Research Interests: Management, Nursing, Rehabilitation, Leadership, Qualitative Research, and 15 moreCapacity Building, Medicine, Humans, Clinical Governance, Focus Group, Facilitation, Implementation, Rehabilitation Centers, Omvårdnad, Professional Competence, Pilot Projects, Health Personnel, Guideline Adherence, Inservice training, and Professional Role
Even though Swedish national guidelines for stroke care (SNGSC) have been accessible for nearly a decade access to stroke rehabilitation in out-patient health care vary considerably. In order to aid future interventions studies for... more
Even though Swedish national guidelines for stroke care (SNGSC) have been accessible for nearly a decade access to stroke rehabilitation in out-patient health care vary considerably. In order to aid future interventions studies for implementation of SNGSC, this study assessed the feasibility and acceptability of study procedures including analysis of the context in out-patient health care settings. The feasibility and acceptability of recruitment, observations and interviews with managers, staff and patients were assessed, as well as the feasibility of surveying health care records. To identify patients from the the hospitals was feasible but not from out-patient care where a need to relieve clinical staff of the recruitment process was identified. Assessing adherence to guidelines and standardized evaluations of patient outcomes through health care records was found to be feasible and suitable assessment tools to evaluate patient outcome were identified. Interviews were found to be...
Research Interests: Nursing, Organizational Culture, Health Informatics, Health Care, Health Services Research, and 15 moreHealth Administration, Medicine, Hospitals, Nursing Research, Library and Information Studies, Humans, Female, Feasibility Studies, Male, Data Collection, Aged, Middle Aged, Omvårdnad, Ambulatory Care, and Health Care Surveys
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Research Interests: Business, Program Evaluation, Economics, Health Services Research, Health Policy, and 15 moreMedicine, Humans, Program Development, Effectiveness of Foreign Aid in Sub Saharan Africa, Health Policy and Planning, Health Sector, Public Administration and Policy, Budgets, Public health systems and services research, Allocative Efficiency, Organizational Survival and Efficiency, Organizational case studies, Health Resources, Interviews as topic, and Regional health planning
Research Interests: Business, Program Evaluation, Research Design, Evidence Based Practice, Political Science, and 14 moreGlobal Health, Developing Countries, International Cooperation, Zambia, Medicine, Humans, Organizations, Lancet, Health System, World Health Organization, Cooperative Behavior, Disabled Persons, The Lancet, and Medical and Health Sciences
Research Interests: Microbiology, Medical Microbiology, Pharmacy Practice, Medicine, Diarrhea, and 15 moreHumans, Child, Health Systems Research, Female, Male, Antimicrobial chemotherapy, Health System, Adult, Oxford university, Pharmacists, Cross sectional Study, Cross Sectional Studies, Pharmacies, Diarrhoea, and Pharmacology and pharmaceutical sciences
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AbstractHypertension with renal artery stenosis is associated with both an activated renin-angiotensin system and elevated sympathetic activity. Therefore, in this condition it may be favorable to use a therapeutic modality that does not... more
AbstractHypertension with renal artery stenosis is associated with both an activated renin-angiotensin system and elevated sympathetic activity. Therefore, in this condition it may be favorable to use a therapeutic modality that does not reflexly increase heart rate, renin secretion, and ...
Research Interests: Electrophysiology, Humans, Hypertension, Blood Pressure, Renin Angiotensin Aldosterone System, and 15 moreFemale, Male, Heart rate, Norepinephrine, Clinical Sciences, Middle Aged, Isotope Dilution, Angiotensin II, Angiotensin Converting Enzyme Inhibitors, Renal artery stenosis, Peroneal nerve, Muscle sympathetic nerve activity, Mean Arterial Pressure, Arterial pressure, and Cardiovascular medicine and haematology
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The reported coverage of any antiretroviral (ARV) prophylaxis for prevention of mother-to-child transmission (PMTCT) has increased in sub-Saharan Africa in recent years, but was still only 60% in 2010. However, the coverage estimate is... more
The reported coverage of any antiretroviral (ARV) prophylaxis for prevention of mother-to-child transmission (PMTCT) has increased in sub-Saharan Africa in recent years, but was still only 60% in 2010. However, the coverage estimate is subject to overestimations since it only considers enrolment and not completion of the PMTCT programme. The PMTCT programme is complex as it builds on a cascade of sequential interventions that should take place to reduce mother-to-child transmission (MTCT) of HIV: starting with antenatal care (ANC), HIV testing, and ARVs for the woman and the baby. The objective was to estimate the number of children infected with HIV in a district population, using empirical data on uptake of PMTCT components combined with data on MTCT rates. This study is based on a population-based cohort of pregnant women recruited in the Iganga-Mayuge Health and Demographic Surveillance Site in rural Uganda 2008-2010. We later modelled different scenarios assuming increased upta...
Home Based Management of fever (HBM) was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed free of charge to febrile... more
Home Based Management of fever (HBM) was introduced as a national policy in Uganda to increase access to prompt presumptive treatment of malaria. Pre-packed Chloroquine/Fansidar combination is distributed free of charge to febrile children <5 years. Persisting fever or danger signs are referred to the health centre. We assessed overall referral rate, causes of referral, referral completion and reasons for non-completion under the HBM strategy. A case-series study was performed during 20 weeks in a West-Ugandan sub-county with an under-five population of 3,600. Community drug distributors (DDs) were visited fortnightly and recording forms collected. Referred children were located and primary caretaker interviewed in the household. Referral health facility records were studied for those stating having completed referral. Overall referral rate was 8% (117/1454). Fever was the main reason for mothers to seek DD care and for DDs to refer. Twenty-six of the 28 (93%) "urgent referr...
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At the Roll Back Malaria summit for African countries in Abuja, the heads of state committed to ensure that by the year 2005 at least 60% of those suffering from malaria would have access to effective treatment within 24 hours of onset of... more
At the Roll Back Malaria summit for African countries in Abuja, the heads of state committed to ensure that by the year 2005 at least 60% of those suffering from malaria would have access to effective treatment within 24 hours of onset of symptoms. The aim of the study was to assess community effectiveness of malaria treatment in children. A community-based survey of 500 households was undertaken in western Uganda. A total of 260 (52%) children were reported to have had fever within the previous 2 weeks: 87% received some kind of treatment, 44% were said to have been treated within 24 hours of onset of symptoms, 47% received appropriate anti-malarials, 25% received the correct dosage, and 24% took the drug for the recommended period of time; altogether, only 7% received all the treatment steps. With drug efficacies of 50-90%, we estimate a community effectiveness of 4-6%, which is far from the 2005 Abuja target. The greatest need for improvement in the Home Based Fever Management strategy is in reducing delay in treatment and improving dosage and duration of treatment.
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The Home-Based Management of Fever/Malaria (HBMF) strategy in rural Uganda was evaluated in a quasi-experimental study. The intervention consisted of volunteers educating mothers and providing a 3-day course of pre-packaged chloroquine... more
The Home-Based Management of Fever/Malaria (HBMF) strategy in rural Uganda was evaluated in a quasi-experimental study. The intervention consisted of volunteers educating mothers and providing a 3-day course of pre-packaged chloroquine plus sulfadoxine/pyrimethamine tablets (HOMAPAK), free of charge, for the treatment of under-five fevers. Using a structured questionnaire, information was obtained on care-seeking and treatment practices before (n=498) and 18
Research Interests: Microbiology, Community-Based Mental Health Services, Medical Microbiology, Malaria, Uganda, and 20 moreTreatment, Public Health, Rural Health, Humans, Child, Patient Compliance, Mothers, Experimental Study, Nursing Home, Questionnaires, Pyrimethamine, Sulfadoxine, Evaluation Studies, Fever, Public health systems and services research, Antimalarials, Combination drug therapy, Large Scale, Chloroquine, and Community Based Mental Health Services
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Current use, misuse, and overuse of antibiotics raise dangers and ethical dilemmas that cannot be solved in isolation, exclusively within a health system building block or even within the health sector only. There is a need to tackle... more
Current use, misuse, and overuse of antibiotics raise dangers and ethical dilemmas that cannot be solved in isolation, exclusively within a health system building block or even within the health sector only. There is a need to tackle antibiotic resistance emergence and containment on levels ranging from individuals, households, and the communities, to health care facilities, the entire health sector, and finally to national and global levels. We analyse emergence of antibiotic resistance based on interdependencies between health systems resources. We further go beyond the health system building blocks, to look at determinants of antibiotic resistance referring to wider global dynamics. Multi-level governance is the key for successful action in containment strategies. This will involve, in a comprehensive way, patients, health facilities where they receive care, health systems to which these facilities pertain, and the wider national context as well as the global community that influ...
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BACKGROUND: Lao PDR is a low-income country with an urgent need for evidence-informed policymaking in the healthcare sector. During the last decade a number of Health Systems Research (HSR) projects have been conducted in order to meet... more
BACKGROUND: Lao PDR is a low-income country with an urgent need for evidence-informed policymaking in the healthcare sector. During the last decade a number of Health Systems Research (HSR) projects have been conducted in order to meet this need. However, although knowledge about research is increasing among policymakers, the use of research in policymaking is still limited. METHODS: This article
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The aim of this paper is to study the relation between leadership behaviour of nursing managers and staff turnover with respect to the intervening variables &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;work... more
The aim of this paper is to study the relation between leadership behaviour of nursing managers and staff turnover with respect to the intervening variables &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;work climate&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;job satisfaction&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Three different well-documented questionnaires were used to assess perceived leadership behaviour, work climate and job satisfaction. Data on staff turnover were collected from a computerized follow-up system. Different statistical analyses such as correlation analyses, regression analyses and analyses of variance were performed in order to explore the relations. The results show strong correlations between leadership behaviour, work climate and job satisfaction. No significant direct relation between leadership behaviour and staff turnover was shown. Staff turnover shows statistically significant correlations with the job satisfaction variable &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;feeling&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; OR = 0.005), and the work climate variables &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;challenge&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;playfulness&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.001). In order to limit staff turnover, decision makers should put effort into recruiting and retaining managers that perform very well according to the needs of staff. Managers that are both relations-oriented and production-oriented, can manage change and are able to stimulate the staff with challenges have the best opportunities to achieve low staff turnover. To the best of the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge there is no study published that explores the influence of leadership behaviour, including the dimension &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;change&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, on staff turnover in relation to intervening intrinsic factors of job satisfaction and creative work climate in nursing.
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Objective: To describe conceptions of the management of hyperlipidaemia and assess changes in conceptions after an educational intervention.- Setting and subjects: Primary care in Sweden. Twenty doctors at community health centres.-... more
Objective: To describe conceptions of the management of hyperlipidaemia and assess changes in conceptions after an educational intervention.- Setting and subjects: Primary care in Sweden. Twenty doctors at community health centres.- Methods: Within an educational experiment evaluating the effects of 'group detailing' by community pharmacists at 67 health centres, a selected sample of doctors were interviewed on two occasions, one and a half year apart, regarding their views on atherosclerotic cardiovascular disease and hyperlipidaemia. Half of the doctors had, in between the interviews, participated in four educational group sessions, where information was presented and discussed regarding the national recommendations on the management of hyperlipidaemia. Applying a phenomenographic approach, the variation of conceptions was described regarding six domains: general attitude to cardiovascular disease, risk factors, prevention of ischaemic heart disease, role of blood lipids, ...
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Twenty primary care physicians at 12 health centres in Sweden were interviewed in a semi-structured way. Analysis was conducted using a phenomenographic method. Concerning the general attitude towards cardiovascular disease (CVD), there... more
Twenty primary care physicians at 12 health centres in Sweden were interviewed in a semi-structured way. Analysis was conducted using a phenomenographic method. Concerning the general attitude towards cardiovascular disease (CVD), there were two categories of answers; (A) CVD is a big threat to public health, and the health care system should play an active role in treatment and prevention, and (B) CVD is a symptom of normal aging with little or no need for active health care intervention. Questions on the management of hypercholesterolaemia showed a general acceptance of diet and lifestyle alterations, with a marked reluctance to use drugs except in cases of hereditary hypercholesterolaemia. The physicians were positive to non-commercial information from official sources. Critical opinions existed, however, questioning the adequacy and applicability of the national expert recommendations. There was a general acknowledgement of the importance of patient information, whereas a lack in communication skills was expressed. The description of attitudes and conceptions can assist in the understanding of mechanism underlying physicians&#39; behaviour and provide a base for future information programmes.
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Research Interests: Sociology, Anthropology, Health Promotion, Health Care, Bangladesh, and 12 moreSocial Science & Medicine, Humans, Health Services, Female, Male, Gender Difference, Health System, Questionnaires, Public health systems and services research, High Density Concrete, Control Group, and Health Expenditure
The intervention level of epidemiology is useful for studying effects in health systems research. Due to practical and ethical reasons, it is often difficult to apply experimental methods such as classical randomized clinical trials in... more
The intervention level of epidemiology is useful for studying effects in health systems research. Due to practical and ethical reasons, it is often difficult to apply experimental methods such as classical randomized clinical trials in the field. However with alternative approaches such as &#39;randomization by group&#39; some of these problems can be overcome. Drug information has since long been considered as an instrument to influence physicians, however evaluation of its effects is a new field of research. In the present study the impact of drug information on prescribing behaviour was evaluated in an outpatient setting in Sri Lanka. The study included 15 state health institutions (45 prescribers) with a common drug formulary. Groups of prescribers were randomized into two interventions; newsletters and newsletters reinforced by a group seminar, and one control group. The target topic was &#39;rational prescribing of antibiotics&#39;. Some 18,766 randomly selected outpatient drug prescriptions were studied. Antibiotics (and sulphonamides) were prescribed to 33.2% of the patients. An overall trend towards a decrease in proportion of patients prescribed antibiotics in the two intervention groups was seen, although the difference was not significant (p greater than 0.05) compared to the control group. This is similar to the effect of written information on prescribing in other studies. A mean difference of -7.4% in written, -7.3% in written + seminar and -0.4% in the control group was shown. The general antibiotic prescribing pattern did not change in any of the three groups. Penicillin was the most commonly prescribed antibiotic and tetracycline was only rarely prescribed to children. This experiment indicates the feasibility of drug information intervention studies in developing countries.(ABSTRACT TRUNCATED AT 250 WORDS)
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Research Interests: Public Opinion, Community-Based Mental Health Services, Focus Groups, Medical Microbiology, Malaria, and 20 moreUganda, Adolescent, Community Health Workers, Humans, Female, Infant, Scaling up, Self-administration, Nursing Home, Health System, Pyrimethamine, Sulfadoxine, Adult, Fever, Antimalarials, Focus Group Discussion, Health Workers, Chloroquine, Assessment Methods, and Community Based Mental Health Services
Antibiotic resistance is considered a major threat to global health and is affected by many factors, of which antibiotic use is probably one of the more important. Other factors include hygiene, crowding and travel. The rapid resistance... more
Antibiotic resistance is considered a major threat to global health and is affected by many factors, of which antibiotic use is probably one of the more important. Other factors include hygiene, crowding and travel. The rapid resistance spread in Gram-negative bacteria, in particular extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (ESBL-E), is a global challenge, leading to increased mortality, morbidity and health systems costs worldwide. Knowledge about resistance in commensal flora is limited, including in China. Our aim was to establish the faecal carriage rates of ESBL-E and find its association with known and suspected risk factors in rural residents of all ages in three socio-economically different counties in the Shandong Province, China. Faecal samples and risk-factor information (questionnaire) were collected in 2012. ESBL-E carriage was screened using ChromID ESBL agar. Risk factors were analysed using standard statistical methods. Data from 1000 indi...
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Research Interests: Engineering, Physics, Chemistry, Decision Making, Health Education, and 20 moreBiology, Malaria, Adolescent, Tanzania, Medicine, Multidisciplinary, Pregnancy, Humans, Child, Female, Young Adult, PLoS one, Aged, Middle Aged, Adult, Antimalarials, Focus Group Discussion, Health Care Provider, Decision Maker, and Informal Care
A concerted global response is needed to tackle rising rates of antibiotic resistance, say Otto Cars and colleagues
Research Interests: Global Health, Pharmaceutical Technology, Developing Countries, International Cooperation, Public sector, and 14 moreHealth Policy, Antibiotic Resistance, British medical history, Human Microbiome, Travel, Humans, Microbial genetic and drug resistance, Developed Countries, Anti-Bacterial Agents, Public health systems and services research, Private Sector, BMJ, World Health Organization, and Communicable disease control
To investigate self reported practice and actual practice of private pharmacy staff in relation to drug regulations and provision of prednisolone (a prescription-only corticosteroid) on request to treat lower back pain. Sixty private... more
To investigate self reported practice and actual practice of private pharmacy staff in relation to drug regulations and provision of prednisolone (a prescription-only corticosteroid) on request to treat lower back pain. Sixty private pharmacies in Hanoi were randomly selected. Self reported practice was assessed through interviews with pharmacy staff using a questionnaire; actual practice was assessed with the Simulated Client Method with 5 encounters in each pharmacy (a total of 295 encounters). Sixty percent of the pharmacy staff interviewed said that they would not dispense corticosteroids without prescription and 60% could mention some adverse effects. In practice all but one pharmacy dispensed corticosteroids without prescription in 76 % of all the encounters. Questions and advice given to the clients were associated with significantly lower dispensing of corticosteroids. The low compliance with prescription regulations and the discrepancy between stated practice and actual pra...
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The European Union (EU) supports North-South Partnerships and collaborative research projects through its Framework Programmes and Horizon 2020. There is limited research on how such projects can be harnessed to provide a structured... more
The European Union (EU) supports North-South Partnerships and collaborative research projects through its Framework Programmes and Horizon 2020. There is limited research on how such projects can be harnessed to provide a structured platform for doctoral level studies as a way of strengthening health system research capacity in sub-Saharan Africa (SSA). The aim of this study was to explore the challenges of, and facilitating factors for, 'nesting' doctoral students in North-South collaborative research projects. The term nesting refers to the embedding of the processes of recruiting, supervising, and coordinating doctoral students in the overall research plan and processes. This cross-sectional qualitative study was undertaken by the EU-funded QUALMAT Project. A questionnaire was implemented with doctoral students, supervisors, and country principal investigators (PIs), and content analysis was undertaken. Completed questionnaires were received from nine doctoral students, s...
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A report by the Swedish National Committee on Gender Disparities in Patient Care (1996) identified many shortcomings in the ability of the health sector to gear patient management and treatment to the specific needs of men and women. To... more
A report by the Swedish National Committee on Gender Disparities in Patient Care (1996) identified many shortcomings in the ability of the health sector to gear patient management and treatment to the specific needs of men and women. To promote gender equity in health care, the Committee presented several proposals relating to research, education, monitoring, and evaluation of health services
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Evidence mainly from high and middle income countries shows that community social capital is associated with positive health outcomes. The current policy interest in social capital stems from the anticipation that investing in it will... more
Evidence mainly from high and middle income countries shows that community social capital is associated with positive health outcomes. The current policy interest in social capital stems from the anticipation that investing in it will enhance improvements in population health and some governments in high income countries have promoted initiatives to enhance its generation. However, there is a paucity of empirical evidence from low income countries on the utility of social capital for health outcomes. To assess the role of social capital in the use of health care services in Uganda, a low income country. The study sample included nine hundred and thirty six febrile children with complete data on place of treatment, caregiver social capital and socio-demographic variables; child demographic variables and household socioeconomic status were selected from the Iganga-Mayuge Health and Demographic Surveillance Site data base. The association for each dimension of social capital and use of...
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Antibiotic use is seen as a critical factor in the emergence of resistant bacteria. The impact of irra- tional use, including inadequate dosing and poor adherence to therapy, is potentially just as important as high consumption (28). At... more
Antibiotic use is seen as a critical factor in the emergence of resistant bacteria. The impact of irra- tional use, including inadequate dosing and poor adherence to therapy, is potentially just as important as high consumption (28). At the same time, limited access to antibiotics in many parts of the world is contributing to high mortality from bacterial infections. Often, irrational behaviour from a biomedical perspective may be perfectly logical for the human being and in the context of the cultural sphere surrounding her. Understanding the reasons that individuals use antibiotics in a particular way is crucial if one is to influence their actions. Containment of antibiotic resistance has been established as a 'Global Public Good for Health' and the rationalising of consumer and provider behaviour is an essential component in achieving this goal (19). In this article, the aim has been to examine the interplay between prescribers, dispensers and consumers, to visualise i...
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To study case management of malaria in children under 5 years of age at primary health care facilities in Kibaha district, Tanzania and to evaluate the accuracy of self-reported... more
To study case management of malaria in children under 5 years of age at primary health care facilities in Kibaha district, Tanzania and to evaluate the accuracy of self-reported mothers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;/guardians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; information on chloroquine use in children. A random sample of 652 mothers/guardians with sick children under 5 years of age attending 10 primary health care facilities was observed and interviewed. Blood samples for determination of chloroquine levels were taken from all children and thick smears for detection of malaria parasites were taken from the children who were prescribed chloroquine. Information on diagnoses and prescriptions was collected from recording books. Fever and respiratory problems were the most common complaints and accounted for 75% and 46% of the presenting conditions, respectively (some complained of both). Fifty-four per cent of the children received medication at home, most commonly antipyretics and chloroquine, 20% had been taken to another health facility and 3% to traditional healers before coming to the health facilities. There was a significantly higher use of antipyretics among home treated children compared with those taken previously to health facilities (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= 0.001). Use of antibiotics was higher among children who had been taken to health facilities previously (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). Nine per cent had received injections. The average consultation time was 3.8 min. Thirty-nine per cent of the children were physically examined, with large interfacility variations. In 71% of the children malaria was diagnosed, either as a single condition or in combination with others, and with respiratory problems as the leading overlapping condition (29%). Malaria parasites were found in 38% of the cases given a malaria diagnosis. A total of 81% of the health facility prescriptions included analgesics, 71% chloroquine and 54% antibiotics. A fourth of all prescriptions were injections. The proportions of chloroquine and antibiotic injections in relation to the total number of prescriptions varied between the facilities. Of the 529 blood samples successfully analysed for chloroquine, 98% had detectable blood drug levels. Ninety-seven per cent of the children without history of prior chloroquine treatment had detectable drug levels in the blood, 11% had high levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or= 1000 nmol/l). Of those prescribed chloroquine, 16% already had high blood concentrations of the drug. Health care services, i.e. presumptive malaria diagnosis, consultation time and procedure for physical examination need to be improved.
Research Interests: Primary Health Care, Malaria, Tropical Medicine, Treatment, Developing Countries, and 18 moreHealth, Tanzania, Medicine, Tropical medicine (Health Sciences), Population, Humans, Female, Male, Infant, Case Management, High Pressure Liquid Chromatography, Newborn Infant, Questionnaires, Anti-Bacterial Agents, Public health systems and services research, Antimalarials, Chloroquine, and Nino
Research Interests: Tropical Medicine, Vietnam, Streptococcus pneumoniae, Tropical medicine (Health Sciences), Humans, and 15 moreBacterial resistance, Female, Male, Microbial genetic and drug resistance, Infant, Caregivers, Aged, Middle Aged, Questionnaires, Anti-Bacterial Agents, Adult, Public health systems and services research, Respiratory Tract Infections, Bacterial infections, and Haemophilus influenzae
Research Interests: Rural, Malaria, Tropical Medicine, Medication Adherence, Treatment, and 19 moreAdolescent, Adhesion, Tropical medicine (Health Sciences), Rural Health, Humans, Health Services, Female, Male, Young Adult, Caregivers, Middle Aged, Adult, Public health systems and services research, Antimalarials, Intervention study, Socio Economic Status, Suppositories, Confidence Interval, and Nino
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Research Interests: Focus Groups, Tropical Medicine, Public Health, Health Policy, Tanzania, and 21 moreTropical medicine (Health Sciences), Mass media, Drug Policy, Rural Health, Humans, Female, Male, Self-administration, Sesquiterpenes, Policy Implementation, Pyrimethamine, Sulfadoxine, Public health systems and services research, Adverse Drug Reaction, Antimalarials, Combination drug therapy, Focus Group Discussion, Health Workers, Chloroquine, Cross sectional Study, and Cross Sectional Studies
Acute respiratory infections (ARI) are leading killers of children. Case management using community health workers (CHW) has halved ARI mortality in children in Asia. WHO/UNICEF recommend integrating pneumonia into Home Management of... more
Acute respiratory infections (ARI) are leading killers of children. Case management using community health workers (CHW) has halved ARI mortality in children in Asia. WHO/UNICEF recommend integrating pneumonia into Home Management of Malaria strategies. However, in sub-Saharan Africa, CHW&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s performance to recognise pneumonia is rarely demonstrated. We evaluated the ability of CHWs to assess rapid breathing in under 5 year olds and explored caretaker interpretation of pneumonia symptoms. Ninety-six CHWs were evaluated for their skills to count and classify breathing rate in inpatient children. Respiratory illness concepts and actions were obtained from focus group discussions with mothers, video probing and key informant interviews. Of the CHW assessments, 71% were within +/-5 breaths/min from the gold standard. The sensitivity of CHW classification was 75% and the specificity was 83%. Many local terms existed for ARIs, such as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;quick breathing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;groaning breathing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. There was consistency in the interpretation of severity, cause and treatment, most being related to fever and treated with antimalarials. Given the ability of CHWs to classify pneumonia, their skills should be tested in real life. To minimise failure to treat and overtreatment, context-specific communication strategies that improve care-seeking and increase illness prevalence among patients assessed by CHWs are needed. A toolkit including a set of methods for this purpose is proposed.
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We assessed the efficacy of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) and DHFR/DHPS genotypes of Plasmodium falciparum in rural Tanzania, 3 years after their introduction as first- and second-line treatments for uncomplicated... more
We assessed the efficacy of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) and DHFR/DHPS genotypes of Plasmodium falciparum in rural Tanzania, 3 years after their introduction as first- and second-line treatments for uncomplicated malaria, respectively. Under five children with uncomplicated malaria were given standard treatments of either SP (n=66) or AQ (n=30) and treatment outcomes after 14 and 28 days were determined. Total treatment failure of 18 and 42.5% was observed for SP on days 14 and 28, respectively. For AQ, total treatment failure of 27 and 53% was found on day 14 and 28, respectively. On day 14, significantly lower SP total treatment failures were observed in 2004 compared with results from a study conducted in 1999 in the same location. No relationship was detected between clinical outcome and DHFR/DHPS genotypes, but the point mutation prevalence in parasites was higher than in 1999. Pre-treatment blood levels of SP were detected in a quarter of the study children: less than expected. We report unacceptably high levels of total treatment failures, both for first- and second-line treatments for uncomplicated malaria in Tanzania 3 years after their introduction, supporting the decision to replace them with artemisinin-based combination therapy.
Research Interests: Microbiology, Medical Microbiology, Treatment Outcome, Tanzania, Rural Health, and 14 moreHumans, Female, Animals, Drug Resistance, Male, Infant, Follow-up studies, Genotype, Pyrimethamine, Sulfadoxine, Public health systems and services research, Plasmodium falciparum, Antimalarials, and Amodiaquine
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Research Interests: Sociology, Anthropology, International Development, Developing Countries, Health Services Research, and 13 moreThird World, Literature Review, Sweden, Social Science & Medicine, Collaborative Research, Humans, Project manager, Subject Areas, Data Collection, Research Method, Public health systems and services research, Cooperative Behavior, and Social Science
Background Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating... more
Background
Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.
Methods
Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.
Results
Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.
Conclusion
Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.
Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation.
Methods
Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention.
Results
Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation.
Conclusion
Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations.