Frontline Health Research Articles

Health Workers in Sexual and Gender Based Violence (SGBV) Care for Refugees: Insights from Frontline Health and Humanitarian Professionals in Rhino Camp Refugee Settlement, Uganda

In the wake of the COVID-19 pandemic, a marked global increase in cases of Sexual and Gender Based Violence (SGBV) has been noted (Johnson et al. 2020). In the refugee settlements of Uganda, this is dramatically illustrated by an escalating crisis of teenage pregnancies (UN Women 2020; Diallo et al. 2023). During lockdowns, conflicts among families and couples increased and vulnerable community members, particularly children and young people, were exposed to heightened risks of abuse (Datzberger et al. 2023). For the humanitarian community, the escalation of the past years highlights the urgent need to sustainably improve SGBV prevention, care and case management in refugee settings.

Teaching comprehensive sexuality education in a traumatized society: recognizing teachers as sexual, reproductive, and mental health frontline workers

IntroductionResearch on school-based sexuality education in South Africa, taught within Life Orientation (LO), has mainly focused on learners’ responses, how teachers approach the subject, and the curriculum content. Critiques have included heteronormative biases, an emphasis on danger, disease and damage, a reinforcement of gendered binaries, and the lack of pleasure or well-being discourses. In contrast, our research focused on the unexpected moments teachers experience, i.e., the ethical, emotional or psychological challenges they encounter in their interactions with learners.MethodsWe interviewed 49 teachers across a range of schools in three provinces. Data were analyzed using narrative thematic analysis.ResultsTeachers’ narratives referred to an alarming array of traumas and psychosocial problems experienced by learners, including sexual abuse, substance abuse, neglect, HIV diagnosis, unsafe abortion, witnessing murders, and attempted suicide. Teaching particular topics, they indicated, triggered learner distress, although, sometimes, distress was triggered by innocuous topics. Teachers felt insufficiently skilled to teach certain topics sensitively to promote the well-being of learners who experienced current or past trauma. They also felt ill-equipped to deal with learners reporting trauma or psychosocial problems to them. Strategies narrated included allowing learners to skip relevant classes, building trust, understanding learners’ needs, being a learner’s advocate, and drawing on learners’ grounded expertise. Teachers spoke of experiencing burnout and secondary trauma themselves.DiscussionWe argue that LO teachers are, in effect, sexual, reproductive and mental health frontline workers. They need in-depth training in learner-centered and dialogical approaches to build trust within the classroom sensitively and in basic screening, containment, referral and lay counselling skills to assist distressed learners outside the class. A wellbeing approach to sexuality education requires providing LO teachers with ongoing support and consultation with peers and mental health professionals to avoid burnout and promote well-being.

Side effects of AZD 1222 COVISHIELD vaccine among front-line health care workers in a tertiary care hospital: A descriptive cross-sectional study

Introduction: Coronavirus disease vaccination has been accepted as a global health measure to prevent severity,transmission and mortality. Vaccine frequently cause adverse effects which is supposed to be due to protective immune response induced by the vaccine. The study aimed to find out the prevalence of side effects of first dose of AZD 1222 COVISHIELD vaccine among front line health care workers receiving vaccination in a tertiary care hospital. Methods: This was a descriptive cross-sectional study among front line health workers who received the first dose of COVISHIELD vaccine. The study was conducted from February 2021 to March 2021 in a tertiary care hospital after receiving ethical approval from the Institutional Review Committee. Convenience sampling was used for data collection and data was analyzed using SPSS version 17 was used for analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Among 629 participants, 344(54.7%) participants reported one or other side effects following vaccination. The major side effects reported were fever 152(19.6%), myalgia 144(22.9%), pain at injection site 123(19.6%), headache 75(11.9%) and in one reactivation of Herpes Zoster. Conclusions: After the first dose of COVISHIELD vaccine, mild symptoms were seen which resolved within few days. Some cases of reactivation of Herpes Zoster was found. The adverse effects were seen more in patients who had history of COVID-19 infection.

A Digital Microintervention Supporting Evidence-Based Parenting Skills: Development Study Using the Agile Scrum Methodology.

Conduct disorder increases risks of educational dropout, future mental illness, and incarceration if untreated. First-line treatment of conduct disorder involves evidence-based parenting skills programs. Time-outs, a frequent tool in these programs, can be effective at improving behavior, and recent apps have been developed to aid this process. However, these apps promote the use of time-outs in inconsistent or developmentally inappropriate ways, potentially worsening behavior problems. Digital microinterventions like these apps could guide parents through high-quality time-outs in the moment, but current time-out apps lack features promoting adherence to the evidence-based best practice. Agile scrum is a respected approach in the software development industry. We aimed to explore the feasibility of using the agile scrum approach to build a digital microintervention to help parents deliver an evidence-based time-out. The agile scrum methodology was used. Four sprints were conducted. Figma software was used for app design and wireframing. Insights from 42 expert stakeholders were used during 3 sprint reviews. We consulted experts who were identified from councils around the Midlands region of the United Kingdom and charities through personal contacts and a snowballing approach. Over 4 development sprints from August 2022 to March 2023, the app was iteratively designed and refined based on consultation with a diverse group of 42 experts who shared their knowledge about the content of common parenting programs and the challenges parents commonly face. Modifications made throughout the process resulted in significant app enhancements, including tailored timer algorithms and enhanced readability, as well as an onboarding zone, mindfulness module, and pictorial information to increase inclusivity. By the end of the fourth sprint, the app was deemed ready for home use by stakeholders, demonstrating the effectiveness of our agile scrum development approach. We developed an app to support parents to use the evidence-based time-out technique. We recommend the agile scrum approach to create mobile health apps. Our experience highlights the valuable role that frontline health and social care professionals, particularly those working with vulnerable families, can play as experts in scrum reviews. There is a need for research to both evaluate the impact of digital microinterventions on child behavioral change and also create digital microinterventions that cater to non-English speakers and individuals who participate in parenting programs in settings outside the United Kingdom.

How do workplace stressors during COVID-19 affect health frontline employees in Iran: Investigating the role of employee resilience and constituent attachment

PurposeThe purpose of the present study is to extend the body of research on healthcare management by examining the effect of workplace stressors, including abusive supervision, customer incivility and the perceived threat of COVID-19 (PCT), on turnover intention. The study also contributes to healthcare management research by examining the mediating role of emotional exhaustion, the moderating role of employee resilience and constituent attachment.Design/methodology/approachThe study developed and tested a model explaining the relationship between abusive supervision, customer incivility, PCT, emotional exhaustion, turnover intention, employee resilience and constituent attachment. Data were collected from a sample of 375 frontline employees who work in private hospitals in Mashhad, the second-most populous city in Iran.FindingsThe findings indicate that abusive supervision and customer incivility, directly and indirectly, affect turnover intention through emotional exhaustion. Furthermore, employee resilience was found to mitigate the relationship between stressors excluding the PCT and emotional exhaustion. Moreover, constituent attachment decreased the likelihood of turnover intention among employees who experienced abusive supervision. The findings suggest that controlling abusive supervision, customer incivility and PCT can lead to less emotionally exhausted employees with lower turnover intention. Furthermore, enhancing employee resilience and constituent attachment can decrease emotional exhaustion and turnover intention.Originality/valueDespite the large body of research on the relationship between the variables mentioned above, few studies have presented a conceptual model based on the relationship between them. This article presents a conceptual model that has not been previously discussed in any other publication to examine the moderating effect of organizational and individual factors in the relationship between workplace stressors and their consequences, which have not been widely covered in existing literature. Drawing upon conservation of resources theory, job embeddedness theory and attachment theory, the present study aims to fill this gap in the literature.

Racial implicit bias: Perspectives of nursing students

BackgroundRacial implicit bias contributes to healthcare disparities. While research has been conducted on other health professionals, there is a lack of evidence about nursing students' experiences with racial implicit bias. PurposeThis study described the perspectives of pre-licensure nursing students regarding racial implicit bias (RIB) and its impact on patient care. MethodA qualitative descriptive methodology utilizing focus groups was used to describe the students' perspectives. ResultsData analysis revealed three main themes: RIB may not be on purpose, but wrong is wrong; Bad nurse versus good nurse; and This is not okay. ConclusionAs RIB continues to contribute to health care disparities, this study reveals the need for it to be addressed in nursing education, while students prepare to be front line health care professionals.

Supplemental Material for The Occupational Moral Injury Scale: Development and Validation in Frontline Health and First Responder Workers

Supplemental Material for The Occupational Moral Injury Scale: Development and Validation in Frontline Health and First Responder Workers

The Occupational Moral Injury Scale: Development and validation in frontline health and first responder workers.

The Occupational Moral Injury Scale: Development and validation in frontline health and first responder workers.

Collaboration between the National Institute of Health Somalia and the Public Health Agency of Sweden

Abstract Public Health Agency Sweden (PHAS) has been funded by Sida to provide support and assist in capacity building of the National Institute of Health (NIH) Somalia for six years (2019-2025). The PHAS work closely with the Federal Ministry of Health Somalia, Member States and partners like WHO Somalia, Africa CDC and academic institutions to establish NIHS as an institution that can be sustained and grow over time, and that can contribute to the public health and health system infrastructure of Somalia. Main areas of collaboration 2019-2023 have been technical support to the joint taskforce on Integrated Disease Surveillance and Response (IDSR); supporting basic level field epidemiology training to front line health care workers; organizing workshops in data analyses, visualisation and reporting together with SPIDER/Stockholm University and Statistics Sweden. Building research capacity has included organizing a digital workshop: Reconstructing public health institutions in Somalia at the16th World Congress on Public Health 2020, Rome, Italy and support to the 1st NIH Research Conference 30 January - 1 February 2022 in Garowe, Puntland: “Laying the Foundation for Health Research in Somalia”. The hybrid conference attracted more than 180 participants from different universities. The tentative plan for the remaining project period include recruiting two Somali-speaking public health experts to develop the human resources and institutional capacities in order for NIH to become a centre of excellence for public health in Somalia. The main focus area for the remaining project period is supporting the development of the disease surveillance system including methods for analysis and reporting data. Research capacity workshops will be organized and supported, as well as a 2nd NIH Research Conference in 2024. Another important task is resource mobilization for long-term sustainability and coordination with other stakeholders. Key messages • Supporting the development of the disease surveillance system including analytical skills and reporting of data is key. • Coordination with other stakeholders and resource mobilization for long-term sustainability is essential.

Nutrition education and counselling by frontline health and nutrition care workers is associated with improved iron adherence among pregnant women: evidence from the National Family Health Surveys, 2015-21

Background: Anaemia is a global public health problem affecting developing and developed countries with major consequences for human health and social and economic development. Methods: This paper attempted to understand the determinants of iron adherence among women of reproductive age during their last pregnancy in India and states/union territories, the iron deficiency being associated with anaemia, using multiple logistic regression analyses of data from the fourth (2015-16) and fifth (2019-21) rounds of the India National Family Health Survey. The individual unit-level data were analysed using Stata 17 software. Results: After adjusting for standard covariates, it was found that those who reported receiving counselling by a frontline health worker and/or antenatal care visits were much more likely to consume at least 90 days of iron-containing supplements. Results shows that for NFHS-4 women who had received counselling from a frontline health and nutrition care worker were 1.489 times (95% CI: 1.429-1.553) to adhere to at least 90 days of iron tablets or syrup after adjusting for potential confounders and for NFHS-5 women who had received counselling from a frontline worker were 1.162 times (95% CI :1.124-1.200) more likely to adhere to IFA supplements or syrup for at least 90 days. Conclusions: Based on insights from these analyses, it appears that counselling seems to be effective in making women aware of the benefits of IFA, thus increasing the likelihood of intake of iron-containing supplements. Counselling seems to be an important predictor of adherence to iron intake in India.

Distribution of Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) Immunoglobulins G and M among Frontline Health Workers in Eleme Local Government of Rivers State, Nigeria

Background: The fight against Corona Virus Disease (COVID-19) globally among front line health workers has been a challenging task, it encompasses working lengthy hours at the isolation Centre’s, intensive care units, emergency departments and molecular laboratories, and also been exposed to pathogens, fatigue, and psychological distress. This has led to high morbidity and mortality rate among front line health workers all over the globe.
 Aim: This study aimed at determining the distribution of SARS CoV -2 IgG and IgM among frontline health workers in Eleme Local Government of Rivers State, Nigeria.
 Materials and Methods: A total of 100 frontline Covid-19 health workers were recruited for this study comprising 48 males and 52 females with ages between 23 and 49 years and included janitors, hygienist, nurses, data Officers, logistics and ambulance drivers, physicians, and medical laboratory scientists, working at the molecular laboratories, sample collection booths and isolation center. The bio-data of the subjects were obtained using a well-structured questionnaire. Only subjects who gave informed consent were recruited for this study. 60ul of capillary blood was collected from each participant using an aseptic technique and immediately followed by the analysis of SAR-CoV-2 IgM and IgG using a lateral flow immunochromatographic assay technique.
 Results: Results from this study showed a total of forty-two (42) 42% subjects were reactive to IgG antibodies while fifty-eight (58) 58% subjects were non-reactive to IgG antibodies also a total of Twenty-One (21) 21% subject were reactive to IgM antibodies while a total of seventy-nine (79) 79% subjects were none reactive to IgM antibodies. A total of nine (9) subjects who were exposed to SAR-CoV-2 for more than one year were reactive to SAR-Cov-2 IgM and IgG antibodies, while a total of two (2) subjects who were exposed to SAR-CoV-2 for less than one year were reactive to SAR-Cov-2 IgM and IgG antibodies and the difference (p ₌ 0.013) was statistically significant. Also, a higher number of subjects within the 20-29 age bracket were reactive to SAR-CoV-2 IgM antibodies while subjects with in the age bracket of 30-39 were more reactive to IgG antibodies.
 Conclusion: This study reveals that serological testing is an ideal approach in assessing the proportion of frontline health workers who might have been exposed to SARS-CoV-2 as part of effort in combating COVID-19 disease globally.

Performance and feasibility of reactive surveillance and response strategies for malaria elimination in Vietnam: a mixed-methods study

BackgroundTo enhance malaria elimination, Vietnam adopted a Reactive Surveillance and Response (RASR) Strategy in which malaria case notification and investigation must be completed within 2 days followed by a focus investigation within 7 days. The nationwide performance of Vietnam’s RASR strategy has yet to be evaluated. This study aims to evaluate the performance and feasibility of RASR in Vietnam, thereby providing recommendations for improved RASR.MethodsTo assess malaria RASR in Vietnam, a mixed-methods study of (1) secondary data analysis of nationwide malaria case-based dataset from 2017 to 2021; (2) a quantitative survey, and (3) qualitative in-depth interviews and focus group discussions administered to central, provincial and district level stakeholders/staff and to the commune and community level front line health services providers was conducted.ResultsIn Vietnam, there are guidelines and procedures for implementation of each step of RASR. The completeness of case notification on the reported monthly aggregated data was very high in both the paper-based (12,463/12,498, 99.7% in 2017–2020) and electronic reporting systems (467/467, 100% in 2021 when electronic reporting was introduced); however, there were delays in notification while using the paper-based system (timely notification—7,978/12,498, 63.8%). In 2021, the completeness (453/467, 97.0%) and timeliness (371/467, 79.4%) of case investigation were found to be high. Reactive case detection was the major focus investigation response, with fever screening achievement of 88.6% (11,481 / 12,965) and 88.5% (11,471 / 12,965) among index case and neighbouring household members, respectively.ConclusionsOverall, there was policy commitment for implementation of RASR in Vietnam. The completeness and timeliness of case notification and case investigation were high and improved after the introduction of the electronic reporting system. More evidence is required for reactive case detection in defining the screening area or population.

Vaccination coverage and breakthrough infections of COVID-19 during the second wave among staff of selected medical institutions in India.

India experienced the second wave of SARS-CoV-2 infection from April 3 to June 10, 2021. During the second wave, Delta variant B.1617.2 emerged as the predominant strain, spiking cases from 12.5 million to 29.3 million (cumulative) by the end of the surge in India. Vaccines against COVID-19 are a potent tool to control and end the pandemic in addition to other control measures. India rolled out its vaccination programme on January 16, 2021, initially with two vaccines that were given emergency authorization-Covaxin (BBV152) and Covishield (ChAdOx1 nCoV- 19). Vaccination was initially started for the elderly (60+) and front-line workers and then gradually opened to different age groups. The second wave hit when vaccination was picking up pace in India. There were instances of vaccinated people (fully and partially) getting infected, and reinfections were also reported. We undertook a survey of staff (front line health care workers and supporting) of 15 medical colleges and research institutes across India to assess the vaccination coverage, incidence of breakthrough infections, and reinfections among them from June 2 to July 10, 2021. A total of 1876 staff participated, and 1484 forms were selected for analysis after removing duplicates and erroneous entries (n = 392). We found that among the respondents at the time of response, 17.6% were unvaccinated, 19.8% were partially vaccinated (received the first dose), and 62.5% were fully vaccinated (received both doses). Incidence of breakthrough infections was 8.7% among the 801 individuals (70/801) tested at least 14 days after the 2nd dose of vaccine. Eight participants reported reinfection in the overall infected group and reinfection incidence rate was 5.1%. Out of (N = 349) infected individuals 243 (69.6%) were unvaccinated and 106 (30.3%) were vaccinated. Our findings reveal the protective effect of vaccination and its role as an essential tool in the struggle against this pandemic.

Impacts of a dispersed unit structure on allied health professionals' experiences in an Australian public hospital setting.

The limited published evidence relating to the experiences and outcomes of a unit dispersement model is generally more negative than positive from an allied health perspective. The perceptions of allied health managers and leaders after the transition to a unit dispersement structure were explored in this study. The objectives were to review the impacts of this type of structure and the factors for health care organizations to consider before incorporating allied health professions into a clinical matrix structure. A qualitative study was conducted in a large regional multisite public hospital and health service located in Australia. Semistructured interviews and focus groups were conducted with 30 allied health frontline managers and leaders. Four negative impacts on the work experience of allied health professionals in a dispersement structure were identified through data analysis as: a negative impact on service delivery to patients, a detrimental effect on professional identity, reduced ability of allied health managers and leaders to do their role effectively, and a negative impact on morale, culture, and emotional well-being. Several key factors for public hospitals to consider before embarking on an organizational structure that includes allied health professionals were identified. The impacts of the unit dispersement structure on allied health professionals working within the organization under study were generally negative and did not deliver on the desired objectives. The findings reinforce the unique requirements pertaining to allied health professionals for optimal functioning. The learnings have implications for administrators in health care organizations embarking on organizational change that incorporates allied health professions in certain settings. The findings recommend that health care organizations consider several important factors before they introduce any structural change that would affect the delivery of allied health services.

Knowledge, attitude, and practices of front line health workers after receiving a COVID-19 vaccine: a cross-sectional study in Pakistan.

Globally, there is an increased risk of COVID-19 infection among front-line health workers (FHW). This study aimed to evaluate the knowledge, attitude, and practices of FHW of Pakistan after receiving the COVID-19 vaccine. A population web-based survey on COVID-19 vaccine was conducted on 635 FHW in Pakistan between April 15, 2021, and July 15, 2021. The survey focused on four main sections consisting of socio-demographic data, knowledge, attitude, and practices after receiving the COVID-19 vaccine. The data was analyzed on SPSS. p < 0.05 was considered significant. Overall, 60% of FHW were nervous before getting vaccinated, with the leading reason to get vaccinated being their concern to protect themselves and their community (53.4%). A majority of FHW had fear about the unseen side effects of the COVID-19 vaccine (59.7%) used in Pakistan, with the most common side effect reported as soreness at the injection site (39%). It has been noted that almost all of the FHW observed preventive practices after getting vaccinated. The results showed that married respondents had favorable practices towards COVID-19 vaccines (B = 0.53, p < 0.01) (B, unstandardized regression coefficient). It was also found that more informational sources (B = 0.19, p < 0.01), higher knowledge of vaccination (B = 0.15, p < 0.001), and favorable attitude toward vaccine (B = 0.12, p < 0.001) significantly predicted favorable practices toward COVID-19 vaccination. The findings reflect that FHW, though they were worried about its side effects, have good knowledge and a positive attitude after getting the COVID-19 vaccine. This study is significant as the FHWs are a symbol for guidance, a reliable source of information, and an encouraging means of receiving COVID-19 vaccine for the general public. This study also reported that post-vaccination side effects were mild which will aid in reducing the vaccine hesitancy among the general Pakistani population.

Contributing Factors Towards Low Back Pain Among Front Line Health Care Workers in Lahore, Pakistan

For nurses’ low back pain is a serious health issue. Objective: To determine the contributing factors towards low back pain among front line health care workers in Lahore, Pakistan. Method: The design of this study was cross-sectional, descriptive, and quantitative. 191 nurses were selected for this study through non-probability purposive sampling. Data were collected by adopted Performa by Prof. Cilliers. Results: This study encompassed 191 nurses working in the four public hospitals of Lahore. The response rate was 100%. The regular prevalence of low back pain was 41.4%. The highest ratio of contributing factors towards low back pain was physical, (poor posture 36.6%), while in the psychological factors fatigue 52.4%, whereas in the social factors age 35.6%, similarly in patient care Lifting a heavy Patient 23.6%, and work environment workload 36.6%. Conclusion: Low back pain was moderately prevalent among front-line health care workers. A physical, psychological, social, patient care, and work environment are all contributing factors towards low back pain.

Pattern of COVID 19 Infection among Front line Health Workers and Contact Tracing Done among them. Our Experience in a Tertiary Care Hospital

Background: A considerable number of front-line workers are under risk due to repeated infection and exposure.The pattern of COVID 19 infection among the front-line workers was important, so that more focus would be laidon protecting them. Contact tracing is one key strategy for interrupting chains of transmission of SARS-CoV-2.This study aimed to find the pattern of COVID 19 infection among front line health workers and describe theprocess of contact tracing.Methodology: The list of front-line workers with possible symptoms of COVID-19 or had come in direct contactwith a “case” was shared with the department of community medicine for contract tracing activity as per theguidelines. The front-line workers who were categorized as High Risk were quarantined immediately and thosewho were categorized as Low-Risk were advised to be vigilant regarding the development of symptoms and wereasked to continue with their routine duties with extra precautionary measures as they form a very vital part of theresource in this combat against COVID-19.Result: About 138 front line health workers were affected by COVID-19 among which staff nurses (51) amountedto the maximum number who were affected.Conclusion: COVID-19 was high among front-line workers and had a large number of high-risk contacts. Nurseswere found to be most affected with COVID 19 infection.

Front Line Health Workers’ COVID-19 Lived Experiences: A Case of Levy Mwanawasa Hospital in Lusaka, Zambia

Front Line Health Workers’ COVID-19 Lived Experiences: A Case of Levy Mwanawasa Hospital in Lusaka, Zambia

The compelling necessity for improvement in cancer screening in India in this decade

In 2020, cancers of the breast, lip and oral cavity and cervix were the three most common cancers in India.(1) The national programme for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) recommends a population-based screening for identifying pre-cancerous lesions and early detection of these three cancers by front line health workers.(2) Data about cancer screening has been included in the latest National Family Health Survey (NFHS-5).(3) We have tried to understand the current status of cervical, breast and oral cancer screening in India.

Impact of Covid-19 Pandemic On Psychological Behavior of Dental Health Care Workers in Peshawar

During the hard time of Covid, front line health care workers were directly involved in one way or the other to treat the patients or perform duties in Covid-wards. They were at great risk of catching the infection as well as be affected by the psychological disorders. Objective: To determine the effects of Covid pandemic on the psychological health of dental health care professionals in Peshawar. Methods: A total of 384 participants both Dentists and Dental paramedical staff and technicians were included in the study. The participants were classified as non-infected and Covid recovered participants. Two validated questionnaires (PHQ-9 scale, Scale for COVID-19 related psychological distress in healthy Dental health care workers) were used for these two types of participants respectively to assess the level of mental distress. The distress scores were analyzed and compared among various groups. Results: The results showed that non infected DHCWs generally had mild (48.98%) to moderate (31.43%) psychological distress as a result of the Covid situation. While Covid recovered DCHWs had minimal (30.86%) and moderate depression (30.07%) The particularly vulnerable groups showing more psychological distress were non-infected female DHCWs and non-infected DHCWs working at Lady Reading hospital Peshawar. Conclusion: The Covid-19 pandemic affected the mental health of DHCWs in a negative way, and most of the DHCWs had mild to moderate severity of distress or depression.