The East African health research journal最新文献

Background: The human immunodeficiency virus (HIV) prevalence among transport workers in sub-Saharan Africa remains high, estimated at as high as 9.9% in western Uganda compared with the national prevalence of 5.4%. The prevalence of HIV among transport workers has been partly attributed to the level of knowledge regarding HIV prevention, perceived HIV risk, and stigma. Accordingly, these have been linked to high-risk HIV transmission behaviours that increase the chances of acquiring HIV among adults. Therefore, this study investigated the predictors of HIV knowledge, perceived HIV risk, and stigma among transport workers in Mbarara city in southwestern Uganda.

Methods: The survey was conducted between November 2021 and February 2022 among transport workers (motorcycle taxi riders, motor vehicles taxi, and truck drivers), aged 18 to 55 years. Face-to-face interviews using a semi-structured questionnaire were conducted with the study's participants. Chi-square and binary multivariate logistic regression statistics were used to assess the predictors of knowledge about HIV prevention, HIV perceived risk, and stigma.

Results: Out of 420 participants, 69.3%, 75.4%, and 62% had good knowledge of HIV prevention, a high perceived HIV risk, and stigma, respectively. Predictors of knowledge of HIV prevention comprised education level (AOR=2.28, 95% CI=1.36-3.84), knowing HIV status (AOR=0.47, 95% CI=0.27-0.81), and perceived HIV risk (AOR=3.04, 95% CI=1.74-5.32). Whereas the determinants of perceived HIV risk included education level (AOR=1.34, 95% CI=1.34-4.24), knowing HIV status (AOR=0.26, 95% CI=0.15-0.48), HIV knowledge (AOR=2.38, 95% CI=1.36-4.178), and perceived stigma (AOR=0.47, 95% CI=0.24-0.89). Last, the predictors of perceived HIV stigma included perceived HIV risk (AOR=0.41, 95% CI=0.21-.791), and knowledge of HIV prevention (AOR=0.29, 95% CI=0.16-0.54).

Conclusions: The study found a high proportion of participants with good knowledge about HIV prevention, a high HIV perceived risk, and HIV-related stigma. In addition, this study suggests that the level of education and awareness of one's HIV status positively influences HIV knowledge and perceived risk. Whereas HIV-related stigma was in turn negatively influenced by the transport workers' HIV knowledge and perceived risk. This calls for multifaceted approaches at individual, group (interpersonal), and community levels to reduce HIV stigma among this study group. Incorporating continuous health education programs about HIV and encouraging HIV testing among transport workers remains critical.

Background: Undergraduate nursing students in clinical practice have a higher risk of hepatitis B infection. The prevalence and factors associated with hepatitis B vaccination (HBV vaccine) uptake among nursing students remained unknown. This study examined the prevalence and factors associated with HBV vaccination among clinical nursing students.

Methodology: A sample of 229 undergraduate nursing students was enrolled in an analytical cross-sectional study. Sociodemographic data, status of vaccination, and beliefs about HBV infection and vaccination using domains of the health belief model (HBM) were collected in a face-to-face interview using a questionnaire. Descriptive statistics were used to summarise the participants' characteristics and prevalence of HBV vaccination. Multivariate logistic regression analysis was used to examine the association between sociodemographic factors and domains of the HBM model and HBV vaccination uptake.

Results: The prevalence of vaccination uptake was 25.8%. Sociodemographic factors associated with uptake of the HBV vaccine included being female (P =.031), being a final-year student (P =.013), and having knowledge of HBV (P =.049). As for HBM, two domains, perceived benefit [Adjusted Odds Ratio (AOR) = 1.40; 95% CI, 1.05 to 1.86; P=.022] and self-efficacy (AOR = 1.87, 95% CI, 1.12 to 3.11; P=.016), were significantly associated with HBV vaccine uptake.

Conclusion: HBV vaccination uptake among undergraduate clinical nursing students was low. Clinical experience, knowledge, perceived benefit, and self-efficacy were positively associated with HBV vaccine uptake. Interventions to improve these domains among BSc Nursing students should be promoted to improve vaccination uptake.

Background: The surgical field in Africa has long grappled with a gender imbalance, with women being significantly underrepresented. Despite global efforts to foster gender diversity in healthcare practices, African women pursuing surgical careers still face substantial hurdles. This paper investigates these women's experiences and challenges, aiming to raise awareness of these issues and propose strategies for improving gender equity.

Objective: To describe contextual aspects of barriers affecting women in surgery in Africa.

Methods: A cross-sectional survey was conducted, targeting female medical students interested in surgical careers, interns, trainees, and surgical consultants across Africa. The survey was distributed in November-December 2021. Data were analysed using descriptive statistics for quantitative data and a simplified thematic analysis for qualitative data.

Results: A total of 105 participants from 17 countries, aged 20 to 50 years and with various training levels, completed the survey. General surgery was the most common speciality among the respondents. Notably, 63% reported gender-based discrimination, with many (74%) attributing societal and familial discouragement and financial commitments as major barriers to pursuing surgical careers. Participants also shared experiences of gender-based inequity, underestimation of their skills, sexist comments, and even instances of sexual harassment during training or work.

Conclusion: This study sheds light on the complex barriers African women face in pursuit of surgical careers. To enhance diversity in the field, fundamental change is required. This necessitates recognising the underlying causes hindering women's progress in surgery and the implementation of interventions to promote gender equity.

Background: Self-medication practice is highly prevalent worldwide despite the scaled-up campaigns to refrain from using drugs without a prescription. Inadequate knowledge has been associated with the increasing practice of self-medication among students. The study aimed to determine the prevalence of self-medication and explore factors associated factors with the practice among health science students.

Methods: A cross-sectional study was conducted in Dodoma, where 255 students were interviewed using a self-administered adapted questionnaire. Univariate and multivariate analysis were performed using SPSS version 25.

Results: Self-medication prevalence was 69%. Paracetamol (52.1%) and Ibuprofen (29.4%) were primarily used for relief of headache (76.7%) and menstrual pain (18.2%). Among the studied students, 59.6% had inadequate knowledge, while 60.8% had a positive attitude towards self-medication. Mode of hospital payment (cash) (AOR=3.75; 95% CI: 1.868-6.825 p<.001) and household income (<10,000TSh) (AOR=2.868; 95% CI: 1.355-6.071 p=.006) were significantly associated with self-medication practice.

Conclusion: Self-medication practice among health science students is prevalent. Inadequate knowledge and low socioeconomic status play a significant role in self-medication practice. Increasing students' access to inexpensive healthcare options and counselling services may help in reducing self-medication practices.

Background: Hospitalised neonates are at increased risk of carrying extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenemase-producing Enterobacterales (CPE), possibly leading to invasive infections. This study determined the faecal carriage of ESBL-PE, CPE, and associated factors among neonates at Muhimbili National Hospital (MNH).

Methods: A hospital-based cross-sectional study was conducted among neonates aged ≤ 28 days admitted at MNH. The participants' data and rectal swab samples were collected. Samples were processed to detect ESBL-PE and CPE. Results were confirmed using the double-disc diffusion synergy test and modified carbapenem inactivation method, respectively. An antimicrobial susceptibility test was performed using the Kirby Bauer disk diffusion method.

Results: Three hundred forty neonates with a median age of 3 days (IQR: 2-9) were enrolled. The carriage rate of ESBL-E and CPE was 39.4%(134/340) and 1.8%(6/340), respectively. Klebsiella pneumoniae (66.9%) and Escherichia coli (66.7%) were the common isolates for ESBL-PE and CPE, respectively. The factors independently associated with ESBL-PE carriage were antibiotic use (aOR 2.73, 95% CI: 1.38-5.39, p=.04), age increase (aOR 1.09, 95% CI: 1.02-1.15, p=.006), prolonged hospitalisation (aOR 2.92, 95% CI: 1.17-7.29, p=.02), and neonate-sucking their fingers (aOR 2.98, 95% CI: 1.04-8.58, p=.04). The study observed a trend of CPE carriage toward neonates with prolonged hospitalisation (p=.05). ESBL-PE low resistance was observed to meropenem (0.9%), amikacin (2.7%-6.7%), and gentamicin (19.4% to 100 %).

Conclusions: The study revealed a relatively high carriage rate of multidrug resistant Enterobacterales among neonates admitted to a tertiary hospital. These findings underscore the importance of continuous surveillance of ESBL-PE and CPE to prevent infections and limit their potential transmission within hospital settings and the community.

Background: Cervical cancer is the fourth most common cause of death among women of reproductive age (15-49 years). In Tanzania, cervical cancer is the first cause of mortality and morbidity among females with cancers. The disease impact is highly associated with a lack of adequate knowledge and a negative attitude toward cervical cancer screening among healthcare workers (HCWs).This study aimed to assess knowledge and attitude toward cervical cancer screening among female students as future HCWs from allied health colleges in the Shinyanga region.

Method: Descriptive cross-sectional study data was collected from 420 students in allied health colleges using a self-administered questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22, Likert, and brooms cut-off points. The association between cervical cancer screening and the independent variables on knowledge, attitude, and other related factors was established by using logistic regression, and the Odds Ratio (OR) of greater than one, 95% confidence interval, and a P-value of <.05 was statistically significant.

Results: Two-thirds of the respondents 276 (65.7%) had low knowledge, while only 34 (8.1%) had very good knowledge of cervical cancer and screening. Most of the respondents 298 (70.1%) had a favorable attitude toward cervical cancer screening. Only 52 (12.1%) had ever screened for cervical cancer. Logistic regression showed odds at 2.37 (95% CI, 1.30-4.31, p=.005) of taking the cervical screening test to students with the correct knowledge and positive attitude to cervical screening at 1.42 (95% CI, 0.32-6.29, p=.647).

Conclusion: The study showed there is low knowledge of cervical cancer screening among female students in health and allied colleges, despite a favorable attitude toward the practice of screening. A well-integrated approach to providing comprehensive and practical aspects of cervical cancer screening during formal training in the curriculum for female students should be adopted to increase their knowledge and positive attitude toward screening.

Background: During the COVID-19 lockdowns, healthcare services were disrupted and community-based health insurance (CBHI) schemes could not operate efficiently. This study assessed the level of client satisfaction with CBHI schemes, associated factors, and service provider perspectives in central Uganda.

Methods: This was an explanatory sequential mixed-methods (quantitative - qualitative) study that was conducted between March and September 2021. In the first phase, a cross-sectional study among the 365 clients of the CBHI schemes who were aged ≥18 years old. The participants were recruited consecutively as they reported to the healthcare facility. Quantitative data were collected at patient exit using a piloted semi-structured interviewer-administered questionnaire. In the second phase, qualitative data were collected through 11 key informant interviews. These data were analyzed using a deductive thematic analysis approach. Modified Poisson regression was used to assess factors associated with client satisfaction and a p-value ≤0.05 at a 95% confidence interval was considered to be statistically significant.

Findings: Of the total number of participants, 38.9% (142/365) were "satisfied" with the CBHI services. Less satisfaction was associated with secondary level of education or above (adjPR = 0.55, 95% CI: 0.36-0.85, P=.007); residing beyond 16 kilometers from the healthcare facility (adjPR = 0.68, 95% CI: 0.41-0.95, P=.014); staying on the scheme for over 3 years (adjPR = 0.71, 95% CI: 0.51-0.99, P=.046); and good knowledge about the CBHI (adjPR = 0.76, 95% CI: 0.58-0.99, P=.040). Irregular availability of healthcare workers and long waiting time affected client satisfaction.

Conclusions: Satisfaction was considerably low during the lockdown. Lockdowns due to pandemics interrupt healthcare services and subsequently affect the satisfaction of CBHI clients with scheme services. Scheme managers need to identify facilities that are closer to enrolees and invest in technologies that reduce waiting time in the healthcare facility.

Background: Modern family planning is considered one of the most cost-effective health intervention to improve the well-being of women and newborns. Little is known about the influence of the theory of planned behaviour on the uptake of modern family planning. Therefore, the study aims to address the existing gap in using the theory of planned behaviour to explain the uptake of modern family planning in rural settings of Morogoro, Tanzania.

Methods: The community-based analytical cross-sectional study was conducted at Malinyi District in rural Morogoro, in June to July 2022. A multistage sampling technique was used to select 421 women of reproductive age. A structured questionnaire adapted from previous studies was used as the data collection tool. The determinants for the uptake of modern family planning were analyzed using bivariable and multivariable binary logistic regression model. The final results, which were statistically significant from the regression analysis model were presented using Adjusted Odd's Ratio (AOR), Confidence Interval (95% CI), and p-value <.05.

Results: The majority of women of reproductive age, 328 (78%), were using modern family planning methods, with more than half of respondents (54.1%) using implants. Depo Provera (29.1%) and the pill (14.4%) were the second and third most frequently used methods. Only 4.9% reported IUCD and 2.8% condom use. The majority of the women, 342 (81%), had a positive attitude, positive subjective norms 289 (68.6%), positive perceived behaviour control 388 (92%), and high intention on uptake of modern family planning 61 (85.7%). The women with a positive attitude on modern family planning uptake (AOR 2.307: 95% CI, 1.243 to 4.281) and positive perceived Behavioural control (AOR 6.015: 95% CI; 0.017 to 2.569) were more likely to be significantly associated with increased uptake of modern family planning. Those with high intention on uptake of modern family planning (AOR 0.038; 95% CI; 0.018 to 0.080) were less likely to be significantly associated with increased uptake of modern family planning.

Conclusion: Positive attitude and high perceived behavioural control have a direct positive effect on the uptake of modern family planning. The family planning education-based programs could be offered to the community, particularly in rural areas, to maximise the community awareness and uptake of modern family planning. The theory of planned behaviour could predict intention to use but not the actual utilisation of modern family planning. A combination of theoretical models may be required to understand additional external elements that may influence the utilisation of modern family planning.

Background: Although guidelines on neonatal care and infection prevention exist, it is unclear what factors influence nurses' adherence to infection prevention and control (IPC) in neonatal care. This study aimed to assess the determinants of nurses' adherence to IPC in neonatal sepsis prevention in the Pwani Region, Tanzania.

Methods: A cross-sectional study with 282 nurses was conducted. Assessing the how Socio demographic characteristics, Health facility factors, attitude of the nurses affect the Nurse's practices on adherence to IPC for prevention of neonatal sepsis. Data collection methods included a questionnaire and an observation checklist. Bivariate and multivariate logistic regression were employed to determine the factors influencing nurses' adherence to IPC. Nurse's adherence to IPC was measured using the mean score whereby those who score above the mean were regarded as adequate adherence. A Probability value of .05 and a 95% confidence interval was regarded as statistically significant.

Results: The present study found that only one-third (37.0%) of the nurses had adequately adhered to IPC. Significant associations were observed between nurse's adherence to IPC in the prevention of neonatal sepsis and; working experience of 13 to 24, 7 to 12, and 6 months [AOR =5.30, p<.001], [AOR=3.9, p<.024] and [AOR=3.640, p<.001] respectively, >10 years in nursing professional [AOR=2.627, p<.023], staffing of 6-10 and 1-5 [AOR=5.992, p<.001] and [AOR=3.791, p<.001] respectively, 3 and >3 staffs per shift [AOR=3.276, p<.017] and [AOR=2.364, p<.017) respectively, working at District and regional hospitals [AOR=1.101, p<.001] and [AOR= 2.320, p<.028] respectively, on-job training [AOR = 2.08, p<.034], isolation room availability [AOR=1.783, p<.042], SOPs and IPC guidelines availability [AOR=4.320, p<.004], sufficient medical equipment and supply [AOR =1.414, p<.015] and positive attitude [AOR=1.490, p<.035].

Conclusion: The study results indicated Nurse's adherence to IPC in the prevention of neonatal sepsis is associated with working experience, staffing, healthcare level, on-job training, isolation room availability, current SOPs and IPC guidelines, access to medical equipment/supply, and positive attitude. Strategies should be employed to strengthen the adherence of nurses to IPC guidelines to minimize the morbidity and mortality resulting from neonatal sepsis. Interventional studies from each factor for nurse's adherence to IPC in the prevention of neonatal sepsis should be of priority.

Background: Insufficient knowledge about COVID-19 and low socioeconomic status have been associated with distrustful attitudes towards vaccination against COVID-19.

Objective: The aim of this study was to explore determinants of COVID-19 vaccine uptake among the general population and health workers.

Methods: A cross sectional study was conducted in 16 councils which included; Milele, Mpanda, Newala, Simanjiro, Nanyumbu, Muleba, Longido, Ulanga, Igunga, Mbulu, Karatu, Mufindi, Mvomero, Kilolo and Tabora Town. A total of 427 health care workers and 1,907 individuals were sampled from health facilities and households. Structured questionnaires were used to collect the required information.

Results: Although the majority (93.2%) of health workers were vaccinated, 35.4% perceived their risk of getting COVID-19 infection as high. Self-reported uptake of COVID-19 vaccine was 42.4% among the general population. Significantly low proportion of the general population in Mufindi district council (7.5%) were vaccinated against COVID-19. Health workers' knowledge and perception on COVID-19 vaccination did not vary with socio-demographic factors. Among the general population, those who were separated/divorced (ARR: 0.8: 95% CI; 0.7 to 0.9), those who attained primary level of education (ARR: 0.8: 95% CI; 0.7 to 0.9), self-employed (ARR: 0.8: 95% CI; 0.7 to 0.9) and unemployed (ARR: 0.7: 95% CI; 0.6 to 0.8) were less likely to be vaccinated against COVID-19. Having positive attitude (ARR: 1.2: 95% CI; 1.1 to 1.5) and perception (ARR:1.8: 95% CI; 1.5 to 2.2), and knowledge on COVID-19 prevention (ARR: 3.0: 95% CI; 2.1to 4.4) increased the likelihood COVID-19 vaccine uptake. Prior experience of vaccination against other diseases (ARR:1.2: 95% CI; 1.0 to1.3), having history of chronic diseases (ARR:1.3: 95% CI; 1.2 to 1.4) and a family member who died of COVID-19 (ARR:1.3: 95% CI; 1.1to1.4) were also determinants of COVID-19 vaccine uptake.

Conclusion: Uptake of COVID-19 vaccine among the general population was significantly low among individuals with primary level of education, self-employed, unemployed, and those who were divorced or separated. Individuals with comprehensive knowledge on COVID-19 vaccination, those with positive attitude and perception on COVID-19 vaccination, having history of chronic diseases, prior vaccination against other diseases, and having a family member who succumbed to COVID-19 increased the likelihood COVID-19 vaccine uptake among the general population. Provision of health education and implementation of socio-behavioural communication change interventions are necessary to equip the general population with appropriate knowledge to transform their negative attitude and perception on COVID-19 vaccination.