Investigation of the sequential validity of quality improvement team self-assessments in a health facility HIV improvement collaborative in Tanzania

Background: Self-assessment is widely used in the health care improvement collaboratives quality improvement (QI) teams’ to assess their own performance. There is mixed evidence on the validity of this approach. This study investigated sequential validity of self-assessments in a QI HIV collaborative in Tanzania.Objectives: Define the separate self-assessment steps in QI process; determine if the validity of self-assessments improved over time; determine if validity improvement is the same for the different self-assessment activities and determine if validity is the same for the different facilities and type of care.Design: Prospective semi-quantitative study.Setting: The study was undertaken over 10 months in nine facilities in Mtwara region of Tanzania following appropriate approvals. Study did not interfere with routine services and processes of continuous quality improvement at the facilities.Subjects:Trained investigators retrieved information from records and the computers using data capture forms. Patients of service providers were not questioned or participate in the study.Conclusion:The validity of self-assessments in the HIV/ART/PMTCT Improvement Collaborative in Mtwara region of Tanzania improved as the collaborative matured. Data from computerised data bases unreliable, calling for more training in the use of computers. The weakness in communication should be addressed by collaborative designers and coaches

The role of metaphor in shaping the identity and agenda of the United Nations: the imagining of an international community and international threat

This article examines the representation of the United Nations in speeches delivered by its Secretary General. It focuses on the role of metaphor in constructing a common ‘imagining’ of international diplomacy and legitimising an international organisational identity. The SG legitimises the organisation, in part, through the delegitimisation of agents/actions/events constructed as threatening to the international community and to the well-being of mankind. It is a desire to combat the forces of menace or evil which are argued to motivate and determine the organisational agenda. This is predicated upon an international ideology of humanity in which difference is silenced and ‘working towards the common good’ is emphasised. This is exploited to rouse emotions and legitimise institutional power. Polarisation and antithesis are achieved through the employment of metaphors designed to enhance positive and negative evaluations. The article further points to the constitutive, persuasive and edifying power of topic and situationally-motivated metaphors in speech-making

O029: Reporting and case management of bloodborne pathogen exposures among health care workers in Tanzania

Introduction: In sub-Saharan Africa, bloodborne pathogens exposure (BPE) is a serious risk to health care workers (HCW). Reporting BPE is necessary for effective post-exposure prophylaxis (PEP), an important element of workplace safety in health facilities. Limited data are available on factors associated with BPE reporting among HCW. Methods: We conducted a cross-sectional study assessing experiences of occupational BPE, history of BPE reporting, and use of PEP among health care workers at three public hospitals in Tanzania. From August to November 2012, HCW were interviewed using Audio-Computer Assisted Self-Interview. All HCW at risk for BPE were invited to participate. Factors associated with reporting BPE were identified using logistic regression. Results: Of the 1,102 eligible HCW, 973 (88%) completed the interview. Of these, 690 (71%) were female and 387 (40%) were nurses. Of 357 HCW who had a BPE in the past 6 months, 120 (34%) reported it. Among these 120 reported exposures, 93 (78%) HCW reported within 2 hours of exposure, 98 (82%) received pre- and post-HIV test counseling, and 70 (58%) were offered PEP; 68 (97%) of these 70 HCWs completed PEP. Independent risk factors associated with reporting BPE were being female (adjusted odds ratio (AOR)=2.0 [95% confidence interval (CI) 1.2-3.5), having ever-received BPE training (AOR=2.0, CI 1.2-3.5), knowledge that HCW receive PEP at another facility (AOR=2.6, CI 1.5-4.4) and HIV testing within the past year (AOR=2.3, CI 1.2-4.4). Conclusion: Despite the significant proportion of HCW with a recent BPE, only one in three reported it. Our results highlight the importance of appropriate and continuous training on the prevention and reporting of occupational exposures to increase acceptance of HIV testing after BPE. Disclosure of interest: None declared

Illicit Drug Users in the Tanzanian Hinterland: Population Size Estimation Through Key Informant-Driven Hot Spot Mapping

We mapped hot spots and estimated the numbers of people who use drugs (PWUD) and who inject drugs (PWID) in 12 regions of Tanzania. Primary (ie, current and past PWUD) and secondary (eg, police, service providers) key informants identified potential hot spots, which we visited to verify and count the number of PWUD and PWID present. Adjustments to counts and extrapolation to regional estimates were done by local experts through iterative rounds of discussion. Drug use, specifically cocaine and heroin, occurred in all regions. Tanga had the largest numbers of PWUD and PWID (5190 and 540, respectively), followed by Mwanza (3300 and 300, respectively). Findings highlight the need to strengthen awareness of drug use and develop prevention and harm reduction programs with broader reach in Tanzania. This exercise provides a foundation for understanding the extent and locations of drug use, a baseline for future size estimations, and a sampling frame for future research

Stance and metaphor: mapping changing representations of (organizational) identity

This article illustrates how metaphor is used as a stance-taking resource and strategy to indirectly index enduring and changing representations of organizational identity through an analysis of speeches delivered by consecutive Secretary Generals of an agency of the United Nations. Drawing on Bucholtz and Hall’s (2005, 2006) framework of identity, and recent research on stance (e.g. Du Bois, 2007), it illustrates how metaphor marks attitudes and orientations to context, propositions and social and political structures/relationships. The analysis highlights similarities in the depiction of the organization over two terms of office, but also reveals differences in identity positioning and inter-subjective framing. Particular metaphorical scenarios and mappings are used rhetorically to strengthen subject positions and alignments, and mark evaluations, supporting Du Bois’s theory of stance as a ‘triune’ act. It is argued that a combined analysis of stance and metaphor provides an important framework and instrument for further research on identity construction, especially in organizational and political discourse. Moreover, the theory of stance can be further enhanced through an investigation of metaphorical mappings