Improving care for patients with epilepsy in rural Sierra Leone: A replicable model for low-resource settings

: 2.015_HRW Nurse educators in Haiti: A quality assurance review A. Mahon, R. Valcourt, L. Merry, F. Dieudonne, J. Tuck; McGill University, Montreal, Canada, Zanmi Lasante, Hinche, Haiti Background and Aims: Nurses provide over ninety percent of health care services worldwide, however training and licensure standards for these professionals, especially in low-resource settings, vary. As populations and health needs grow, empowering and educating those at the bedside must be a top priority. Unfortunately, there is limited understanding of professional development and continuing education for nurses in low and middle resource settings. In this review we: 1) describe an initiative launched by Zanmi Lasante to implement nurse educators in two tertiary care centres in the Lower Artibonite and Central Plateau regions of Haiti; and 2) highlight barriers and facilitators experienced by the nurse educators in this role. Methods: We used a quality assurance framework with qualitative description. Data were collected through participant observation, document reviews, and semi-structure interviews with four nurse educators and three support staff. Findings: The educator positions were created as part of a larger plan to improve the health infrastructure at one hospital site. With the success of the implementation of the first educators at this site, additional positions were added in a second hospital and plans made to expand to other hospitals. Educators were tasked with assessing learning needs, training and mentoring nursing staff, and performing skill evaluations. Barriers included: little specialized training for educators; limited resources; poor attendance at trainings; disparate education and skills among staff; and high expectations and ambiguous role definition. Facilitators included: previous management experience; peer support; value placed on continuing education by staff; and a perception that care was improving. Conclusion: As the educator role continues to develop, additional studies are needed to assess the merit and feasibility of this intervention in other low and middle resource settings. Initial outcomes suggest this is a promising initiative for improving nursing in Haiti. Funding: Institute for Health and Social Policy; McGill Faculty of Medicine. Abstract #: 2.016_HRW: 2.016_HRW The knowledge and perceptions regarding the role of family physicians among patients in primary care clinics in Nairobi G. Mohamoud, M. Merali, A. Gilani, M. Mahoney; Aga Khan University East Africa, Nairobi, Kenya, Stanford University, Stanford, USA Background: Family Medicine is recognized by the Kenya Ministry of Health as a way to provide high quality and cost-effective care at the population level and address the fragmentation of the current health care system. Understanding the current perception of Family Medicine, while the specialty is in its nascent stage, is a crucial step in promoting, marketing and planning the delivery of family medicine services. Methods: The aim of this study was to identify gaps in primary care patients’ knowledge about the role of family physicians in Aga Khan University clinics in Nairobi. The study is a questionnaire based cross-sectional survey of patients visiting selected primary care clinics in Nairobi. Convenience sampling was used; all consenting English-speaking adult patients were included in the study. Ethical approval was obtained from the Ethics committee of the Aga Khan University Hospital, Nairobi. SPSS Software and Excel spreadsheet were used for the data entry and analysis. Findings: One hundred sixty-two participants were surveyed (n 1⁄4 162). The majority of participants were between the ages of 18 and 45 years, with 54% being female, 61.3% employed, 83.8% university graduates, 69.1% had children, 65.4% resided in Nairobi and 34.6% were from the periphery of Nairobi. Sixty-eight percent (68.5%) had heard about family physicians. Regarding family doctor services, 45.1% of participants were unsure or didn’t believe that family doctors couldprovidepediatric, ante-natal care, pap smear tests, family planning services and circumcision. While the majority of participants thought the family doctor can treat small babies, a comment noted “Infants are supposed to be treatedwith a pediatrician.”Therewasmore variance in results regarding FP treating chronic illnesses and other noncommunicable diseases, and performing common procedures. Interpretation: Based on the findings of this study, a campaign that raises more awareness on the role of the family physicians in Nairobi will be developed in partnership with the Kenyan Association of Family Physicians.

Background and Aims: Nurses provide over ninety percent of health care services worldwide, however training and licensure standards for these professionals, especially in low-resource settings, vary. As populations and health needs grow, empowering and educating those at the bedside must be a top priority. Unfortunately, there is limited understanding of professional development and continuing education for nurses in low and middle resource settings. In this review we: 1) describe an initiative launched by Zanmi Lasante to implement nurse educators in two tertiary care centres in the Lower Artibonite and Central Plateau regions of Haiti; and 2) highlight barriers and facilitators experienced by the nurse educators in this role.

Methods:
We used a quality assurance framework with qualitative description. Data were collected through participant observation, document reviews, and semi-structure interviews with four nurse educators and three support staff.

Findings:
The educator positions were created as part of a larger plan to improve the health infrastructure at one hospital site. With the success of the implementation of the first educators at this site, additional positions were added in a second hospital and plans made to expand to other hospitals. Educators were tasked with assessing learning needs, training and mentoring nursing staff, and performing skill evaluations. Barriers included: little specialized training for educators; limited resources; poor attendance at trainings; disparate education and skills among staff; and high expectations and ambiguous role definition. Facilitators included: previous management experience; peer support; value placed on continuing education by staff; and a perception that care was improving.
Conclusion: As the educator role continues to develop, additional studies are needed to assess the merit and feasibility of this intervention in other low and middle resource settings. Initial outcomes suggest this is a promising initiative for improving nursing in Haiti.
Funding: Institute for Health and Social Policy; McGill Faculty of Medicine.
Abstract #: 2.016_HRW The knowledge and perceptions regarding the role of family physicians among patients in primary care clinics in Nairobi G. Mohamoud 1 , M. Merali 1 , A. Gilani 2 , M. Mahoney 1,2 ; 1 Aga Khan University East Africa, Nairobi, Kenya, 2 Stanford University, Stanford, USA Background: Family Medicine is recognized by the Kenya Ministry of Health as a way to provide high quality and cost-effective care at the population level and address the fragmentation of the current health care system. Understanding the current perception of Family Medicine, while the specialty is in its nascent stage, is a crucial step in promoting, marketing and planning the delivery of family medicine services.
Methods: The aim of this study was to identify gaps in primary care patients' knowledge about the role of family physicians in Aga Khan University clinics in Nairobi. The study is a questionnaire based cross-sectional survey of patients visiting selected primary care clinics in Nairobi. Convenience sampling was used; all consenting English-speaking adult patients were included in the study. Ethical approval was obtained from the Ethics committee of the Aga Khan University Hospital, Nairobi. SPSS Software and Excel spreadsheet were used for the data entry and analysis.
Findings: One hundred sixty-two participants were surveyed (n ¼ 162). The majority of participants were between the ages of 18 and 45 years, with 54% being female, 61.3% employed, 83.8% university graduates, 69.1% had children, 65.4% resided in Nairobi and 34.6% were from the periphery of Nairobi. Sixty-eight percent (68.5%) had heard about family physicians. Regarding family doctor services, 45.1% of participants were unsure or didn't believe that family doctors could provide pediatric, ante-natal care, pap smear tests, family planning services and circumcision. While the majority of participants thought the family doctor can treat small babies, a comment noted "Infants are supposed to be treated with a pediatrician." There was more variance in results regarding FP treating chronic illnesses and other noncommunicable diseases, and performing common procedures.
Interpretation: Based on the findings of this study, a campaign that raises more awareness on the role of the family physicians in Nairobi will be developed in partnership with the Kenyan Association of Family Physicians.
Abstract #: 2.017_HRW Improving care for patients with epilepsy in rural Sierra Leone: A replicable model for low-resource settings Program/Project Purpose: Epilepsy is an important cause of morbidity, unemployment, poverty and stigma in Sierra Leone. The burden of disease is high with more than 60,000 people affected, but the disease is not prioritized within the national healthcare system. People living with epilepsy e especially in rural areas e have virtually no access to healthcare providers, medications, or psychosocial support for their condition. Partners In Health / Wellbody Alliance (PIH/WBA) has developed a program in the rural Kono district to meet these essential needs for epilepsy patients.
Structure/Method/Design: In collaboration with the Epilepsy Association of Sierra Leone, in March 2015, PIH/WBA led a nation-wide training for community health officers (CHOs), including a CHO from our staff, on the diagnosis and evidencebased management of epilepsy. The PIH/WBA health center has provided free services to epilepsy patients for many years. To address the problem of limited access in rural areas, after the national training, PIH/WBA organized a regularly scheduled outreach clinic in Sewafe, one of the hardest-to-access areas in the Kono district.
Outcome & Evaluation: As part of the national program, these outreach clinics are organized monthly by CHOs from the Epilepsy Association of Sierra Leone. Medication is provided at a cost of two dollars per month. Given poor outcomes associated with epilepsy, PIH/WBA aimed to strengthen this program in Kono district. Regular physician supervision was provided to the CHO for program management and implementation. Supply chain for medications was ensured and all medications provided at no cost to the patient. Given the rural nature of our community, eliminating the barrier of medication cost has improved adherence. There has also been a significant increase in the number of visits and we now have 200 patients on treatment.
Going Forward: Untreated epilepsy is associated with a high risk of complications, including cognitive impairment, mental illness and injury. The expansion of the epilepsy program in our rural district using midlevel healthcare workers with supervision and supply chain support is a promising model to improve the outcomes for these vulnerable patients. Background: Facing the drastic increase in the last years of sedentary lifestyle and obesity it is necessary to look for tools that help us confront these two entities and show people that through physical activity they can achieve beneficial results for their health, drastically reducing the risk of suffering degenerative conditions such as cardiovascular diseases, diabetes and cancer, among others. (1) Methods: This program consists of a simple interview about nutritional and physical activity habits, somatometric measurements, simple physical tasks among which, we find the Course-Navette, an internationally accepted test for cardiorespiratory capacity that can be easily done in large areas with pre and post measurements of vital signs. We used a written informed consent based on the International Conference of Harmonization guidelines and approved by the Anáhuac University Investigation and Bioethical Committee, obtained from the participants or legal guardians. Data analysis was made with the statistical program, SPSS, searching basically for central tendency measures. Functional capacity evaluation (FCE) is a set of tests that includes four parameters: oxygen consumption, nutritional, psychopedagogical status, and anaerobic tests status. This is a transversal, observational, descriptive study with a random sample of 1,200,453 individuals selected from different institutions across México (inclusion criteria: anyone older than four years old willing to participate; exclusion criteria: anyone that notified being pregnant, have any chronic lung or cardiac disease, or psychomotor disorder).
Findings: Its objective was to measure, evaluate and implement a FCE measuring system in which personal measures were established. Our analysis outcome showed that most of our population has results for poor and low FCE (<59%), followed by those with a result for healthy FCE (60-79%). Our median for FCE was 58.09%, average of 57.32%, mode of 53%.
Interpretation: The aim of building up regional, state and national strategies is to offer preventive care if any alarming data is detected and build up a diagnosis tool for Mexican population. Obtaining data from a sample big enough to represent Mexican population allowed us to make a general diagnosis which may be used for the creation and improvement of models for FCE measurement and preventive measures. This study aims to map and characterize the surgical workforce in Brazil, in order to stimulate discussion in future surgical policy reforms.
Methods: Using data from the Ministry of Health and professional medical societies, surgeons, anesthesiologists and obstetricians (SAO) were identified. The physicians were geo-located and mapped against the population density and distribution of Brazil. Migratory patterns were analyzed to determine donor and recipient areas of the surgical workforce.