scholarly journals Evaluation of a Breast Cancer Early Detection Curriculum Among Nurses Working in 5 Antiretroviral Clinics in Eswatini

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 14-14
Author(s):  
Daniel S. O’Neil ◽  
Sifiso Nxumalo ◽  
Cebisile Ngcamphalala ◽  
Judith S. Jacobson ◽  
Harriet Nuwagaba-Biribonwoha ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care Providers ◽  
Clinical Skills ◽  
Early Stage ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Maximum Score ◽  
Cancer Early Detection ◽  
Sub Saharan

PURPOSE Breast cancer (BC) incidence is rising in sub-Saharan Africa, and approximately 75% of cases are diagnosed at stages III and IV. Women living with HIV, who are surviving longer with antiretroviral use, are also increasingly affected. Survey data suggest that primary care providers often fail to recognize early-stage BC. We trained nurses from 5 antiretroviral clinics in Eswatini to assess breast abnormalities and evaluated our curriculum’s effectiveness in improving BC knowledge and skills. METHODS The 2-day curriculum covered breast physiology, benign pathology, and BC. Clinical breast exam and management were taught using mannequins and standardized patient scenarios, with emphasis on prompt referral for biopsy. After training, mentoring was provided every 2 to 4 weeks at each study clinic. A written examination of BC knowledge (maximum score, 23 points) and an observed examination of practical clinical skills (maximum score, 28 points) were administered before training, immediately after training, and 90 days after training. Pre- and post-training scores were compared using Wilcoxon signed-rank tests. RESULTS Forty-four nurses, with a median of 10 years of experience, underwent training; only 5 nurses (11%) reported prior BC education. All nurses completed the pre- and immediate post-training exams, and 38 completed the 90-day post-training exams. Median scores on pre-, immediate post-, and 90-day post-training knowledge exams were 17.5 (interquartile range [IQR], 16-19), 20 (IQR, 19-21), and 20 (IQR, 19-21), respectively. Median scores on pre-, immediate post-, and 90-day post-training practical exams were 10 (IQR, 7-11), 23 (IQR, 21.5-25), and 23 (IQR, 22-24), respectively. Compared with pretraining scores, immediate post- and 90-day post-training scores on both exams were significantly improved ( P < .0001 for all comparisons). CONCLUSION Our curriculum produced a sustained improvement in nurses’ BC-related knowledge and clinical skills, including identification of possible early cancers. Our results resemble those among similarly trained Rwandan nurses, suggesting that the curriculum may generally benefit front-line health care providers and patients in sub-Saharan Africa.

scholarly journals SAT0640-HPR RHEUMATOLOGY CARE OF MIGRANTS FROM SUB-SAHARAN AFRICA; A QUALITATIVE PILOT STUDY OF PATIENTS’ PERSPECTIVES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1279.1-1279
Author(s):  
Z. Rutter-Locher ◽  
J. Galloway ◽  
H. Lempp
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Care ◽  
Health Care Providers ◽  
Unmet Need ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Specialist Care ◽  
Sub Saharan ◽  
The Uk

Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared

scholarly journals Pregnancy and childbirth in Mozambique: men as decision makers and women as caretakers?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Galle ◽  
H Cossa ◽  
N Osman ◽  
K Roelens ◽  
S Griffin ◽  
...  
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Hiv Prevention ◽  
Health Care Providers ◽  
Male Involvement ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Pregnancy And Childbirth ◽  
Policy Level ◽  
Sub Saharan

Abstract Background Increasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men's involvement in maternal health in southern Mozambique. Methods Ten key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in maternal health, followed by 10 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis. Results Results show a lack of strategy at policy level to stimulate male involvement in maternal health. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives and women accompanied by a husband are often put in a submissive position. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity. Conclusions A clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and health programs should step away from linking male involvement to HIV prevention. Key messages Linking the promotion of gender equality to male involvement is the key for success. Step away from linking HIV prevention to male involvement in maternal health.

scholarly journals FAKTOR YANG BERHUBUNGAN DENGAN PERILAKU IBU RUMAH TANGGA MELAKUKAN PEMERIKSAAN PAYUDARA SENDIRI (SADARI)

2018 ◽  
Vol 12 (2) ◽  
pp. 143
Author(s):  
Alvita Brilliana R. Arafah ◽  
Hari Basuki Notobroto
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Health Care Providers ◽  
Early Stage ◽  
Health Providers ◽  
Care Providers ◽  
Cross Sectional ◽  
Information Accessibility ◽  
Breast Examination ◽  
Access Information

Breast cancer is cancer with the number of new cases and deaths highest in Indonesia. According to the Data Center and Information Ministry of a health Indonesia in the year 2013, the number of new cases of breast cancer of 819 and the number of deaths amounted to 217. In general, breast cancer known after stepping on an advanced stage. So the methods of early detection of breast cancer are focused on the detection of early stage tumors that are usually small with self-breast examination (SADARI). The purpose of this research is to predict the factors related to the behavior of self-breast examination (SADARI) the housewives aged 40–50 years. This research is an observational study with cross sectional approach. Sample research totaling 100 people  housewife in Kelurahan Sidotopo Wetan Kenjeran Subdistrict Surabaya. The measurement was done by providing a questionnaire to obtain information about the research variables. Variable independent research is k nowledge, attitudes, information accessibility, support health providers and descent with breast cancer. The results of this research showed the variables that are associated with the  SADARI behavior of the housewifes is attitude (p = 0.000), accessibility of information (p = 0.000), and health care providers support (p = 0.010). The majority of housewives in Kelurahan Sidotopo Wetan Kenjeran Sub-district Surabaya showed a good attitude and support toward SADARI. In the area surrounding the residence h ousewife get access information easily. There are no support for doing SADARI from health care providers.

scholarly journals Impact of Breast Cancer Early Detection Training on Rwandan Health Workers’ Knowledge and Skills

2018 ◽  
pp. 1-10 ◽  
Author(s):  
Lydia E. Pace ◽  
Jean-Marie Vianney Dusengimana ◽  
Nancy L. Keating ◽  
Vedaste Hategekimana ◽  
Vestine Rugema ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Center ◽  
Health Care Providers ◽  
Health Workers ◽  
Critical Role ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Knowledge And Skills ◽  
Written Test ◽  
The Impact

Purpose In April 2015, we initiated a training program to facilitate earlier diagnosis of breast cancer among women with breast symptoms in rural Rwanda. The goal of this study was to assess the impact of the training intervention in breast cancer detection on knowledge and skills among health center nurses and community health workers (CHWs). Methods We assessed nurses’ and CHWs’ knowledge about breast cancer risk factors, signs and symptoms, and treatability through a written test administered immediately before, immediately after, and 3 months after trainings. We assessed nurses’ skills in clinical breast examination immediately before and after trainings and then during ongoing mentorship by a nurse midwife. We also examined the appropriateness of referrals made to the hospital by health center nurses. Results Nurses’ and CHWs’ written test scores improved substantially after the trainings (overall percentage correct increased from 73.9% to 91.3% among nurses and from 75.0% to 93.8% among CHWs ( P < .001 for both), and this improvement was sustained 3 months after the trainings. On checklists that assessed skills, nurses’ median percentage of actions performed correctly was 24% before the training. Nurses’ skills improved significantly after the training and were maintained during the mentorship period (the median score was 88% after training and during mentorship; P < .001). In total, 96.1% of patients seen for breast concerns at the project’s hospital-based clinic were deemed to have been appropriately referred. Conclusion Nurses and CHWs demonstrated substantially improved knowledge about breast cancer and skills in evaluating and managing breast concerns after brief trainings. With adequate training, mentorship, and established care delivery and referral systems, primary health care providers in sub-Saharan Africa can play a critical role in earlier detection of breast cancer.

scholarly journals Clinical application and utility of genomic assays in early-stage breast cancer: key lessons learned to date

2018 ◽  
Vol 25 ◽  
pp. 125 ◽  
Author(s):  
S.K.L. Chia
Keyword(s):  
Breast Cancer ◽  
Health Care Providers ◽  
Hormone Receptor ◽  
Early Stage ◽  
Prospective Trial ◽  
Lessons Learned ◽  
Her2 Status ◽  
Care Providers ◽  
Screening Programs ◽  
Genomic Assays

Early-stage hormone receptor–positive breast cancer is the most common subtype and stage presenting in countries with organized screening programs. Standard clinical and pathologic factors are routinely used to support prognosis and decisions about adjuvant therapies. Hormone receptor and her2 status are essential for decision-making about the use of adjuvant hormonal and anti-her2 therapies respectively. Genomic assays are now commercially available to aid in either further prognostication or in refining the potential benefit of adjuvant chemotherapy. The current genomic assays all generally quantify estrogen receptor and proliferation gene sets (among others) by rna expression, although the specific genes assayed are quite discordant. The present review focuses on the pivotal studies in which each assay attempted to demonstrate clinical utility, with an emphasis on prospective trial data for each assay, if available. Using genomic assays, health care providers will increasingly be able to individualize therapy or de-escalate therapy, optimizing clinic benefit while minimizing toxicities from systemic therapies.

Breast cancer in Sub-Saharan Africa: 1,000 patients with primary breast cancer in Addis Ababa followed for up to 5 years.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 580-580
Author(s):  
Eva Johanna Kantelhardt ◽  
Peter Zerche ◽  
Pietro Trocchi ◽  
Assefa Mathios ◽  
Anne Reeler ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Addis Ababa ◽  
Right Censoring ◽  
Sub Saharan Africa ◽  
Endocrine Treatment ◽  
Worst Case Analysis ◽  
Worst Case ◽  
Sub Saharan ◽  
Stage 1

580 Background: There is little information on breast cancer (BC) patients (pts) receiving standardized treatment in Sub-Saharan Africa. This study evaluates pts presenting 2005-10 at the University Radiotherapy Center in Addis Ababa, the only institution in the country offering standardized radiotherapy, systemic therapy and free endocrine treatment (ET) during that time. Methods: All pts with histologically verified BC were included. Ethical approval was obtained. Axios/AstraZenaca provided free ET. Therefore, the majority of pts underwent regular follow-up (FUP). We analyzed survival at 18 months by means of Kaplan-Meier survival analysis. We assumed right-censoring to be unrelated to the risk of metastasis. In a worst case sensitivity analysis, we considered all censored pts developing metastasis. Results: Pts with primary diagnosis between July 1st, 2005 and December 31st, 2010 were included (n=1303). The majority of pts were female (95.2%), most (52.3%) postmenopausal. Mean age was 44.1yrs (20-88yrs). Stages 1-4 presented in 3/19/53/25% respectively (36% unknown). Grade 2 tumors were seen in 434 out of 574 pts (58%). Estrogen receptor was pos. in 251 out of 381 pts (66%). Most M0-pts (n=942) underwent surgery (84%), received chemotherapy (59%), and received ET (63%). Median FUP was 18.4 months, 186 events (metastases) occurred. Metastasis-free survival (MFS) was 86%. Worst case analysis on censored observations revealed that MFS declined down to 52%. Pts with early stage 1/2 showed a better MFS than pts with stage 3 disease (93 to 77%). Surgery (no surgery 78% vs surgery 87%) and ET (79% vs 89%) improved MFS. The 5-year MFS for stage 1/2 was 78% and stage 3 was 38%. Conclusions: To our knowledge this is the first presentation of clinical features in 1300 pts with BC in Sub-Saharan Africa. Most pts in Addis Ababa (AA) are <45yrs and present at stage 3/4. Differences to 5-year MFS from Europe stage 1/2 around 90% (AA 78%) and stage 3 around 70% (AA 38%) are smaller in pts treated with surgery and ET. This data is consistent with overall survival in a treated pt cohort from Uganda stage 1/2: 74% and stage 3/4: 39% (n=285) (Gakwaya Brit J Cancer 2008). Policies should focus on earlier presentation and access to care.

scholarly journals Pilot Experience in Senegal with Peritoneal Dialysis for End-Stage Renal Disease

2014 ◽  
Vol 34 (5) ◽  
pp. 539-543 ◽  
Author(s):  
Abdou Niang ◽  
Mouhamadou Moustapha Cisse ◽  
Sidi Mohamed Ould M. Mahmoud ◽  
Ahmed Tall Ould Lemrabott ◽  
El Hadji Fary Ka ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Health Care Providers ◽  
End Stage Renal Disease ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Female Ratio ◽  
Sub Saharan ◽  
Stage Renal Disease ◽  
End Stage

IntroductionPeritoneal dialysis (PD) is occasionally used in western sub-Saharan Africa to treat patients with end-stage renal disease (ESRD). The present study is a retrospective review of the initial six years’ experience with PD for ESRD therapy in Senegal, a West African country with a population of over 12 million.Material and MethodsSingle-center retrospective cohort study of patients treated with PD between March 2004 and December 2010. Basic demographic data were collected on all patients. Peritonitis rates, causes of death and reasons for transfer to hemodialysis (HD) were determined in all patients.ResultsSixty-two patients were included in the study. The median age was 47 ± 13 years with a male/female ratio of 1.21. Nephrosclerosis and diabetic nephropathy were the main causes of ESRD. The mean Charlson score was 3 ± 1 with a range of 2 to 7. Forty five peritonitis episodes were diagnosed in 36 patients (58%) for a peritonitis rate of 1 episode/20 patient-months (0.60 episodes per year). Staphylococcus aureus and Pseudomonas aeruginosa were the most commonly identified organisms. Touch contamination has been implicated in 26 cases (57.7%). In 23 episodes (51%), bacterial cultures were negative. Catheter removal was necessary in 12 cases (26.6%) due to mechanical dysfunction, fungal or refractory infection. Sixteen patients died during the study.ConclusionPeritoneal dialysis is a suitable therapy which may be widely used for ESRD treatment in western sub-Saharan Africa. A good peritonitis rate can be achieved despite the difficult living conditions of patients. Challenges to the development of PD programs include training health care providers, developing an infrastructure to support the program, and developing a cost structure which permits expansion of the PD program.

scholarly journals Integrating Oral PrEP Into Family Planning Services for Women in Sub-saharan Africa: Findings From a Multi-Country Landscape Analysis

2021 ◽  
Vol 3 ◽  
Author(s):  
Neeraja Bhavaraju ◽  
Rose Wilcher ◽  
Regeru Njoroge Regeru ◽  
Saiqa Mullick ◽  
Imelda Mahaka ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Health Care Providers ◽  
Sub Saharan Africa ◽  
Management Service ◽  
Care Providers ◽  
Road Map ◽  
Sub Saharan ◽  
Exposure Prophylaxis ◽  
Oral Prep

Integration of HIV and family planning (FP) services is a renewed focus area for national policymakers, donors, and implementers in sub-Saharan Africa as a result of high HIV incidence among general-population women, especially adolescent girls and young women (AGYW), and the perception that integrating HIV pre-exposure prophylaxis (PrEP) into FP services may be an effective way to provide comprehensive HIV and FP services to this population. We conducted a focused desk review to develop a PrEP-FP integration framework across five key categories: plans and policies, resource management, service delivery, PrEP use, and monitoring and reporting. The framework was refined via interviews with 30 stakeholders across seven countries at varying stages of oral PrEP rollout: Kenya, Lesotho, Malawi, South Africa, Uganda, Zambia, and Zimbabwe. After refining the framework, we developed a PrEP-FP integration matrix and assessed country-specific progress to identify common enablers of and barriers to PrEP-FP integration. None of the countries included in our analysis had made substantial progress toward integrated PrEP-FP service delivery. Although the countries made progress in one or two categories, integration was often impeded by lack of advancement in other areas. Our framework offers policymakers, program implementers, and health care providers a road map for strategically assessing and monitoring progress toward PrEP-FP integration in their contexts.

Sign in / Sign up

Export Citation Format

Share Document