Management of co-morbidity of depression and chronic non- communicable diseases in Rwanda

Background: Chronic non-communicable diseases (NCDs) are a major global health problem of the 21 stcentury. They are now the world’s leading cause of disease burden and high mortality. An even more alarming health problem is when depression coexists with chronic NCDs, as is frequently the case. Management of this co-morbidity with collaborative care has become a global topic of interest, with the World Health Organization (WHO) recommending implementation of collaborative care for this purpose. The study investigated existing protocols and/or interventions for managing this co-morbidity in Rwandan district hospitals.Methods: The study used an action research design involving a research team of 14 health care professionals to collaboratively identify existing protocols or interventions for managing co-morbidity of depression and NCDs in Rwanda. Focus group discussion using a structured interview guide was used to collect qualitative data, followed by qualitative content analysis using inductive approach.Results: We found no particular protocols or interventions in place to manage the co-morbidity of depression and chronic NCDs. Depression and chronic NCDs were found to be treated separately, in separate health care settings and by different health professionals.Conclusion: The findings revealed a gap in management of co-morbid depression and chronic NCDs in Rwanda district hospitals. We recommend that health care providers follow the WHO collaborative care advisory for better quality care and better patient improvement in management of this co-morbidity.Keywords: Chronic NCDs,depression, co-morbidity, managemen

The development and implementation of policy guidelines for health promotion in the workplace.

Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.The three phased study aimed to develop policy guidelines for workplace health promotion based on an exploration of the current status of health promotion in South African workplaces. In the first phase of the study a case study approach was used to analyse the current situation of health promotion in the workplace. For this phase of the study the particular aim was to determine to what extent the participating workplaces were involved in health promotion, or were salutogenic in nature. A total of 6 organizations participated in the first phase of the study, with a total of 258 participants. The second phase aimed at developing policy guidelines for health promotion in the workplace. The consensus method, using the Delphi technique, was used in this phase, involving seven participants who were experts in the field of occupational health and health promotion. The third phase was an observation of the implementation of the policy guidelines. Implementation analysis, which is part of evaluation research, was the methodology used. Two organizations from phase one participated in the implementation phase. In summarising the findings on the current situation of employee health promotion programs the study showed that none of the participating organizations emerged as health promoting workplaces. Organizations that offered employee health promotion/wellness programs mainly focused on individual health and on HIV/AIDS and none of them was found to provide comprehensive holistic programs that aimed at providing healthy work environments. In phase 2 of the study it emerged that there was a very strong concurrence between the findings from the experts and literature in terms of what needs to be included in health promotion policy guidelines. The key elements for health promotion policy documents were (1) organizational philosophy (2) stakeholder involvement and (3) the description of programs to be included in the policy. During the policy implementation process it emerged that different strategies were used in the policy development process. This process was largely influenced by such factors as organizational size, type and internal structures. Recommendations include an emphasis on more legislative support for health promotion in the workplace, and for more concrete aids such as policy guidelines and educational preparation of occupational health professionals for this component of their role

Integration experiences of student and qualified nurses with disabilities who graduated from selected KwaZulu-Natal nursing education institutions: An exploratory case study

Background: Despite the introduction of the Disability Policy Guidelines in South Africa (SA), student nurses who have disabilities (SNWDs) are still habitually and effectively excluded from nurse training programmes, and hence from the nursing profession. Yet SNWD may be able to offer a unique perspective. Objectives: To explore and describe the integration experiences of both student and qualified nurses with disabilities who graduated from selected KwaZulu-Natal nursing education institutions (NEIs). Method: A concurrent mixed-method design based on multiple embedded case studies served as the primary data collection instrument in this paper. The researcher initially conducted a survey of all the private NEIs to determine which had experienced training SNWDs; 3 cases and 10 embedded cases were selected, using non-probability purposive sampling. Individual interviews were conducted with students and qualified nurses with who have a disability (n = 10) who had graduated from NEIs. Results: The findings of the study indicated that, largely, private NEIs are paving the way for integrating SNWDs; however, there are still some gaps in meeting the needs of these students. Despite strong legislative policies, an inclusive and enabling teaching and learning environment for SNWDs in nurse training remains largely absent. Conclusion: The study recommends that NEIs develop policy guidelines for integrating SNWDs in nursing education programmes promoting an inclusive nursing education for SNWDs. The introduction of a disability liaison to assist SNWDs by liaising between key stakeholders and, perhaps, addressing many of the challenges that SNWDs experience in the clinical facilities where nursing personnel are unaware of their disability

Current access and recruitment practices in nursing education institutions in KwaZulu-Natal: A case study of student nurses with disabilities

Background: While institutions of higher education may have increased access and accommodation for students with disabilities, institutions primarily providing nurse training in South Africa do not mirror the same practice. Objectives: Notwithstanding the integration of disability policies enacted in South Africa in 2010, a majority of people with disabilities are still excluded from the activities of society equally applicable to nursing education. This article describes the current access and recruitment practices for student nurses with disabilities (SNWDs) in nursing education institutions in KwaZulu-Natal to provide baseline data, which is largely absent in nursing institutions. Method: A concurrent mixed-method design using a multiple embedded case study approach was employed. This article presented phase 1 of the study, a quantitative survey of all private nursing education institutions (n = 27), complemented by individual, in-depth interviews with SNWDs (n = 10). Quantitative data were analysed using SPSS version 24, with a response rate of 78% (n = 21), whereas qualitative data were analysed using content analysis. Results: The findings revealed that the majority of private NEIs lack policy guidelines for recruiting SNWDs; however, other means of guidance is sought, for example, using the technical assistance. While NEIs were willing to recruit SNWDs, access to clinical sites, lectures, support systems and reasonable accommodation was challenging. Conclusion: Private NEIs are providing an inclusive education to all students including those with disabilities; however, they still have a long way to go in meeting the needs of SNWDs with regards to support and accommodation

Relationships between anti-retroviral adherence, self-efficacy, and resilience among women living with HIV in Niger State, Nigeria

The objectives of the study were to describe the level of self-efficacy and its relationship with resilience among women living with HIV in Niger State, Nigeria. Self-efficacy is an important predictor of treatment outcomes among people living with HIV. Using a systematic random sampling technique, 676 participants completed adherence self-efficacy and resilience measures from three selected hospitals in Niger State. The result showed high levels of self-efficacy among the participants, linear relationships between perceived stress and resilience (-.601), perceived stress and self-efficacy integration (-.504), perceived stress and selfefficacy perseverance (-.220), resilience and self-efficacy integration (.667) and resilience and self-efficacy perseverance (.377). Hierarchical multiple linear regression indicated that 48.3% of the variance in resilience was explained by the two sub-scales of self-efficacy (p = < .001). Also, 26% (p = < .001) of the variance in perceived stress was explained by the two subscales of the self-efficacy. It is concluded that self-efficacy is a significant predictor of resilience and perceived stress among women living with HIV in Niger State, Nigeria. Keywords: HIV, Nigeria, Perceived stress, Resilience, Self-efficacy, Women Les objectifs de l'étude étaient de décrire le niveau d'auto-efficacité et sa relation avec la résilience chez les femmes vivant avec le VIH dans l'État du Niger, au Nigéria. L'auto-efficacité est un prédicteur important des résultats du traitement chez les personnes vivant avec le VIH. À l'aide d'une technique d'échantillonnage aléatoire systématique, 676 participants ont complété des mesures d'auto-efficacité et de résilience de l'observance dans trois hôpitaux sélectionnés dans l'État du Niger. Le résultat a montré des niveaux élevés d'auto-efficacité chez les participants, des relations linéaires entre le stress perçu et la résilience (- .601), le stress perçu et l'intégration de l'auto-efficacité (-.504), le stress perçu et la persévérance de l'auto-efficacité (-.220) ), l'intégration de la résilience et de l'auto-efficacité (.667) et la persévérance de la résilience et de l'auto-efficacité (.377). Larégression linéaire multiple hiérarchique a indiqué que 48,3% de la variance de la résilience était expliquée par les deux souséchelles d'auto-efficacité (p = <.001). De plus, 26% (p = <.001) de la variance du stress perçu était expliquée par les deux souséchelles de l'auto-efficacité. Il est conclu que l'auto-efficacité est un prédicteur significatif de la résilience et du stress perçu chez les femmes vivant avec le VIH dans l'État du Niger, au Nigéria. Mots-clés: VIH, Nigéria, Stress perçu, Résilience, Auto-efficacité, Femme

Stakeholders perceptions regarding implementing maternal and newborn health care programs in Rwanda.

HEARD, 2021.Background: While maternal and newborn deaths has been decreasing since 2008 in Rwanda, there is room for improvement to meet its sustainable development goals. The maternal and newborn health care program needs to be monitored to ensure its effective implementation. This study therefore aimed to explore stakeholder’s perceptions of the Rwandan maternal and newborn health care program to identify areas for improvement. Methods: The convergent, parallel, mixed method study used quantitative and qualitative data in a single phase. The quantitative data was obtained from 79 health care workers, ranging from maternal community health care workers to program supervisors. The 10 areas of the Project Implementation Profile (PIP) instrument checklist with a five-point Likert scale were used to indicate their perceptions (strongly disagree to strongly agree). The qualitative interviews of five nurse managers used a manifest inductive content analysis, directed approach that entailed using existing theory and prior research to develop the initial coding scheme before starting data analyse. Results: There was disagreement about the level of top management support, human resources was regarded as an area of concern, with 18.7% (n = 14/79) indicating that they did not agree that this was adequately provided for; urgent solutions for unexpected problems was regarded as an areas of concern by 46.8% (n = 36/79). Top management support weakness were inadequate support training, materials, money for home visits, supervision and leaderships, and training of newly recruited maternity health care workers. For human resources, there were insufficient trained staff to take care of mothers and newborns due to the shortages of health providers. The management of unexpected problems was also an area of concerns and related to getting patients to health facilities during pregnancy emergencies and the lack of qualified birth attendants at health facilities. Conclusion: The study identified three areas for improvement: top management support, human resources and urgent solutions for unexpected problems, as they may be affecting the provision of maternal and newborn health care program services. Using the PIP enable managers to improve the country’s maternal and newborn health care program, and to provide ongoing monitoring and evaluation of with respect to the desired outcomes of reducing maternal and neonatal mortality

Community-based maternal and newborn interventions in Africa: systematic review.

HEARD, 2021.Aim and objectives: This review analysed the implementation and integration into healthcare systems of maternal and newborn healthcare interventions in Africa that include community health workers to reduce maternal and newborn deaths. Background: Most neonatal deaths (99%) occur in low-and middle-income countries, with approximately half happening at home. In resource-constrained settings, community-based maternal and newborn care is regarded as a sound programme for improving newborn survival. Health workers can play an important role in supporting families to adopt sound health practices, encourage delivery in healthcare facilities and ensure timeous referral. Maternal and newborn mortality is a major public health problem, particularly in sub-Saharan Africa, where the Millennium Development Goals 4, 5 and 6 were not achieved at the end of 2015. Methods: The review includes quantitative, qualitative and mixed-method studies, with a data-based convergent synthesis design being used, and the results grouped into categories and trends. The review took into account the participants, interventions, context and outcome frameworks (PICO), and followed the adapted PRISMA format for reporting systematic reviews of the qualitative and quantitative evidence guide checklist. Results: The results from the 17 included studies focused on three themes: antenatal, delivery and postnatal care interventions as a continuum. The main components of the interventions were inadequate, highlighting the need for improved planning before each stage of implementation. A conceptual framework of planning and implementation was elaborated to improve maternal and newborn health. Conclusion: The systematic review highlight the importance of thoroughly planning before any programme implementation, and ensuring that measures are in place to enable continuity of services. Relevant to the clinical practice: Conceptual framework of planning and implementation of maternal and newborn healthcare interventions by maternal community health workers

Women’s experiences on the use of Implanon as a contraceptive method in a selected primary healthcare facility in KwaZulu-Natal

Background: The South African department of health recently introduced subdermal Implanon contraceptive implant with the aim to reduce teenage pregnancy and maternal mortality. First used in all public healthcare facilities across the country since early 2014, this method of contraception has been described as highly effective. However, some women have reported unbearable side effects, forcing them to remove the contraceptive implant early before its expiry date. Negligible emphasis has been placed on staff training and development to equip the nurses with new protocol and policies on Implanon. Objectives: The objective of this study was to explore experiences of women using Implanon as method of contraception at a selected primary healthcare facility in KwaZulu-Natal province of South Africa. Methods: A qualitative, descriptive and exploratory study design was used. A purposive sampling technique was used and a sample of seven women aged between 15 and 50 years was selected for this study. Semi-structured interviews were used in the data collection process. The Tesch’s method for data coding and data analysis was utilised. Necessary ethical measures were taken to ensure that the study is trustworthy. The study was conducted at Community Health Centre, KwaZulu-Natal between June 2017 and December 2018. Results: The findings showed that some participants were still willing to continue using this method of contraception regardless of the unwanted side effects. Major side effects reported were heavy menstrual bleeding, pain and discomfort, weight loss, insomnia and decreased sexual interest, which resulted in most participants stopping the use of Implanon. Conclusion: Most of the participants’ experience unwanted side effects because of poor screening, counselling and support. There is a clear demand to develop a screening tool and facilitate training of healthcare workers when initiating the use of Implanon. Keywords: Implanon; Implanon users; experiences; perceptions; primary healthcar

Condom use: a less travelled route among minibus taxi drivers and their taxi queens in KwaZulu-Natal, South Africa

Background: Despite significant gains in the HIV epidemic in South Africa, with reduction in mortality and elimination of vertical transmission, national HIV prevalence remains high, with women rather than men continuing to bear higher burden of the disease. Population subgroups, through ignorance, disbelief or recklessness, continue to engage in risky sexual behaviour. A substantial proportion of minibus taxi drivers engage in risky sex, seldom seeing themselves at risk for STIs or HIV/AIDS. These taxi drivers have been linked with so-called taxi queens, with whom they engage in transactional and intergenerational relationships. Objectives: The study explored condom use and condom negotiation strategies among taxi drivers and taxi queens in KwaZulu-Natal, South Africa. Methods: Applying explorative qualitative design, we conducted focus group discussion and individual interviews among participants who were purposively recruited in KwaZulu-Natal. Results: Qualitative data analysis revealed that condom use and negotiation are sources of conflict for the participants. In addition, the strategies employed by participants to ensure condom usage are not always sustainable and are likely to be problematic due to a variety of complex factors. Conclusion: Our study concludes by recommending a nested public health response that takes cognizance of factors that promote sustainable condom use strategies among this population subgroup

Predictors of tuberculosis (TB) and antiretroviral (ARV) medication non-adherence in public primary care patients in South Africa: A cross sectional study

Background: Despite the downward trend in the absolute number of tuberculosis (TB) cases since 2006 and the fall in the incidence rates since 2001, the burden of disease caused by TB remains a global health challenge. The co-infection between TB and HIV adds to this disease burden. TB is completely curable through the intake of a strict anti-TB drug treatment regimen which requires an extremely high and consistent level of adherence.The aim of this study was to investigate factors associated with adherence to anti-TB and HIV treatment drugs. Methods: A cross-sectional survey method was used. Three study districts (14 primary health care facilities in each) were selected on the basis of the highest TB caseload per clinic. All new TB and new TB retreatment patients were consecutively screened within one month of anti-tuberculosis treatment. The sample comprised of 3107 TB patients who had been on treatment for at least three weeks and a sub-sample of the total sample were on both anti-TB treatment and anti-retro-viral therapy(ART) (N = 757). Data collection tools included: a Socio-Demographic Questionnaire; a Post-Traumatic-Stress-Disorder (PTSD) Screen; a Psychological Distress Scale; the Alcohol Use Disorder Identification Test (AUDIT); and self-report measures of tobacco use, perceived health status and adherence to anti-TB drugs and ART. Results: The majority of the participants (N = 3107) were new TB cases with a 55.9% HIV co-infection rate in this adult male and female sample 18 years and older. Significant predictors of non-adherence common to both anti-TB drugs and to dual therapy (ART and anti-TB drugs) included poverty, having one or more co-morbid health condition, being a high risk for alcohol mis-use and a partner who is HIV positive. An additional predictor for non-adherence to anti-TB drugs was tobacco use. Conclusions: A comprehensive treatment programme addressing poverty, alcohol mis-use, tobacco use and psycho-social counseling is indicated for TB patients (with and without HIV). The treatment care package needs to involve not only the health sector but other relevant government sectors, such as social development.IS