Care seeking for under-five children and vaccine perceptions during the first two waves of the COVID-19 pandemic in Lagos State, Nigeria: a qualitative exploratory study

Objective: To explore healthcare seeking practices for children and the context-specific direct and indirect effects of public health interventions during the first two waves of COVID-19 in Lagos State, Nigeria. We also explored decision-making around vaccine acceptance at the start of COVID-19 vaccine roll-out in Nigeria. Design, setting and participants: A qualitative explorative study involving 19 semistructured interviews with healthcare providers from public and private primary health facilities and 32 interviews with caregivers of under-five children in Lagos from December 2020 to March 2021. Participants were purposively selected from healthcare facilities to include community health workers, nurses and doctors, and interviews were conducted in quiet locations at facilities. A data-driven reflexive thematic analysis according to Braun and Clark was conducted. Findings: Two themes were developed: appropriating COVID-19 in belief systems, and ambiguity about COVID-19 preventive measures. The interpretation of COVID-19 ranged from fearful to considering it as a ‘scam’ or ‘falsification from the government’. Underlying distrust in government fuelled COVID-19 misperceptions. Care seeking for children under five was affected, as facilities were seen as contagious places for COVID-19. Caregivers resorted to alternative care and self-management of childhood illnesses. COVID-19 vaccine hesitancy was a major concern among healthcare providers compared with community members at the time of vaccine roll-out in Lagos, Nigeria. Indirect impacts of COVID-19 lockdown included diminished household income, worsening food insecurity, mental health challenges for caregivers and reduced clinic visits for immunisation. Conclusion: The first wave of the COVID-19 pandemic in Lagos was associated with reductions in care seeking for children, clinic attendance for childhood immunisations and household income. Strengthening health and social support systems with context-specific interventions and correcting misinformation is crucial to building adaptive capacity for response to future pandemics

Visiting the iron cage: Bureaucracy and the contemporary workplace

Bureaucracy as an organizational form has always been a controversial issue and placed at the very heart of most discussions within organizational theory. One side of this prolonged discussion praises this administrative form as the ‘rational’ way to run an organization. It provides needed guidance and clarifies responsibilities, which enables employees to become more efficient. However, the opposition claims that in a non-linear world, where industrial organizations are forced to confront the challenging task of sensing and responding to unpredictable, novel situations of highly competitive markets, such an organizational form stifles creativity, fosters de-motivation and causes pressure on employees. Dealing with a bureaucratic form of organization and its consequences begs for a context. It would be appropriate to quit ‘taking sides’ and develop a sound analysis of this phenomenon under the conditions of today’s global workplace environment. This chapter intends to delineate the conditions under which bureaucracy has emerged and the way it has been interpreted since its inception and develop a sound and appropriate analytical approach to its functioning given the prevailing conditions of the contemporary workplace.Publisher's VersionAuthor Post Prin

Population awareness of risks related to medicinal product use in Vientiane Capital, Lao PDR: a cross-sectional study for public health improvement in low and middle income countries

BACKGROUND: While essential medicines have been made more available in all but the most remote areas in low and middle income countries (L/MICs) over the past years, inappropriate and incorrect use of good quality medicines remains a key impediment for public health. In addition, as medicines have a potential to cause harm (medicine risks), adequate awareness by medicine users of the risks of adverse reactions is essential, especially as self-medication is common in L/MICs. This study aimed to investigate the awareness of Lao residents regarding medicine risks in Vientiane Capital, Lao People’s Democratic Republic. METHODS: Face-to-face interviews using structured questionnaires of 144 residents older than 16 years were carried out in 12 randomly selected villages out of the 146 villages of Vientiane Capital with at least one health facility. RESULTS: The respondents were mainly (85.0 %) the heads of households or their husband/spouse . The majority of the respondents were unaware (61.8 %) of medicine risks. Compared to residents living in the urban district of Xaysetha, living in peri-urban and even more in rural areas were identified as factors associated with being unaware of medicine risks [adjusted odds ratio (aOR) =3.3, 95 % Confidence Interval (CI) = 1.1–9.4]) and aOR =7.5 (95 % CI = 2.3–24.2), respectively]. In addition, more than half of the respondents had never heard of poor quality medicines, with a higher rate in rural/peri-urban compared to urban districts (55.6 % vs 38.9 %, respectively, p = 0.02). Finally, approximately one third of all respondents thought that traditional medicines could not cause harm. CONCLUSIONS: Overall, these results suggest a lack of awareness about medicinal product risks. Differences according to the place of residence are apparent and could be partly explained by a lower level of training of healthcare providers in contact with the population in the rural districts in particular. Communication on medicinal product risks to patients through well-trained healthcare providers could probably make a valuable contribution towards the appropriate use of medicines in L/MICs

Expatriation and Incapacity created by a Multitude of Hidden Inequalities

The ability of UK based Academics to function within collaborative partnerships is becoming an important part of the UK Universities internationalisation agenda. This chapter offers an auto-ethnographical academic expatriate experience detailing some of the challenges faced when moving to work in a ‘UK environment positioned abroad’, specifically in China. It will provide HR personnel with alternative understandings of possible support strategies that could assist individuals in dealing with a variety of hidden inequalities that surface. These hidden inequalities can contribute to a possible shortening of the assignment due to cultural contexts in which they are operating (Foster 1997; Wang and Varma 2017)

Organisationskultur. Eine Konkretisierung aus systemtheoretischer Perspektive

Kühl S. Organisationskultur. Eine Konkretisierung aus systemtheoretischer Perspektive. Managementforschung. 2018;28(1):7-35.Die Bestimmung des Verhältnisses von Informalität und Organisationskultur bereitet in der Organisationstheorie Schwierigkeiten. Das liegt daran, dass der Begriff Informalität häufig stillschweigend durch den Begriff der Organisationskultur ersetzt wurde, ohne dass dafür eine präzise, abgrenzungsscharfe Definition vorgenommen worden wäre. Unter Rückgriff auf Überlegungen von Dario Rodríguez argumentiert dieser Artikel, dass die beiden Begriffe Organisationskultur und Informalität das gleiche Phänomen bezeichnen: die nichtentschiedenen Entscheidungsprämissen einer Organisation. Dabei wird systematisch zwischen „unentscheidbaren Entscheidungsprämissen“ und „prinzipiell entscheidbaren, aber nicht entschiedenen Entscheidungsprämissen“ unterschieden. Es wird gezeigt, wie sich mit einer präzisen Bestimmung über das Konzept der Entscheidungsprämissen Ordnung in die „wilden Merkmallisten“ der Literatur sowohl über Informalität als auch Organisationskultur bringen lässt und empirische Phänomene genauer erfasst werden können

Shaping healthcare-seeking processes during fatal illness in resource-poor settings. A study in Lao PDR

BACKGROUND: There are profound social meanings attached to bearing children that affect the experience of losing a child, which is akin to the loss of a mother in the household. The objective of this study is to comprehend the broader processes that shape household healthcare-seeking during fatal illness episodes or reproductive health emergencies in resource-poor communities. METHODS: The study was conducted in six purposively selected poor, rural communities in Lao PDR, located in two districts that represent communities with different access to health facilities and contain diverse ethnic groups. Households having experienced fatal cases were first identified in focus group discussions with community members, which lead to the identification of 26 deaths in eleven households through caregiver and spouse interviews. The interviews used an open-ended anthropological approach and followed a three-delay framework. Interpretive description was used in the data analysis. RESULTS: The healthcare-seeking behavior reported by caregivers revealed a broad range of providers, reflecting the mix of public, private, informal and traditional health services in Lao PDR. Most caregivers had experienced multiple constraints in healthcare-seeking prior to death. Decisions regarding care-seeking were characterized as social rather than individual actions. They were constrained by medical costs, low expectations of recovery and worries about normative expectations from healthcare workers on how patients and caregivers should behave at health facilities to qualify for treatment. Caregivers raised the difficulties in determining the severity of the state of the child/mother. Delays in reaching care related to lack of physical access and to risks associated with taking a sick family member out of the local community. Delays in receiving care were affected by the perceived low quality of care provided at the health facilities. CONCLUSIONS: Care-seeking is influenced by family- and community-based relations, which are integrated parts of people’s everyday life. The medical and normative responses from health providers affect the behavior of care-seekers. An anthropological approach to capture the experience of caregivers in relation to deciding, seeking and reaching care reveals the complexity and socio-cultural context surrounding maternal and child mortality and has implications for how future mortality data should be developed and interpreted