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Multimorbidity, Healthcare Processes, And Mortality Among Tb/Hiv Patients Treated With Antiretroviral Therapy In Uganda, Abel Nkolo

Walden Dissertations and Doctoral Studies

Globally, Uganda is one of the 30 tuberculosis (TB) and human immunodeficiency virus (HIV) high burden countries with high antiretroviral therapy (ART) coverage, yet mortality is still high among TB/HIV patients on ART. The reasons for the high mortality have not been fully explored. The purpose of this study was to determine the association between multimorbidity, age, sex, marital status, phase of TB treatment, timing of initiation for ART, and type of TB and mortality among TB/HIV patients on ART in Uganda. The health outcomes conceptual framework with 3 domains that directly or indirectly affect the outcome domain was used …

How Women Who Have Recidivated Describe Their Readiness For Employment After Release From Prison, Simba Kathleen Fox

Walden Dissertations and Doctoral Studies

Since the 1980s, the population of women prisoners incarcerated in the state of California had significantly increased by 500% more than that of the male prisoners. The United States had more incarcerated women than any other country. Along with this alarming rise in female incarceration, recidivism rates were also higher among female inmates. This problem has negatively affected women in California; whereas 57% of the women released from prison were rearrested within three to seven years. The purpose of this qualitative phenomenological research study was to investigate how 18 women who had recidivated with the same or a different criminal …

Risk Factors For Foodborne Illness Outbreaks In Retail Food Establishments, Brendalee Viveiros

Walden Dissertations and Doctoral Studies

Despite policies and interventions over the last two decades, foodborne illness remains a significant public health concern. According to the CDC’s Foodborne Disease Outbreak Surveillance System, 60% of reported foodborne illness outbreaks involved food that was prepared at a restaurant. Reducing foodborne illness outbreaks that occur at restaurants would have a significant impact on the overall number of foodborne illnesses that occur each year. The purpose of this study was to quantitatively analyze the differences in risk factors in food establishments that have had a foodborne illness outbreak compared to food establishments that have not. This study used Reckwitz’s theory …

Impact Of Out-Of-Pocket Fees On Under-5 Infant Mortality In Cameroon, Amelie Olga Mafotsing Fopoussi

Walden Dissertations and Doctoral Studies

Health facilities in Cameroon charge fees for treatment and services, which can affect health outcomes for those unable to pay for services. Some studies have shown that the removal of user fees had a positive impact on child health outcomes in selected African countries. The aim of this quantitative, cross-sectional study was to understand whether there is a link between out-of-pocket expenses and under-5 mortality in Cameron. The study was guided by the social ecological framework. Secondary data from the 2011 Cameroon Demographic Health Survey were used in the study. Chi-square, binary logistic regression, and multicollinearity analyses were used to …

Examining Terrorism Attacks And Regional Preparedness In The United States, Trebor Curtis Yocum

Walden Dissertations and Doctoral Studies

After the 9/11 terrorist attacks, the U.S. government renewed efforts to prepare for future attacks. Despite research on federal and state government preparedness, there was a lack of scholarship on trends in terrorist attacks at the local level. The purpose of this quantitative descriptive study was to examine trends in terrorism attacks in the United States between 2001 and 2018 and determine whether significance exists between characteristics of the terrorism incidents (weapon used, target type) and region. The conceptual framework included Grundmann’s risk management and Tomuzia et al.’s risk assessment scenario models. Answering the research questions entailed examining trends in …

Demographic And Socioeconomic Determinants Of Lassa Fever In Edo State, Nigeria, Faith Ogagaroghene Ireye

Walden Dissertations and Doctoral Studies

Lassa fever is a viral hemorrhagic fever caused by the Lassa virus and associated with significant morbidity and mortality. Yearly outbreaks of the disease occur in Edo State, Nigeria. The purpose of this study was to examine the demographic and socioeconomic factors that can influence transmission of the disease. The Commission on Social Determinants of Health conceptual framework was used in this research study. This framework describes the relationship between structural and intermediary factors and how they determine health outcomes. To answer the research question of how demographic and socioeconomic factors influence Lassa fever transmission in Edo State, a cross-sectional …

Staff Education Program For Chlamydia And Gonorrhea Self-Collected Vaginal Swabbing, Cheryl Marie Tugman

Walden Dissertations and Doctoral Studies

Girls and women carry the burden of negative consequences of untreated sexually transmitted diseases (STDs), such as chlamydia and gonorrhea. Screening for chlamydia and gonorrhea by increasing self-collected vaginal swabbing (SCVS) can improve access of care and prevent delayed treatment. Nurses may support their patients if they receive training in how to teach screening for sexual self-healthcare. The purpose of this project was to develop and conduct a staff education program in an urban primary care clinic. The project addressed whether the education program would increase nurses’ knowledge of SCVS. The goal is to ultimately increase female patients’ access to …

The Role Of The Public During The Decision-Making Process In Preparation For And In Response To A Pandemic, Ludmila M. Flores

Walden Dissertations and Doctoral Studies

AbstractMany advances have been made in technology and medicine; however, humanity remains vulnerable to existing, emerging, and re-emerging infectious diseases that have a profound negative impact on our society. This study investigated how individuals balance socioeconomics, demographics, and religious views with their actual behavior in response to public health guidelines during an epidemic/pandemic. The participants' perceptions and experiences of a practical problem, how the public was asked to respond, and how the public ultimately responded to public health guidelines were explored. The theoretical model for the study, the polarity of democracy model, has been explored as a possible decision-making tool …

Sociodemographic Factors Associated With Childhood Vaccination Status In Sokoto State, Nigeria, Dauda Milgwe Madubu

Walden Dissertations and Doctoral Studies

Immunization remains one of the most successful and cost-effective public health interventions worldwide. Despite the critical role of vaccines in improving childhood and maternal health, Sokoto state recorded the lowest childhood vaccination completion rate among the 37 states in Nigeria with only 5% of children aged 12-23 months having had full childhood vaccination based on data from the 2018 demographic and health survey. The factors associated with the state’s low childhood vaccination status have not been explored. The study examined the relationship between the sociodemographic factors including parents’ socioeconomic and ethnoreligious factors, place of residence, and children’s biological characteristics and …

Associations Between The Use Of Bed Nets And Malaria Infection On The School Performance Of Juveniles In Ghana, Ans Bumbokuri

Walden Dissertations and Doctoral Studies

Millions of malaria cases are reported yearly in sub-Saharan Africa, events which adversely influence children’s school performance. The purpose of this quantitative, cross-sectional study was to investigate the effectiveness of major malaria control policies in reducing malaria cases as a means of improving academic performance among school children in the greater Accra region of Ghana. A secondary data set was obtained from the 2014-2016 data from the Ghana Malaria Indicator Survey (GMIS). Findings indicated that bed net use and malarial episodes in children of participant recorded a p-value of 0.43 which is a significant association between the variables. The likelihood …

Surgical Site Infection Rates After Implementation Of The Surgical Care Improvement Project Initiative, Victor Lao De Guzman Jr

Walden Dissertations and Doctoral Studies

Surgical site infections (SSIs) reflect a serious complication in modern healthcare and are a substantial burden to healthcare systems and service payers worldwide in terms of patient morbidity, mortality, and additional costs. The Surgical Care Improvement Project (SCIP), introduced in 2006, was developed by the Centers for Medicare and Medicaid Services to reduce SSI rates by 25%. However, SCIP was retired in 2015. Given the considerable financial burden of SSIs and because SSIs may be prevented using evidence-based measures, it was worth revisiting and re-evaluating the quality improvement efforts brought about by the success of the evidence-based SCIP initiative. This …

The Experience Of Women With Opioid Use Disorder Accessing Methadone Treatment, Lizette Cristine Keenan

Walden Dissertations and Doctoral Studies

The number of women experiencing opioid use disorder (OUD) in Canada has increased exponentially. In Canada, healthcare is socialized and free for all citizens and often medications like methadone are free as well, yet few individuals with OUD access treatment services. The purpose of this study was to describe the lived experiences of Canadian women with OUD who were receiving methadone treatment. Interpretive phenomenology was used to investigate the treatment experiences of seven women with OUD. The conceptual framework of self-care of chronic illness was used examine this phenomenon. Data was analyzed using a seven step process of interpretive phenomenological …

Determinants Of Substance Abuse Among Users With Mental Health Issues In Ogun State, Nigeria, Michael Olusegun Adejimi

Walden Dissertations and Doctoral Studies

In Nigeria, about 14.3 million people use drugs without physician prescription and approximately 30% of Nigerians suffer from mental illness, some of which is due to substance abuse. This study examined the associations between (a) socio-demographic factors and substance abuse among users with mental health issues in Ogun State Nigeria, (b) clinical variables and substance abuse among users with mental health issues, (c) negative life events and substance abuse among users with mental health issues, and (d) social supports and substance abuse among users with mental health issues. This study theoretical framework was based on the definition of mental health …

Reducing Infection Rates Through Handwashing Education, Maureen N. Osegbe

Walden Dissertations and Doctoral Studies

AbstractHealth care-associated infections (HCAIs) affect millions of people worldwide, causing morbidity and mortality among hospitalized patients. Hand hygiene is the single most effective way to prevent HCAIs. This project addressed a gap in practice regarding nurses’ knowledge on the effective use of hand hygiene in a medical/surgical unit in a hospital located in northeastern Maryland. This project addressed the question of whether an educational program on handwashing for nurses reduced HCAI rates. A literature review was conducted to support the development of the educational program; relevant sources included peer-reviewed journal articles, systematic reviews, and guidelines that supported the practice-focused question, …

Antibiotic Stewardship: Decreasing Antibiotic Use For Viral Upper Respiratory Infections, Merkessie Taresa Redix

Walden Dissertations and Doctoral Studies

AbstractOverprescribing antibiotics for viral upper respiratory infections is a common practice in the United States. This overprescribing of antibiotics can cause several health issues and increase health care costs. Despite the current guidelines recommended by the Centers for Disease Control and Prevention (CDC) the overprescribing of antibiotics by providers remains an issue. The purpose of this project was to educate providers on antibiotic stewardship for viral upper respiratory infections. The practice question was used to explore whether an educational program using concepts from Lewin’s change theory and Kolb’s learning theory would increase provider’s knowledge about the current evidence- based prescriptive …

Blood Culture Staff Education To Improve Knowledge And Contamination Prevention, Christina Michelle Harvey

Walden Dissertations and Doctoral Studies

AbstractThere was an underlying issue with nurses improperly drawing blood cultures resulting in false results that impact patient care. The project examined the question whether a staff education program for Veteran’s Affairs Registered Nurses on the effects of correct blood culture specimen collection can demonstrate an increase in knowledge in the VA’s collection procedure leading toward increasing compliance. The purpose was to correct a knowledge deficit leading to a lack of compliance of the VA nurses on the target unit. The project was directed by the principles of the Knowles’ adult learning model. The sources that generated evidence for the …

Evaluating Compliance With The Produce Safety Rule And Managing Mycotoxins, Yvette May Molajo

Walden Dissertations and Doctoral Studies

Foodborne diseases are the cause of many illnesses that occur from foods that contain mycotoxins. Mycotoxins are produced from fungi and are environmental and carcinogenic agents that contaminate agricultural foods during preharvest and postharvest conditions. While researchers have conducted many studies on mycotoxin occurrence and production, there is a significant gap in the current literature regarding which environmental factors could put farmers’ ability to remain in compliance with the Food Safety Modernization Act’s Produce Safety Rule at risk. Therefore, the purpose of this quantitative study was to investigate which environmental factors could put farmers’ ability to remain in compliance with …

Misuse Of Prescription Pain Relievers Among Pregnant Women In The United States, Winnie Chebet Rono

Walden Dissertations and Doctoral Studies

The non-medical use of prescription pain relievers has increased remarkably, posing social and public health concerns particularly in developed countries such as the United States. The management of pain experienced by pregnant women poses a challenge to clinicians considering the effects of the regimen on unborn babies. Guided by the health belief model, which aims to predict health-related behavior in terms of certain health beliefs and explain change and behavior maintenance as well as to guide health behavior interventions, this cross-sectional study aimed to understand the associations between misusing pain relievers and social determinants of health such as education level …

Predictors Of Obesity Among Young Adults In The State Of Maryland, Kala Shahi

Walden Dissertations and Doctoral Studies

AbstractObesity has become a global wellness concern for young adults. In the past, there were very few studies conducted on predictors of obesity among young adults, even though there have been several studies on the potential predictors of obesity on the general population. The social ecological model was used to guide this quantitative cross-sectional study to identify the possible predictors of obesity among young adults. The Behavioral Risk Factor Surveillance System was used to analyze the potential predictors of obesity among young adults between the ages 18 – 34 years old in Montgomery County, Frederick County, and Princess Georges County, …

Social/Cultural Factors In Preschool Immunizations, Mozambique, Kristine Gayle Bernabe

Walden Dissertations and Doctoral Studies

Immunizations are scientifically proven, effective global health interventions that prevent infectious diseases and save lives. Yet, in Mozambique at the national level, less than 65% of children are fully immunized, i.e., received all the basic/routine vaccinations. The overall purpose of the doctoral study was to conduct quantitative research examining the sociocultural factors that may impact childhood immunization status in the context of the social ecological model. The study examined the relationship between child’s gender, mother’s and her husband/partner’s educational level, household wealth index, religion, ethnicity/language, urban-rural residency, and province/region with the child’s full immunization status in Mozambique. Secondary analysis of …

The Exploration Of Clinical Supervision For Substance Abuse Social Workers In Bermuda, Steva Aria Bean

Walden Dissertations and Doctoral Studies

As specialists who bridge the gap between the social work and substance abuse treatment fields, substance abuse social workers are expected to develop themselves as social workers by designation, substance abuse counselors by occupation, and deliver competent therapeutic services that align both professions seamlessly. As documented in the National Association of Social Workers Code of Ethics, their support in achieving this feat is clinical supervision. Despite this documentation, a review of the social work literature revealed an absence of information on clinical supervision between the social work and substance abuse fields, their supervisory alliance, and outcomes. Accordingly, this project was …

The Combined Impact Of Race And Education On Obesity Among U.S. Adults By Fidelis Okoye, Fidelis Chidi Okoye

Walden Dissertations and Doctoral Studies

Walden University

College of Health Professions

This is to certify that the doctoral dissertation by

Fidelis Okoye

has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made.

Review Committee Dr. Vasileios Margaritis, Committee Chairperson, Public Health Faculty Dr. Srikanta Banerjee, Committee Member, Public Health Faculty Dr. James Rohrer, University Reviewer, Public Health Faculty

Chief Academic Officer and ProvostSue Subocz, Ph.D.

Walden University2021

AbstractThe Combined Impact of Race and Education on Obesity Among U.S. Adults by Fidelis Okoye

MA, Walden University, 2009BS, Marygrove College, 2001

Dissertation …

Operation Enduring Freedom And Operation Iraqi Freedom Veterans In The Veterans Health Administration, Exekiel Montoya Aranez

Walden Dissertations and Doctoral Studies

The Veterans’ Health Administration (VHA) has faced critical issues regarding the deaths of war veterans, the result of which stakeholders raised questions about the quality of health care given within the VHA. Through patient-centered care standards of health care, the VHA worked diligently to end such horrific events that more than 300,000 veterans may have died while waiting for health care service. This study examined five core concepts of the health care system and whether VHA has utilized its five core concepts of patient-centered care to deliver proper health care to war veterans. This study used qualitative research in the …

Improving Nursing Knowledge On Antibiotic Therapy To Prevent Pneumonia Readmissions, Muskuda Deen

Walden Dissertations and Doctoral Studies

Lack of education on the appropriate use of antibiotic therapy can lead to an increase in early readmissions for patients with community-acquired pneumonia (CAP). The purpose of this project was to educate medical-surgical nurses at an inpatient hospital in the southern region of the United States on the appropriate use of antibiotic therapy to decrease early CAP readmissions. The project practice question was whether the infection control clinical practice guidelines would increase the medical-surgical nurses’ knowledge on the appropriate use of antibiotic therapy to decrease the 30-day readmission rates for patients diagnosed with CAP. The staff education development was guided …

Reproductive Health Factors And Maternal Mortality Of Internally Displaced Women In Nigeria, Fatima Mahmood Jibirilla

Walden Dissertations and Doctoral Studies

Approximately 529,000 women die from pregnancy-related causes every year, with 99% of these maternal deaths occurring in developing countries. Each year, about 59,000 maternal deaths occur in Nigeria, with a mortality rate of 576 deaths per 100,000 births. Women constitute about half of the 33.2 million internally displaced persons (IDPs) worldwide. The purpose of this retrospective cross-sectional study was to explore the association between the reproductive health factors and maternal mortality of internally displaced women in Borno state, Nigeria. McCarthy and Maine’s model for determinants of maternal mortality informed this study. A secondary dataset of 400 women (age 14-49 years) …

The Causes And Control Measures Of Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae In Long-Term Care Facilities, Ismaila Olatunji Sule

Walden Dissertations and Doctoral Studies

Due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), infections among residents are increasing in long-term care facilities (LTCFs), resulting in high rate of morbidity and healthcare costs. ESBL-PE resists empirical antibiotics and reduces treatment options, and a designated infection control team is unavailable to prevent the prevalence of the disease. Ecological theory guided this study. A systematic review and meta-analysis were conducted to characterize the causes of ESBL-PE and evaluate the infection control strategies within LTCFs. Multiple regression analysis (MRA) was included as supplementary statistical analysis to identify relationships between LTCFs, geographical locations, infection control measures (ICMs), and ESBL-PE. A systematic search …

Lived Experiences Of Lassa Fever Survivors In Southsouth Nigeria, Albert Oamen Oyeribhor

Walden Dissertations and Doctoral Studies

AbstractLassa fever, a viral disease, was first isolated in the late 1960s and affects 300,000 to 500,000 people, causing 5,000 to 10,000 fatalities annually across West Africa. Although there are studies on the causes and prevalence of Lassa fever, there is a paucity of studies regarding the quality of life (QoL) and lived experiences of survivors. The purpose of this qualitative study, guided by Leininger’s culture care theory, was to describe the QoL and meanings of the lived experiences of Lassa fever survivors in the Southsouth region of Nigeria. Fifteen survivors of Lassa disease were interviewed. Data were analyzed using …

Post-Conflict Mental Health Policy And Substance Use Among Liberian Adults, Ekua Amonoo-Lartson

Walden Dissertations and Doctoral Studies

AbstractThe objective of post-conflict countries after an extended period of war and trauma is to maintain peace and stability. However, the physical and psychological effects of substance use to cope with the devastation of war remains long after the crisis has ended. The purpose of this qualitative phenomenological study was to examine substance use among Liberian working-age adults, including their substance use habits, experiences with substance use, and access to mental health rehabilitative treatment. The access to medical care theoretical framework was used to guide the study. Data were collected from face-to-face semistructured interviews with 15 individuals regarding their experiences …

Leadership, Quality Improvement, Team Functionality, And Hiv Viral Load Suppression In Uganda, Esther Karungi Karamagi Nkolo

Walden Dissertations and Doctoral Studies

Low viral load suppression rate is a significant public health issue in Uganda and similar countries. A nationwide quality improvement (QI) initiative was implemented from January 2019 to improve viral load suppression. Although QI team characteristics have been shown to influence the success of such QI initiatives, no studies have been found to understand how they influence the success of QI efforts to improve HIV viral load suppression in Uganda. The purpose of this cross-sectional, quantitative study was to determine whether there is a significant association between HIV clinic leader involvement in QI teams, QI team functionality, QI team diversity, …

Syndromic Surveillance Markers Associated With Dengue In Saint Lucia, Brendan Lee

Walden University Research Conference

This study was executed to identify the specific clinical symptoms associated with dengue in Saint Lucia. A retrospective, non-experimental study was designed using syndromic surveillance data from the Ministry of Health and Wellness Saint Lucia from 2009-2017. Results allowed the demonstration of a significant relationship between undifferentiated fever, acute respiratory infections or fever with respiratory signs, gastroenteritis, and dengue. These results potentially can be used by clinicians in Saint Lucia to more quickly identify cases of dengue that may have otherwise not have included dengue in an initial differential diagnoses list, especially in light of a current regional dengue epidemic. …