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Solutions to infection prevention and control challenges in developing countries, do they exist?

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by Vanessa Sparke, PhD candidate and Lecturer – Nursing and Midwifery, JCU

As colleagues at Atoifi Hospital and other hospitals in Solomon Islands know, applying Western-based infection prevention and control (IP&C) programs and practices to health facilities with limited resources is difficult. A group of us from Solomon Islands and Australia conducted a literature review to find out what is known about IP&C in contexts like Atoifi Hospital, and to search for possible solutions.

Around the world IP&C is important for patient safety and quality of care however due to a higher burden of disease, a lack of physical and financial resources, geographical isolation, extremes of climate, and differing cultural and spiritual beliefs, the number of healthcare associated infections in hospitals in developing countries is much higher than that of Western nations.

The literature review aimed to look for solutions to this challenge, and while limited success has been documented for some IP&C core program components, there appears to be very little research on the problem overall. The review found that education of health care workers, strong governance and leadership, adopting a systematic approach, participation of patients and taking into account their culture and needs, or a combination of all these have had the most success.

What hasn’t been well-researched is the influence that health care worker knowledge and beliefs have on their understanding and subsequent practices of IP&C. The review found that this gap in the literature is an opportunity for further research.

The integrative review was authored by Vanessa L Sparke, Jason Diau, David MacLaren and Caryn West, and can be found at: https://researchonline.jcu.edu.au/63060/

For more information about this review or IP&C research being facilitated at Atoifi Hospital, please email: Dr Jason Diau jasondiau@atoifi.org.sb or Ms Vanessa Sparke vanessa.sparke1@jcu.edu.au

Photo via: https://www.ijic.info/index

From the Frontline - new article about pandemic preparedness and research capacity strengthening

A timely new article has been published by James Cook University, Atoifi Health Research Group members, WHO and other Pacific collaborators showing how grassroots research can help strengthen surveillance and response capacities of the rural workforce in the Asia-Pacific Region.

Health systems in the Asia-Pacific region are poorly prepared for pandemic threats, particularly in rural/provincial areas. Yet future emerging infectious diseases are highly likely to emerge in these rural/provincial areas, due to high levels of contact between animals and humans (domestically and through agricultural activities), over-stretched and under-resourced health systems, notably within the health workforce, and a diverse array of socio-cultural determinants of health.

In order to optimally implement health security measures at the frontline of health services where the people are served, it is vital to build capacity at the local district and facility level to adapt national and global guidelines to local contexts, including health systems, and community and socio-cultural realities.

During 2017/18 James Cook University (JCU) facilitated an implementation research training program (funded by Australian Department of Foreign Affairs and Trade) for rural/provincial and regional health and biosecurity workers and managers from Fiji, Indonesia, Papua New Guinea (PNG), Solomon Islands and Timor-Leste. This training was designed so frontline health workers could learn research in their workplace, with no funding other than workplace resources, on topics relevant to health security in their local setting.

The program, based upon the WHO-TDR Structured Operational Research and Training IniTiative (SORT-IT) consists of three blocks of teaching and a small, workplace-based research project. Over 50 projects by health workers including surveillance staff, laboratory managers, disease control officers, and border security staff included: analysis and mapping of surveillance data, infection control, IHR readiness, prevention/response and outbreak investigation.

Policy briefs written by participants have informed local, provincial and national health managers, policy makers and development partners and provided on-the-ground recommendations for improved practice and training. These policy briefs reflected the socio-cultural, health system and disease-specific realities of each context. The information in the policy briefs can be used collectively to assess and strengthen health workforce capacity in rural/provincial areas.

The capacity to use robust but simple research tools for formative and evaluative purposes provides sustainable capacity in the health system, particularly the rural health workforce. This capacity improves responses to infectious diseases threats and builds resilience into fragile health systems.

For more information about the SORT-IT training at Atoifi Hospital, watch: https://www.youtube.com/watch?v=p4RHLTyjNTw

To read the new article for free, visit: https://www.frontiersin.org/articles/10.3389/fpubh.2020.00507/full

Reference Details: Larkins, S., K. Carlisle, H. Harrington, D. MacLaren, E. Lovo, R. Harrington, L. Fernandes Alves, E. Rafai, M. Delai and M. Whittaker (2020). "From the Frontline: Strengthening Surveillance and Response Capacities of the Rural Workforce in the Asia-Pacific Region. How Can Grass-Roots Implementation Research Help?" Frontiers in Public Health 8(507).

For more information, please email: humpress.harrington@gmail.com

Family planning to save lives

JCU PhD candidate and Atoifi Health Research group member, Relmah Harrington, is one of the many women in health working to create a safer future for families in the Pacific. Relmah is an experienced nurse, midwife and educator researching how family planning services could save lives in the Solomon Islands.

Imagine a commercial plane, carrying 200 passengers crashing every six hours, killing all passengers continuously the whole day, the whole week, the whole month and the whole year. In 2017, more than 800 women died worldwide every day from preventable causes related to pregnancy. Globally, strong advocates support the use of family planning contraceptives as cost effective interventions to reduce these deaths.

The Solomon Islands is a low-income pacific nation. About 80 per cent of people live in rural and remote areas. On average, one woman dies every three weeks from pregnancy complications. Imagine you are a father in the Solomon Islands expecting the birth of your next child. You did not plan this pregnancy, it just happened. Your wife leaves to give birth and does not come back. You are shocked to hear she tragically dies giving birth. No more hugs, no kisses, there was no good bye. Thoughts raised in your head, "who will bring home food from the gardens?", "who will take care of the children?", "who will do the washing or cook?". How can these tragedies be prevented and the situations improved?

Read how at this story from James Cook University: https://www.jcu.edu.au/this-is-uni/health-and-medicine/articles/family-p...

For more information about this research, please email: relmah.harrington@my.jcu.edu.au
Photo: Relmah Harrington

Looking at the bigger picture for reproductive health

Republished from James Cook University website, 10 July 2020
https://www.jcu.edu.au/this-is-uni/articles/looking-at-the-bigger-pictur...

World Population Day on 11 July focuses attention on the importance and urgency of population issues, such as population growth, ageing, migration, and urbanisation. The theme for this year’s World Population Day recognises that reproductive health and gender equality are essential in achieving sustainable development and a brighter future. JCU PhD candidate Relmah Harrington is looking to the role the wider community can play in creating a healthier and safer future for maternal and neonatal health outcomes in the Solomon Islands.

As an experienced nurse, midwife, and nurse educator and trainer, Relmah has witnessed first-hand the reproductive healthcare challenges faced by the communities and healthcare workers in her home nation, the Solomon Islands.

Maternal and neonatal mortality, limited access to health services, and high teen pregnancy rates are some of the issues that the she has seen throughout her career. On way of improving outcomes in these areas is through the provision of reproductive health advise and family planning resources.

The availability of such services, however, does not necessarily relate to the number of people using the service. “I didn’t see women come forward very much to access family services,” Relmah says. “We used to give health talks and education talks to them but not many people came forward to take family planning options. I was wondering why women, or men, weren’t coming forward and if there was something I need to know from their perspectives.”

In order to understand the gap between the high-level of family planning knowledge and the uptake rate of family planning services, Relmah decided to combine her experience as a Solomon Islands woman and her time as a nurse and midwife to examine what was happening at the service provision level. “I needed to go back to the other part of me,” she says, “the community member, to see what might work for us in the community and how we can get everyone to be involved so that women can come forward.”

Relmah’s preliminary results suggest that connecting the provision of family planning with community context is key. “We only talk to women when we talk about family planning and not the men,” she says. “In the cultural context, men are the decision makers in the family, and they will have to agree before a woman will accept these resources — we didn’t actually reach the husband.”

Considering the cultural contexts of men and woman is also important when it comes to who is delivering the service. “Men would prefer to deal with a male service provider, but in my remote hospital there was no man in the family planning clinic it was only women. It is like men and boys cannot fit into the service, so we need to make space for them, and involve men in the delivery of family planning.”

The location of the clinic was also an important factor in the uptake of family planning services. “What happened was our family planning clinic in that hospital was a little room attached to the delivery suite,” Relmah says. “The nearby communities in the mountains practice ancestral worship and have a belief that their women could not call near the birthing place. Unless they are birthing it is taboo, so if the building is connected then they can’t come. There is a similar taboo for the men. They believe that they can’t come near the birthing suite, which means they can’t access the family planning clinic. They said if the clinic is a separate building not connected to the birthing suite then they can come there to access family planning resources and advice.”

For Relmah, understanding that a one size fits all approach would not work is key. Health services must meet the community where they are and in their own context. As Relmah points out, cultural values and religious beliefs can play an important role in making family planning more accessible, as opposed to being viewed as an impediment to service delivery and care. “Rather than just blaming culture and religion, if we can also look at facilities and how we actually make the service available to each community it would make a difference to the uptake and provision of family health services,” she says. “The main thing is where the service is located, who is providing the service, and how it is provided.”

While women and their babies are at the forefront of pregnancy and childbirth risk, encouraging the uptake of family planning to improve reproductive health outcomes requires a community approach. “I hope I can change the way that we provide services and change it in a way that suits the context of people who access that particular health centre, so people are able to come forward and utilise the service.”

For more information, please email Relmah Harrington: relmah.harrington@my.jcu.edu.au
Feature image: Shutterstock

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