Medicine and Health Sciences Commons^™

Factors Associated With Hiv Testing Among Pregnant Women In Rwanda: A Nationwide Cross-Sectional Survey, Lilian Nuwabaine, Joseph Kawuki, Angella Namulema, John Baptist Asiimwe, Quraish Sserwanja, Ghislaine Gatasi, Elorm Donkor

School of Nursing & Midwifery, East Africa

Human immunodeficiency virus (HIV) testing during pregnancy is crucial for the prevention of mother-to-child transmission of HIV, through aiding prompt treatment, care, and support. However, few studies have explored HIV testing among pregnant women in Rwanda. This study, therefore, aimed to determine the prevalence and associated factors of HIV testing among pregnant women in Rwanda. We used secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS), comprising 870 pregnant women. Multistage stratified sampling was used by the RDHS team to select participants. We conducted bivariable and multivariable logistic regression to explore factors associated with HIV testing using SPSS …

The Social, Mental, And Physical Health Impacts Of The Covid-19 Pandemic On People With Hiv: Protocol Of An Observational International Multisite Study, Yvette P. Cuca, Christine Horvat, Inge Corless, Craig Phillips, Álvaro José Sierra-Perez, Solymar Solís Báez, Emilia Iwu, Motshedisi Sabone, Mercy Tshilidzi Mulaudzi, Sheila Shaibu

School of Nursing & Midwifery, East Africa

As the COVID-19 pandemic spread across the world, immunocompromised individuals such as people with HIV (PWH) may have faced a disproportionate impact on their health and HIV outcomes, both from COVID-19 and from the strategies enacted to contain it. Based on the SPIRIT guidelines, we describe the protocol for an international multisite observational study being conducted by The International Nursing Network for HIV Research, with the Coordinating Center based at the University of California, San Francisco (UCSF) School of Nursing. Site Principal Investigators implement a standardized protocol to recruit PWH to complete the study online or in-person. Questions address demographics; …

Global Partnerships In Transformation Of Nursing And Midwifery Education In Africa: A Systematic Scoping Review Protocol, Claudine Muraraneza, Donatilla Mukamana, Godfrey Katende, Oliva Bazirete, Liz Wolvaardt

School of Nursing & Midwifery, East Africa

Background In recent decades, the literature on global partnerships in nursing and midwifery education, for the purpose of enhancing quality of education, strengthening health care system, and achieving universal health coverage is on the rise in Africa. However, there is a gap regarding the best practices and barriers in the African context. The purpose of this systematic scoping review is to map the evidence on global partnerships in transforming nursing and midwifery education in Africa.

Methods A search will be conducted with the use of the following electronic databases: Cumulative Index to Nursing and Applied Health Literature [CINAHL], PubMed, Cochrane …

Disrespect And Abuse In Maternity Care In A Low-Resource Setting In Tanzania: Provider’S Perspectives Of Practice, Loveluck Mwasha, Lucy Kisaka, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Background

Globally, women experience disrespectful and abusive care from maternity healthcare providers at health facilities, committed intentionally or unintentionally, particularly during labor and delivery. Disrespectful care affects women’s childbirth experience and birth outcomes.

Methods

This study used a descriptive qualitative design to obtain thick and rich data on disrespect and abuse in maternity care in a low-resource setting in Tanzania. Three days workshop was conducted at the Aga Khan University comprising maternity healthcare providers from diverse settings. The workshop was designed based on the existing evidence and anecdotal data and inspired by the authors’ experiences of disrespectful and abusive care …

Experiences Of Mothers And Significant Others In Accessing Comprehensive Healthcare In The First 1000 Days Of Life Post-Conception During Covid-19 In Rural Uganda, Grace Nakate, Sean Mackay, Eunice Ndirangu, Valerie Fleming

School of Nursing & Midwifery, East Africa

Background: COVID-19 presented an unprecedented global public health challenge because of its rapid and relentless spread, and many countries instituted lockdowns to prevent the spread of infection. Although this strategy mayhave been appropriate to reduce infection, it presented unintended difficulties in rural Uganda, especially in maternal and born newborn care. For example, some services were suspended, meaning the nearest health facility was at a considerable distance. This study explored the experiences of mothers and their significant others of comprehensive care in the first 1000 days of life post-conception during the COVID-19 pandemic in Bunghokho-Mutoto sub-county, Mbale District, Uganda.

Methods …

Capacity Building Among Nursing And Midwifery Professional Associations In East Africa, Stephen Ruhmel, Eunice Ndirangu, Joseph Mwizerwa, Ahmed Sarki, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Background: Despite improvements in educational opportunities, policy changes, and pay raises in the nursing and midwifery professions in East Africa, poor working conditions, few professional development opportunities, and a general lack of respect for these professions predominate. These issues contribute to a low quality of care among a population with a high burden of communicable diseases. Health professional associations may help to address these challenges by providing a voice for nurses and midwives.

Objective: This study evaluated the impact of a 5-year programme focused on strengthening nurses’ and midwives’ professional associations in East Africa. Methods: This study used …

Knowledge, Attitudes, And Preparedness For Managing Pregnant And Postpartum Women With Covid-19 Among Nurse-Midwives In Kenya, Rose Maina, Rachel Kimani, James Orwa, Bernard Mutwiri, Carolyne K. Nyariki, Sheila Shaibu, Valerie Fleming

School of Nursing & Midwifery, East Africa

Introduction: Globally, maternal morbidity and mortality have increased during the COVID-19 pandemic. Given the high burden of maternal and neonatal mortality in Kenya prior to COVID-19, front line health workers, including nurse-midwives, must be competent to ensure continued quality maternal services. Knowledge and awareness of COVID-19 transmission influence nurse-midwives risk perception and ability to implement prevention strategies.

Objective: We examined nurse-midwives’ knowledge, attitudes, and preparedness in managing pregnant and postpartum women with COVID-19 in Kenya.

Methods: A cross-sectional online survey was conducted among 118 nurse-midwives between July 2020 and November 2020. A 31-item survey comprising 15 knowledge, …

Midwife-Led Community Transformation (Milcot) Nursing Now Challenge In Uganda, Harriet Nayika, Cliff Aliga, Lisa Bayliss-Pratt, Robert Kagwire, Grace Edwards

School of Nursing & Midwifery, East Africa

Summary

This paper describes the journey of a young African midwife utilising the Nursing Now Nightingale Challenge framework to undertake a gap analysis and a mapping exercise to provide high-quality continuous professional development education for midwives working in isolation in a deprived suburb in Uganda. The project was completed in three stages:

• Stage one mapped out the services available within Nansana, Uganda
• Stage two identified the gaps in education for midwives and nurses within the area
• Stage three developed and offered educational study days for nurses, midwives and adolescents based on the gap analysis.

Perinatal Care In Western Uganda: Prevalence And Factors Associated With Appropriate Care Among Women Attending Three District Hospitals, Mercy Muwema, Dan K. Kaye, Grace Edwards, Gorrette Nalwadda, Joanita Nangendo, Jaffer Okiring, Wilson Mwanja, Elizabeth N. Ekong, Joan N. Kalyango, Joaniter I. Nankabirwa

School of Nursing & Midwifery, East Africa

Background: Perinatal mortality remains high globally and remains an important indicator of the quality of a health care system. To reduce this mortality, it is important to provide the recommended care during the perinatal period. We assessed the prevalence and factors associated with appropriate perinatal care (antenatal, intrapartum, and postpartum) in Bunyoro region, Uganda. Results from this study provide valuable information on the perinatal care services and highlight areas of improvement for better perinatal outcomes.

Methods: A cross sectional survey was conducted among postpartum mothers attending care at three district hospitals in Bunyoro. Following consent, a questionnaire was …

Healthcare Providers' Experiences With A Clinical Mentorship Intervention To Improve Reproductive, Maternal And Newborn Care In Mwanza, Tanzania, Kahabi Isangula, Columba Mbekenga, Tumbwene Mwansisya, Loveluck Mwasha, Lucy Kisaka, Edna Selestine, David Siso, Thomas Rutachunzibwa, Secilia Mrema, Eunice Pallangyo

School of Nursing & Midwifery, East Africa

Introduction: There is increasing evidence suggesting that clinical mentorship (CM) involving on-the-job training is one of the critical resources—friendly entry points for strengthening the knowledge and skills of healthcare providers (HCPs), which in turn facilitate the delivery of effective reproductive, maternal, and newborn health (RMNH) care. The article explores the experiences of HCPs following participation in the CM program for RMNH in eight districts of Mwanza Region in Tanzania.

Materials and Methods: A qualitative descriptive design employing data from midterm project review meetings and Key Informant Interviews (KIIs) with purposefully selected HCPs (mentors and mentees) and District Medical Officers (DMOs) …

Predictors Of Fear Of Childbirth And Depressive Symptoms Among Pregnant Women: A Cross-Sectional Survey In Pwani Region, Tanzania, Agnes Fredrick Massae, Margareta Larsson, Sebalda Leshabari, Columba Mbekenga, Andrea Barnabas Pembe, Agneta Skoog Svanberg

School of Nursing & Midwifery, East Africa

Background: Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors.

Methods: A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data …

Evaluating A Work/Study Programme For Nurses And Midwives At Aga Khan University, Uganda, Hellen Kyakuwaire, Agnes Kirikumwino, Juliet Nabossa, Grace Edwards

School of Nursing & Midwifery, East Africa

The work/study programme for nurses and midwives at Aga Khan University School of Nursing and Midwifery (AKU-SONAM) is a unique concept in East Africa. This study explored whether nursing and midwifery students undergoing a work-study programme at AKU-SONAM felt their education was underpinned by an adult education philosophy. A semi-structured questionnaire designed specifically for this study based on the Knowles’ (1980) ‘Principles of Adult Education’ was administered to 96 students who completed their programmes in 2017 and 2018 respectively. Our paper reports on both the positive aspects of students’ experiences in this work-study programme, including the improvement of critical thinking …

Sociodemographic Factors Associated With Mothers’ Experiences Of Psychosocial Care And Communication By Midwives During Childbirth In Nairobi, Kenya, Jane Kabo, Eleanor Holroyd, Grace Edwards, Ahmed Sarki

School of Nursing & Midwifery, East Africa

Purpose: To clarify sociodemographic and socioeconomic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya.

Design: A descriptive cross-sectional study conducted in a government national referral hospital. Respondents were 109 systematically sampled mothers who delivered in the study hospital. Mothers’ experiences of intrapartum care were assessed using three subscales from the Experience of Psychosocial Care and Communication during Childbirth Questionnaire (effective communication; emotional support; and respect, care and dignity). Simple and multivariable logistic regression analyses were used to assess associations between sociodemographic factors, socioeconomic factors and mothers’ experiences of intrapartum care.

Findings: …

Acquiring Knowledge About The Use Of A Newly Developed Electronic Fetal Heart Rate Monitor: A Qualitative Study Among Birth Attendants In Tanzania, Sara Rivenes Lafontan, Johanne Sundby, Hussein Kidanto, Columba Mbekenga, Hege L. Ersdal

School of Nursing & Midwifery, East Africa

In an effort to reduce newborn mortality, a newly developed strap-on electronic fetal heart rate monitor was introduced at several health facilities in Tanzania in 2015. Training sessions were organized to teach staff how to use the device in clinical settings. This study explores skilled birth attendants’ perceptions and experiences acquiring and transferring knowledge about the use of the monitor, also called Moyo. Knowledge about this learning process is crucial to further improve training programs and ensure correct, long-term use. Five Focus group discussions (FGDs) were carried out with doctors and nurse-midwives, who were using the monitor in the labor …

A Pilot Study Exploring Nursing Knowledge Of Depression And Suicidal Ideation In Kenya, Timothy Muga, Gladys Mbuthia, Samwel Gatimu, Rachel Rossiter

School of Nursing & Midwifery, East Africa

Nurses play key roles in recognizing, diagnosing, managing, and referring persons with mental disorders. This cross-sectional study assessed mental health literacy (depression and suicidal ideation) among nurses in a private urban referral hospital in Kenya. Nurses read a vignette and answered questions regarding diagnosis, treatment/interventions, and related attitudes and beliefs. Thirty-seven nurses (12 males) completed the questionnaire. Three correctly identified the diagnosis and 23 identified depression only. Although 75% noted the symptoms were extremely distressing, fear, and stigma were common reactions. This highlights challenges in mental health promotion/prevention in Kenya, and suggests continuous nursing education and curriculum enhancement is needed.

A Qualitative Exploration Ofdoctors And Nurses Experienceson The Management Of Tubercu-Losis And Hiv Co-Infection In Atuberculosis-Hiv High Burdencommunity In Northernkwazulu-Natal, South Africa, Mbuso Mabuza, Constance Shumba

School of Nursing & Midwifery, East Africa

South Africa is faced with a huge challenge of addressing the high burden of tuberculosis-human immune virus (TBHIV) co-infection, and this challenge is more pronounced in the province of KwaZulu-Natal which has one of the highest burdens of TB-HIV co-infection in the world. The study explored the experiences of doctors and nurses with regard to the management of tuberculosis and HIV coinfection in a TB-HIV high burden community in northern KwaZulu-Natal, South Africa. The particular focus was to provide insight and to inform policy and programme development for effective management of TB-HIV co-infection in the TB-HIV high burden community of …

Children’S Perspectives Of Their Psychosocial Wellbeing In Tanzanian Orphanages, Agnes Msoka, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

The aim of this study was to explore factors affecting the wellbeing of institutionalized orphaned children in Dar es Salaam, Tanzania. A descriptive qualitative study was used to collect data from Tanzanian orphaned children receiving orphanage care. Purposive sampling was employed to select 10 orphanage centers from which 123 orphaned children were recruited. A semi-structured interview guide relevant to the study objectives was developed from the literature and was used to guide the focus group interviews. Data was analysed by way of thematic analysis. There were 76 male and 47 female orphans; orphans without one or both parents were 87 …

Factors Affecting Effective Ventilation During Newborn Resuscitation: A Qualitative Study Among Midwives In Rural Tanzania, R. Moshiro, H. L. Ersdal, P. Mdoe, H. L. Kidanto, Columba Mbekenga

School of Nursing & Midwifery, East Africa

Background: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers.

Objective: This study aimed at exploring barriers and facilitators to effective bag mask ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania.

Methods: Eight midwives, each with more than one year’s working experience in the labour ward, were interviewed individually …

Nursing And Midwifery Research Output In Africa: A Review Of The Literature, Rose Chalo Nabirye, Alison Annet Kinengyere, Grace Edwards

School of Nursing & Midwifery, East Africa

Background: Nurses and midwives form the backbone of health service delivery and satisfaction with care often depends on the competencies of nurses and midwives who provide the care (World Health Organization [WHO], 2002). Healthcare has become complex, challenging, and demanding across diverse sociocultural and socioeconomic changes and environments. To optimize their impact, nurses and midwives therefore need to be prepared with evidence-based competences. Nursing research therefore, is the cornerstone for evidence-based practice and for establishing the professional status of nursing and building research capacity. However, although nursing research began in the 19th century, it is limited in Africa, with little …

Global Collaboration Between Tanzania And Japan To Advance Midwifery Profession: A Case Report Of A Partnership Model, Yoko Shimpuku, Shigeko Horiuchi, Sebalda C. Leshabari, Dickson Mkoka, Yasuko Nagamatsu, Miwako Matsutani, Hiromi Eto, Michiko Oguro, Yukari Yaju, Mariko Iida, Columba Mbekenga, Lilian Mselle, Agnes Mtawa

School of Nursing & Midwifery, East Africa

The global health agenda to reduce maternal mortality is delayed in Sub-Saharan Africa. The shortage of skilled birth attendants in Tanzania hinders the improvement of midwifery care to prevent maternal mortality and morbidity. It is urgently neccesary to develop midwifery leaders capable of working as educators, researchers, administrators, and advanced practitioners, contributing to the improvement of midwifery care and maternal child health in their own country. This report describes the process of establishing the first midwifery master’s program in Tanzania through the efforts of two academic institutions, one in Tanzania and one in Japan. The collaboration developed a sustainable partnership …

Utilizing The Delphi Survey Approach: A Review, Nilufar Shariff

School of Nursing & Midwifery, East Africa

No abstract provided.

A Delphi Survey Of Leadership Attributes Necessary For National Nurse Leaders’ Participation In Health Policy Development: An East African Perspective, Nilufa Jivraj Shariff

School of Nursing & Midwifery, East Africa

Background: Nurses’ involvement in health policy development ensures that health services are: safe, effective, available and inexpensive. Nursing history reveals several legendary nurse leaders who have influenced policy and the course of nursing and health care. In the recent times there have been concerns regarding the availability of effective leaders physically, symbolically and functionally at clinical, organizational and national levels, who can effectively influence health policy. Exerting influence in the policy arena requires that nurse leaders acquire attributes that enable them to be effective in policy development activity.

This paper reports part of a larger study whose purpose included: “build …

Psychobiobehavioral Model For Preterm Birth In Pregnant Women In Low- And Middle-Income Countries, Shahirose S. Premji, Ilona S. Yim, Aliyah Dosani (Mawji), Zeenatkhanu Kanji, Salima Sulaiman, Wangira Musana, Pauline Samia, Kiran Shaikh, Nicole Letourneau

School of Nursing & Midwifery, East Africa

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in …

Factors That Act As Facilitators And Barriers To Nurse Leaders' Participation In Health Policy Development, Nilufa Jivraj Shariff

School of Nursing & Midwifery, East Africa

Background: Health policies impact on nursing profession and health care. Nurses' involvement in health policy development ensures that health care is safe, of a high quality, accessible and affordable. Numerous factors influence nurse leaders' ability to be politically active in influencing health policy development. These factors can be facilitators or barriers to their participation. There is scant research evidence from Eastern African region that draws attention to this topic. This paper reports part of the larger study. The objectives reported in this paper were those aimed to: build consensus on factors that act as facilitators and barriers to nurse leaders' …

Responding To Health Care Complexity: Suggestions For Integrated And Interprofessional Workplace Learning, Pim Kuipers, Carolyn Ehrlich, Sharon Brownie

School of Nursing & Midwifery, East Africa

This report highlights complexity in health care and the relevance of integrated and interprofessional care and learning. It is proposed that appropriate workforce training in response to complexity should be contextually relevant and workplace integrated, and should focus on building interprofessional capability for reflective practice and critical thinking. This training should be interprofessional and foster systems thinking. It is suggested that the World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a useful integrating framework.

A Single Competency-Based Education And Training And Competency-Based Career Framework For The Australian Health Workforce: Discussing The Potential Value Add, Sharon Brownie, Janelle Thomas

School of Nursing & Midwifery, East Africa

This brief discusses the policy implications of a research study commissioned by Health Workforce Australia (HWA) within its health workforce innovation and reform work program. The project explored conceptually complex and operationally problematic concepts related to developing a whole-of-workforce competency-based education and training and competency-based career framework for the Australian health workforce and culminated with the production of three reports published by HWA. The project raised important queries as to whether such a concept is desirable, feasible or implementable – in short what is the potential value add and is it achievable? In setting the scene for discussion, the foundation …

Post Exposure Prophylaxis Among Ugandan Nurses Accidents Do Happen, J. Mill, Esther Nderitu, S. Richter

School of Nursing & Midwifery, East Africa

Purpose: In 2009 we conducted a study to explore Ugandan nurses’ practice of universal precautions while caring for persons living with HIV. During our interviews about universal precautions, nurses’ also shared their experience with post-exposure prophylaxis (PEP) following needle-stick injuries. We present findings related to nurses’ understanding of PEP and their experience with, and reporting of, needle stick injuries.

Background: Nurses have high rates of exposure to blood-borne pathogens. Although there is minimal risk of the transmission of blood-borne pathogens from health care workers (HCWs) to patients and vice versa, post-exposure prophylaxis, has become routine following the occupational exposure of …

Does “Asymptomatic” Mean Without Symptoms For Those Living With Hiv Infection?, Suzanne Willard, William L. Holzemer, Dean J. Wantland, Yvette P. Cuca, Kenn M. Kirksey, Carmen J. Portillo, Inge B. Corless, Marta Rivero-Méndez, María E. Rosa, Patrice K. Nicholas, Mary Jane Hamilton, Elizabeth Sefcik, Jeanne Kemppainen, Gladys Canaval, Linda Robinson, Shahnaz Moezzi, Sarie Human, John Arudo, Lucille Sanzero Eller, Eli Bunch, Pamela J. Dole, Christopher Coleman, Kathleen Nokes, Nancy R. Reynolds, Yun-Fang Tsai, Mary Maryland, Joachim Voss, Teri Lindgren

School of Nursing & Midwifery, East Africa

Throughout the history of the HIV epidemic, HIV-positive patients with relatively high CD4 counts and no clinical features of opportunistic infections have been classified as ‘‘asymptomatic’’ by definition and treatment guidelines. This classification, however, does not take into consideration the array of symptoms that an HIV-positive person can experience long before progressing to AIDS. This short report describes two international multi-site studies conducted in 2003 - 2005 and 2005 - 2007. The results from the studies show that HIV-positive people may experience symptoms throughout the trajectory of their disease, regardless of CD4 count or classification. Providers should discuss symptoms and …