Human Resource Constraints Research Articles

Factors influencing provider deviation from national HIV and nutritional guidelines for HIV-exposed children in western Kenya: a qualitative study

BackgroundMalnutrition and HIV interact in a vicious cycle for HIV-exposed infants (HEIs), increasing vulnerability and the severity of each condition and contributing to poor health outcomes. We identified multi-level factors influencing provider adherence to Kenyan HIV and nutrition guidelines for HEIs.MethodsWe conducted six focus group discussions and seven in-depth interviews using a semi-structured question guide. Participants were selected through purposive maximum variation sampling of health workers involved in maternal and child health services and outpatient nutrition programs at two facilities in western Kenya. Data collection and analysis were guided by the Theoretical Domains Framework (TDF). Transcripts were coded by two primary coders using both deductive and inductive thematic analysis.ResultsTDF domains that drove guideline adherence included: environmental context and resources, beliefs about capabilities, and social influences. While participants praised attempts to integrate HIV and nutritional services through teamwork and service colocation, challenges in the successful referral of patients between services persisted. Participants described siloed HIV and nutrition-related knowledge across staff, leading to missed or delayed care if certain providers were unavailable. Participants emphasized understaffing as a major contributor to gaps in care. Inconsistent material resource availability also disrupted linkages between HIV and nutrition services for patients. While participants frequently expressed high intention and internal motivation to link children between services, they described minimal structured supervision or positive reinforcement from supervisors and feeling demoralized when resource constraints interfered with care provision. Lastly, participants described patient-level factors that made it challenging for families to seek or remain in care, including poverty and HIV and malnutrition-related stigma. Participants made several recommendations, including training multiple cadres in the fundamentals of both HIV and nutritional care to address siloed services and understaffing.ConclusionsThis study details the factors that facilitate or hinder health workers as they implement national guidelines and link HEIs between HIV and nutritional services, including the impact of physical integration of service sites, human and material resource constraints, and health worker motivation. Future interventions can address these challenges by expanding access to needed resources, task sharing, and testing implementation strategies that increase the efficiency of service delivery to improve linkages in care for vulnerable infants.

Implementation of a paraprofessional role across the public health sector in Manitoba: Impacts on system capacity.

Manitoba experiences sexually transmitted and blood-borne infection (STBBI) incidence rates above the national average and fundamental public health sector responses face human resource constraints. Manitoba implemented a paraprofessional role, the Communicable Disease Technician (CD Tech), to complete low-complexity STBBI investigations and support STBBI testing, care engagement initiatives, provider reporting, harm reduction supply distribution, and community engagement. Secondary roles included tuberculosis directly observed treatment (DOT) and virtual DOT, and flu and COVID immunization support. Twenty CD Tech positions were allocated to regional public health teams along with additional Public Health Nurse (PHN) positions to support the role. Mixed methods were used to evaluate the impact on public health system capacity. Follow-up of chlamydia and gonorrhea case investigations increased from 35% to 98%. Volume of contacts followed by public health increased for chlamydia (114%), gonorrhea (33%), and HIV (68%). Health care provider reporting for cases of STBBI and treatment more than doubled (116%). No significant differences in case investigation data quality were found between CD Techs and PHNs. Qualitative interviews by public health staff (n = 24) found CD Techs highly flexible and competent team members who can fill gaps and expand capacity in direct client service, outreach, administration, data entry, or community/partner engagement. Mentorship, ongoing supervision, role clarity, training, and clear practice standards are required to optimize the role. There is potential to expand this innovation and build surge capacity in other areas of public health practice, and other public health jurisdictions.

Public, Private and Public-Private Partnerships (PPP) to Implement a One Health Approach to Combat Antimicrobial Resistance in Colombia

Abstract The establishment of public-private partnerships (PPPs) within Colombia, Latin America, is a recent, innovative effort within the nation’s agricultural industry to tackle antimicrobial resistance (AMR) under a One Health approach. PPPs are a formal alliance between representatives from the public and private sectors that aim to promote cross-sectoral collaboration, stewardship and accountability. Members agree on shared objectives and responsibilities, resources and risks to establish monitoring, prevention and mitigation activities against AMR within the farming industry. Key learnings of this initiative within the context of Colombia include: maximisation of results when monitoring is assigned to the private sector, and this may apply to other lower-middle-income countries (LMICs); objectives are better achieved when they are pre-defined according to time, budget and human resource constraints of member institutions; and confidentiality agreements must be consistent with the sensitive nature of surveillance information. Barriers to implementation were also identified, such as frequent changes of government personnel at decision making levels that make governance planning and adaptation challenging, while legal formalities and bureaucracy hinder formalisation of agreements. The success of this PPP is a useful example for other LMICs to aid in the control and prevention of animal diseases, promotion of food safety and reduction in poor animal health which limit commerce, while at the same time, minimising production loss and ensuring the provision of a fair income for producers. Information © The Authors 2024

Digital Transformation of Archives through the SRIKANDI Application

The digitalization of archive management represents a strategic step toward modernizing government administration. This study examines the implementation of the Integrated Dynamic Archival Information System (APLIKASI SRIKANDI) at the Regional Archives and Library Office of Sikka Regency. Key aspects explored include challenges in digital archive transformation, objectives of system integration, methodologies employed, and the outcomes achieved, alongside future prospects for improvement. The study highlights the role of Universitas Nusa Nipa students’ internship programs in supporting digital archive initiatives. The findings reveal that APLIKASI SRIKANDI has significantly improved the efficiency of archival management processes. However, technical limitations, inadequate technological infrastructure, and human resource constraints remain challenges. To address these issues, the study recommends enhancing infrastructure, offering comprehensive training programs, and developing inclusive digital communication strategies. These efforts aim to optimize system implementation and ensure sustainability in achieving a fully integrated archival management framework. This research underscores the importance of strategic planning and collaboration in driving successful digital transformation within the public sector.

Implementation of CITES in Tanzania: Fairytale or Promising Journey? An Analysis of Legal Framework and Practice

Tanzania is rich in natural resources and home to one of Africa’s largest networks of wildlife-protected areas, including over 1,000 bird species and the world’s largest elephant population. As a dedicated wildlife conservation advocate, Tanzania ratified the Convention on International Trade in Endangered Species (CITES) in 1979 and became a party in 1980. The Wildlife Conservation Act (WCA), enacted in 1974 and revised in 2009, along with CITES-specific regulations from 2005, guide Tanzania's conservation efforts. Using both descriptive and normative research legal approaches, this article expounds the Country’s implementation with CITES. It notes that, while the country generally complies with CITES obligations by designating authorities and regulating trade, challenges remain in maintaining trade records, reporting, and controlling illegal wildlife trade. Since 2015, political will to enforce wildlife laws has increased, but Tanzania still faces constraints in human and financial resources, limited capacity to investigate wildlife crimes, and lack of awareness among communities and law enforcement agencies. Additionally, weaknesses in Zanzibar’s legal framework hinder conservation effectiveness. Despite these issues, Tanzania has the potential to improve CITES enforcement by enhancing resource allocation, legal reforms, and regional collaboration. Community involvement in conservation efforts is key to achieving sustainable management of the country's rich natural heritage.

Takt complementing Last Planner® System on residential construction projects.

Ireland is experiencing a national housing crisis, and this is replicated across many developed economies. This challenges governments and housebuilders to increase production whilst balancing challenging human resource and supply chain constraints. Lean construction methodologies have enhanced project delivery in other sectors of the industry. This study evaluates the outcomes of Last Planner System and Takt planning implementation on two residential projects. The study adopted a mixed methods approach utilising case study design and data collected from a literature review, site observation diary, site documentation analysis, and semi-structured interviews. Findings demonstrate schedule reduction opportunities through higher and more consistent PPC, reduction of cycle times, and enhanced adherence to start and finish dates. The study proposes a more holistic focus is needed on productivity improvement initiatives on the entire project scope as opposed to singular exercises on aspects like internal finishes alone. Increased inter-contractor communication and engagement led to a positive working environment with greater focus on the softer aspects of collaborative working. This study posits the discipline, detail, and diligence of Takt complements LPS to deliver an enhanced production-system that betters traditional schedule milestones in residential project delivery.

High-speed railways, audit partner changes across audit offices and audit quality: Evidence from China

The development of high-speed railways (HSRs) has significant regional economic and social implications. We study a micro externality of such development, namely the impact of HSRs on audit firms' human resource allocation and audit quality. Specifically, we investigate the relationship between the availability of HSRs and audit partner changes across audit offices in China which involves a simultaneous change in audit partner and audit office to reallocate human resources. We find that the advent of HSRs between clients and audit offices increases the likelihood of audit partner changes across audit offices especially for predecessor audit offices with severe human resource constraints due partly to the mandatory auditor rotation requirement. Such audit partner changes across audit offices most likely are reciprocal over time, occur within the optimal HSR transportation interval and can significantly improve audit quality in terms of reducing excessive financing reporting discretions, misstatements and regulatory sanctions, but exert no effect on audit fees. Our study has implications for audit firms’ human resource management in light of infrastructure improvements and for audit policy makers to evaluate the standards for audit partner rotations.

Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis.

The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland.

Pengaturan dan Kewenangan Polisi Pamong Praja dalam Upaya Penanggulangan Gelandangan dan Penduduk Pendatang di Kabupaten Badung

The linkage between the Civil Service Police Unit officers with appropriate agencies whose activities have a close connection in creating a conducive environment between local government and the people can perform activities in a safe, peaceful, orderly and applicable in areas with motivating people to create the rule of law. This needs to be pursued so that the police authority of the civil service as a law enforcement officer in fostering peace and order will be based on the activities and supervision of extension, no longer be a matter of the sanctions, penalties or fines. Be aware that in creating an orderly and safe condition, not just the responsibility of the Municipal Police alone, but public participation is crucial the achievement of order and peace. Given the number of homeless and migrants who are not registered in the registry office or the competent authority, in addition to the lack of government attention to the homeless, so the implication raises public order and public tranquility be disturbed. Principal issues to be addressed in this study is the First, the setting and the authority of the Municipal Police and the Homeless curb migrants in Badung, and constraints faced in the Municipal Police enforcing rules on homeless and migrants. This study is the approach taken by the normative approach to law (statute approach), approaches the concept (conceptual research), case-based approach (case approach) the nonnative analysis shows that the police authority of the civil service is based on the principles of the law, the nonns applicable law, whereas the juridical conceptual analysis regarding the effectiveness of law enforcement. Based on the results of the discussion, setting and Municipal Police Authority in carrying out duties and discipline Homeless Population entrants subject to the provisions of Law No. 32 of 2004, and regulations Badung District No. 4 of 2001 on public order. Constraints faced by local governments in the enforcement of rules against bums and penduduku immigrants are human resource constraints the police civil service itself is still not professional and legal culture of society that still considers the work is still a beggar or bum culture.

Exploring the influence of rural longitudinal multidisciplinary student placements on interprofessional education and collaborative practice in South Africa

Background. Training health professions students along the continuum of care on the distributed training platform (DTP) is increasingly being adopted by universities across Africa to promote the development of responsive healthcare professionals. Interprofessional collaboration to meet patient needs is an integral part of this ideal. Multidisciplinary student placement on the DTP (MDTP) provides opportunities for interprofessional education (IPE). Stellenbosch University offers longitudinal undergraduate student placement at two rural MDTPs in South Africa. Objective. The objective of this study was to explore the perceived IPE opportunities in Worcester and Upington in South Africa. Methods. Sixteen purposively selected undergraduate students from five-degree programmes who trained in Upington or Worcester were individually interviewed in 2022 using a qualitative case study research design. Inductive thematic analysis was conducted in reflection with an independent researcher, after which data were deductively analysed using the definition of IPE to guide data coding and theme development. Results. The value of curricular IPE activities and the need for co-curricular IPE activities focused on holistic patient care were noted. Extracurricular themes related to purposive co-ordination of accommodation, transport and social activities to promote interprofessional interaction were noted. Conclusion. It is not always possible to purposively design IPE activities on rural MDTPs owing to financial and human resource constraints. This study offers insight into curricular, co-curricular and extracurricular facilitators for IPE in the design of learning opportunities and logistics on rural MDTPs. Recommendations for the development of future MDTPs are presented.

BIM Adoption in MENA's Construction Industry: A Contractor's Perspective

This study delves into the multifaceted landscape of Building Information Modeling (BIM) adoption and implementation across the Middle East and North Africa (MENA) region's construction industry. Employing an online survey methodology, the research scrutinizes the varied profiles of contractors. Through regression analysis, the study investigates the impact of institutional pressures on the contractors’ BIM adoption, implementation, encountered barriers and challenges, expected benefits and outcomes, and related expertise and training. The analysis then extends to evaluate the interrelationships among such BIM variables. The key findings reveal significant influences of institutional pressures on BIM adoption and benefits as well as their expected benefits and outcomes but less impact on overcoming BIM barriers and challenges and enhancing expertise and training. The research highlights the limited role of BIM expertise and training in the adoption, implementation, and realization of its benefits and outcomes within the MENA construction sector. Furthermore, the study concludes that barriers, challenges, benefits, and outcomes don’t have a significant effect on BIM's adoption and implementation. The study also evaluates the primary benefits and outcomes of BIM alongside the main barriers and challenges encountered. Crucially, the research identifies and dissects the salient barriers to BIM deployment, such as awareness and expertise deficiency, financial and human resource constraints, training shortages, and resistance to change. This study not only provides a detailed snapshot of the BIM landscape but also lays the groundwork for addressing the persistent challenges and harnessing the full potential of BIM in revolutionizing construction methodologies in the MENA region. Doi: 10.28991/CEJ-2024-010-08-015 Full Text: PDF

Timeliness and quality of peripartum care provision during a health system strengthening initiative in rural Guinea-Bissau: a qualitative situation analysis

Guinea-Bissau has among the world’s highest maternal and perinatal mortality rates. To improve access to quality maternal and child health (MCH) services and thereby reduce mortality, a national health system strengthening initiative has been implemented. However, despite improved coverage of MCH services, perinatal mortality remained high. Using a systems-thinking lens, we conducted a situation analysis to explore factors shaping timeliness and quality of facility-based care during labour, childbirth, and the immediate postpartum period in rural Guinea-Bissau. We implemented in-depth interviews with eight peripartum care providers and participant observations at two health facilities (192 h) in 2021-22, and analysed interview transcripts and field notes using thematic network analysis. While providers considered health facilities as the only reasonable place of birth and promoted facility birth uptake, timeliness and quality of care were severely compromised by geographical, material and human-resource constraints. Providers especially experienced a lack of human resources and materials (e.g., essential medicines, consumables, appropriate equipment), and explained material constraints by discontinued donor supplies. In response, providers applied several adaptation strategies including prescribing materials for private purchase, omitting tests, and delegating tasks to birth companions. Consequences included financial barriers to care, compromised patient and occupational safety, delays, and diffusion of health worker responsibilities. Further, providers explained that in response to persisting access barriers, women conditioned care seeking on their perceived risk of developing birthing complications. Our findings highlight the need for continuous monitoring of factors constraining timeliness and quality of essential MCH services during the implementation of health system strengthening initiatives.

Exploratory study of the influence of the adoption of total quality management on the level of neonatal mortality in Moroccan hospitals

ABSTRACT The objective of this research was to investigate the impact of the adoption of total quality management (TQM) practices on neonatal mortality rates within Moroccan hospitals. An exploratory qualitative methodology was adopted. The dataset comprised qualitative inputs from 12 face to face interviews with hospital management staff and associated stakeholders. The study revealed several factors affecting the adoption of TQM practices in Moroccan hospitals, including human resource constraints, financial and material resource deficiencies, lack of leadership, and gaps in the quality of services provided. Moreover, while TQM practices significantly influence neonatal mortality rates, other external factors, such as accessibility to hospitals, infrastructure, and patient care quality, also play crucial roles. There’s a clear intertwining of neonatal mortality rates with the broader healthcare management dynamics. The findings underscore the need for Moroccan hospitals to adopt a comprehensive approach to TQM. This not only involves addressing internal managerial and operational challenges but also considering broader systemic issues within the healthcare ecosystem. Embracing TQM holistically could pave the way for improved neonatal care outcomes and reduced mortality rates. Additionally, understanding patient perspectives, especially those of pregnant women and recent mothers, can further enhance the quality of healthcare delivery in the region.

Understanding Kenyan policymakers' perspectives about the introduction of new maternal vaccines.

New vaccine policy adoption is a complex process, especially in low-and-middle-income countries (LMICs), requiring country policymakers to navigate challenges such as competing priorities, human and financial resource constraints, and limited logistical capacity. Since the Expanded Programme on Immunization's (EPI) beginning, most new vaccine introductions under this structure have not been aimed at adult populations. The majority of adult vaccines offered under the EPI are not typically tested among and tailored for pregnant persons, except those that are specifically recommended for pregnancy. Given that new maternal vaccines, including RSV and GBS vaccines, are on the horizon, it is important to understand what barriers may arise during the policy development and vaccine introduction process. In this study, we sought to understand information needs among maternal immunization policymakers and decision-makers in Kenya for new vaccine maternal policy adoption through in-depth interviews with 20 participants in Nakuru and Mombasa counties in Kenya. Results were mapped to an adapted version of an established framework by Levine et al., (2010) focused on new vaccine introduction in LMICs. Participants reported that the policy process for new maternal vaccine introduction requires substantial evidence as well as coordination among diverse stakeholders. Importantly, our findings suggest that the process for new maternal vaccines does not end with the adoption of a new policy, as intended recipients and various actors can determine the success of a vaccine program. Previous shortcomings, in Kenya, and globally during HPV vaccine introduction show the need to allocate adequate resources in education of communities given the sensitive target group. With maternal vaccines targeting a sensitive group - pregnant persons- in the pipeline, we are at an opportune time to understand how to ensure successful vaccine introduction with optimal acceptance and uptake, while also addressing vaccine hesitancy to increase population benefit.

Analisis Implementasi Monitoring dan Evaluasi dalam Pencegahan Korupsi di Pemerintah Kota Kupang

Corruption is a serious issue that negatively impacts development and public trust in government. This study aims to analyze the implementation of monitoring and evaluation in corruption prevention in the Kupang City Government over the 2021-2023 period. The method used is a descriptive qualitative approach, with data collection through in-depth interviews, document analysis, and observation. The results of the study indicate that the Monitoring Center for Prevention (MCP) score of the Kupang City Government fluctuated during the study period, with a decline in 2022 and a significant increase in 2023. Factors affecting the effectiveness of corruption prevention include internal management, technological infrastructure, government regulations, and external partnerships. Although there have been some improvements, major challenges include budget and human resource constraints, a lack of employee understanding of the importance of monitoring and evaluation, and resistance to organizational culture change. The study recommends increasing budget allocation and human resources, intensive training for employees, cultural change toward transparency and accountability, and strengthening partnerships with external institutions. Furthermore, routine evaluation and continuous improvement should be implemented to ensure the effectiveness of corruption prevention in the future.

Developing and Implementing a Competency-Based Veterinary Medicine Program at the Université de Montréal.

This article outlines the comprehensive reform of the Doctorate in Veterinary Medicine (DVM) program at the Université de Montréal, with a focus on the integration of a competency-based approach within the existing curriculum. The primary purpose of this reform was to enhance student competency and address specific deficiencies in competencies as revealed by annual outcomes assessment surveys. The authors developed a competency framework with seven competencies and specific elements, providing a foundation for the educational redesign. This framework guided the creation of learning-assessment situations (LAS) aimed at promoting active and contextualized learning throughout the program. The competency development and assessment pathway (CDAP) matrix was established to align LAS within the traditional program structure and track student progress. A learning portfolio and a competency certification process were introduced to support student learning and assess competency achievement. The authors discuss change management, including the paradigm shift towards programmatic assessment, and provide insights into the evolution of the program post-implementation. Preliminary outcomes assessment reveals positive changes in how teaching staff and students perceive the program. Despite challenges related to human resource constraints, the authors emphasize the significance of this reform, which aligns with current trends in medical education. This paper underscores the importance of tailoring educational approaches to specific institutional environments while maintaining programmatic rigor and quality assurance.

Infection prevention and control: Qualitative study of the preparedness and response of Christian health Association of Ghana to Marburg virus disease in Ghana

ObjectiveRecent disease outbreaks underscore the importance of robust disease surveillance and infection prevention and control (IPC) programmes to bolster Africa's public health response system. Yet, available evidence shows extensive gaps in the emergency response capacity of faith-based healthcare providers on the continent. Accordingly, this study examines the IPC and surveillance strategies adopted by a faith-based healthcare provider and the challenges encountered during Marburg Virus Disease outbreak (MVD) in Ghana. MethodWe collected data from 15 clinical and nonclinical health workers from the Christian Health Association of Ghana (CHAG) and the Ghana Health Service (GHS). Data was collected through online interviews to examine two pillars of the WHO COVID-19 SPRP-AFR (2021) framework. We analyzed the data using Braun and Clarke's thematic analysis. FindingsThe facility performed creditably well with contact tracing and other quarantine protocols during MVD outbreak in Ghana. However, it also encountered several challenges in the enforcement of IPC protocols, including human resource constraints, the lack of decontamination equipment, and limited infrastructure, among others. Given these limitations, we assessed that the facility cannot handle major outbreaks. ConclusionDue to numerous infectious disease outbreaks in Sub-Saharan Africa in recent years, the government of Ghana and faith-based healthcare providers must resource their facilities with the relevant equipment and qualified human resources against future disease outbreaks.

Business environment and adoption of AI: Navigation for internationalization by new ventures in emerging markets

AbstractThis study explores the intersection of international business and artificial intelligence (AI), focusing on how new ventures navigate environmental challenges for international expansion within Africa's transportation sector. Despite a wealth of literature on AI in developed countries, a notable gap exists in the understanding of the challenges emerging economies face in implementing AI practices, particularly in the context of Africa‐to‐Africa internationalization. The current study delved into the transformative potential of AI, identifying institutional voids as opportunities for innovation on the continent. Employing the Technology Organization and Environment framework, the study investigated the adoption of AI technology in the African business environment. Qualitative data gathered through interviews with transport tech startup founders across Africa provided insights into technological innovation, institutional dynamics, and market peculiarities. The founders recognized hurdles such as data scarcity, human resource constraints, and regulatory obstacles amid institutional voids. The study underscores the importance of understanding expectations, balancing possibilities and realities, and fostering collaboration. It offers valuable insights into the complexities faced by and opportunities for new ventures leveraging AI in internationalization, with practical implications for strategic AI implementation, policy development, market expansion, technology solutions, and cross‐border transportation within Africa's unique business landscape.

Implementation of early essential neonatal care for newborns delivered by cesarean section in Jiaxing: a single-center prospective randomized controlled trial

BackgroundAs an essential part of Early Essential Newborn Care, 90 minutes of mother-infant skin-to-skin contact is significant in improving maternal and infant outcomes. However, due to human resource constraints and the consideration of maternal and infant safety, it is difficult to achieve continuous uninterrupted skin-to-skin contact for at least 90 minutes during and after cesarean delivery. The aim of this study was to investigate the efficacy and safety of the continuous uninterrupted skin-to-skin contact for at least 90 minutes during and after cesarean section for exclusive breastfeeding rate during hospitalization and maternal and infant health indicators during and after cesarean delivery.MethodsThis is a single-center, prospective randomized controlled trial conducted in one tertiary care hospital in China. We selected 280 cases of elective cesarean delivery in a tertiary maternal and child specialty hospital in Zhejiang Province from September 2018 to August 2022, which were randomly divided into two groups: in the conventional group, doulas performed at least 30 minutes for early continuous SSC within 10–30 minutes during and after cesarean delivery. In the EENC group, with immediate continuous SSC within 5–10 minutes of neonatal delivery until surgery is completed and continued SSC after returning to the ward. Exclusive breastfeeding rate during hospitalization and maternal and infant health indicators were compared between the groups.ResultsA total of 258 cases were analyzed. Compared with the control group, the EENC group had earlier first breastfeeding initiation (13.7 ± 3.6 vs 62.8 ± 6.5 minutes, P < 0.001), longer duration of first breastfeeding (42.6 ± 9.0 vs 17.9 ± 7.5 minutes, P < 0.001), earlier onset of lactogenesis II (73.7 ± 3.6 vs 82.5 ± 7.4 hours, P < 0.001), higher breastfeeding self-efficacy score (128.6 ± 8.9 vs 104.4 ± 8.5, P < 0.001), higher Exclusive breastfeeding rate during hospitalization (88% vs 81%, P = 0.018), higher maternal satisfaction scores (18.9 ± 1.1 vs 14.0 ± 2.7, P < 0.001). Meanwhile the EENC group showed lower incidence of neonatal hypothermia (0% vs 4.6%, P = 0.014), lower neonatal hypoglycemia (0% vs 5.4%, P = 0.007) and less cumulative blood loss within 24 hours postpartum (254.2 ± 43.6 vs 282.8 ± 63.8 ml, P < 0.001).ConclusionThe implementation of EENC up to 90 minutes by caesarean doula company nurses is feasible and beneficial to maternal and infant health.Trial RegistrationChiCTR1800018195(2018-09-04).

Assessing the integration between disaster risk reduction and urban and regional planning curricula at tertiary institutions in South Africa

Urban areas are increasingly being affected by more frequent and severe disasters. It has been argued in theory and international development policy that the integration of disaster risk reduction (DRR) within existing urban planning (UP) curricula would greatly benefit efforts to build resilient urban environments. However, the current status quo and progress of this crucial transdisciplinary integration in the South African University context remain unclear. Through the application of an exploratory mixed method research design, this article established that UP lecturers at South African universities have a good grasp of the theoretical need for the integration of DRR into existing curriculums and have also tentatively started to integrate DRR into some of their modules. However, because of challenges such as full curricula, financial and human resources constraints and integration predominantly happening on postgraduate level, integration has not occurred in sufficient depth while also missing the opportunity to expose the majority of the student cohort and future urban planners to much-needed DRR knowledge.Transdisciplinary contribution: This article illuminates the current status of integration across and collaboration between DRR and UP at selected South African Universities.