Usability, acceptability, and feasibility of the World Health Organization Labour Care Guide: A mixed-methods, multicountry evaluation.

Introduction The World Health Organization’s (WHO) Labour Care Guide (LCG) is a “next-generation” partograph based on WHO’s latest intrapartum care recommendations. It aims to optimize clinical care provided to women and their experience of care. We evaluated the LCG’s usability, feasibility, and acceptability among maternity care practitioners in clinical settings. Methods Mixed-methods evaluation with doctors, midwives, and nurses in 12 health facilities across Argentina, India, Kenya, Malawi, Nigeria, and Tanzania. Purposively sampled and trained practitioners applied the LCG in low-risk women during labor and rated experiences, satisfaction, and usability. Practitioners were invited to focus group discussions (FGDs) to share experiences and perceptions of the LCG, which were subjected to framework analysis. Results One hundred and thirty-six practitioners applied the LCG in managing labor and birth of 1,226 low-risk women. The majority of women had a spontaneous vaginal birth (91.6%); two cases of intrapartum stillbirths (1.63 per 1000 births) occurred. Practitioner satisfaction with the LCG was high, and median usability score was 67.5%. Practitioners described the LCG as supporting precise and meticulous monitoring during labor, encouraging critical thinking in labor management, and improving the provision of woman-centered care. Conclusions The LCG is feasible and acceptable to use across different clinical settings and can promote woman-centered care, though some design improvements would benefit usability. Implementing the LCG needs to be accompanied by training and supportive supervision, and strategies to promote an enabling environment (including updated policies on supportive care interventions, and ensuring essential equipment is available)

Life with an Indwelling Urinary Catheter: Experiences from Male Patients Attending the Urology Clinic at a Tertiary Hospital in Northwestern Tanzania—A Qualitative Study

Experiences from patients living with a long-term indwelling urinary catheter (IUC) at home among men attending urology clinics have not been reported. Evidence-based information on such experiences is important for improving nursing care in low- and middle-income countries such as Tanzania. Using a descriptive phenomenological qualitative research design, we observed two main themes: “Adjustments to positive living with a catheter at home”, denoting that social interaction and psychological and spiritual support are important to positively live with the catheter, and “The home environment influences negative or positive living”, considering intimacy and altered body image to significantly influence the ability to practice sex, leading to wives’ self-sacrifice. Respondents experienced difficulties in living with a long-term IUC at home due to a lack of information from healthcare professionals on how to manage their catheters and urine bags. In adjusting to positive or negative living with a catheter at home, respondents had to figure out strategies to minimize psychological and emotional trauma and hasten the adjustment process. A clear guideline or checklist is needed to ensure that all important information is provided by health professionals at the time of discharge and during subsequent visits to patients on how to care for the catheter insertion sites and help them adjust to living with a long-term IUC

Urinary Tract Infections and Associated Factors among Patients with Indwelling Urinary Catheters Attending Bugando Medical Centre a Tertiary Hospital in Northwestern Tanzania

Complications of indwelling urinary catheterization (IUC) are associated with significant morbidity and mortality, thus affecting patient’s well-being. Understanding the magnitude and factors associated with complications is crucial in designing appropriate preventive strategies. A cross-sectional study was conducted at Bugando Medical Centre, involving patients with long-term and short-term IUC from December 2016 to September 2017. The data were analyzed by STATA 13.0. Catheter-associated urinary tract infection (CA-UTI) was the leading (56.8%; 250/440) complication among patients with IUC. Gram-negative bacteria were predominantly isolated (98.1%, 252/257), whereas E. coli (30.7%, 79/257) and Klebsiella spp. (29.6%, 76/257) were the leading pathogens. CA-UTI was significantly higher among out-patients than in-patients (82.2% v 35.3%, p p p = 0.029) and catheter duration of ≥6 weeks (OR: 2.43, (95%CI: 1.1–5.5), p = 0.031) independently predicted CA-UTI among outpatients, while female gender (OR: 2.1, (95%CI: 1.2–3.7), p = 0.014), catheter bags not freely hanging (OR: 0.4, (95%CI: 0.2–0.7), p = 0.002) and residing outside Mwanza region (OR: 0.4, (95%CI: 0.2–0.6), p < 0.001) predicted CA-UTI among in-patients. CA-UTI is the common complication among patients with IUC, significantly higher in out-patients than in-patients. We recommend involving patients and carers in infection prevention and control measures in out-patients living with IUC

A Delphi survey to determine midwifery research priorities among midwives in sub-Saharan Africa

Objective: In sub-Saharan Africa, midwifery input into the generation of important research questions is limited. The authors aimed to address this issue by enabling midwives to set their own research priorities with the intention of developing a research strategy to conduct studies relevant to clinical practice. Methods: A survey was carried out in six countries (Kenya, Malawi, Uganda, Zambia, Zimbabwe and Tanzania). The Delphi method was used with six panels of midwives (n=118) to attain a convergence of opinion on midwifery research priorities. Consensus-building was achieved by using a series of questionnaires delivered using multiple iterations to collect data. Data were analysed using ranked means and proportions. Findings: Consensus was reached on 11 research questions which were considered regional priorities. These covered three key areas: midwifery training, clinical care and organisational issues. Conclusions: Midwives prioritised areas of research that had direct applicability to their own practice. All questions were at the applied end of the research spectrum. Priorities tended to cover broad areas within reproductive health, as opposed to being disease-focused. This is likely to reflect the desire to provide quality care that embraces the social aspects of health. Some of these research priorities are being taken forward by midwives in the group. </jats:sec

Understanding the complexities of unexplained stillbirth in sub‐Saharan Africa: a mixed‐methods study

Objective: To understand the complexities surrounding unexplained stillbirth for the development and implementation of culturally acceptable interventions to underpin care in Tanzania and Zambia. Design: Mixed-methods. Setting: Tertiary, secondary and primary care facilities in Mansa, Zambia and Mwanza, Tanzania. Sample: Quantitative; 1997 women giving birth at two tertiary care facilities (one in each country). Qualitative; 48 women and 19 partners from tertiary, secondary and primary care facilities. Methods: Case review using data from a 2000 consecutive case record target. Qualitative interviews with a purposive sample of women and partners, using a grounded theory approach. Results: A total of 261 stillbirths were recorded; Tanzania rate 16%, Zambia 10%, higher than previous country estimates of 2.24% and 2.09%, respectively. Women in both countries who reported a previous stillbirth were more likely to have stillbirth (RR (95% CI): 1.86 (1.23 – 2.81)). Cause of death was unexplained in 28% of cases. Qualitative findings indicated that not knowing what caused the baby to be stillborn prevented women from grieving. This was compounded by poor communication skills of health professionals who displayed little empathy and skill when counselling bereaved families. Conclusion: Stillbirth risk in both facilities was far higher than national data, with women reporting a previous stillbirth at higher risk. Women want to know the cause of stillbirth and exploration of appropriate investigations in this setting is required. Providing health professionals with support and ongoing training is key to improving the experiences of women and future care. Funding: National Institute for Health Research. Keywords: Stillbirth, autopsy, communication, grief, sub-Saharan Africa, mixed-methods

Tick burden and acquisition of immunity to Theileria parva by Tarime cattle in comparison to Sukuma cattle under different tick control regimes in the Lake Zone of Tanzania

Journal of Veterinary Medicine and Animal Health 2016, Vol 8(3), pp. 21-28This study was conducted to determine tick burden and immunological parameters of resistance to East Coast fever (ECF) in Tarime and Sukuma cattle. Tick load, packed cell volume (PCV), Theileria parva (T. parva) specific antibody percent positivity (PP), and prevalence of T. parva parasites were studied in relation to dipping regime, strains, and season. A total of 50 experimental cattle were included in this study. Tick load was determined by whole body counts, antibody percent positivity was determined by the polymorphic immunodominant molecule (PIM)-based T. parva enzyme-linked immunosorbent assay (ELISA), and prevalence of T. parva parasites was detected by a nested polymerase chain reaction (PCR) based on the p104 gene. Dipping frequency on tick burden showed no statistically significant differences when cattle of either strain were dipped either once every 2 or 3 weeks in the dry and wet seasons. However, Tarime cattle had higher (p<0.05) tick count than Sukuma cattle and non dipped groups maintained high tick infestation throughout the experimental period. The PCV values were within the physiological range, although this parameter was lower in Tarime cattle (p<0.05). All cattle regardless of strain were seropositive, although Tarime cattle maintained higher PP compared to Sukuma by 15%. Conversely, the prevalence of T. parva parasites was lower in Tarime (38%) compared to Sukuma cattle (38.5%), but the difference was not significant (p>0.05). During the study period, 20% (5/25) of Sukuma cattle contracted ECF, but none of the Tarime cattle showed clinical signs for the disease. The differences between the two strains shown in terms of PP and T. parva parasite prevalence may indicate the ability of individual cattle to resist tick infestation and ECF infection under natural challenge. Higher antibody levels but lower parasite prevalence attained by Tarime cattle, suggests inherent ability of Tarime cattle to resist clinical development of ECF infection, but to remain as T. parva carriers

Screening of women for intimate partner violence : a pilot intervention at an outpatient department in Tanzania

Intimate partner violence (IPV) is a public health problem in Tanzania with limited health care interventions. OBJECTIVES: To study the feasibility of using an abuse screening tool for women attending an outpatient department, and describe how health care workers perceived its benefits and challenges. METHODS: Prior to screening, 39 health care workers attended training on gender-based violence and the suggested screening procedures. Seven health care workers were arranged to implement screening in 3 weeks, during March-April 2010. For screening evaluation, health care workers were observed for their interaction with clients. Thereafter, focus group discussions (FGDs) were conducted with 21 health care workers among those who had participated in the training and screening. Five health care workers wrote narratives. Women's responses to screening questions were analyzed with descriptive statistics, whereas qualitative content analysis guided analysis of qualitative data. RESULTS: Of the 102 women screened, 78% had experienced emotional, physical, or sexual violence. Among them, 62% had experienced IPV, while 22% were subjected to violence by a relative, and 9.2% by a work mate. Two-thirds (64%) had been abused more than once; 14% several times. Almost one-quarter (23%) had experienced sexual violence. Six of the health care workers interacted well with clients but three had difficulties to follow counseling guidelines. FGDs and narratives generated three categories Just asking feels good implied a blessing of the tool; what next? indicated ethical dilemmas; and fear of becoming a 'women hospital' only indicated a concern that abused men would be neglected. CONCLUSIONS: Screening for IPV is feasible. Overall, the health care workers perceived the tool to be advantageous. Training on gender-based violence and adjustment of the tool to suit local structures are important. Further studies are needed to explore the implications of including abuse against men and children in future screening.Forskningsfinansiär/funding agency: Swedish Agency for Research Cooperation, SAREC.</p