End-of-life experiences and expectations of Africans in Australia: cultural implications for palliative and hospice care

Author version made available in accordance with the publisher's policy.The ageing and frail migrants who are at the end of life are an increasing share of migrants living in Australia. However, within such populations, information about end-of-life experiences is limited, particularly among Africans. This article provides some insights into the sociocultural end-of-life experiences of Africans in Australia and their interaction with the health services in general and end-of-life care in particular. It provides points for discussion to consider ethical framework that include Afro-communitarian ethical principles to enhance the capacity of current health services to provide culturally appropriate and ethical care. This article contributes to our knowledge regarding the provision of culturally appropriate and ethical care to African patients and their families by enabling the learning of health service providers to improve the competence of palliative care systems and professionals in Australia. Additionally, it initi- ates the discussion to highlight the importance of paying sufficient attention to diverse range of factors including the migration history when providing palliative and hospice care for patients from African migrant populations

The role of information technology in strengthening human resources for health: The case of the Pacific Open Learning Health Network

Author version made available in accordance with the publisher's policy.Purpose: The purpose of this paper is to discuss innovative ways of addressing Human Resources for Health (HRH) shortage in the Pacific, supported by a review of the literature and the Pacific Open Learning Health Net (POLHN), a program created in response to the Pacific’s HRH concern. Design/Methodology/Approach: A systematic search was conducted of English literature between 1990 and 2012. A number of key words, singly and/or in combination, were used to search for articles on ProQuest and PubMed. Original articles were identified and reference lists scrutinised to obtain additional literature. Due to the paucity of information, only narrative review was conducted and themes emerging from the literature identified and critically reviewed. Findings: There is a worldwide HRH shortage and a need to improve the skills of the health workforce to respond to changing population health needs. Continuing education (CE) through use of information technology (IT) is a means to strengthen HRH. POLHN is one example of an initiative to improve health worker skills and motivation. Technological change is increasingly common place in society. To make sense of these changes, practitioners can look for common themes in successful technological innovations of interactivity; information access, creation, or sharing; communication; and simplicity. To ensure effective governance CE and IT are used to strengthen HRH, there is a need to incorporate qualitative as well as quantitative measures, to prioritise the creation of quality, relevant, and appropriate resources, and to facilitate access and active participation by health workers. Originality/values: The paper highlights the complexity of HRH shortage as a global problem, which demands multiple initiatives to respond to the shortage in the pursuit of skilled, equitable and just delivery of health services and distribution of health service providers. One initiative that has worked elsewhere is professional development of health professionals through the provision of continuing education (CE) using information technology (IT). Online learning offers a pathway to address HRH shortage and overcomes challenges posed by distance, limited infrastructure, and in small remote communities. POLHN contributes to improved skills and knowledge among health professionals who can, as a result, deliver better health services in a region as geographically dispersed and isolated as the Pacific

Assessment of Multidrug Resistant Organism Related Prevention and Control Policies and Environment at KFHH, Saudi Arabid

This work by European American Journals is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en_GB)Worldwide, Healthcare Associated Infections (HAIs) and Multidrug Resistant Organisms (MDROs) cause a significant clinical and economic burden. One of the strategies that have been implemented to reduce antimicrobial resistance is the development of healthcare settings with specific MDROs control policies and guidelines. The aim of this study was to perform an audit in order to assess whether, at the time of writing, the relevant policies and procedures were in place at the King Fahad Hofuf Hospital. The Carter and colleagues’ model, which uses a matrix of acknowledging, auditing, stating of aims, and setting out of actions was used as a model for the assessment of the policies. The researchers conducted site visit rounds of the ICU and the general wards to report on the ratio of rooms for patient care, and the general areas in which hand washing sinks and alcohol-based hand rub products were available. Eight policies related to multidrug resistant organisms were analysed. Inappropriate scientific references were presented in the policies and there were no acknowledgements, auditing, or recommended actions in the majority of these policies according to the Carter and colleagues’ method. The sink to bed ratio was 1:6 in the ICU and 1:25 in the general ward. As well, the sinks were not equipped with non-manual control equipment. In conclusion, An audit of policies in the healthcare setting indicated a number of deficiencies regarding best standard policies and guidelines for infection control. Moreover, there were also inadequate environmental control measures for HAIs and MDROs, including hand hygiene facilitie

Addressing childhood under nutrition in Tanzania: Challenges and opportunities

Childhood undernutrition is highly prevalent in low and middle-income countries resulting in a substantial increase in overall disease burden and mortality. The problem is markedly severe in low-income countries particularly in Africa, and Tanzania is not exceptional. Childhood undernutrition is associated with decreased productivity resulting in a vicious cycle of poverty in affected families, communities and nations. Children who survive after two years of life may develop poor healthoutcomes including faltering growth and irreversible damage to their cognitive, physical and psychosocial development. In a long term, childhood undernutrition can lead to poor socio-economic development of individuals, families and affected communities. Childhood undernutrition in African countries significantly contributes to poor development and the burden of disease as it complicates the existing problem of infectious diseases. Current strategies addressing this problem largely utilise amedical care model which aims to reduce mortality and may have limited selected preventative aspects confined broadly to vaccinations, food fortifications, and micronutrient supplementations. It is apparent that environmental, cultural and social factors are receiving limited attention. This complex and dire situation demands systematic, effective comprehensive multi-level and multi-sectoral policy drivers thatprovide effective socioeconomic, environmental, health policies and legislations in the pursuit of effective, equitable and just delivery of social and health services for all groups of its citizens regardless of their socio-economic status. Tanzania as a nation alongside other developing countries need to recognise the magnitude of this scourge and develop comprehensive approaches that will enable development of legislations,policies and long term solution to childhood undernutrition. This paper reviews strategies outside of the health sector with high potential for preventing childhood undernutrition in Tanzania and that can be translated in many developing countries. Comprehensive range of legislations and policies are recommended for implementation of interventions to reduce their occurrence or ameliorate childhood undernutrition consequences.Key words: childhood undernutrition, Tanzania, effective approac

Indonesian Rural Medical Internship: The Impact on Health Service and The Future Workforce

Background: Studies have shown a shortage of medical practitioners in rural areas, and that graduate doctors are reluctant to practice in the rural areas. To address this shortage and reluctance, the Government of Indonesia implemented a rural medical internship program with the aims of preparing medical graduates for primary medical practice, and attracting them to rural areas. The purpose of this study was to understand the experience of medical interns in the rural medical internship program, and to identify the barriers and enablers to achieving the program aims. Method: A purposive sample of 38 medical interns (70.4%) from five districts of West Sumatera Province, participated in focus group interviews. The interviews were recorded and transcribed verbatim. Data was coded and categorized before thematic analysis for experiences in rural setting specifically to identify factors important for retention of the doctors. Results: The medical interns indicated that their exposure to rural practice did not influence their decision to practice in rural area in the future, with most interns reporting that they did not intend to undertake clinical practice as rural doctors. The main reasons expressed were due to interpersonal issues with senior clinicians, nurses and hospital staff, which resulted in their autonomy and decision making processes being undermined; and a perceived lack of professional and financial reward for practicing as rural doctors. Overall, the study found that the program improved access to medical services in the five districts, but may not improve the shortage of medical practitioners in rural areas on a long term basis Conclusion: A rural medical internship program improves rural medical services. However, the program alone will not address the long term goal of improving rural workforce shortage. Providing incentives for rural doctors and structural change are needed in order to make rural practice more attractive. Key Words: medical internship, rural, primary care, Indonesi

Effects of free maternity service policy in Kenya: an interrupted time series analysis

Background: In Kenya, more than 6000 maternal deaths, and 35000 stillbirths occur each year. In June, 2013, the Government of Kenya abolished user fees for maternity care in all public health facilities under the Free Maternity Service (FMS) policy, to make maternity services accessible and affordable, and to reduce maternal and perinatal deaths. This study aims to establish whether the FMS policy has influenced use of, access to, and quality of maternity care in Kenya. Methods: We did an observational retrospective study in three counties in Kenya. We used daily maternity registers in 90 public health facilities to extract monthly observations for six maternal health indicators in the time period 2 years before and 2 years after the introduction of the FMS policy. We used interrupted time series analysis with a single group to assess the effects of the FMS policy. Standard linear regression using generalised least squares model was used to run the final results for each of the six variables. We calculated absolute and relative changes using model coefficients. Findings: A total of 82962 women from Kilifi, Turkana, and Wajir counties were included in the study. Data were collected between June, 2011, and July, 2015. After policy implementation, there was an increase in antenatal care visits, health facility deliveries, and livebirths of 98% (p=0·0008), 97% (p\u3c0·0001), and 89% (p\u3c0·0001), respectively. The six maternal health output indicators were observed 24 months before implementation of the free maternity service policy (June, 2011, to May, 2013) and 25 months after implementation (June, 2013, to June, 2015), giving 49 observations. We noted an immediate and significant increase of 27% in women who received emergency obstetric care in the first month after policy implementation (p=0·0149). No significant change was observed in rates of stillbirth (p=0·4985) or caesarean section (p=0·4361). Interpretation: The 2013 introduction of free maternity services in Kenya saw an immediate, and then sustained, increase in the use of skilled care during pregnancy and childbirth. This sharp rise in the uptake of services suggest that the hospital cost is the main expense incurred by most women and their families when seeking maternity care services and that this cost is, therefore, a barrier to uptake of maternity care. Funding: Afya Bora Consortium fellowship career development award

Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: a cross-sectional survey

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background The provision of health education involving self-care and good adherence to medications has been acknowledged to be a cost effective strategy for improving quality of life of diabetes patients. We assessed levels of knowledge about type 2 diabetes mellitus (T2DM), self-care behaviours and adherence to medication among DM patients. Methods A facility based cross-sectional survey of 325 adults with T2DM patients attending Jimma University Teaching Hospital, Southwest Ethiopia was conducted. We used diabetes Knowledge Test, Expanded Version of the Summary of Diabetes Self-Care Activities and Morisky 8-Item medication adherence as tools to measure diabetic knowledge, self-care behaviours and adherence to medications respectively. Multinomial logistic regression analyses were used to assess the independent predictors of diabetes knowledge and adherence to medications. The binary logistic regression was applied for self-care behaviours. Results 309 respondents were included in the survey. Of all the respondents, 44.9 %, 20.1 % and 34.9 % had low, medium and high level diabetic knowledge respectively. High level of diabetic knowledge was the reference group. Being illiterate (AOR = 3.1, 95%CI: 1.03-9.3), having BMI <18 kg/m2 (AOR = 6.4, 95%CI: 1.2-34.9) and duration of DM < 5 years (AOR = 4.2, 95%CI: 1.9-9.5) were significantly associated with low level of diabetic knowledge. T2DM patients who practiced good self-care (AOR = 0.5, 95%CI: 0.3-0.9) were less likely to have low knowledge. Duration of DM < 5 years (AOR = 9.8, 95%CI: 3.2-30.2) was significantly associated with medium level of diabetic knowledge. 157(50.8 %) patients had poor self-care behaviour and this was associated with level of education and adherence to medication. The proportions of patients with low, medium and high adherence to medication were 24.9 %, 37.9 % and 37.2 % respectively. Being a merchant, having medium level of diabetic knowledge and having good glycemic control level were associated with low adherence to medications. Conclusions Significant number of DM patients had low level of knowledge, poor self-care behaviours and low level of adherence to medications. These findings call for the need of integrated interventional management on diabetic knowledge, self-care behaviours and adherence to medications. To ensure effective T2DM management, a strategic approach that improves health literacy could be a cross cutting intervention. Electronic supplementary material The online version of this article (doi:10.1186/s12902-016-0114-x) contains supplementary material, which is available to authorized users

Accuracy of maternal recall of birth weight and selected delivery complications in Zanzibar

Background: Birth weight is one of the key predictor for survival, health and future development of a child. In developing countries data on birth weights are limited to obtain due to difficulties in keeping records especially among rural women. Maternal recall of birth weight can therefore become a useful source of birth weight data. This study was carried out to determine recall of birth weight and delivery complications among mothers in Unguja West District of Zanzibar.Methods: This cross-sectional study involve mothers who had children below five years of age. Pretested structured questionnaire was used to collect information on socio-demographic characteristics of the mother, age of the child, birth weight of the child and delivery complications. Other information was obtained from maternal antenatal clinic and child’s growth monitoring cards. Results: A total of 260 women were included in the study. The mean age of the mothers was 29 years, ranging from 17 to 45 years. More than half (62%) had attained secondary education and few had informal education (6.5%) or post-secondary education (12%). Majority of the mothers (85%) delivered at the health facility assisted by trained health care provider. Those who delivered at home (15%) were either assisted by a relative or Traditional Birth Attendant (TBA). Over three quarters (78.5%) of the mothers had birth weights of their children recorded in the postnatal care cards. Out of 38 children who were born at home, 87% (n = 33) were not weighed and there were 23 women (10.4%) who delivered at the hospital but their children’s weight were not recorded. Overall, 46 (20%) mothers could not correctly recall birth weights of their children where. There was strong correlation between recall and recorded birth weight (r2=0.79; p&lt;0.01). Reported/recorded delivery complications were hypertension, excessive bleeding, low birth weight, episiotomy, anaemia and preeclampsia.Conclusion: Maternal recall can provide reliable information with regard to child’s birth weight and delivery complications. Health facility staff should measure child’s weight correctly, inform the mother and record in the child’s card in order to facilitate correct recall by the mothers

Nutrients and antinutrients composition of raw, cooked and sun-dried sweet potato leaves

Traditional indigenous vegetables are the most economically efficient source of micronutrients in terms of both land required and production costs per unit. Promotion of production and consumption of such micronutrient-rich foods will improve intakes, the overall diet, and health status. This study aimed to determine nutrient (iron, calcium, vitamin A and ascorbic acid) and anti-nutrient (oxalates and polyphenols) contents in raw, cooked and dried sweet potato leaves Two varieties of sweet potatoes, which were identified as commonly grown for leaves consumption were analyzed at Department of Food Technology, Sokoine University of Agriculture and at the Government Chief Chemist Laboratory Tanzania. The analysis included proximate, nutrient (ascorbic acid, carotenoids, iron and calcium) and anti-nutrient (oxalate and polyphenols) composition. The purple midrib sweet potato leaves were further analyzed for nutrient and anti-nutrient retention after cooking (with and without lemon) and open sun-drying (with and without salting). There was no significant difference (P&gt;0.05) between the two varieties in crude protein, crude lipid and moisture content. The purple midrib sweet potato leaves had significantly (P&lt;0.05) higher ash, crude fibre, carotenoids, calcium and iron contents while the green midrib sweet potato leaves had significantly (P&lt;0.05) higher ascorbic acid content. The polyphenols were about 4 times higher in the purple midrib sweet potato leaves (22.16%) as compared to that of the green ones (5.28%), which had significantly higher oxalate levels (3730 mg/100g). Drying with salt and cooking with lemon reduced polyphenols significantly (p&lt;0.05), with retention of 42% and 56% respectively; while cooking with lemon lowered significantly the oxalate levels. The traditional methods of cooking SPL with addition of lemon is advantageous because it reduces polyphenols while retaining higher levels of minerals, &beta; carotene and vitamin C. Drying with salt results in a nutritionally and organoleptically good product, hence, drying with salt and cooking with addition of lemon is encouraged. Since the sweet potato leaves are harvested more than once before the plant is uprooted, further studies are recommended to assess whether there is variation in nutrient and anti-nutrient contents in consecutive harvests.Key words: Sweet potato leaves, nutrients, antinutrient

Association between maternal stature and household-level double burden of malnutrition : findings from a comprehensive analysis of Ethiopian Demographic and Health Survey

Background: Undernutrition among under-five children is one of the intractable public health problems in Ethiopia. More recently, Ethiopia faced a rising problem of the double burden of malnutrition—where a mother may be overweight/obese, and a child is stated as having undernutrition (i.e., stunting, wasting, or underweight) under the same roof. The burden of double burden of malnutrition (DBM) and its association with maternal height are not yet fully understood in low-income countries including Ethiopia. The current analysis sought: (a) to determine the prevalence of double burden of malnutrition (i.e., overweight/obese mother paired with her child having one form of undernutrition) and (b) to examine the associations between the double burden of malnutrition and maternal height among mother–child pairs in Ethiopia. Methods: We used population-representative cross-sectional pooled data from four rounds of the Ethiopia Demographic and Health Survey (EDHS), conducted between 2000 and 2016. In our analysis, we included children aged 0–59 months born to mothers aged 15–49 years. A total of 33,454 mother–child pairs from four waves of EDHS were included in this study. The burden of DBM was the primary outcome, while the maternal stature was the exposure of interest. Anthropometric data were collected from children and their mothers. Height-for-age (HFA), weight-for-height (WFH), and weight-for-age (WFA) z-scores < − 2 SD were calculated and classified as stunted, wasting, and underweight, respectively. The association between the double burden of malnutrition and maternal stature was examined using hierarchical multilevel modeling. Results: Overall, the prevalence of the double burden of malnutrition was 1.52% (95% CI 1.39–1.65). The prevalence of overweight/obese mothers and stunted children was 1.31% (95% CI 1.19–1.44), for overweight/obese mothers and wasted children, it was 0.23% (95% CI 0.18–0.28), and for overweight/obese mothers and underweight children, it was 0.58% (95% CI 0.51–0.66). Children whose mothers had tall stature (height ≥ 155.0 cm) were more likely to be in the double burden of malnutrition dyads than children whose mothers’ height ranged from 145 to 155 cm (AOR: 1.37, 95% CI 1.04–1.80). Similarly, the odds of the double burden of malnutrition was 2.98 times higher for children whose mothers had short stature (height < 145.0 cm) (AOR: 2.98, 95% CI 1.52–5.86) compared to those whose mothers had tall stature. Conclusions: The overall prevalence of double burden of malnutrition among mother–child pairs in Ethiopia was less than 2%. Mothers with short stature were more likely to suffer from the double burden of malnutrition. As a result, nutrition interventions targeting households’ level double burden of malnutrition should focus on mothers with short stature to address the nutritional problem of mother and their children, which also has long-term and intergenerational benefits