of scholarships, favouritism and non-reinforcement of bonding contracts are factors that contribute to brain drain of nurses in the Malawi health sector. This research contributes to the enrichment of the theoretical knowledge pool of determinants of brain drain of registered nurses in the Malawi Health Sector and offers guidance to policy makers and hospital managers most appropriate strategies and measures to put in place to prevent the further loss of these much-needed professionals to keep the Malawi health sector system functional

Unravelling the impact of occupational stress on employee performance in a non-profit organisation in the UK

The manifestation of stress affects every aspect of the workplace. A plethora of research examines the sources and the effects of work-related-stress on employees' health and productivity. Occupational stress very often causes an imbalance and decrease in overall performance. Non-profit organisations are notoriously known to live in a precarious financial position. A review of the literature in the UK indicates that non- profit organisations are not immune to occupational stress and therefore managers have a duty of care to ensure that stress levels are mitigated to keep employees motivated

Exploring the determinants of occupational stress in variable hour teaching staff in the UK Higher Education institution

In the world of work where demands and pressure are prevalent, personal stress is inevitable. The World Health Organisation (WHO) has noted work-related stress as a medical condition that requires attention. Professionals have coined the term occupation stress to denote to what employees experience in the workplace. Such stress at work can have a toll on the employees' productivity and well-being. In the academic work, there have been high levels of stress caused by the job demands, and this has caused an adverse effect on the individuals. A semi-structured interview of 30 variable hour teaching staff was utilised in the UK Higher Education. The findings indicated that most variable staff experienced job stressful elements. Overall, this chapter provides insights into the determinants of occupation stress among variable hours teaching staff

Investigating determinants of brain drain of health care professionals in developing countries: A review

Developing countries continue to lose a significant number of health care professionals to developed countries. Malawi is not an exception. Without health workers, health care cannot be delivered. The study assesses the determinants of brain drain of health care professionals in developing countries, the case of Malawi health sector. Health care professionals in developing countries suffer from low wages, unbearable working and living conditions in their country of origin and seek elsewhere for better salaries, safer working conditions, better living conditions and a better life. This has for several years created a brain drain of skilled labour from where it is most needed, leaving already fragile health systems even more vulnerable. However, the study finds that so far, too little attention has been paid to organizational factors that influence brain drain. This study presents insights on determinants of brain drain among health care professionals from developing countries to developed countries. The paper contributes to the understanding of main factors that influence brain drain in a developing context environment. To this end, the study informs public sector managers and policy makers the need to address these factors if they are to curb brain drain in developing countries

Circumstances for treatment and control of invasive Enterobacterales infections in eight hospitals across sub-Saharan Africa: a cross-sectional study.

BACKGROUND: Bloodstream infections caused by Enterobacterales show high frequency of antimicrobial resistance (AMR) in many Low- and Middle-Income Countries. We aimed to describe the variation in circumstances for management of such resistant infections in a group of African public-sector hospitals participating in a major research study. METHODS: We gathered data from eight hospitals across sub-Saharan Africa to describe hospital services, infection prevention and antibiotic stewardship activities, using two WHO-generated tools. We collected monthly cross-sectional data on availability of antibiotics in the hospital pharmacies for bloodstream infections caused by Enterobacterales. We compared the availability of these antibiotics to actual patient-level use of antibiotics in confirmed Enterobacterales bloodstream infections (BSI). RESULTS: Hospital circumstances for institutional management of resistant BSI varied markedly. This included self-evaluated infection prevention level (WHO-IPCAF score: median 428, range 155 to 687.5) and antibiotic stewardship activities (WHO stewardship toolkit questions: median 14.5, range 2 to 23). These results did not correlate with national income levels. Across all sites, ceftriaxone and ciprofloxacin were the most consistently available antibiotic agents, followed by amoxicillin, co-amoxiclav, gentamicin and co-trimoxazole. There was substantial variation in the availability of some antibiotics, especially carbapenems, amikacin and piperacillin-tazobactam with degree of access linked to national income level. Investigators described out-of-pocket payments for access to additional antibiotics at 7/8 sites. The in-pharmacy availability of antibiotics correlated well with actual use of antibiotics for treating BSI patients. CONCLUSIONS: There was wide variation between these African hospitals for a range of important circumstances relating to treatment and control of severe bacterial infections, though these did not all correspond to national income level. For most antibiotics, patient-level use reflected in-hospital drug availability, suggesting external antibiotics supply was infrequent. Antimicrobial resistant bacterial infections could plausibly show different clinical impacts across sub-Saharan Africa due to this contextual variation