Ministry Of Health And Social Services Research Articles

Optimizing Midwives’ Uptake of a Provincial Perinatal Data System: Lines of Thinking

In Quebec, the perinatal data available is fragmentary, comes from a number of different databases that are not well integrated, and offers little information regarding the quality of care and services provided by midwives. In 2012, the Ministry of Health and Social Services (MSSS) asked midwives to contribute to the information system on users of local community services centers (I-CLSC). The I-CLSC system is, above all, an administrative monitoring tool; however, it makes it possible to document certain aspects of midwifery practice. Using literature from the fields of knowledge transfer and modification of clinical practices, this article aims to explore under which conditions and to what extent the I-CLSC system could help document midwifery practice. Given the context and the nature of the I-CLSC tool, the success of its uptake by midwives involves the simultaneous reinforcement of its acceptance by midwives, and the provision of support while they use it, so that the data collected is reliable and solid. Training and feedback activities constitute promising avenues in terms of attaining these goals. Literature suggests that, without adequate support, there is a high risk that data fed into the I-CLSC system by midwives will be unreliable. If that is the case, the individual time and effort invested in this system by midwives are unlikely to be cost-effective for either the midwives themselves or midwifery in general.

Knowledge of breastfeeding women regarding exclusive breastfeeding in one district in Omusati region, Namibia.

Breast milk is needed for the growth and development of the baby; therefore, a woman should breastfeed exclusively for six months for the baby to get all the necessary nutrients. Breastfeeding mother's knowledge on exclusive breastfeeding plays an important role in the baby's growth. To determine and describe the knowledge of breastfeeding women regarding exclusive breastfeeding in the Outapi District, Omusati region. A quantitative, descriptive research design was used. The population were all women in nine clinics in Outapi district breastfeeding babies aged 0 to 6 months. The target population consisted of 401 lactating mothers of postnatal attendance with babies from 0-6 months in the Outapi district, in nine clinics. Cluster sampling was used to select clinic according to higher attendance, low and moderate attendance and three clinic were selected. The sample size was calculated using Solvin's formula. Simple random sampling was used to select the sample size of 200 participants. Data were collected using a self developed questionnaires that collected socio-demographic information and knowledge questions. Data was analysed using SPSS version 26. Descriptive statistics generating frequencies and percentages. The results revealed that majority of the participants have knowledge regarding exclusive breastfeeding, include, the definition, the importance and advantages of breastfeeding. Most of the participants have higher knowledge on the importance of colostrum, complementary feeding as well as the importance of breastfeeding in disease prevention on the mother and the baby. The overlall knowledge of participants were higher. The study found out that most of the particpants are aged 20 to 31 years old, single and unemployed. The study have identified that participants have higher knowledge regarding exclusive breastfeeding. The study recommended that the Ministry of Health and Social Services (MoHSS) should institute strategies and actions that can help breastfeeding mothers to better utilize their knowledge on practicing exclusive breastfeeding and enshrined in the nutritional policy to promote health and wellbeing of new-born babies.

Nurses' knowledge, attitudes, and practices about rehabilitation of patients after heart valve surgery in Namibia.

A cardiac rehabilitation programme is a medically supervised intervention to assist patients in recovery after heart surgeries and to prevent potential complications. Nurses should have the knowledge, a positive attitudes, and good practices to improve patient quality of life during the recovery process. This study aimed to describe the knowledge, attitudes, and practices of the nurses regarding cardiac rehabilitation for patients after heart valve surgery. The study setting was Windhoek Central Hospital, Cardiac Unit, in Windhoek, Namibia. A quantitative and descriptive research design was used for convenient non-probability sampling of (N = 23) nurses who consented to participate in the study. Data were collected through self-administered questionnaires and analyzed using SPSS Version 26. Descriptive statistics were used and Fischer's Exact test for associations of variables was performed. The study results showed a high level of knowledge, good attitudes, and poor to fair practices toward cardiac rehabilitation. However, the respondents demonstrate a lack of knowledge about the indications, and benefits of cardiac rehabilitation, negative attitudes regarding counselling of patients on sexual activities, and poor practice regarding exercises and counseling of patients and caregivers on cardiac rehabilitation. Furthermore, there is a positive relationship between the respondents' older age, senior rank, and having been trained I cardiac conditions and their knowledge, attitudes and practices regarding some core components of cardiac rehabilitation with P-value < 0.050. There is a need for a cardiac rehabilitation programme to improve nurses' attitudes and practices toward cardiac rehabilitation. Understanding the gap in knowledge, attitudes, and practices among the nurses regarding cardiac rehabilitation would guide the Ministry of Health and Social Services (MoHSS) in the implementation of the cardiac rehabilitation for patients after heart valve surgery.

Assessing the Impact of Universal Test and Treat Implementation Strategy on Retention to Antiretroviral Therapy in HIV Care: A Retrospective Cohort Review

Namibia has an adult HIV prevalence of 12.6% according to the Namibia population-based HIV impact assessment survey of 2017 making it one of the highest in the world. Early initiation of antiretroviral therapy (ART) has excellent outcomes for both morbidity and mortality. The National Strategic Framework for HIV and the Namibia Ministry of Health and Social Services (MoHSS) rolled out the WHO 2015 UTTS guidelines making Namibia one of the first African countries to implement UTTS. With UTTS guidelines, rolled out in October 2016, clients who test HIV positive are initiated on ART immediately preferably the same day or within seven days regardless of their HIV clinical stage or CD4 count. Retention in care is required for optimal clinical outcomes in patients with HIV infection. However, after two years of adopting the strategy, it is not well understood whether UTTS affects the retention to care. We therefore sought to establish any emerging differences in retention of ART care after the implementation of UTTS. We used a retrospective cohort review study design that employed both quantitative and qualitative methods. 879 client records were reviewed, 678 clients were initiated on treatment two years prior to the UTTS and 201 were initiated after January 2017 when the UTTS was fully rolled out and had been on treatment for at least 12 months. Data analysis was done using Excel and Statistical Package for Social Sciences (SPSS) version 23.0 software. The overall retention after 12 months of follow-up was (822/879) 93.5% (95% CI: 91.3% to 95.7%). The retention rate at 12 months among clients in the UTTS cohort was 95.5% (95% CI: 93.5% to 97.5%) and somewhat higher than that in the pre-UTTS cohort 92.9% (95% CI: 90.6% to 95.2%). At the end of the review period, attrition was higher in the pre-UTTS cohort 251/678 (37.0%; 95% CI 34.8 to 39.2) versus 42/201 (21.0%; 95% CI 19.0 to 23) during UTTS. Retention on ART was nearly 5% higher after UTTS implementation but young adults and men between 31 and 40 years of age had higher chances of attrition at the time of ART initiation. We recommend that all facilities in Namibia and other parts of sub-Saharan Africa should embrace the UTTS strategy to benefit their clients. Keywords: Antiretroviral therapy, Retention, Retrospective cohort review, Universal test &amp; treat.

Implementing quality management strategies improves clinical quality as a voluntary medical male circumcision program in Namibia matures: a process analysis

BackgroundSurgical voluntary medical male circumcision (VMMC) is a safe procedure; however, maintaining quality standards at scale, particularly during scale-up, is a challenge making ongoing quality management (QM) efforts essential. This study describes program quality measured by rates of adverse events (AEs) over four years of VMMC implementation in Namibia, compares AE rates over time, and discusses QM processes that contextualize AE trends and illustrate improvements in quality as the program matured. The International Training and Education Center for Health (I-TECH) assisted the Namibian Ministry of Health and Social Services (MoHSS) in expanding VMMC in three regions among boys and men over 10 years of age between January 2015 and September 2019.MethodsA comprehensive package of QM strategies was implemented by multi-disciplinary onsite teams with support from national and international technical advisors. Retrospective routine MoHSS data from the VMMC register, client forms, and monthly AE reports were collected during implementation in the three regions to assess the impact of QM interventions on AEs and to calculate the proportion of clients who experienced AEs over time. The proportion of clients who experienced an AE over time was compared using a Cochran-Armitage test for trend.ResultsBetween January 2015 and September 2019, 40,336 clients underwent VMMC and 593 (1.5%) clients experienced a post-operative AE in the three supported regions. The AE rate was highest in the first quarter of clinical service delivery in each region (January-March 2015 in Oshana and Zambezi, October-December 2017 in //Kharas) but declined over the implementation period as the program matured. This observed trend between program maturity and declining AE rates over time was significant (p < 0.001) when compared using a Cochran-Armitage test for trend.ConclusionsAs the I-TECH-supported VMMC program matured, QM measures were introduced and routinized, and clinical quality improved over time with the rate of AEs decreasing significantly over the implementation period. Applying systematic and continuous QM processes and approaches across the continuum of VMMC services and considering local context can contribute to increased clinical safety. QM measures that are established in more mature program sites can be quickly adopted to respond to quality issues in program expansion sites.

Establishment of the Namibian National Public Health Institute: laboratory systems strengthening

Abstract In 2020, the Namibian Ministry of Health and Social Services (MoHSS) and the Robert Koch Institute (RKI) started a twinning project with the long-term goal of establishing a Namibia Institute of Public Health (NIPH). A fundamental pillar of an NIPH is a fully operational Public Health laboratory system. Due to the COVID-19 pandemic, the need for strengthening the existing Namibian Laboratory system became eminent. Following the Intra-Action Review (IAR) of the COVID-19 response in Namibia in 2020, three regional diagnostic laboratories, at points of entry, were assessed. The major issues identified were long delays between sampling of both suspected cases and COVID-19 patients and receiving test results due to extended sample transport times to the central laboratory in Windhoek and the overload of the central capacities due to overwhelming numbers of samples during peak times. This led to the establishment of three SARS-CoV-2 PCR diagnostic laboratories through procurement and installation of equipment, provision of consumables/reagents, and on-site training of laboratory technicians with continued virtual technical support. Consequently, an important reduction of the diagnosis turnaround time was achieved. Of great value was the technical support given by the staff at the central laboratory during the trainings allowing for immediate validation of the newly established laboratories and to strengthen the communication between regional laboratories and the central laboratory. The Namibian molecular diagnostic capacities have increased in important regions in Namibia and will provide data to support the health policies of the future NIPH. New diagnostic protocols will be developed to foster the sustainability of the established laboratories and could support the implementation of genomic surveillance capacities. Finally, stronger relationships were built through these joint activities, which will support and the next steps of the establishment of the NIPH. Key messages • Supporting and Strengthening the Namibian Public Health Laboratory system. • Long-term goal of establishing a Namibia Institute of Public Health (NIPH).

Application of activity theory to examine the implementation of e-health in Namibia

ABSTRACT Despite the investment and efforts to improve the health systems through the e-health solution, systems and activities remain fragmented, which hamper service delivery. These challenges persist because either the factors that influence the implementation of the e-health solutions are not known or they remain speculative. Empirically, this study reveals the factors that influence the development of e-health solutions in the country. It is an interpretivist study in which the semi-structured interview technique was employed to collect data and relevant documents authored by different health stakeholders, such as Ministry of Health and Social Services (MoHSS), Office of the Prime Minister (OPM) and from public and private health facilities in the country were gathered. The activity theory (AT) underpins the study, meaning it guided the analysis, from which eight factors: (1) disparity, which affects transparency; (2) isolation; means that e-health solutions are currently stand-alone; (3) governance; which includes standardization, policies, and principles; (4) requirements that cover functions and technology specifications; (5) know-how; entails skillset and human capacity; (6) interoperability; exchange and information use between IT solutions; (7) synchronization of data and processes; and (8) heterogeneity were found to be the main influence on the implementation of e-health solutions in the country.

COVID-19 impact on diagnosis and staging of colorectal cancer: A single tertiary Canadian oncology center experience.

33 Background: COVID-19 pandemic urged public health to imposed drastic reduction on endoscopic activities and surgery, leading to delays that still not have been caught up today. The Ministry of Health and Social Services (MSSS) of Quebec conducted a study of the impact of those measures and reported a 66% reduction of colonoscopy and a 30% reduction of colorectal cancer (CRC) surgery activities during the first wave (March to May 2020). Whether those reduction had an impact on diagnosis and staging of CRC remains unknown. Methods: Demographic information of CRC diagnosed at Centre Hospitalier de l’Université de Montréal (CHUM) between January 1 2018 and March 12 2020 (pre-pandemic period), and March 13 2020 and June 30 2021 (pandemic period) were obtained from the SARDO registry and data regarding colonoscopy, surgery and staging at diagnosis (clinical or pathological as appropriate) were collected. Priority of elective colonoscopy was defined using the MSSS grading system ranging from P1 to P5. We compared delays to colonoscopy, delays to surgery and CRC staging of the pandemic period to the pre-pandemic period using one-way ANOVA, t tests and Chi-square tests as appropriate. Only delays in elective surgeries intended as first and curative treatment were analyzed. Results: 280 CRC diagnosis were made at the pre-pandemic period compared to 127 CRC diagnosis during the pandemic period. Mean diagnosis rates of the pandemic period tend to be lower (8.3 vs. 10.5 diagnosis/month, p=0.03) compared to the pre-pandemic period. 37.6% of patient in the pandemic period had a diagnosis of CRC during a hospitalization compared to 25.9% at the pre-pandemic period (p=0.048). 51.7% of elective colonoscopy leading to a diagnostic of CRC during the pandemic period did not meet required delays according to priority compared to 38.3% (p=0.049) during the pre-pandemic period. P3 colonoscopies (mostly indicated for a positive FIT and iron deficiency anemia) were the most affected (58.9 vs. 106.5 days, p˂0.001). P2 colonoscopy (indicated for suspected colorectal cancer) did not experienced an augmentation in delays (20.9 vs. 25.2 days, p=0.39). A mean of 3.5 elective curative surgeries per month were performed during the pandemic period compared to 3.4 at the pre-pandemic period (p=0.96), and mean delays for surgery were not affected (60.4 vs. 57 days, p=0.59). Stages at diagnosis did not differ (p=0.2). Most of the delayed colonoscopies led to a stage 0 or I CRC and did not lead to a higher stage at diagnosis (p=0.2). Conclusions: In our center, the COVID-19 pandemic led to overall less CRC diagnosis and increased diagnostic endoscopic delays without a higher rate of advanced stage disease. Delays for elective surgeries were quite similar once the CRC diagnostic established.

Economic Analysis of the Prevention and Control of Nosocomial Infections: Research Protocol.

Background: Nosocomial infections (NIs) are among the main preventable healthcare adverse events. Like all countries, Canada and its provinces are affected by NIs. In 2004, Ministry of Health and Social Services (MSSS) of Quebec instituted a mandatory surveillance NI program for the prevention and control (NIPC) in the hospitals of the province. One target of the MSSS 2015–2020 action plan is to assess the implementation, costs, effects, and return on investment of NIPC measures. This project goes in the same way and is one of the first major studies in Canada to evaluate the efficiency of the NIPC measures. Three objectives will be pursued: evaluate the cost of implementing clinical best practices (CBPs) for infection control; evaluate the economic burden attributable to NIs; and examine the cost-effectiveness of the NIPC by comparing the costs of CBPs against those of NIs.Methods: This project is based on an infection control intervention framework that includes four CBPs: hand hygiene; hygiene and sanitation; screening; and additional precautions. Four medical and surgical units in two hospitals (nonUniversity, University) in the province of Quebec will be studied. The project has four components. Component 1 will construct and content validate an observation grid for measuring the costs of CBPs. Component 2 will estimate CBP costs via 2-week prospective observations of health workers, conducted every 2 months over a 1-year period. Component 3 will evaluate, through a matched case-control study, the economic burden of the four most monitored NIs in Quebec (C-difficile, MRSA, VRE, and CPGNB). Archival patient data will be collected retrospectively. Component 4 will determine the optimal breakeven point for CBPs associated with NIPC.Discussion: This project will produce evidence of the economic analysis of NIPC and give health stakeholders an overview of NIPC cost-effectiveness. It will meet the objectives of the Canadian Patient Safety Institute and the MSSS action plan to analyze the efficiency of NIPC preventive measures. To our knowledge, this is the first such exercise in Quebec and Canada. It will provide governments with a decision support tool through a major empirical study that could be replicated nationally to capture the financial benefits of NIPC.

Quality Improvement Training Framework Adoption at Katutura Hospital in Windhoek Namibia

In Namibia, most health care facilities have not been yielding good results in response to patients’ health care needs. Health care systems are becoming more complex with paradoxical challenges resulting into inefficiencies due to ever increasing science and knowledge in medicine, which makes it difficult to internalise and understand, as well as to implement certain procedures. The study explored and found that research indicates that total quality management (TQM) and continual quality improvement (CQI) principles can be applied to strengthen a health system to improve its quality. This could be particularly useful in Namibia where people demand basic services and the health service users raise their issues with the Ministry of Health and Social Services (MoHSS). It becomes essential to ascertain the extent to which health care facilities have responded to this call. Against this background, it is important to analyze the responses to QI and QA and how it could be used to develop a framework for quality health care delivery at the health care facilities in Namibia. The main focus of this paper is to identify quality improvement aspects at Katutura Hospital and to develop a quality improvement training framework to empower and equip health professionals with the right knowledge, skills, aptitudes, and behaviours to apply the methods and techniques with the purpose of improving customer service.

Evaluation of the cause-and-effect relationship of internal controls on financial reporting in the Ministry of Health and Social Services, Namibia

This article evaluates the effect of the internal control environment on the quality of financial reporting in the Ministry of Health and Social Services (MOHSS) in Namibia. The Internal Control- Integrated Conceptual Framework of the Committee of Sponsoring Organizations (COSO) of the Treadway Commission was applied as the standard of measurement against the variable internal control, and the Conceptual Framework for Financial Reporting of the International Financial Reporting Standards (IFRS) was used to measure the qualitative characteristics of the financial reporting process. A mixed research method was used to evaluate the cause and effect relationship between the key variables and to measure the perceptions of the respondents on the quality of the financial report. Probability sampling techniques were used on the 269 staff members of the MOHSS, and data were analysed using both descriptive and inferential statistics, using the SPSS software programme. The validity and reliability of data were computed using Cronbach’s Alpha. The results of the study indicated that there is a positive relationship between the key variables although it is weak. Therefore, the study recommends the strengthening of governance systems to improve the safeguarding of financial resources.

Factors Contributing to Pregnancies among Tertiary Students at the University of Namibia

The Government of Republic of Namibia through the services rendered by the Ministry of Health and Social Services (MoHSS) continues to provide various free health services including contraceptives to its citizens. Nevertheless, several challenges related to unplanned pregnancies among tertiary student&amp;rsquo;s remains a challenge, which includes poor reproductive health status, socio-economic consequences rapid-population growth, rural-urban migration of youths accompanied by proliferation of informal settlements around cities, high youth unemployment and crime. This requires institutions of higher learning to establish which strategies are likely to address these problems of unplanned pregnancies among tertiary students. The aim of this study was to explore and describe the contributing factors to pregnancies amongst tertiary students at a selected satellite campus in order to make recommendations to the University of Namibia (UNAM). &#x0D; &#x0D; An exploratory, descriptive and qualitative design was used. The study was contextual in nature. A convenient sampling was used. The data were collected through three focus-group discussions with 19 students from the three faculties namely: Education, Health Sciences and Management Sciences. Data were analyzed through qualitative content analysis. Strategies to ensure trustworthiness and ethical implementation of the study were implemented. It became evident from the study findings that factors which are contributing to pregnancies, as evidenced by the four emerged themes namely: Personal factors, institutional related factors and improvements measures. This study has implications for higher education institutions in terms of promoting sexual and reproductive health information and increasing access to a range of contraceptive methods of campus which are key in the prevention of pregnancies among tertiary students. Participants in this study recommended that peer educators and students counsellor within the campus should be used as a vehicle to provide support and guidance to students on reproductive health choices.

Rapid Adaptation of HIV Treatment Programs in Response to COVID-19 - Namibia, 2020.

Namibia is an upper-middle income country in southern Africa, with a population of approximately 2.5 million (1). On March 13, 2020, the first two cases of coronavirus disease 2019 (COVID-19) in Namibia were identified among recently arrived international travelers. On March 17, Namibia's president declared a state of emergency, which introduced measures such as closing of all international borders, enactment of regional travel restrictions, closing of schools, suspension of gatherings, and implementation of physical distancing measures across the country. As of October 19, 2020, Namibia had reported 12,326 laboratory-confirmed COVID-19 cases and 131 COVID-19-associated deaths. CDC, through its Namibia country office, as part of ongoing assistance from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided technical assistance to the Ministry of Health and Social Services (MoHSS) for rapid coordination of the national human immunodeficiency virus (HIV) treatment program with the national COVID-19 response.

Implementation and evaluation of a Project ECHO telementoring program for the Namibian HIV workforce

BackgroundThe Namibian Ministry of Health and Social Services (MoHSS) piloted the first HIV Project ECHO (Extension for Community Health Outcomes) in Africa at 10 clinical sites between 2015 and 2016. Goals of Project ECHO implementation included strengthening clinical capacity, improving professional satisfaction, and reducing isolation while addressing HIV service challenges during decentralization of antiretroviral therapy.MethodsMoHSS conducted a mixed-methods evaluation to assess the pilot. Methods included pre/post program assessments of healthcare worker knowledge, self-efficacy, and professional satisfaction; assessment of continuing professional development (CPD) credit acquisition; and focus group discussions and in-depth interviews. Analysis compared the differences between pre/post scores descriptively. Qualitative transcripts were analyzed to extract themes and representative quotes.ResultsKnowledge of clinical HIV improved 17.8% overall (95% confidence interval 12.2–23.5%) and 22.3% (95% confidence interval 13.2–31.5%) for nurses. Professional satisfaction increased 30 percentage points. Most participants experienced reduced professional isolation (66%) and improved CPD credit access (57%). Qualitative findings reinforced quantitative results. Following the pilot, the Namibia MoHSS Project ECHO expanded to over 40 clinical sites by May 2019 serving more than 140 000 people living with HIV.ConclusionsSimilar to other Project ECHO evaluation results in the United States of America, Namibia’s Project ECHO led to the development of ongoing virtual communities of practice. The evaluation demonstrated the ability of the Namibia HIV Project ECHO to improve healthcare worker knowledge and satisfaction and decrease professional isolation.

Experiences of inadequate interpersonal relationships regarding quality improvement and quality assurance in the Ministry of Health and Social Services in Namibia

ABSTRACT Quality improvement and quality assurance in healthcare settings depend to a great degree on interpersonal relationships that enable effective communication and understanding between individuals. Poor interpersonal relationships between health professionals, patients or groups are considered detrimental to the achievement and sharing of common goals. This paper explored the experiences of managers and health professionals regarding the quality of health care delivery at the Ministry of Health and Social Services (MoHSS) in Namibia, using interviews and focus group discussions. The findings indicated negative attitudes by health professionals towards patients; poor communication among health professionals; lack of motivation and team work as well as resistance to change. It was concluded that most of the problems at MoHSS health care facilities are due to the lack of strong interpersonal relationships, either between patients and health professionals or between health professionals and management. The researchers recommend future research to document the views and experiences of private health providers and patients.

The Effectiveness of Reactive Focal Mass Drug Administration (rfMDA) and Reactive Focal Vector Control (RAVC) to Reduce Malaria Transmission: A Cluster-Randomised Controlled Open Label Two-by-Two Factorial Design Trial from the Low-Endemic Setting of Namibia

Background: In low-endemic malaria settings, screening and treatment near index cases (reactive case detection, RACD) is practiced for surveillance and response; however, other approaches may be more effective. Methods: We conducted a cluster-randomised controlled two-by-two factorial design trial to evaluate the impact of reactive focal mass drug administration, rfMDA, and reactive focal vector control, RAVC, in the low-endemic setting of Zambezi, Namibia. Fifty-six clusters were randomised to: RACD or rfMDA, and RAVC or no RAVC (RACD: rapid diagnostic testing and treatment with artemether-lumefantrine (AL); rfMDA: presumptive treatment with AL; RAVC: indoor residual spraying using pirimiphos-methyl), with interventions administered within 500 meters of index cases. To evaluate the effectiveness of interventions targeting the parasite reservoir in humans (rfMDA vs RACD), in mosquitos (RAVC vs no RAVC), and in both humans and mosquitoes (rfMDA+RAVC vs RACD only), a modified intention-to-treat analysis was used to compare cumulative incidence of locally acquired malaria cases and cross-sectional prevalence of infection with parasites. Trial registration: ClinicalTrials.gov NCT02610400. Findings: From Jan-Nov 2017, 55 clusters had index cases triggering 342 interventions that covered 8 948 individuals. Incidence per 1 000 person-years for rfMDA, RAVC, and rfMDA+RAVC clusters vs control was: 30·8 vs 38·3 (adjusted incidence rate ratio (aIRR) 0·54 [95% CI 0·14-0·94, p=0·03]), 30·2 vs 38·9 (aIRR 0·51 [0·12-0·90, p=0·01]), and 25·0 vs 41·4 (aIRR 0·28 [0·10-0·84, p=0·02]), respectively. Compared to control, prevalence of infection (%) for rfMDA, RAVC, and rfMDA+RAVC vs control was 3·2 vs 3·8 (adjusted prevalence ratio (aPR) 0·58 [95% CI 0·18-0·98, p=0·04]), 2·9 vs 4·1 (aPR 0·34 [0·11-0·57, p<0·001]), and 1·8 vs 3·7 (aPR 0·15 [0·04-0·55, p=0·01]), respectively. Interpretation: In a low-endemic setting, rfMDA and RAVC implemented alone, but particularly in combination, reduced malaria transmission and should be considered as alternatives to RACD for malaria elimination. Funding: Novartis Foundation, Bill and Melinda Gates Foundation, Horchow Family Fund. Declaration of Interest: All authors declare no competing interests. Ethical Approval: Ethics approval was obtained from Namibia Ministry of Health and Social Services (MoHSS) (17/3/3), Institutional Review Boards of the University of Namibia (MRC/259/2017), University of California San Francisco (15-17422) and London School of Hygiene and Tropical Medicine (10411).

Estimating the Population Size of Female Sex Workers in Namibia Using a Respondent-Driven Sampling Adjustment to the Reverse Tracking Method: A Novel Approach.

BackgroundKey populations, including female sex workers (FSWs), are at a disproportionately high risk for HIV infection. Estimates of the size of these populations serve as denominator data to inform HIV prevention and treatment programming and are necessary for the equitable allocation of limited public health resources.ObjectiveThis study aimed to present the respondent-driven sampling (RDS) adjusted reverse tracking method (RTM; RadR), a novel population size estimation approach that combines venue mapping data with RDS data to estimate the population size, adjusted for double counting and nonattendance biases.MethodsWe used data from a 2014 RDS survey of FSWs in Windhoek and Katima Mulilo, Namibia, to demonstrate the RadR method. Information from venue mapping and enumeration from the survey formative assessment phase were combined with survey-based venue-inquiry questions to estimate population size, adjusting for double counting, and FSWs who do not attend venues. RadR estimates were compared with the official population size estimates, published by the Namibian Ministry of Health and Social Services (MoHSS), and with the unadjusted RTM.ResultsUsing the RadR method, we estimated 1552 (95% simulation interval, SI, 1101-2387) FSWs in Windhoek and 453 (95% SI: 336-656) FSWs in Katima Mulilo. These estimates were slightly more conservative than the MoHSS estimates—Windhoek: 3000 (1800-3400); Katima Mulilo: 800 (380-2000)—though not statistically different. We also found 75 additional venues in Windhoek and 59 additional venues in Katima Mulilo identified by RDS participants’ responses that were not detected during the initial mapping exercise.ConclusionsThe RadR estimates were comparable with official estimates from the MoHSS. The RadR method is easily integrated into RDS studies, producing plausible population size estimates, and can also validate and update key population maps for outreach and venue-based sampling.

Implementing an Integrated Pharmaceutical Management Information System for Antiretrovirals and Other Medicines: Lessons From Namibia.

The success of the Namibian government's "treatment for all" approach to control and stop the country's HIV epidemic is dependent on an uninterrupted supply of antiretrovirals (ARVs) for people living with HIV. The public health system in Namibia, however, was constrained by an inefficient paper-based pharmaceutical information system resulting in unreliable and inaccessible data, contributing to persistent stock-outs of ARVs and other essential pharmaceuticals. This article describes the incremental implementation of an integrated pharmaceutical management information system to provide timely and reliable commodity and patient data for decision making in Namibia's national antiretroviral therapy (ART) program and the Ministry of Health and Social Services (MoHSS). The system has 4 interlinked information tools: (1) the Electronic Dispensing Tool (EDT) that manages the dispensing and inventory of antiretrovirals at service delivery points; (2) the EDT national database, which facilitates the flow, storage, and collation of ART data at the central level; (3) the Facility Electronic Stock Card used to manage pharmaceutical stocks and report inventory movement data to the national level; and (4) the Pharmaceutical Management Information Dashboard that integrates all 3 tools plus the warehouse management tool used by the central and regional medical stores into 1 dashboard that serves as a platform for the analysis and dissemination of pharmaceutical information throughout the health system. Implementing the pharmaceutical management information system was a prolonged and complicated process, with key challenges related to user acceptance and human resource constraints. The integrated pharmaceutical management information system enables Namibia to collect more than 90% of transactional commodity and patient dispensing data from more than 85% of all ART sites. Health managers use information from the system for medicine quantification decisions and to improve pharmaceutical service delivery. The MoHSS and its partners in the national ART program use the information for monitoring the World Health Organization early warning indicators for HIV drug resistance; ART defaulter tracing; and for planning, reporting, and research purposes. Namibia's pharmaceutical management information system demonstrates the feasibility and benefits of integrating related tools while maintaining their specialized functionality to address country-specific information and inventory management needs.

HIV Voluntary Counselling and Testing in Namibia: Status, Successes, and Barriers

Voluntary Counselling and Testing is one of the strategies to respond to the increasing number of Human Immunodeficiency Virus/Acquired immunodeficiency syndrome (HIV/AIDS) new infections. The purpose of this study was to assess the current status of HIV Voluntary Counselling and Testing (VCT) in Rundu urban and identify the barriers to fully effective service.The objectives of the study was to identify the barriers that prevents effective HIV Voluntary Counselling and testing services; asses its success and determine its status in urban, Namibia. A qualitative explorative and descriptive design was employed in this study where all health care and HIV/AIDS professionals including hospital nurses, employees and New Start VCT Centres, and representatives from relevant NGOs, Community-Based Organizations (CBOs), and the Ministry of Health and Social Services (MoHSS)providing Voluntary Counselling services in Rundu urban in Namibia were interviewed. In this study, in depth individual interview structured in accordance with interview guide was used. Content analysis method was employed to analyze the data. Themes that emerged from this study includes: Fear of a positive results (stigma that accompanies seropositivity) and lacks of perceived benefit to getting tested. In addition, financial barriers affecting the poorest populations in Rundu. To increase access and relevance of VCT services, it is recommended that the Ministry of Health and Social Services should develop more detailed counselling guidelines and increase the scope of counselling by addressing the inadequacies of current risk reduction. Despite these hopeful possibilities a number of barriers remains before VCT can be fully effective.

Modelling spatio-temporal patterns of disease for spatially misaligned data: An application on measles incidence data in Namibia from 2005-2014.

BackgroundMaking inferences about measles distribution patterns at small area level is vital for more focal targeted intervention. However, in statistical literature, the analysis of originally collected data on one resolution with the purpose to make inferences on a different level of spatial resolution is referred to as the misalignment problem. In Namibia the measles data were available in aggregated format at regional level for the period 2005 to 2014. This leads to a spatial misalignment problem if the purpose is to make decisions at constituency level. Moreover, although data on risk covariates of measles could be obtained at constituency level, they were not available each year between 2005 and 2014. Thus, assuming that covariates were constant through the study period would induce measurement errors which might have effects on the analysis results. This paper presents a spatio-temporal model through a multi-step approach in order to deal with misalignment and measurement error.MethodsFor the period 2005–2014, measles data from the Ministry of Health and Social Services (MoHSS) were analysed in two steps. First, a multi-step approach was applied to correct spatial misalignment in the data. Second, a classical measurement error model was fitted to account for measurement errors. The time effects were specified using a nonparametric formulation for the linear trend through first order random walk. An interaction between area and time was modelled through type I and type II interaction structures.ResultsThe study showed that there was high variation in measles risk across constituencies and as well as over the study period (2005–2014). Furthermore, the risk of measles was found to be associated with (i) the number of people aged between 0 and 24 years, (ii) the percentages of women aged 15–49 with an educational level more than secondary, (iii) the percentages of children age 12–23 months who received measles vaccine, (iv) the percentages of malnourished children under 5 years, and (vi) the measles cases for each previous year.ConclusionThe study showed some of the determinants of measles risk and revealed areas at high risk through disease mapping. Additionally, the study showed a non-linear temporal distribution of measles risk over the study period. Finally, it was shown that ignoring the measurement errors may yield misleading results. It was recommended that group and geographically targeted intervention, prevention and control strategies can be tailored on the basis these findings.