Reducing HIV-related stigma and discrimination in healthcare settings through the development of an evidence-informed guideline

The stigma and discrimination related to human immunodeficiency virus (HIV) have been obstacles against the achievement of the global health priority targets by negatively impacting adherence to, and uptake of services. As an effort to improve the practice and service in HIV and related areas, this project sought to develop an evidence-informed guideline to reduce HIV-related stigma and discrimination. Aims: The overall aim of this project was to develop an evidence-informed guideline to reduce HIV-related stigma and discrimination among healthcare workers in the Ethiopian context. Method First, I conducted a systematic literature search for guidelines and systematic reviews, followed by systematic review of primary studies. After appraising the evidence found through the literature search, a content analysis of the included units of evidences was carried out to generate a list of working recommendations. Summaries of Findings tables were produced using software package developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. The feasibility and appropriateness of the recommendations were then assessed using the Guideline Implementability Appraisal (GLIA v.2) checklist. Consensus was established through two rounds of a Delphi panel survey and two consensus meetings. The recommendations were also evaluated by external reviewers. In the final phase of this project, barriers and facilitators to the implementation of the guideline were assessed through key informant interviews with health professionals and health managers. Results Through the systematic literature search for guidelines, best practices, tools and systematic reviews I included 12 records (six guideline-related tools, and six systematic reviews). Since adequate conclusive evidence could not be drawn from these resources,a systematic review of quantitative evidence was undertaken. Initially, 31 recommendations and good practice points were extracted and drafted from the content analysis of the documents included. The recommendations were evaluated using a Delphi panel and external experts. Based on these evaluations, 12 recommendations and three good practice points were retained in the final draft. To contextualize the recommendations, barriers and facilitators were further explored using key informant interviews. The key informants suggested that the guideline should be introduced through training, workshops, hard copies, multidisciplinary team (MDT) meeting of experts working on care and treatment of clients living with HIV and HIV mentorship program and through one-to-five networks in healthcare facilities. It was also suggested that the indicators should be integrated into local hospital key performance indicators (KPI). The importance of identifying and establishing the implementation structure, implementation team and a focal person responsible for overseeing the implementation of the guideline was stressed. Key informants specifically reported that the guideline would help to achieve not only HIV-related goals, but also other health facility initiatives such as ‘compassionate,respectful, and caring’ (CRC) services and clean and safe health facility (CASH)initiatives. Conclusion The project sought to develop trustworthy and rigorous guideline that is applicable and can be integrated into current initiatives and practices in the Ethiopian context. The current guideline can be implemented into new and existing health facility initiatives (such as CRC and CASH) and included in platforms like mentorship, multidisciplinary team (MDT) meetings and one-to-five networks. To ensure uptake of this guideline, health managers need to identify the implementation structure, implementation team and a focal person to implement the guideline.Thesis (Ph.D.) -- University of Adelaide, The Joanna Briggs Institute, 201

How Effective are Mentoring Programs for Improving Health Worker Competence and Institutional Performance in Africa? A Systematic Review of Quantitative Evidence.

INTRODUCTION: Mentoring programs are frequently recommended as innovative and low-cost solutions, and these have been implemented in many healthcare institutions to tackle multiple human resource-related challenges. This review sought to locate, appraise and describe the literature reporting on mentorship programs that were designed to improve healthcare worker competence and institutional performance in Africa. METHODS: This review searched and synthesized reports from studies that assessed the effectiveness of mentorship programs among healthcare workers in Africa. We searched for studies reported in the English language in EMBASE, CINAHL, COCHRANE and MEDLINE. Additional search was conducted in Google Scholar. RESULTS: We included 30 papers reporting on 24 studies. Diverse approaches of mentorship were reported: a) placing a mentor in health facility for a period of time (embedded mentor), b) visits by a mobile mentor, c) a mentoring approach involving a team of mobile multidisciplinary mentors, d) facility twinning, and e) within-facility mentorship by a focal person or a manager. IMPLICATION FOR PRACTICE: Mentoring interventions were effective in improving the clinical management of infectious diseases, maternal, neonatal and childhood illnesses. Mentoring interventions were also found to improve managerial performance (accounting, human resources, monitoring and evaluation, and transportation management) of health institutions. Additionally, mentoring had improved laboratory accreditation scores. Mentoring interventions may be used to increase adherence of health professionals to guidelines, standards, and protocols. While different types of interventions (embedded mentoring, visits by mobile mentors, facility twinning and within-facility mentorship by a focal person) were reported to be effective, there is no evidence to recommend one model of mentoring over other types of mentoring. IMPLICATIONS FOR RESEARCH: Further research-experimental methods measuring the impact of different mentoring formats and longitudinal studies establishing their long-term effectiveness-is required to compare the effectiveness and cost-effectiveness of different models of mentoring. Further studies are needed to explore why and how different mentoring programs succeed and the meaningfulness of mentoring programs for the different stakeholders are also required

Operative Deliveries: Indications and Post operative Complications at Mattu Karl Hospital, Oromia Regional State, south west Ethiopia

Introduction: The normal mechanism of labour leads to spontaneous vaginal delivery in many mothers. Under some circumstances cesarean section, vacuum assisted, use of forceps and destructive deliveries are helpful interventions in saving the lives of the mother and the new born. There is paucity of information on complication of operative deliveries and indications at Mattu Karl Hospital Objective: The main objective of this study is to determine the proportion, indications and postoperative complications of operative deliveries in Mattu Karl hospital. Methods: The records of all mothers who delivered operatively and with cards of full information during the period from January 2011 to Jan2013 were reviewed using pre-prepared checklist. Binary Logistic regression analysis was used to see the statistical association of the variables. The significant factors were declared at p-value <0.05. Result: Out of the total 3346 deliveries during the study period there were 984 (29.4%) operative deliveries. Among 727 (73.9%) were cesarean section, vacuum 190(21.7%), Forceps 45(1.3%) and Destructive delivery 22(0.65%).The main indications for cesarean section were caphalopelvic disproportion 257 (26.1%). Mothers Who had malpresentation as an indication of operative deliveries are 65% less likely to have bad maternal outcome  as compared to caphalopelvic disproportion  with AOR: 0.35, 95% CI (0.144-0.856). Conclusion: prolonged second stage & HDP of labour were major factors associated with immediate neonatal outcome. All stake holders should work to reduce high maternal mortality and morbidity rates by increasing ANC antenatal care follow up. Keywords: Operative deliveries, Mattu Karl hospital, maternal outcome, fetal outcom

Validation of an HIV-related stigma scale among health care providers in a resource-poor Ethiopian setting

Background: Stigma and discrimination (SAD) against people living with human immunodeficiency virus (HIV) are barriers affecting effective responses to HIV. Understanding the causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The objective of this study was to validate an HIV-related stigma scale among health care providers in a resource-poor setting. Methods: A cross-sectional validation study was conducted in 18 health care institutions in southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support (PIS) and HIV-related SAD. Exploratory factor analysis (EFA) with principal component extraction and varimax with Kaiser normalization rotation were employed to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction. Items with item-factor loadings less than 0.4 and items loading onto more than one factor were dropped. The convergent validity of the scales was tested by assessing the association with HIV knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence of an antiretroviral therapy (ART) service in the health care facility, and perceived religiosity. Results: Seven factors emerged from the four dimensions of SAD during the EFA. The factor loadings of the items ranged from 0.58 to 0.93. Cronbach’s alphas of the scales ranged from 0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance of training on topics related to SAD, degree or higher education levels, high HIV case loads, the availability of ART in the health care facility and claiming oneself as nonreligious were all negatively associated with SAD as measured by the seven newly identified latent factors. Conclusion: The findings in this study demonstrate that the HIV-related stigma scale is valid and reliable when used in resource-poor settings. Considering the local situation, health care managers and researchers may use this scale to measure and characterize HIV-related SAD among health care providers. Tailoring for local regions may require further development of the tool.Garumma Tolu Feyissa, Lakew Abebe, Eshetu Girma, Mirkuzie Woldi

Effectiveness of interventions to reduce child marriage and teen pregnancy in sub-Saharan Africa: A systematic review of quantitative evidence

IntroductionChild marriage and teen pregnancy have negative health, social and development consequences. Highest rates of child marriage occur in sub-Saharan Africa (SSA) and 40% of women in Western and Central Africa got married before the age of 18. This systematic review was aimed to fill a gap in evidence of effectiveness to reduce teen pregnancy and child marriage in SSA.MethodsWe considered studies conducted in sub-Saharan Africa that reported on the effect of interventions on child marriage and teen pregnancy among adolescent girls for inclusion. We searched major databses and grey literature sources.ResultsWe included 30 articles in this review. We categorized the interventions reported in the review into five general categories: (a) Interventions aimed to build educational assets, (b) Interventions aimed to build life skills and health assets, (c) Wealth building interventions, and (d) Community dialogue. Only few interventions were consistently effective across the studies included in the review. The provision of scholarship and systematically implemented community dialogues are consistently effective across settings.ConclusionProgram designers aiming to empower adolescent girls should address environmental factors, including financial barriers and community norms. Future researchers should consider designing rigorous effectiveness and cost effectiveness studies to ensure sustainability.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022327397

Mothers’ perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa : a qualitative systematic review protocol

Kangaroo mother care (KMC) has been identified as an alternative way to care for low-birthweight (LBW) and preterm neonates. It promotes parent-child bonding and breastfeeding, and stabilizes the vital signs of the neonate, particularly body temperature and heart and respiratory rates, leading to increased weight gain and improved growth. KMC reduces the need for expensive conventional medical care, improves parental involvement in care provision and offers opportunities for health education. The article proposes a systematic review of the literature to identify barriers and to facilitate uptake of KMC

Community health volunteers could help improve access to and use of essential health services by communities in LMICs: an umbrella review.

A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs). We report an umbrella review of systematic reviews, searching PubMed, the Cochrane library, the database of abstracts of reviews of effects (DARE), EMBASE, ProQuest dissertation and theses, the Campbell library and DOPHER. We considered a review as 'systematic' if it had an explicit search strategy with qualitative or quantitative summaries of data. We used the Joanna Briggs Institute (JBI) critical appraisal assessment checklist to assess methodological quality. A data extraction format prepared a priori was used to extract data. Findings were synthesized narratively. Of 422 records initially found by the search strategy, we identified 39 systematic reviews eligible for inclusion. Most concluded that services provided by CHVs were not inferior to those provided by other health workers, and sometimes better. However, CHVs performed less well in more complex tasks such as diagnosis and counselling. Their performance could be strengthened by regular supportive supervision, in-service training and adequate logistical support, as well as a high level of community ownership. The use of CHVs in the delivery of selected health services for population groups with limited access, particularly in LMICs, appears promising. However, success requires careful implementation, strong policy backing and continual support by their managers

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe