African Hospital Research Articles

Assessing the continuum of care in Sub-Saharan African hospitals performing surgery for breast cancer: a secondary analysis of the GlobalSurg 3 study

BackgroundWhile breast cancer incidence rates in Sub-Saharan Africa (SSA) are among the lowest worldwide, mortality rates remain among the highest, reflecting particularly poor survival. Only a few studies in SSA have investigated the capabilities of treatment services to adequately provide a continuum of care for breast cancer. Our aim was to assess the availability of diagnostic facilities and adjuvant therapies in hospitals performing breast cancer surgery in SSA.MethodsWe performed a secondary analysis of the GlobalSurg3 study data collected in the SSA region. The GlobalSurg 3 study is a multicenter, international, prospective, observational study of hospitals providing surgical services for cancer patients (including breast cancer) around the world. A total of 47 hospitals from 15 SSA countries and 43 cities were included between April 1, 2018, and Jan 31, 2019.ResultsOne-third of hospitals covered a population greater than two million (n = 17; 36.2%). Ultrasound was available in all hospitals; however, it was not consistently functional in 11 hospitals (23.4%). Only half of the included hospitals (n = 26, 55.3%) had access to a full-time pathologist, whilst the multidisciplinary team (MDT) approach was absent in 42.4% of hospitals. Radiotherapy equipment was only available in nine hospitals (19.1%). Only half of the hospitals (n = 25, 53.1%) had chemotherapy drugs available on site. In nine hospitals (19.1%), patients had to travel more than 50 km to access chemotherapy drugs.ConclusionsOutcomes for breast cancer patients in SSA cannot be improved without significant investments in pathology, surgical and oncological treatment pathways to provide timely diagnostic and effective treatment.

Contraceptive Coercion in Pre-Abortion Counseling: A Conversation Analysis

We explored how contraception is addressed in pre-abortion counseling, with a focus on the conversational strategies used by healthcare providers. We recorded 28 pre-abortion counseling sessions at three South African public hospitals and analyzed them using conversation analysis. In discussions about past contraceptive use, patients were often positioned as irresponsible and required to account for assumed inadequate contraceptive practices. This framing laid the groundwork for the coercive provision of post-abortion contraception, particularly long-acting reversible contraceptives (LARCs). Short-term users and younger patients were singled out, receiving repeated warnings about daily adherence or parental enforcement. Providers’ efforts to prevent the perceived “mistake” of abortion led to the use of coercive conversational tactics.

The radiological features of HPV-positive vs HPV-negative OPSCC at a South African hospital.

Studies have found that, at presentation, human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has a less advanced primary tumour, more advanced lymph node spread and commonly has cystic metastatic lymph nodes in comparison to HPV-negative OPSCC. To compare the radiological features of HPV-positive and HPV-negative OPSCC in South African patients. A retrospective cross-sectional study was conducted at a large South African hospital. Eligibility required a histologically proven OPSCC between 2007 and 2023; a p16 antigen test and, if positive, a confirmatory HPV DNA PCR test and a baseline pre-treatment contrast enhanced neck CT scan. All eligible HPV-positive OPSCC patients and a random sample of eligible HPV-negative OPSCC patients were enrolled. Twenty-one HPV-positive and 55 HPV-negative OPSCC patients were recruited. There was no statistically significant difference in the tumour epicentre location, local advancement (≥ T3 in 67% and 71%, respectively, p = 0.54), mean primary tumour size (41 mm vs. 39 mm, p = 0.73), lymph node spread (bilateral or more in 67% vs. 82%, p = 0.22) or morphologically cystic lymph nodes (10% and 4%, p = 0.61). There was no statistically significant difference in the CT imaging appearances of HPV-positive and HPV-negative OPSCC in the studied sample of South African patients. This study documents the radiological features of OPSCC in a small South African sample population, where HPV-positive and HPV-negative OPSCC could not be distinguished on CT criteria and did not display the classic features described in the literature.

Assessment of Facility Readiness for Pediatric Emergency and Critical Care Utilizing a 2-Phase Survey Conducted in Six Hospitals in Uganda and Cameroon: A Quality Improvement Study.

Each year, 5.3 million children under 5 years of age die in low-resource settings, often due to delayed recognition of disease severity, inadequate treatment, or a lack of supplies. We describe the use of a comprehensive digital facility-readiness survey tool, recently developed by the Pediatric Sepsis Data CoLaboratory, which aims to identify target areas for quality improvement related to pediatric emergency and critical care. Facility-readiness surveys were conducted at six sub-Saharan African hospitals providing pediatric emergency and critical care in Uganda (n = 4) and Cameroon (n = 2). The tool is a 2-phase survey to assess readiness to provide pediatric essential emergency and critical care: (1) an "environmental scan," focusing on infrastructure, availability, and functionality of resources, and (2) an "observational scan" assessing the quality and safety of care through direct observation of patients receiving treatment for common diseases. Data were captured in a mobile application and the findings analyzed descriptively. Varying levels of facility readiness to provide pediatric emergency care were observed. Only 1 of 6 facilities had a qualified staff member to assess children for danger signs upon arrival, and only 2 of 6 had staff with skills to manage emergency conditions. Only 21% of essential medicines required for pediatric emergency and critical care were available at all six facilities. Most facilities had clean running water and soap or disinfectants, but most also experienced interruptions to their electricity supply. Less than half of patients received an appropriate discharge note and fewer received counseling on postdischarge care; follow-up was arranged in less than a quarter of cases. These pilot findings indicate that facilities are partially equipped and ready to provide pediatric emergency and critical care. This facility-readiness tool can be utilized in low-resource settings to assist hospital administrators and policymakers to determine priority areas to improve quality of care for the critically ill child.

Evaluation of clinical, laboratory, radiographical and histopathological characteristics in patients with spinal tuberculosis in the context of HIV infection: An analysis of 52 patients from a South African tertiary hospital.

South Africa (SA) has the highest prevalence of people with tuberculosis (TB) and HIV coinfection globally. People living with HIV have an increased risk of TB infection, and are more likely to develop extrapulmonary TB. Approximately 10 - 20% of extrapulmonary TB accounts for skeletal TB, with spinal involvement in 50 - 60% of instances. Previous studies have shown highly heterogenic results regarding the effect of HIV status on clinical and laboratory characteristics in patients with spinal TB (STB). To describe the clinical, laboratory, radiographical and histopathological characteristics of patients diagnosed with STB stratified by HIV status. Data from patients who were treated for STB at the Division of Orthopaedic Surgery, Groote Schuur Hospital, SA, between 2013 and 2016 were analysed. We compared clinical, laboratory, radiographical and histopathological parameters of STB patients with HIV infection to those without HIV infection. To assess differences in means between the two groups, an independent samples t-test was used for normally distributed continuous data, and a χ2 test for categorical data. To assess correlations between continuous data groups, the Pearson correlation coefficient was used. We assessed 52 patients with STB (mean (standard deviation (SD) age 38 (15.2) years, range 17 - 80 years), of whom 55.8% were female, and 59.6% HIV infected. Five (9.6%) patients were identified with multidrug-resistant TB of the spine, with four (19.0%) in the HIV-infected cohort and one in the HIV-uninfected cohort (p=0.058). Significantly more STB patients without HIV infection presented with neurogenic symptoms (29%, p=0.029). The mean (SD) overall erythrocyte sedimentation rate was 69.3 (35.9) mm/h, with no significant difference between HIV-infected and HIV-uninfected patients (p=0.086). The rate of vertebral collapse was higher in the HIV-infected cohort (39% v. 67%, p=0.048). HIV-infected patients showed a higher count of involved vertebrae (mean 3.0 v. 3.85; p=0.034). There was no correlation between CD4 count and the number of involved vertebrae. The mean (SD) number of granulomata per low-power field was 10 (12.6), with no difference between the two cohorts. However, we found a positive correlation between granuloma count and CD4 cell count in HIV-infected STB patients (Pearson 0.503, p=0.02), with significantly higher formation of granulomata at a CD4 cell count >400 cells/μL (p=0.045). In our cohort, HIV-infected patients with STB were more likely to present with vertebral collapse, and more vertebrae on average were diseased compared with HIV-uninfected patients with STB. CD4 cell count may affect granuloma formation, and it seems that HIV infection has a negative effect on cellular immunoresponse in STB, which emphasises the need for early antiretroviral therapy initiation.

“They are not even called by name”: Security guards in a South African psychiatric hospital

BackgroundSecurity guards (SGs) play a significant role in health care and are an integral part of many psychiatric institutions. While their main duty is to ensure service users' (SUs) and staff's safety and protect the premises, they are also called upon for other tasks, often ones for which they are not adequately trained. This study aimed to explore the roles, formal and informal tasks performed, training, working conditions and well-being of SGs working in psychiatric services. MethodsGuided interviews were conducted with n = 12 SGs and n = 18 mental healthcare providers (MHCPs) at a psychiatric hospital in the Western Cape of South Africa. All interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach. ResultsIn addition to ensuring safety, SGs take on numerous informal tasks, often for which they are not adequately trained and which formally fall under the purview of other MHCPs, mostly nurses, including talking with SUs about their mental health issues, dressing, showering, feeding, and administering medication. SGs also serve informally as interpreters, raising ethical concerns regarding accuracy and confidentiality. SGs lack formal training for working in psychiatric services and handling aggressive SUs, which may lead to increased violence instead of de-escalation and, in the worst case, injuries. SGs work under precarious working conditions (i.e. low salary, outsourced employment, absence of labour rights and job insecurity) and lack professional recognition, potentially leading to lower job satisfaction and increased emotional distress. ConclusionAddressing the challenges outlined in the study requires collaborative efforts between government, psychiatric institutions, private security companies, SGs and MHCPs. The establishment of clear roles, implementation of comprehensive formal training, psychosocial support and improved working conditions, particularly in-house employment, higher pay, increased employee rights and job security, are needed.

Improving perioperative cancer care: experience with the Enhanced Recovery After Surgery (ERAS) programme

Aim Surgery plays a pivotal role in the management of the majority of patients with cancer. Surgical cancer care in low-and middle-income countries is negatively impacted by high complication rates and failure to rescue the deteriorating patient. Implementation of the Enhanced Recovery After Surgery (ERAS) programme offers an opportunity to improve care. Methods Over eight years, one public and three private sector South African hospitals implemented the ERAS evidence-based colorectal guidelines tailored for context and led by multidisciplinary teams. Demographic variables, treatment and clinical outcomes were collected using an electronic audit system and analysed using statistical software for data science. Primary outcomes included length of stay and complication rates. The relationship between outcomes and compliance with ERAS guidelines year-by-year was evaluated. Results The study comprised 368 and 325 colorectal cancer patients from public and private sector hospitals, respectively, with an overall length of stay of 6 (interquartile ratio 4,9) and 4 (interquartile ratio 3,7) days, respectively. Complication rates were 39.9% (public sector) and 43.7% (private sector). Overall, ERAS compliance was greater than 70% in both sectors and ERAS compliance was greatest in the pre- and intra-operative phase. An association was seen between increasing compliance and decreased length of stay as well as decreased complication rates. Conclusions A robust colorectal cancer ERAS programme can achieve high compliance, decreased length of stay, and fewer complications in South Africa. This study provides a foundation for a large-scale national strategy for ERAS implementation for perioperative cancer care across all disciplines.

Multicentre external validation of the Neonatal Healthcare-associated infectiOn Prediction (NeoHoP) score: a retrospective case–control study

Background and objectivesNeonatal mortality due to severe bacterial infections is a pressing global issue, especially in low-middle-income countries (LMICs) with constrained healthcare resources. This study aims to validate the Neonatal...

Coping in crisis: The role of sense of coherence, life satisfaction, and resilience in the relationship between depression, social support, fear of COVID-19, and perceived vulnerability to disease among nurses in South Africa

In the context of the formidable challenges posed by the COVID-19 pandemic, healthcare professionals coped in various ways. This cross-sectional survey study sought to examine the protective role of satisfaction with life, sense of coherence, and resilience in the relationship between depression, social support, fear of COVID-19, and perceived vulnerability to disease among nurses in South Africa. Participants were a convenience sample of nurses ( n = 264) working at four South African hospitals in the Western Cape. Data were collected by means of an electronic survey and analysed using structural equation modelling. Participants completed a comprehensive battery of psychological measures. We found that while higher levels of fear of COVID-19 robustly predicted depressive symptomology among nurses, factors such as sense of coherence, and social support emerged as protective resources. These protective factors have the potential to alleviate the mental health impacts of pandemic-related stressors among nurses.

Changes in the medical admissions and mortality amongst children in four South African hospitals following the COVID-19 pandemic: A five-year review.

Vulnerable children from poor communities with high HIV and Tuberculosis(TB) burdens were impacted by COVID-19 lockdowns. Concern was raised about the extent of this impact and anticipated post-pandemic surges in mortality. Interrupted time series segmented regression analyses were done using routinely collected facility-level data of children admitted for medical conditions at four South African referral hospitals. Monthly admission and mortality data over 60 months from 01 April 2018 to 31 January 2023 was analysed using models which included dummy lockdown level variables, a dummy post-COVID period variable, Fourier terms to account for seasonality, and excess mortality as a proxy for healthcare burden. Of the 45 015 admissions analysed, 1237(2·75%) demised with significant decreases in admissions during all the lockdown levels, with the most significant mean monthly decrease of 450(95%, CI = 657·3, -244·3) p<0·001 in level 5 (the most severe) lockdown. There was evidence of loss of seasonality on a six-month scale during the COVID periods for all admissions (p = 0·002), including under-one-year-olds (p = 0·034) and under-five-year-olds (p = 0·004). No decreases in mortality accompanied decreased admissions. Post-pandemic surges in admissions or mortality were not identified in children with acute gastroenteritis, acute pneumonia and severe acute malnutrition.During the COVID-19 pandemic, paediatric admissions in 4 hospitals serving communities with high levels of HIV, TB and poverty decreased, similar to global experiences; however, there was no change in in-hospital mortality. No post-pandemic surge in admissions or mortality was documented. Differences in the impact of pandemic control measures on the transmission of childhood infections and access to health care may account for differing outcomes seen in our setting compared to the global experiences. Further studies are needed to understand the impact of pandemic control measures on healthcare provision and transmission dynamics and to better inform future responses amongst vulnerable child populations.

Electronic health records model to improve the quality of patients' healthcare.

Electronic health records (EHR) has been acknowledged for bringing down healthcare costs and enhancing hospital service standards. The aim of this study was to develop an EHR model to lower patient treatment costs and enhance healthcare quality in South African public healthcare. In this study, a cross-sectional quantitative methodology was used. The research data for this study were provided by medical healthcare professionals, at Dr. George Mukhari Academic Hospital (DGMAH). This included doctors, nurses, pharmacists, radiologists, and radiographers who completed a semi-structured questionnaire. The final model's findings show that the use of EHR significantly improves information quality (IQ) and positively influences medical errors reduction (MER). Knowledge quality (KQ) has a positive significant impact on MER, whereas IQ has a considerable negative impact on MER. Furthermore, cost reduction in patient treatment (CRPT) has a positive significant influence on MER. Patients obtain better medical care when medical professionals have access to complete and accurate information. Medical errors can be reduced or even prevented with the use of EHRs, which can lead to better patient outcomes. The quality of patient care at South African public hospitals and in other developing countries can be enhanced by using this framework as a guide to reduce treatment costs.

Klebsiella pneumoniae with carbapenemases: high prevalence of sequence type 307 with blaOXA181 in South African community hospitals

This study investigated the molecular characteristics of urinary carbapenemase-producing Klebsiella pneumoniae isolates (n = 194) in Gauteng, South Africa, using simple, cost-effective PCR methodologies. Extensively drug resistant (XDR) ST307 with blaOXA-181 on IncX3 plasmids was endemic in Gauteng community hospitals leaving limited options for treating in- and outpatient urinary tract infections. High-level ceftazidime/avibactam resistance was detected among isolates harbouring blaOXA-48-like including blaOXA-181. These findings highlighted the need for genomic methodologies suitable for lower- and middle-income countries to track XDR clones and plasmids in community hospitals. Such results will aid with treatment and stewardship strategies.

The prevalence of hepatitis B virus, human T-lymphotropic virus and human immunodeficiency virus in patients receiving blood transfusions in South Africa.

South Africa has a high prevalence of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and to a lesser extent human T-lymphotropic virus (HTLV). Each of these agents is transfusion-transmissible (TT)but deciding whether to implement preventive screening depends upon knowledge of background prevalence in transfused patients. We determined the prevalence of HIV, HBV and HTLV I/II among blood transfusion recipients in South African hospitals. We obtained identity-unlinked samples used for blood cross-matching at 634 South African hospitals served by the South African National Blood Service (SANBS). The ABBOTT Alinity S® Immunochemiluminescent system measured HIV, HBV and HTLV I/II antibodies. Repeatedly reactive samples were confirmed using the Roche Cobas® 8000. Logistic regression was performed to investigate the determinants of associations for HIV, HBV and HTLV infections. The overall prevalences of HIV, HBV and HTLV were 37.8%, 7.4% and 0.6%, respectively. The HIV prevalence in blood recipients was twice as high as general population estimates. Public hospital patients had a significantly higher prevalence compared with private hospital patients for HIV and HBV. HIV prevalence was significantly higher in females, and HBV prevalence was significantly higher in males, excluding the unknown gender results. Patients receiving blood transfusions in South Africa have high rates of HIV and HBV infection that should be taken into consideration when determining donor screening strategies for other viral infections. Measurable prevalence of HTLV indicates endemicity of this infection in South Africa.

The management of community-acquired pneumonia in adults at a rural regional hospital in KwaZulu Natal

BackgroundPneumonia stands as a significant global contributor to mortality, particularly in South Africa, where it ranks as the second leading cause of death. The country’s high prevalence of HIV infection compounds this issue, significantly increasing mortality rates associated with community-acquired pneumonia (CAP).ObjectiveThis study aimed to audit CAP patient management at a regional rural hospital in KwaZulu-Natal.MethodA retrospective review of patient files from September to December 2016 was undertaken. Data extraction from clinical files, conducted according to inclusion criteria, was transferred to a data collection sheet and analyzed using SPSS version 21.ResultsThe review encompassed 124 patient files over four months, revealing that 117 (94.4%) patients were not managed by the Standard Treatment Guidelines and Essential Medicines List for South Africa. Of the patients admitted with CAP, 54% were HIV positive, and 49 (39.5%) patients succumbed to the illness. Notably, none of the patients underwent assessment using a severity score.ConclusionThe findings underscore a need for more adherence to South African guidelines for managing CAP among staff at the rural regional hospital. This leads to severe consequences, exemplified by the high mortality rate. Urgent intervention is required to incorporate severity assessment scores into pneumonia evaluations, thus enabling appropriate clinical management.ContributionThis study sheds light on the significant impact of CAP within the South African hospital context, delineating critical gaps in clinical care and emphasizing the imperative to address clinical inertia.

Perspectives of Hospital Staff on Barriers to Smoking Cessation Interventions among Drug-Resistant Tuberculosis Patients in a South African Management Hospital.

Drug-resistant tuberculosis (DR-TB) remains a major cause of illness and death, with personal and non-addiction-related barriers. This study aimed to explore the perspectives of hospital staff on barriers to smoking cessation interventions (SCIs) for in-patients at a DR-TB management hospital in Durban, KwaZulu-Natal, South Africa. In-depth interviews were conducted with a purposive sample of eighteen hospital staff (HS), and the data were analyzed using NVivo 10. Three core themes were identified: patients' barriers (addiction to tobacco, relapse after improvement in health, and non-disclosure of smoking status to HS), staff personal barriers (poor knowledge of smoking's effect on treatment outcomes and smoking cessation aids), and institutional barriers (staff shortage, time constraints, lack of pharmacological smoking cessation aids, access to cigarettes around hospital premises, and SCIs not prioritized and not assigned to a specific category of HS). Training on SCIs for HS, assigning SCIs to specific HS, integrating SCIs within existing services, and banning access to cigarettes within the hospital premises are assumed to assist DR-TB patients in smoking cessation, improving their response to TB treatment and overall health outcomes.

Undergraduate acute care clinical competencies for managing acute care cases in adult patients within a South African in-hospital environment: A modified Delphi Study

IntroductionWith the increase of global population, there has been an increased demand for acute care services both locally and globally. In the absence of an acute care competency-based curriculum in South Africa, this study sought to identify the core competencies required by undergraduate medical students to safely manage adult patients within an acute care setting in a South African hospital environment. MethodologyThe modified Delphi study comprised of three rounds. The traditional Delphi method, which uses the same participants across various rounds, was modified by using different stakeholders across the three rounds. Emergency Medicine (EM) specialist trainees (registrars) generated competencies in round one, which were provided to a multi-disciplinary team with expertise in undergraduate curriculum development in round two, using a 5-point Likert scale for rating their agreement-disagreement. Round three entailed inviting the round one contributors to anonymously comment, via online survey, on the competencies generated in round two. ResultsA total of 34 EM registrars participated during round one and 7 curriculum development experts participated during round two. A total of 120 competencies were identified from the 3-round Delphi study; of these 103 (85.8%) were reached by “Strong Agreement”; 16 (13.3%) reached by “Agreement”; and 1 (0.8%) was undecided. DiscussionThe results of the modified Delphi study contributed to developing a comprehensive list of undergraduate acute care clinical competencies set in a South African context. The value of engaging with medical practitioners at the forefront of delivering acute care in a South African healthcare environment who are exposed on a daily basis to the healthcare needs of society, became evident. The findings of this study highlight and reinforce the importance of contextual relevance during the curriculum development process. ConclusionThe modified Delphi method, based on three iterative rounds and feedback from experts, was effective in reaching consensus on the competencies required by undergraduate medical students to manage acute care adult patients safely within a South African hospital environment.

Performance comparison of three commercial multiplex molecular panels for respiratory viruses at a South African academic hospital.

Respiratory infections are a major contributor to hospital admissions. Identification of respiratory pathogens by means of conventional culture and serology methods remains challenging. Multiplex molecular assays are an appealing alternative that endeavours to be rapid, more accurate and less arduous. The study aimed to compare the clinical performance of three commercial multiplex molecular assays for respiratory viruses. Forty-eight respiratory specimens obtained from patients at Tygerberg Hospital in the Western Cape province of South Africa were studied. These specimens were collected between May 2020 and August 2020. The results of the Seegene Anyplex™ II RV16, FilmArray® Respiratory 2.1 plus Panel (FARP), and QIAstat-Dx® Respiratory SARS-CoV-2 Panel (QRP) were analysed based on the overlapping targets. A composite reference standard was applied to provide a standard reference for comparison. The overall sensitivity of the Seegene Anyplex™ II RV16 was 96.6% (57/59), the FARP 98.2% (56/57) and the QRP 80.7% (46/57). The overall specificities were 99.8% (660/661), 99.0% (704/711) and 99.7% (709/711), respectively. The QRP failed to detect coronaviruses and parainfluenza viruses in 41.7% (5/12) and 28.6% (4/14) of positive specimens, respectively, while the FARP produced the lowest target specificity of 88.4% (38/43) for rhinovirus/enterovirus. The overall specificity of all three platforms was comparable; however, the sensitivity of the QRP was inferior to that of the ARV and FARP. This study adds to the body of performance characteristics described for respiratory multiplex panels, especially in the African context where molecular diagnostics for infectious diseases are gaining momentum.

Core collections: Essential titles for health libraries.

Core collections have been produced by CILIP's Health Libraries Group, then called the Library Association's Medical Section, since 1952. Maintained by a Working Group of health librarians based in the UK NHS, higher education and specialist libraries, the collections provide an up-to-date curated list of reliable titles essential to health libraries. The core collections currently include nursing, midwifery, medicine and dentistry. The newest core collection is being developed in collaboration with the African Hospital Libraries to provide a list of key resources relevant to sub-Saharan Africa. Expressions of interest to help develop this latest collection are invited.

Exploring strategies promoting interprofessional collaborative practice in spinal cord injury rehabilitation at a private South African hospital group

Background. Implementing an interprofessional collaborative practice (IPCP) in hospitals improves health outcomes, enhances patient safety and reduces length of stay by optimising resource utilisation. Although this approach was desired at a private hospital group in South Africa (SA), the specific strategies for clinical guidelines and capacity management pertaining to spinal cord injury (SCI) patients and the implementation of IPCP were unknown. Objective. To explore strategies for implementing clinical guidelines and capacity management for SCI rehabilitation to promote IPCP in a private hospital group in SA. Method. This exploratory descriptive qualitative study included participants who were selected through purposive sampling. The participants comprised 11 staff from various disciplines and management of the private hospital group, one local and one international expert in IPCP. Three online focus groups (n=13) were conducted, involving three to five participants. The transcriptions were analysed thematically using Braun and Clarke’s framework. Results. Interprofessional communication and tools as well as capacity development were three emergent themes from the data. Strategies pertaining to communication methods, digitisation, visual displays, patient care information, educational information and education of healthcare workers were suggested to promote IPCP. Conclusion. These findings from the emergent themes could assist in implementing and integrating an IPCP approach into the rehabilitation service. Further research assessing the efficacy of implementing the IPCP strategies and digital platform would be beneficial.

Assessing post-abortion care using the WHO quality of care framework for maternal and newborn health: a cross-sectional study in two African hospitals in humanitarian settings

BackgroundAbortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR).MethodsWe mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals’ PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively.ResultsAmong the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time.ConclusionOur comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.