A Mixed Methods Study of a Health Worker Training Intervention to Increase Syndromic Referral for Gambiense Human African Trypanosomiasis in South Sudan

BACKGROUND: Active screening by mobile teams is considered the most effective method for detecting gambiense-type human African trypanosomiasis (HAT) but constrained funding in many post-conflict countries limits this approach. Non-specialist health care workers (HCWs) in peripheral health facilities could be trained to identify potential cases for testing based on symptoms. We tested a training intervention for HCWs in peripheral facilities in Nimule, South Sudan to increase knowledge of HAT symptomatology and the rate of syndromic referrals to a central screening and treatment centre. METHODOLOGY/PRINCIPAL FINDINGS: We trained 108 HCWs from 61/74 of the public, private and military peripheral health facilities in the county during six one-day workshops and assessed behaviour change using quantitative and qualitative methods. In four months prior to training, only 2/562 people passively screened for HAT were referred from a peripheral HCW (0 cases detected) compared to 13/352 (2 cases detected) in the four months after, a 6.5-fold increase in the referral rate observed by the hospital. Modest increases in absolute referrals received, however, concealed higher levels of referral activity in the periphery. HCWs in 71.4% of facilities followed-up had made referrals, incorporating new and pre-existing ideas about HAT case detection into referral practice. HCW knowledge scores of HAT symptoms improved across all demographic sub-groups. Of 71 HAT referrals made, two-thirds were from new referrers. Only 11 patients completed the referral, largely because of difficulties patients in remote areas faced accessing transportation. CONCLUSIONS/SIGNIFICANCE: The training increased knowledge and this led to more widespread appropriate HAT referrals from a low base. Many referrals were not completed, however. Increasing access to screening and/or diagnostic tests in the periphery will be needed for greater impact on case-detection in this context. These data suggest it may be possible for peripheral HCWs to target the use of rapid diagnostic tests for HAT

Embedding ethics of care into primary science pedagogy : Reflections on our criticality

In this chapter, the authors analyze the difficulties and opportunities to broaden the purpose of science education using critical perspectives derived from ethics of care theory. Through the analysis of a science school-university collaborative project we discuss how the ethic of care theory became central to our work and how collaborative relations pushed the boundaries of acceptable practice and purposes of science education. We also reflect on the university roles relating to issues of parity and power within the collaborative project using narratives to describe the changes in expectations and participation. We provide an overview of the ethics of care as we believe it accedes with, and has the potential to progress criticality in science education. Carolina’s adoption and development of an ethics of care approach to her own teaching and scholarship is explored in light of her commitment to criticality and how she connects her personal life experiences, her previous path as a scientist and the political issues surrounding science. We contrast her views and our aims for the project we carried out with the teachers work and views. We conclude the chapter with a discussion of some insights that we hope will iteratively progress further the analysis and reporting of our approach to critical professional learning and pedagogy