270 research outputs found
A qualitative investigation of facilitators and barriers to DREAMS uptake among adolescents with grandparent caregivers in rural KwaZulu-Natal, South Africa.
Get PDFAdolescents with grandparent caregivers have experienced challenges including the death of one or both parents due to HIV in sub-Saharan Africa. They may be left out of existing HIV prevention interventions targeting parents and children. We investigated the facilitators and barriers to DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) programme uptake among adolescents with grandparent caregivers across different levels of the socio-ecological model in rural South Africa. Data were collected in three phases (October 2017 to September 2018). Adolescents (13-19 years old) and their grandparent caregivers (≥50 years old) (n = 12) contributed to repeat in-depth interviews to share their perceptions and experiences regarding adolescents' participation in DREAMS. Data were triangulated using key informant interviews with DREAMS intervention facilitators (n = 2) to give insights into their experiences of delivering DREAMS interventions. Written informed consent or child assent was obtained from all individuals before participation. All data were collected in isiZulu and audio-recorded, transcribed verbatim and translated into English. Thematic and dyadic analysis approaches were conducted guided by the socio-ecological model. Participation in DREAMS was most effective when DREAMS messaging reinforced existing norms around sex and sexuality and when the interventions improved care relationships between the adolescents and their older caregivers. DREAMS was less acceptable when it deviated from the norms, raised SRH information that conflicts with abstinence and virginity, and when youth empowerment was perceived as a potential threat to intergenerational power dynamics. While DREAMS was able to engage these complex families, there were failures, about factors uniquely critical to these families, such as in engaging children and carers with disabilities and failure to include adolescent boys in some interventions. There is a need to adapt HIV prevention interventions to tackle care relationships specific to adolescent-grandparent caregiver communication
Acceptability of fixed-dose combination treatments for hypertension in Kenya: A qualitative study using the Theoretical Framework of Acceptability.
Get PDFFixed-dose combinations (FDCs) - 2-3 anti-hypertensive medications in a single pill - have the potential to improve hypertension treatment and outcomes. Yet, they are not widely implemented. Factors undermining implementation remain unknown, particularly in sub-Saharan Africa, where hypertension is a major cause of disease burden and is poorly controlled. This study explored the acceptability of FDCs among patients, caregivers, and healthcare workers. We conducted semi-structured in-depth interviews with 58 participants from four purposively selected health facilities in Kiambu county, Kenya. Data were analyzed using an iterative thematic analysis approach, guided by the Theoretical Framework of Acceptability. Our findings indicate that FDCs are potentially acceptable to all participant groups. Acceptability is supported by the perception of FDCs as a means of reducing treatment burden (for patients and healthcare workers) and improving treatment adherence, and by patients' deferral to and trust in healthcare workers. However, acceptability among healthcare workers may be undermined by variable levels of knowledge about FDCs, concerns about FDCs as an "inflexible" treatment that does not allow dose titration or identifying causes of side effects, and concerns about inconsistent availability and affordability of FDCs in Kenya. To enhance acceptability and implementation of FDCs for hypertension treatment in Kenya, it is crucial to strengthen the capacity of all healthcare worker cadres to appropriately prescribe, inform patients about, and support adherence to FDCs. These efforts must align with broader initiatives to address upstream health system factors such as poor availability and affordability
Barriers and facilitators of primary care management of type II diabetes mellitus in the West African sub-region: A scoping review.
Get PDFThe prevalence of diabetes is rising rapidly across West Africa, posing a significant public health challenge. Effective diabetes management through accessible and quality primary healthcare is crucial, yet multiple barriers persist. This review aimed to synthesise the available evidence on factors influencing access, utilisation, and quality of diabetes primary care in West Africa. Following Arksey and O'Malley's framework and PRISMA-ScR guidelines, we searched four electronic databases (PubMed, Scopus, Google Scholar, CAIRN Info) and grey literature sources. Eligibility criteria included: peer-reviewed studies published between 2000-2023 in English or French; primary research focusing on adult type II diabetes care in West African countries; and studies reporting on factors affecting access, utilisation, or quality of primary healthcare. Data were extracted using a standardised form and analysed through framework synthesis integrating the WHO Primary Health Care Framework, Social Determinants of Health model, and Innovative Care for Chronic Conditions model. Twelve studies were included from Nigeria (n=7), Ghana (n=4), and Senegal (n=1). Key barriers to access, utilisation, and quality were identified as health system deficiencies, including inadequate infrastructure, workforce shortages, supply gaps, fragmented coordination of care, absence of standardised guidelines, high costs of care, and inefficient leadership/governance for chronic disease management. Broader determinants of health, such as poverty, gender, cultural beliefs, reliance on traditional medicine, and health policy gaps, significantly influenced access to and utilisation of care. Individual-level barriers like psychological distress and delays in care-seeking were also significant. Family/social support systems emerged as potential facilitators of accessing and utilising PHC services. Our review identified that to improve diabetes care, West Africa needs context-specific models that align indigenous healing practices with PHC, strengthen health systems, and address sociocultural determinants. Future research should focus on developing and evaluating culturally resonant interventions that can navigate both biomedical and sociocultural factors shaping diabetes management in resource-constrained settings
Revisiting the choice : to involve hospitals in the partnership for tuberculosis control in Indonesia
No full textTuberculosis (TB) is a major public health problem in many low- and middle-income countries, including Indonesia. To accelerate TB case detection, and to improve the quality of diagnosis and treatment provided by all providers, the Public-Private Mix for implementing Directly Observed Treatment Short-course (PPM DOTS) was introduced in 2000. However, previous studies on PPM DOTS have focused on private practitioners and there has been a scarcity of research on PPM DOTS in the hospital setting. This dissertation aims to capture the potential of the PPM DOTS strategy, and identify the barriers to its implementation in hospitals in Indonesia. This dissertation is based on four separate but interrelated studies: 1. A costeffectiveness analysis, comparing incremental cost per additional number of TB cases successfully treated under three strategies of PPM DOTS in four provinces. 2. An evaluation of the access to TB services by a cross-sectional study among 62 hospitals, by estimating the proportion of TB cases receiving standardised diagnosis and treatment according to the DOTS strategy. The data were analysed using poststratification analysis. 3. The quality aspect was explored in a multiple-case study, including eight selected hospitals. The data were analysed using cross-case analysis. 4. The process of partnership was explored through a qualitative study. In-depth interviews were conducted with 33 informants, who were actors involved in PPM DOTS in hospitals in Yogyakarta province. Content analysis was applied to the qualitative data. PPM DOTS in hospitals was shown to be a cost-effective intervention in this particular context. However, the quality of the implementation was commonly suboptimal. In addition, a substantial number of TB cases did not get standardised diagnosis and treatment as per the DOTS strategy. The process of creating partnership among hospitals and National TB Programme was shown to be complex and dynamic. Process factors, such as commitment to collaboration and interaction and trust among the actors, were shown to be important. The rapid scaling-up of PPM DOTS in hospitals at the national level in Indonesia should be revisited. Indeed, considering the importance of hospitals in TB control, the implementation should be continued and expanded. However, more attention needs to be given to process, context and governance
PENINGKATAN KUALITAS PELAYANAN TUBERKULOSIS DI RUMAH SAKIT DI INDONESIA: PEKERJAAN YANG BELUM SELESAI
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COST EFFECTIVENESS ANALYSIS DALAM PENENTUAN KEBIJAKAN KESEHATAN: SEKEDAR KONSEP ATAU APLIKATIF?
No full textTERSEDIA DALAM FIL
Pengukuran Kemampuan Belajar Mandiri pada Mahasiswa Pendidikan Profesi Dokter
Get PDFSelf directed learning is autonomy of learners to control their learning process. Capacity to perform self-directed learning can be developed during the learning process. Previous studies showed potential barriers to performing self-directed learning among medical students. This study aimed to analyse difference of self-directed learning capacity among medical students before and after undergoing professional education program in a certain clinical department.
This study was an observational study with comparative cross-sectional approach. The subjects were medical students on the professional education program at a certain clinical department at a teaching hospital Surakarta city. Thirty-three students underwent the 4-weeks program from August to September 2012, were selected by purposive sampling. We used the instrument from Fischer, King and Tague, which was further translated into Bahasa Indonesia and validated. Data was analysed using t-test statistical test.
The study found no statistically significant difference on average self-directed learning capacity before (149.6) and after (151.9) following the professional education program at a certain clinical department (p=0.47). More studies are needed particularly to investigate alternatives of interventions to increase self-directed learning in the professional phase of medical education.
Keywords: Self-directed learning, medical professional education, medical students
Cost Effectiveness Analysis dalam Penentuan Kebijakan Kesehatan: Sekedar Konsep Atau Aplikatif?
No full textHubungan antara malnutrisi, suplementasi gizi dan malaria pada anak 0-5 tahun
No full textBackgrounds: Studies in 1950s until 1980s led to the controversial conclusion that malnourished children were less susceptible to malaria infection. In addition, animal studies appeared to support the reported malaria suppressive effect of a poor diet, leading to the perception that malnourished children are less susceptible to malaria infection, morbidity and mortality. The goal of the article was to perform a literature review on recent studies about the interaction between nutrition and malaria among children under 5 years of age which are the most vulnerable group for both malnutrition and malaria.
Methods: Literature on nutrition and malaria was searched in Medline and PubMed databases using combinations of the following keywords: malaria, nutrition, malnutrition, micronutrient, iron, zinc, vitamin A, and child. In total, 271 articles from Medline and 222 articles from PubMed were found. Among these, 13 relevant articles were included. Also, an article from other source (searched by Yahoo), i.e. recommendation of relevance to the topic, was included.
Results and conclusion: From review of the literature, it is known that there has been a debate about iron supplementation in malaria endemic area in the last decade. However, recent studies show a positive impact of iron supplementation on malaria morbidity and mortality. In addition, a consensus recommendation about iron supplementation in malaria endemic areas was made by the International Nutritional Anaemia Consultative Group (INACG) because of the urgent need to control Iron Deficiency Anaemia (IDA) especially in vulnerable groups: pregnant women and children less than 5 years of age. A debate about other micronutrient supplementation such as zinc and vitamin A in malaria cases also exists. Some studies have found a positive impact of such supplementation in malaria settings, but others have revealed no impact. In addition, studies about the association between protein-energy malnutrition (PEM) and malaria have shown conflicting results. However, the most recent studies have concluded that malnourished children are at higher risk of malaria morbidity than are non-malnourished children.
Keywords: malaria, nutrition, malnutrition, micronutrient, iron, zinc, vitamin A, and chil
Hubungan Antara Malnutrisi, Suplementasi Gizi Dan Malaria Pada Anak 0-5 Tahun
Get PDFAbstract:
Backgrounds: Studies in 1950s until 1980s led to the controversial conclusion that malnourished children were less susceptible to malaria infection. In addition, animal studies appeared to support the reported malaria suppressive effect of a poor diet, leading to the perception that malnourished children are less susceptible to malaria infection, morbidity and mortality. The goal of the article was to perform a literature review on recent studies about the interaction between nutrition and malaria among children under 5 years of age which are the most vulnerable group for both malnutrition and malaria.
Methods: Literature on nutrition and malaria was searched in Medline and PubMed databases using combinations of the following keywords: malaria, nutrition, malnutrition, micronutrient, iron, zinc, vitamin A, and child. In total, 271 articles from Medline and 222 articles from PubMed were found. Among these, 13 relevant articles were included. Also, an article from other source (searched by Yahoo), i.e. recommendation of relevance to the topic, was included.
Results and conclusion: From review of the literature, it is known that there has been a debate about iron supplementation in malaria endemic area in the last decade. However, recent studies show a positive impact of iron supplementation on malaria morbidity and mortality. In addition, a consensus recommendation about iron supplementation in malaria endemic areas was made by the International Nutritional Anaemia Consultative Group (INACG) because of the urgent need to control Iron Deficiency Anaemia (IDA) especially in vulnerable groups: pregnant women and children less than 5 years of age. A debate about other micronutrient supplementation such as zinc and vitamin A in malaria cases also exists. Some studies have found a positive impact of such supplementation in malaria settings, but others have revealed no impact. In addition, studies about the association between protein-energy malnutrition (PEM) and malaria have shown conflicting results. However, the most recent studies have concluded that malnourished children are at higher risk of malaria morbidity than are non-malnourished children.
Keywords:
malaria, nutrition, malnutrition, micronutrient, iron, zinc, vitamin A, and chil
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