/pdf/time-for-united-action-on-depression-a-lancet-world-2voi6uix.pdf

Time for united action on depression: a Lancet–World Psychiatric Association Commission

The prevention of healthcare associated infections is central to the provision of safe, high quality healthcare. Infections acquired in healthcare facilities are a major public health concern, contributing to increased morbidity, mortality, and cost in both developed and developing countries. Although most of these infections can be prevented with relatively inexpensive infection prevention and control measures in many developing countries, in sub-Saharan African healthcare facilities have no effective infection prevention programs. Additionally, there is limited information on healthcare worker infection prevention knowledge and practice in countries such as Ethiopia. The aim of this study was to assess the knowledge and practices of healthcare workers with respect to infection prevention and associated factors in healthcare facilities in southeast Ethiopia. A facility-based cross-sectional study design was used to study healthcare workers in the southeast, Ethiopia. Multi-stage sampling was employed to select 680 healthcare workers from 30 randomly selected healthcare facilities. Data was collected using a self-administered structured questionnaire. Descriptive statistics were computed. Multivariable logistic regression was performed to identify factors associated with healthcare workers infection prevention knowledge and practice. A total of 648 healthcare workers participated in this study, for a response rate of 95.3%. Of these, 53.7% (95% CI: 49.8, 57.4%) and 36.3% (95% CI: 32.4, 40.1%) of the respondents were assessed as knowledgeable and reported safe infection prevention practices respectively. The likelihood of self-reporting safe infection prevention practice significantly increased if healthcare workers had received training (AOR = 5.31; 95% CI: 2.42,11.63) and had infection prevention guidelines available (AOR = 3.34; 95% CI: 1.65, 6.76). Healthcare workers were more likely to have infection prevention knowledge if they worked longer ten years or more (AOR = 3.41; 95% CI: 1.22, 9.55); worked in facilities with infection prevention committees (AOR = 1.78; 95% CI: 1.01, 3.13), had infection prevention guidelines available (AOR = 2.44; 95% CI: 1.45, 4.12); had training (AOR = 5.02; 95% CI: 1.45, 8.59). Inadequate infection prevention knowledge and unsafe practices were frequent among study participants, reflecting a potentially common problem at public healthcare facilities in southeast Ethiopia. Healthcare workers have better knowledge and safer practices if they had received infection prevention training and had infection prevention guidelines in their workplace. Interventions should be designed to consider these identified factors.

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Assessment of knowledge and practices of healthcare workers towards infection prevention and associated factors in healthcare facilities of West Arsi District, Southeast Ethiopia: a facility-based cross-sectional study.

Background Given the inherent characteristics of the Hajj pilgrimage, the event is a risk for tuberculosis (TB) infection. Early diagnosis and appropriate management of TB cases by knowledgeable and skilled healthcare workers (HCWs) are key in improving patients’ outcome and preventing transmission during the Hajj mass gathering and globally. Method We conducted a cross-sectional study to assess knowledge, attitude and practice (KAP) of HCWs deployed during the 2016 Hajj regarding TB and its management using an anonymous self-administered questionnaire. Results Data was collected from 540 HCWs from 13 hospitals. HCWs originated from 17 countries and included physicians, nurses and other non-administrative HCWs. Nearly half of HCWs declared having experience dealing with TB patients. In general, HCWs had average knowledge (mean knowledge score of 52%), above average attitude (mean attitude score of 73%) and good practice (mean practice score of 85%) regarding TB, based on our scoring system and cut-off points. Knowledge gaps were identified in relation to the definition of MDR-/XDR-TB and LTBI, smear microscopy results, length of standard TB treatment for drug-sensitive TB, 2nd line anti-TB drugs, BCG vaccination, and appropriate PPE to be used with active PTB patients. Poor attitudes were found in relation to willingness to work in TB clinic/ward and to the management and treatment of TB patients. Poor practices were reported for commencing anti-TB treatment on suspected TB cases before laboratory confirmation and not increasing natural ventilation in TB patients’ rooms. Age, gender, nationality, occupation, length of work experience and experience dealing with TB patients were associated with knowledge scores. Age and occupation were associated with attitude scores while length of work experience and occupation were associated with practice scores. There was a weak but statistically significant positive correlation between score for knowledge and attitude (rs = 0.11, p = 0.009) and attitude and practice (rs = 0.13, p = 0.002). Conclusions While the results of the study are encouraging, important knowledge gaps and some poor attitudes and practices regarding TB were identified among HCWs during Hajj. This calls for multifaceted interventions to improve HCWs KAP regarding TB including tailored, periodic TB education and training aimed at boosting knowledge and improving behaviour.

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Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 Hajj

Choosing appropriate language to reduce the stigma around mental illness and substance use disorders

Importance Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care. Objective To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs). Design, Setting, and Participants This pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021. Interventions In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives. Main Outcomes and Measures Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining. Results Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirty-four facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were −10.6 points (95% CI, −14.5 to −6.74 points) in RESHAPE and −2.79 points (−8.29 to 2.70 points) in the control group. Role-play–based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events. Conclusions and Relevance This pilot cluster randomized clinical trial found that procedures were feasible and acceptable for PCPs to be trained by PWLE. These pilot results will help inform a full trial to evaluate benefits of collaboration with PWLE during training of PCPs to reduce stigma and improve diagnostic accuracy. Trial Registration ClinicalTrials.gov Identifier:NCT02793271

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Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services: A Pilot Cluster Randomized Clinical Trial.

Background Low birth weight is a preventable public health problem. It is an important determinant of child survival and development, as well as long-term consequences like the onset of non-communicable disease in the life course. A large number of mortality and morbidity can be prevented by addressing the factors associated with low birth weight. The main objective of this study was to identify associated risk factors of low birth weight. Methodology A health facility-based unmatched case-control study was carried out from July 2018 to March 2019 among the mothers who delivered in health facilities of Dang district of Nepal from 17th August to 16th November 2018. The total sample size for the study was 369; 123 cases and 246 controls. Cases and controls were randomly selected independent of the exposure status in the ratio of 1:2. Information regarding exposure status was assessed through interviews and medical records. Mothers who delivered outside Dang districts were excluded from the study. Ethical clearance was obtained from the Institutional Review Committee (IRC) of the Institute of Medicine, Tribhuvan University and written consent was taken from each participant after explaining the objectives of the study. Results Multivariate logistic regression found that having the kitchen in the same living house (AOR 2.7, CI: 1.5–4.8), iron intake less than 180 tablets (AOR 3.2, CI: 1.7–5.7), maternal weight gain during second and third trimester less than 6.53 kg (AOR 2.6, CI: 1.5–4.7), co-morbidity during pregnancy (AOR 2.4, CI: 1.3–4.5), preterm birth (AOR 2.9, CI: 1.4–6.1) were the risk factors associated with low birth weight. Conclusion Having the kitchen in the same living house, iron intake less than 180 tablets during pregnancy, maternal weight gain less than 6.53 kg during the second and third trimester, co-morbidity during pregnancy and preterm birth were the risk factors associated with low birth weight.

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Low birth weight and its associated risk factors: Health facility-based case-control study

Infection control remains a key challenge for Tuberculosis (TB) control program with an increased risk of TB transmission among health care workers (HCWs), especially in settings with inadequate TB infection control measures. Poor knowledge among HCWs and inadequate infection control practices may lead to the increased risk of nosocomial TB transmission. An institution-based cross-sectional survey was conducted in 28 health facilities providing TB services in the Kathmandu Valley, Nepal. A total of 190 HCWs were assessed for the knowledge, attitudes and practices on TB infection control using a structured questionnaire. The level of knowledge on TB infection control among almost half (45.8%) of the HCWs was poor, and was much poorer among administration and lower level staff. The knowledge level was significantly associated with educational status, and TB training and/or orientation received. The majority (73.2%) of HCWs had positive attitude towards TB infection control. Sixty-five percent of HCWs were found to be concerned about being infected with TB. Use of respirators among the HCWs was limited and triage of TB suspects was also lacking. Overall knowledge and practices of HCWs on TB infection control were not satisfactory. Effective infection control measures including regular skill-based training and/or orientation for all categories of HCWs can improve infection control practices in health facilities.

Health care workers' knowledge, attitudes and practices on tuberculosis infection control, Nepal.

This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1: n = 94, Study 2: n = 213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control. In Study 2 (depression and psychosis), there were no differences among the three arms. When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos describing depression and psychosis. In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for considering different strategies to address stigma based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761.

https://www.mdpi.com/1660-4601/18/4/2143/pdf

Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial.

Background: Occupational safety and health vulnerability considers multiple dimensions, such as hazard, policy/procedure to protect workers, workers’ awareness and their empowerment to participate in injury prevention. This study attempts to bridge the inadequate knowledge regarding the factors associated with occupational safety and health vulnerability in brick factories. Objectives: To identify the status and factors associated with occupational safety and health vulnerability among brick factory workers in Dhading district. Methods: A cross-sectional descriptive study was carried out in five brick kilns of Dhading district. A two-stage cluster sampling method was used; at the first stage, probability proportionate to sample size was used to select the brick factories and simple random sampling was used to select participants from each selected brick factory. A total of 201 workers with at least a year of experience and who had worked over the last year in brick factories were included in the study. The data was collected through face-to-face interviews using a structured questionnaire. Vulnerability was defined as exposed to hazards and having inadequate policies, procedures, awareness and empowerment. Pearson Chi-square test was used to examine the relationship between vulnerability and demographic, occupational and workplace characteristics. Results: Four-fifths of the participants experienced occupational safety and health vulnerability. All participants experienced policy/procedure vulnerability; four-fifths experienced hazard vulnerability and about two-thirds experienced awareness and empowerment vulnerability. Younger, nonnative immigrants, workers carrying bricks out of a chimney and workers from small-sized workplaces experienced higher odds of vulnerability across all domains and overall vulnerability. Conclusion: Occupational safety and health vulnerability was very high among the brick factory workers. Young workers, non-native immigrant workers, workers carrying cooked bricks out of a chimney and workers from small-sized workplace were found to be more vulnerable.

Occupational Safety and Health Vulnerability among Brick Factory Workers in Dhading District, Nepal

Poor sleep quality has been found to affect students’ learning abilities, academic performance, and interpersonal relationships. However, little is known about this issue in Nepal. This study aimed to identify the factors associated with poor sleep quality among undergraduate medical students in Nepal. A web-based survey was conducted in March 2021 among 212 undergraduate medical students at the Institute of Medicine, Kathmandu, Nepal. Sleep quality was measured using a 19-item Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression analysis was done to assess the factors associated with sleep quality. In the study participants, 38.2% of the students were identified as poor sleepers. Factors like being depressed (AOR = 4.5, 95% CI; 1.2–5.4), current alcohol use (AOR = 2.5, 95% CI; 1.8–10.8), poor academic achievement (AOR = 3.4, 95% CI; 1.1–10.9), and being a fourth-year student (AOR = 3.6, 95% CI; 1.1–11.8) were significantly associated with poor sleep quality. Poor sleep quality was common among undergraduate medical students. Routine screening of sleep quality and depressive symptoms is necessary to mitigate their impact among medical students. Medical students of the fourth year, current alcohol users, and those who did not have good academic achievement had poor sleep quality. Special attention on these population subgroups is thus needed to enhance sleep quality.

https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0000012&type=printable

Prem Basel

Papers

Low birth weight and its associated risk factors: Health facility-based case-control study

Health care workers' knowledge, attitudes and practices on tuberculosis infection control, Nepal.

Impact of Service User Video Presentations on Explicit and Implicit Stigma toward Mental Illness among Medical Students in Nepal: A Randomized Controlled Trial.

Occupational Safety and Health Vulnerability among Brick Factory Workers in Dhading District, Nepal

Sleep quality and its correlates among undergraduate medical students in Nepal: A cross-sectional study