The Institute for Global Health and Development
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Item Learning from implementation of a COVID case management desk guide and training: a pilot study in Sierra Leone(BioMed Central, 2023-09-25) Witter, Sophie; Zou, Guanyang; Cheedella, Kiran; Walley, John; Wurie, HajaBackground: When the COVID pandemic hit the world, there was need for applied guides and training materials to support frontline health care staff to manage patients effectively and safely and to educate themselves and communities. This article reports on the development and piloting of such a set of materials in Sierra Leone, which were based on international evidence but adapted to the local context. Reflecting on this experience, including community and health system barriers and enablers, is important to prepare for future regional shocks. Methods: This study, in Bombali district in 2020, piloted user-friendly COVID guides for frontline health workers (the intervention), which was evaluated using facility checklists (pre and post training), routine data analysis and 32 key informant interviews. Results: Key informants at district, hospital and community health centre levels identified gains from the training and desk guides, including improved diagnosis, triaging, infection prevention and management of patients. They also reported greater confidence to share messages on protection with colleagues and community members, which was needed to encourage continued use of essential services during the pandemic. However, important barriers were also revealed, including the lack of testing facilities, which reduced the sense of urgency, as few cases were identified. Actions based on the Ebola experience, such as setting up testing and isolation centres, which the community avoided, were not appropriate to COVID. Stigma and fear were important factors, although these were reduced with outreach activities. Supplies of essential medicines and personal protective equipment were also lacking. Conclusion: This pilot study demonstrated the relevance and importance of guides adapted to the context, which were able to improve the confidence of health staff to manage their own and the community’s fears in the face of a new pandemic and improve their skills. Previous epidemics, particularly Ebola, complicated this by both creating structures that could be revitalised but also assumptions and behaviours that were not adapted to the new disease. Our study documents positive adaptations and resilience by health staff but also chronic system weaknesses (particularly for medicines, supplies and equipment) which must be urgently addressed before the next shock arrives.Item Developing a social mobilisation intervention for salt reduction: participatory action research in Bombali district, Sierra Leone(BioMed Central, 2023-09-12) Cheedella, Kiran; Conteh, Peter; Zou, Guanyang; Walley, John; Kamara, Ajaratu; Wurie, Haja; Witter, SophieBackground: High salt intake is a major risk factor for hypertension, which in turn contributes to cardiovascular diseases, the major cause of death from non communicable diseases (NCDs). Research is limited on social mobilisation interventions to tackle NCDs, including in fragile health settings such as Sierra Leone. Methods: Participatory action research methods were used to develop a social mobilisation intervention for salt reduction in Bombali District, Sierra Leone. A team of 20 local stakeholders were recruited to develop and deliver the intervention. Stakeholder workshop reports and interviews were used to record outcomes, enablers, and barriers to the intervention. Focus group discussions were used to observe knowledge, attitudes, and behaviours of community members pre- and post- the intervention. Results: Stakeholders showed enthusiasm and were well engaged in the social mobilisation process around salt reduction. They developed radio jingles, radio show talks, organised community awareness raising meetings, school sensitisation outreaches, and door to door engagements. Stakeholders reported benefiting personally through developing their own skills and confidence in communication and felt positive about their role in educating their community. The interventions led to reported increased awareness of risks of high salt intake and NCDs, resulting in a reduction of salt use in the community, leading to perceived health gains. However, salt reduction was also met with some resistance due to social factors. Local community structures were also reactivated to work on the interventions and connect the community to the local health facility, which saw an increase in patients having their blood pressure checked. The comparison villages also experienced an increase in awareness and perceived reductions in salt intake behaviours. This was as messages had cascaded via the radio and initial focus group discussions. The social mobilisation stakeholders also agreed on future activities that could continue at no or low cost. Conclusion: Social mobilisation interventions can provide low-cost strategies to tackle NCDs in fragile settings such as Sierra Leone through the utilisation of community structures. However, more research is required to ascertain the key enablers for replicability and if such successes can be sustained over a longer follow up period.Item ‘You say you are a TB doctor, but actually, you do not have any power’: health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China(BioMed Central, 2022-06-23) Zou, Guanyang; McPake, Barbara; Kielmann, KarinaAbstract: Background: In China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into ‘designated’ public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB ‘designated’ hospitals in Zhejiang province, we explored factors influencing hospital-based health workers’ motivation in the context of integrated TB service delivery. Methods: We conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation. Results: Health workers tasked with TB care in ‘designated’ hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their salaries compared with other clinical staff. In both sites, health workers were concerned about poor infection control and weak risk management assessment systems. Conclusions: Inadequate attention to workforce issues for TB control in China, specifically the professional status, welfare, and development as well as incentivization of infectious disease control workers has contributed to dissatisfaction and consequently poor motivation to serve TB patients within the integrated model of TB care. It is important to address the failure to motivate health workers and maximize public good-oriented TB service provision through improved government funding and attention to the professional welfare of health workers providing TB care in hospitals.Item Adapting and implementing training, guidelines and treatment cards to improve primary care-based hypertension and diabetes management in a fragile context: Results of a feasibility study in Sierra Leone(BMC, 2020-07-29) Zou, Guanyang; Witter, Sophie; Caperon, Lizzie; Walley, John; Cheedella, Kiran; Senesi, Reynold G. B.; Wurie, HajaBackground: Sierra Leone, a fragile country, is facing an increasingly significant burden of non-communicable diseases (NCDs). Facilitated by an international partnership, a project was developed to adapt and pilot desktop guidelines and other clinical support tools to strengthen primary care-based hypertension and diabetes diagnosis and management in Bombali district, Sierra Leone between 2018 and 2019. This study assesses the feasibility of the project through analysis of the processes of intervention adaptation and development, delivery of training and implementation of a care improvement package and preliminary outcomes of the intervention.Item Perceived challenges in delivering comprehensive care for patients following stroke: A qualitative study of stroke care providers in Guangdong Province, China(Taylor & Francis, 2020-04-28) Wu, Chanchan; Zou, Guanyang; Chen, Minjie; Wan, Lihong; Kielmann, Karina; McCormack, BrendanPurpose: To understand the challenges in delivering comprehensive care for patients recovering from stroke.Item Rural-urban health seeking behaviours for non-communicable diseases in Sierra Leone(BMJ, 2020-03-02) Idriss, Ayesha; Diaconu, Karin; Zou, Guanyang; Senesi, Reynold G. B.; Wurie, Haja; Witter, SophieIntroduction Non-communicable diseases (NCDs) are the leading cause of mortality globally. In Africa, they are expected to increase by 25% by 2030. However, very little is known about community perceptions of risk factors and factors influencing health-seeking behaviour, especially in fragile settings. Understanding these is critical to effectively address this epidemic, especially in low-resource settings.Item Results of a cluster randomized controlled trial to promote the use of respiratory protective equipment among migrant workers exposed to organic solvents in small and medium-sized enterprises(MDPI, 2019-08-31) Chen, Wen; Li, Tongyang; Zou, Guanyang; Renzaho, Andre M. N.; Li, Xudong; Shi, Leiyu; Ling, LiBackground: Existing evidence shows an urgent need to improve respiratory protective equipment (RPE) use, and more so among migrant workers in small and medium-sized enterprises (SMEs). The study aimed to assess the effectiveness of a behavioral intervention in promoting the appropriate use of RPE among internal migrant workers (IMWs) exposed to organic solvents in SMEs. Methods: A cluster randomized controlled trial was conducted among 1211 IMWs from 60 SMEs in Baiyun district in Guangzhou, China. SMEs were deemed eligible if organic solvents were constantly used in the production process and provided workers with RPE. There were 60 SMEs randomized to three interventions on a 1:1:1 ratio, namely a top-down intervention (TDI), a comprehensive intervention, and a control group which did not receive any intervention. IMWs in the comprehensive intervention received a module encompassing three intervention activities: An occupational health education and training component (lectures and leaflets/posters), an mHealth component in the form of messages illustrative pictures and short videos, and a peer education component. The TDI incorporated two intervention activities, namely the mHealth and occupational health education and training components. The primary outcome was the self-reported appropriate RPE use among IMWs, defined as using an appropriate RPE against organic solvents at all times during the last week before measurement. Secondary outcomes included IMWs’ occupational health knowledge, attitude towards RPE use, and participation in occupational health check-ups. Data were collected and assessed at baseline, and three and six months of the intervention. Generalized linear mixed models were performed to evaluate the effectiveness of the trial. Results: Between 3 August 2015 and 29 January 2016, 20 SMEs with 368 IMWs, 20 SMEs with 390 IMWs, and 20 SMEs with 453 IMWs were assigned to the comprehensive intervention, the TDI, and the control group, respectively. At three months, there were no significant differences in the primary and secondary outcomes among the three groups. At six months, IMWs in both intervention groups were more likely to appropriately use RPE than the control group (comprehensive intervention: Adjusted odds ratio: 2.99, 95% CI: 1.75–5.10, p < 0.001; TDI: 1.91, 95% CI: 1.17–3.11, and p = 0.009). Additionally, compared with the control group, the comprehensive intervention also improved all three secondary outcomes. Conclusions: Both comprehensive and top-down interventions were effective in promoting the appropriate use of RPE among IMWs in SMEs. The comprehensive intervention also enhanced IMWs’ occupational health knowledge, attitude, and practice. Trial registration: ChiCTR-IOR-15006929. Registered on 15 August 2015.Item Health service seeking behavior among migrant workers in small and medium-sized enterprises in Guangdong, China: Does family migration matter?(Hindawi, 2018-11-21) Dang, Yuewen; Zou, Guanyang; Peng, Boli; Ling, Li; Wand, HandanObjective. This study aims to understand the health service seeking behavior of migrant workers and explore its association with their living status (i.e., living with family members or not), in Guangdong, China. Methods. This was a cross-sectional survey conducted with 912 migrant workers in 2012 using a structured questionnaire adapted from the National Health Service Survey. Data were analyzed using the multivariable logistic regression. Results. Of all migrant workers, 58% lived with at least one family member in the host city. Most of the respondents rated their health status being “very good or good” (58%). Fifty-four percent of the respondents reported having at least one disease in the past 12 months. Sixty-two percent of those who reported at least one disease visited doctors in the past 12 months. Of these, 22% returned to their hometown for medical treatment. Logistic regression showed that migrant workers living with families rated themselves as having better health status (P<0.05) but had more diseases (P>0.05) and had higher doctor visitation rate than those living with alone (58% vs. 66%, P<0.05). Conclusion. The Andersen health service utilization model helps to understand the health seeking behavior of the migrant workers in the host cities. Migrant workers living with family members were positively associated with self-rated health status and health service seeking behavior in small and medium-sized enterprises. Our findings suggest the importance of the assistance programs and social support to improve seeking of healthcare services among migrant groups, especially those who live alone in the host cities.Item Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: Perceptions of policy-makers and health providers in Sierra Leone(BMC, 2020-01-06) Witter, Sophie; Zou, Guanyang; Diaconu, Karin; Senesi, Reynold G. B.; Idriss, Ayesha; Walley, John; Wurie, HajaBackground: The growing burden of non-communicable diseases in low- and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic.Item Renaming non-communicable diseases [Letter](2017-07-01) Zou, Guanyang; Decoster, Kristof; McPake, Barbara; Witter, Sophie