Suboptimal Practices Research Articles

Antenatal care and breastfeeding practices in Sub-Saharan Africa: an analysis of demographic and health surveys

BackgroundThe World Health Organization (WHO) recommends immediate breastfeeding (within the first hour after birth) and exclusive breastfeeding (for the first six months of life), particularly in low-resource settings such as sub-Saharan Africa. In 2016, WHO updated its antenatal care (ANC) guidelines, recommending at least eight (8+) ANC contacts during pregnancy to improve maternal and child health outcomes. This study investigates i) trends in breastfeeding practices across sub-Saharan Africa following the rollout of the revised WHO 2016 ANC policy and ii) the relationship between ANC uptake and exclusive or early breastfeeding.MethodsWe performed a secondary analysis of Demographic and Health Survey data from 19 countries, from 2018-2023. Key variables included exclusive breastfeeding, early initiation of breastfeeding (within one hour of birth), and the number of ANC contacts (categorized into 0-3, 4-7, and 8 + visits) among mothers with a live birth in the six months preceding the survey.ResultsExclusive breastfeeding rates ranged from 19% in Gabon to 81% in Rwanda (median = 53%), while early initiation of breastfeeding ranged from 32% in Senegal to 85% in Rwanda (median = 60%). The percentage of women with 8 + ANC contacts ranged from 0.3% in Rwanda to 39% in Ghana (median = 4%). Women with 8 + ANC contacts did not show increased odds of early initiation (aOR: 0.94; 95% CI: 0.84, 1.05) or exclusive breastfeeding (aOR: 0.85; 95% CI: 0.76, 0.94) compared to women with 4-7 contacts.DiscussionThese findings reveal low rates of 8 + ANC contacts against a backdrop of suboptimal breastfeeding practices across sub-Saharan Africa. Furthermore, the results suggest limited additional benefits of 8 + ANC contacts over 4-7 contacts in promoting immediate and exclusive breastfeeding, as recommended by the WHO 2016 ANC policy. Urgent efforts are needed to promote ANC uptake and improve the quality of ANC contacts through behavior change interventions and complementary health service delivery. Sub-national, national, and global stakeholders should prioritize these interventions.

Knowledge, attitudes and practices of healthcare professionals in the management of patients with hypertension and concurrent bronchial asthma: a cross-sectional study in the Yellow River Delta region of China

ObjectiveTo assess the Knowledge, Attitudes and Practices (KAP) among healthcare professionals in managing patients with coexisting hypertension and bronchial asthma.DesignA cross-sectional survey. The reporting of this study followed the Strengthening...

Enhancing Quality Standards: A Critical Evaluation of Genuine Cyclodextrin-Containing Products in the Post-Soviet Market

This study addresses suboptimal formulation practices observed in cyclodextrin (CD)- containing medicinal products within the post-Soviet region, particularly in Russia, where CDs are often used in amounts significantly lower than stoichiometric amounts. By analyzing ten products using transparent package inserts, this research underscores the unique transparency observed in the composition information of medicinal products within the post-Soviet region. This study highlights the importance of justifying cyclodextrin quantities in formulations and recommends thorough evaluation by the Ministry of Health for marketing authorization. The exceptional transparency observed in the post-Soviet region enables increased awareness among physicians, patients, and healthcare professionals regarding exposure to inactive ingredients and their functionality. This transparency provides valuable insights into optimizing the use of cyclodextrins in pharmaceutical formulations.

Campylobacter colonization and undernutrition in infants in rural eastern Ethiopia - a longitudinal community-based birth cohort study.

Campylobacter is associated with environmental enteric dysfunction (EED) and malnutrition in children. Campylobacter infection could be a linchpin between livestock fecal exposure and health outcomes in low-resource smallholder settings. We followed a birth cohort of 106 infants in rural smallholder households in eastern Ethiopia up to 13 months of age. We measured anthropometry, surveyed sociodemographic determinants, and collected stool and urine samples. A short survey was conducted during monthly visits, infant stool samples were collected, and Campylobacter spp. was quantified using genus-specific qPCR. In month 13, we collected stool and urine samples to assay for EED biomarkers. We employed regression analyses to assess the associations of household determinants with Campylobacter colonization, EED, and growth faltering. The Campylobacter load in infant stools increased with age. The mean length-for-age Z-score (LAZ) decreased from -0.45 at 3-4 months of age to -2.06 at 13 months, while the prevalence of stunting increased from 3 to 51%. The prevalence of EED at 13 months of age was 56%. A higher Campylobacter load was associated with more frequent diarrhea. Prelacteal feeding significantly increased Campylobacter load in the first month of life. Over the whole follow-up period, Campylobacter load was increased by keeping chickens unconfined at home and unsanitary disposal of infant stools while decreased by mothers' handwashing with soap. Longitudinally, Campylobacter load was positively associated with food insecurity, introduction of complementary foods, and raw milk consumption. There were no significant associations between Campylobacter load, EED, and LAZ. This study found that most determinants associated with increased Campylobacter infection were related to suboptimal feeding practices and hygiene. The findings related to livestock-associated risks were inconclusive. Although stunting, EED, and Campylobacter prevalence rates all increased to high levels by the end of the first year of life, no significant association between them was identified. While additional research is needed to investigate whether findings from this study are replicable in other populations, community efforts to improve infant and young child feeding practices and food hygiene, and water, sanitation, and hygiene (WaSH) at the household level, could reduce (cross-)contamination at the point of exposure.

Knowledge, attitudes and practices of intensive care unit physicians towards the management of acute respiratory distress syndrome in China: a cross-sectional survey

ObjectivesThis study aimed to assess the knowledge, attitudes and practices (KAP) of intensive care unit (ICU) physicians in China towards acute respiratory distress syndrome (ARDS).DesignA cross-sectional study was conducted between...

Trends in initial pharmacological COPD treatment in primary care (2010–2021): a population-based study using the PHARMO Data Network

Abstract Background Pharmacological treatment is a cornerstone of chronic obstructive pulmonary disease (COPD) management, with general practitioners providing the most care. However, the lack of data on prescribing trends in initial pharmacotherapy in primary care hinders the understanding of how scientific and technical developments impact patient care and may also perpetuate suboptimal practices. Hence, this study aims to analyze trends in the initial pharmacological treatment of newly diagnosed COPD patients in Dutch primary care from 2010 to 2021. Methods A repeated cross-sectional study was conducted via the PHARMO GP Database. Data were extracted from the electronic health records of individuals managed by general practitioners in the Netherlands within the PHARMO Data Network. Individuals aged ≥ 40 years at diagnosis with an International Classification of Primary Care code for COPD (R95) were included. Initial pharmacological treatment was identified based on the first prescription issued within 90 days postdiagnosis. The annual proportions of individuals receiving a specific treatment among those diagnosed were calculated and directly standardized by age and sex according to the 2021 Dutch population structure. Trend analysis was performed via joinpoint regression. Results A total of 54,628 COPD patients were included (median [IQR] age: 65 [57–73]; 53.7% male), with 36.4% not receiving respiratory medication within 90 days of diagnosis, and 4.2% on other treatments. Trend analysis revealed that LAMA monotherapy increased from 13.4% in 2010 to 15.1% in 2015 and then declined to 11.0% by 2021. Moreover, LABA-ICS decreased from 17.6% to 8.5% between 2010 and 2018, after which it plateaued. In contrast, LABA-LAMA sharply increased, from 0.6% in 2010 to 9.6% in 2021. LABA monotherapy increased from 2.6% in 2010 to 5.7% in 2021. Triple therapy has remained constant. For reliever-only therapies, SABA increased from 8.5% in 2010 to 14.3% in 2018 and then stabilized, whereas SAMA and SABA-SAMA remained low throughout. Conclusions Shifts in initial pharmacological COPD treatment from 2010 to 2021 likely reflect the introduction of new inhalers and updated management strategies. However, a significant proportion of patients remain without GP prescriptions, which warrants further investigation.

KNOWLEDGE, ATTITUDE, AND PRACTICE REGARDING MENSTRUAL HYGIENE IN FEMALE ADOLESCENTS

Menstrual hygiene is a critical aspect of adolescent health and well-being. However, cultural taboos, lack of education, and limited resources contribute to poor menstrual hygiene management (MHM), particularly in developing countries like Pakistan. Objective: To assess the knowledge, attitudes, and practices (KAP) regarding menstrual hygiene among female adolescents in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted among 172 female adolescents aged 12–18 years. Data were collected using a structured questionnaire covering socio-demographic characteristics, knowledge, attitudes, and practices related to menstrual hygiene. Descriptive and inferential statistics were analyzed using SPSS version 26.Results: The study found that 45.3% of participants had low knowledge of menstrual hygiene, 59.3% exhibited negative attitudes, and 65.1% demonstrated poor practices. Parents were the primary source of information (72.7%), while schools and healthcare providers played a minimal role. Common misconceptions and suboptimal practices, such as reusing cloth, highlighted the urgent need for education and awareness. Conclusion: Despite some awareness, significant gaps in knowledge, negative attitudes, and unsafe practices prevail among female adolescents in Lahore. Comprehensive educational programs involving families, schools, and healthcare providers are essential to improve menstrual hygiene management and empower adolescent girls to manage menstruation safely and with dignity.

Exploring food safety knowledge and practices in Lebanon

Background: Lebanon’s economic and financial crises have affected the quality-of-life, including food safety and food security. Aim: To assess food safety knowledge and practices among a sample Lebanese population and the association with the sociodemographic and economic characteristics of participants. Methods: This cross-sectional study collected data online from 412 Lebanese adults aged ≥ 18 years [mostly female (77.7%)] between October and December 2021. The data included their sociodemographic characteristics, food safety knowledge and practices, experience of food insecurity, and financial wellbeing. We conducted logistic regression analyses to explore the associations between food safety knowledge and practices, sociodemographic variables, and food security status of participants. Results: A significantly higher proportion of married (vs single) participants said they reheated refrigerated meat or chicken before consumption (74.3% vs 63.1%, P = 0.017). A significantly higher proportion of participants in the higher income category and those with university education (versus lower level of education) knew the characteristics of a contaminated food (34.2% vs 15.0%, P = 0.008). Older participants were significantly more knowledgeable about the management of leftover food (mean 34.54 years vs 31.25 years; P = 0.014). Household food security status did not show any statistically significant association with any of the 5 food safety measures examined. Conclusion: This study confirms the existence of suboptimal food safety knowledge and practices by almost half of the sample. There is therefore a need for evidence-based public health interventions to increase knowledge, and promote better practices, of safe food handling, thereby reducing the risk of foodborne diseases in Lebanon.

PARTISIPASI PETANI JAGUNG DALAM KEGIATAN PENYULUHAN PERTANIAN DI DESA ALEBO KECAMATAN KONDA KABUPATEN KONAWE SELATAN

The agricultural sector is a significant contributor to the regional and national economies, particularly in South Konawe Regency, which boasts extensive agricultural land and a prominent maize production industry. However, the efficacy of maize production is frequently constrained by deficiencies in knowledge and suboptimal agricultural practices. One of the most crucial endeavors in the field of agricultural development is the provision of extension services, which are designed to enhance the knowledge and expertise of farmers, thereby facilitating enhanced agricultural productivity and quality. The objective of this study is to examine the level of participation of maize farmers in Alebo Village in agricultural extension activities. The population under investigation consisted of all corn farmers, amounting to 164 families. This figure was obtained through the application of simple random sampling to a population of 15% (25 families), and the resulting data was subjected to quantitative analysis. The findings revealed that farmer involvement in corn farming extension activities in Alebo Village, Konda Subdistrict, can be classified into distinct phases. These include participation in planning activities, attendance, active engagement in extension activities, and evaluation of agricultural extension activities. Farmer participation in agricultural extension planning activities is classified as low. The participation of respondents in agricultural extension activities is classified as attendance. The participation of corn farmers in each extension activity is classified as active (participating). The participation of corn farmers in their activeness is also classified as active (participating). Finally, the participation of farmers in the evaluation of extension tends to accept the results of extension activities that they have done. Nevertheless, farmers perceive the presence of agricultural extension workers to be highly beneficial for the implementation of their maize farming practices.

Knowledge, attitude, and practice of healthcare professionals towards irritable bowel syndrome: a multicenter, cross-sectional study

Irritable bowel syndrome (IBS) is a disorder of the gut brain interaction (DGBI) characterized by abdominal pain and altered bowel habits, affecting approximately 10% of adult populations worldwide. Comprehending the knowledge and attitudes of healthcare professionals towards IBS may enhance patient care, leading to more accurate diagnoses and improved treatment, ultimately elevating the quality of life for IBS patients. This multicenter, cross-sectional study was conducted among healthcare professionals from 5 hospitals between June and August, 2023, utilizing a self-administered questionnaire. A total of 697 (92.1%) valid questionnaires were enrolled, with 499 (71.59%) females, and 358 (51.36%) being physicians. Their mean knowledge, attitudes, practices scores were 10.9 ± 9.57 (possible range: 0–30), 29.33 ± 3.39 (possible range: 7–35), and 35.67 ± 8.75 (possible range: 11–55), respectively. The structural equation modeling analysis demonstrated direct influence of knowledge on attitude (β = 0.195, P < 0.001) and practice (β = 0.410, P < 0.001). Additionally, attitudes were found to have a direct influence on practice (β = 0.607, P < 0.001). In addition, their KAP score varied with different gender, education, occupation, professional title, department, with families have IBS, years of work experience, and institution type (all P < 0.05). Healthcare professionals had inadequate knowledge, positive attitude and suboptimal practice towards IBS, which might be influenced by their sociodemographic characteristics.

Association between parents’ perceived social support and children’s psychological adjustment: a cross-sectional study

BackgroundThis study examined the relationship between parents’ perceived social support and their children’s psychological adjustment.MethodsThis cross-sectional survey study was conducted in 52 kindergartens and 78 preschools in Nagoya, Aichi, a major metropolitan area in Japan. Parents of eighth-grade children aged 13–14 years (N = 1,195) completed a questionnaire. A total of 602 valid responses were received. To accurately assess the relationship between parents’ perceived social support and behavioral characteristics, respondents diagnosed with a developmental disability or who failed to answer the required questionnaire items were excluded from the analysis. Consequently, 536 (89.0%) of the 602 participants met the eligibility criteria.ResultsThe results indicated that the stronger the social support for parents, the lower the scores for externalizing and internalizing problems, and the higher the scores for prosociality. Conversely, insufficient social support may pose a risk to parental mental health and lead to suboptimal parenting practices. Issues in parental mental health adversely affect parenting, leading to fewer positive interactions with young children, increased rates of negative interactions and hostility, diminished communication, and delayed responses to children’s behaviors.ConclusionsThese results underscore the significant influence of parents’ perceptions of social support on their parenting beliefs and behaviors, which may, in turn, affect the development of their children’s mental health. Therefore, parents’ perceptions of social support are likely positively associated with children’s mental health.

Knowledge, attitude, and practice regarding stone formation and recurrence among urolithiasis patients: a cross-sectional study

This study investigated the knowledge, attitude, and practice (KAP) concerning stone formation and recurrence among patients with urolithiasis treated at Ningbo Medical Centre Lihuili Hospital between August 19, 2023, and April 19, 2024. A total of 394 patients were included, among which 70.30% were males. The median scores for knowledge, attitude, and practice were 7 (6-8.25), 29 (26.75-31), and 21.5 (18–25), respectively, indicating good knowledge and attitude but suboptimal practice. Positive correlations were found between knowledge and attitude (r = 0.274, P < 0.001) and between attitude and practice (r = 0.126, P < 0.05). Logistic regression revealed that knowledge, education, and whether the patient experienced a new or recurrent stone were independent predictors of attitude. Attitude, education, body mass index (BMI), and daily water intake were independent predictors of practice. Structural equation modeling (SEM) showed that knowledge, family history, and education directly influenced attitude, while education also significantly impacted practice. Our findings highlight the need for targeted diet, hydration, and lifestyle education to enhance preventive practices among patients with urolithiasis.

Nurse’s Knowledge, Attitudes and Practices Toward Perinatal Depression—A Study Among Nurses in Southern Ghana

Introduction Nurses in perinatal care are the initial point of interaction making them crucial for early detection of depression among pregnant or birthed women. Though prevalent, there is limited data on the knowledge levels, attitudes, and practice among nurses in Ghana toward perinatal depression. This study investigated nurse’s knowledge, attitude, and practices on perinatal depression at two hospitals in Ghana. Methodology 211 perinatal care nurses at the Korle Bu Teaching Hospital and the Greater Accra Regional Hospital were surveyed on their knowledge, attitude &amp; practices on perinatal depression and analyzed using STATA version 15. Logistic regression was performed to determine factors associated with nurses’ and midwives’ practices toward the identification and management of perinatal depression. At a confidence interval of 95%, a p value of &lt;.05 was considered statistically significant. Results Nearly half of the nurses (47.4%) of nurses depicted inadequate knowledge, 46.9% had an overall poor attitude toward identification and management of perinatal depression, and 79.6% depicted poor practices toward the identification and management of perinatal depression. Conclusions This study highlights knowledge gaps and suboptimal attitudes and practices regarding perinatal depression among nurses in Ghana. Addressing these gaps through targeted education and training may enhance early identification and management of perinatal depression in perinatal care settings.

Knowledge, attitudes, and practices of patients with hyperlipidemia towards stroke: a cross-sectional study

Objective With the rising incidence and mortality rates of stroke, understanding the knowledge, attitudes, and practices (KAP) of patients with hyperlipidemia towards stroke is crucial for improving their health management and preventing stroke. This study aimed to investigate the KAP of patients with hyperlipidemia towards stroke. Methods A cross-sectional study was conducted at the First Hospital of Hebei Medical University between November 2, 2023, and December 31, 2023. Demographic information and KAP scores of the participants were collected via questionnaire administration. Results In this study, a total of 385 patients diagnosed with hyperlipidemia were included. Among them, 211 (54.8%) were male, and 214 (55.6%) had been dealing with hyperlipidemia for less than one year. Multivariate analyses showed that age greater than or equal to 55 years (OR = 4.016, 95% CI: [2.128,7.579], p < .001) and attitude score greater than or equal to 21 (OR = 5.673, 95% CI: [3.432,9.376], p < .001) were independently associated with proactive practice. Mediation analysis showed that knowledge directly affected the attitude (β = 0.637, p = .010) and attitude directly affected the practice (β = 0.721, p = .010). Meanwhile, the direct effect of knowledge on practice was not significant (β = −0.059, p = .438), however, knowledge was found to indirectly affected practice through attitude (β = 0.459, p = .010). Conclusion Our study reveals that patients with hyperlipidemia exhibit a concerning gap in their understanding of stroke, despite holding positive attitudes and displaying suboptimal preventive practices.

The prevalence of suboptimal prescribing of medication in First Nations older adults in the Torres Strait.

This study assessed the prevalence of suboptimal prescribing of medicines in First Nations older adults in the Torres Strait. Types of suboptimal prescribing included polypharmacy, over-prescribing, under-prescribing and anticholinergic burden. It also assessed any significant associations between suboptimal prescribing and common age-related problems such as falls, reduced function and cognition. Cross-sectional study (2015-2018) on 18 island and five mainland communities in the Torres Strait and Northern Peninsula Area of Far North Queensland, Australia. Community-dwelling residents aged 45 years and older who identified as Torres Strait Islander and/or Aboriginal with complete medication histories were recruited in this study. Validated prescribing tools were used to identify suboptimal prescribing practises. There were 254 participants with complete medication histories. The mean age was 65.7 (SD ± 10.9, range 45-93), with 65% female. Suboptimal prescribing in this study was 74%. Of these, 49% of participants had polypharmacy, 44% were over-prescribed, and 36% were under-prescribed. Anticholinergic burden was identified in 26% of participants. Polypharmacy was more prevalent in participants who were dependent on instrumental activities of daily living (iADLs). The results demonstrate the importance of general practitioners, health-care workers or pharmacists, to monitor medication prescribing in this population. Frequent review of medications to reduce suboptimal prescribing practices within these communities may help to reduce adverse outcomes because of prescribing practices.

Infant and young child feeding practices among conflict-affected Ukrainian households: A cross-sectional survey in Kyiv, Lviv and Odesa regions.

Infant and young child feeding practices (IYCF) are crucial for children's growth and development but often deteriorate during periods of instability. A cross-sectional survey conducted in three oblasts of Ukraine-Kyiv City and Kyiv, Lviv, and Odesa-enroled 724 children 0-23 months of age from 699 households. Using global WHO IYCF Guidelines, 12 indicators of optimal IYCF practices were evaluated. The study found IYCF practices to be relatively stable since 2015, despite the continued escalation of conflict, with an improvement in exclusive breastfeeding (EBF). EBF was reported by 51% of mothers, while breastfeeding was initiated early in 65% of children. Complementary feeding practices were optimal for most children, with 79% having a minimum acceptable diet. Infant formula assistance was independently associated with suboptimal breastfeeding practices in multi-variable models. Children from households that received formula assistance had 67% (adjusted odds ratio [aOR] 0.33, 95% confidence interval [CI] 0.14-0.73) lower odds of being exclusively breastfed, 65% (aOR 0.35, 95% CI 0.20-0.61) lower odds of continued breastfeeding at 12 months, and 3.3 times (95% CI 2.31-4.78) higher odds of being bottlefed. Baby food assistance did not independently predict a minimum acceptable diet. High levels of optimal complementary feeding sustained since 2015 suggest protective factors for child nutrition in Ukraine, such as domestic agriculture and social safety nets. Additionally, maternal education was consistently linked to better IYCF outcomes, highlighting the need for targeted support for less-educated mothers. The negative association of formula assistance with EBF warrants further research alongside reinforcement of guidelines to prevent inappropriate formula targeting.

A qualitative study of type 1 diabetes complications, mental health, and structural pathways of complications occurrence among young people (14–24 years) and caregivers in southern Ghana

BackgroundYoung people (aged 14–24 years) living with Type 1 Diabetes (T1D), especially, those in low-resource settings experiencing having T1D complications, and poor mental health. Yet, little is known about T1D complications, mental health, and their lived experiences among young people and their caregivers in Ghana. ObjectiveThis article sought to understand a) the dynamics of T1D complications, mental health, and lived experiences, and b) drawing on this evidence, develop structural and behavioural pathways of T1D complication occurrence among young people in Ghana. MethodsThe study design was interpretivist phenomenology (qualitative). Twenty-eight young people living with T1D (YPLWD), 12 caregivers, and six healthcare providers across three regions in southern Ghana were purposively recruited and interviewed using interview guides. The methods included a photovoice where the YPLWD took photographs to highlight visible complications. Themes were formed from the quotes and photovoice. The analytical technique was thematic - performed with the aid of QSR NVivo 14. ResultsFour main themes which were: physical complications, mental health, other adverse health outcomes, and structural pathways of complication occurrence were identified from the analyses. Physical complications discussed included visual impairment, diabetic coma, reproductive ill-health, and kidney disease. We found on the average, eight (8) years of living with T1D (with minimum and maximum years of 2 and 4 respectively). Mental health issues including anxiety and suicidal ideation transcended YPLWD to caregivers. Multiple structural and behavioural risk factors of T1D complications were also found. ConclusionThe YPLWD and caregivers in Ghana experienced multiple T1D complications and poor mental health. Unfortunately, these manifested early in their natural history of T1D, and were influenced by inadequate structural resources, and the adoption of sub-optimal self-care practices. This article underscores the need to improve structural T1D resources, promote optimal blood glucose control, alongside mental/psychosocial support for patients and their caregivers in Ghana.

An evaluation of the impact of the Lambeth PCN pharmacist anticoagulation skills development project

Abstract Background Atrial Fibrillation (AF) is a prevalent heart condition linked to significant morbidity and mortality due to its association with stroke.1 Despite the clear benefits of anticoagulation in reducing stroke risk, its underuse and suboptimal monitoring remain a concern.2 Aim This study aims to evaluate the impact of a pharmacist-led training programme in Lambeth, London, focusing on improving pharmacists' competency and confidence in managing Direct Oral Anticoagulants (DOACs). It assesses if the training met pharmacists' needs, evaluates current monitoring patterns to determine if training was warranted, and identified areas for further training improvement. Methods The study involved 41 GP practices across 9 Primary Care Networks (PCNs) in Lambeth. Practices were eligible based on their involvement in the management of AF patients prescribed DOACs. All pharmacists at these practices who were actively engaged in anticoagulation management and willing to participate in pre- and post-training assessments were invited to take part. Recruitment involved direct communication through practice managers and emails detailing the study’s objectives and benefits. DOAC monitoring data was extracted from patient medication records and subsequently compared to the South East London anticoagulation guidelines3 to establish compliance percentages. A competency assessment was conducted on pharmacists using a pre- and post-training checklist framework devised by the Consultant Anticoagulant Team at Guy’s and St Thomas’ NHS Foundation Trust (GSTT). The Wilcoxon signed-rank test analysed this paired data, with a p &amp;lt; 0.05 set for statistical significance. Additionally, semi-structured interviews were conducted to gather insights on their training experience and perceptions. Transcripts were coded using NVIVO software to identify themes. Ethical approval was obtained from Kingston University London. Results Of the 2,987 AF patients across the 41 GP practices, 87.6% were on DOACs. Prescribing and monitoring trends were consistent across all GPs, with scope to improve compliance across all parameters, such as CHA₂DS₂-VASc score assessment prior to DOAC initiation. The competency assessment, completed by ten pharmacists, showed a significant improvement post-training, with mean scores rising from 3.3 to 4.1 (p&amp;lt; 0.00001). Improvements were seen across all domains, particularly in explaining the rationale for anticoagulation, showing CHA₂DS₂-VASc and HASBLED scores, and discussing modifiable HASBLED factors. Competency in patient communication remained highest, while managing particular cases like reversal procedures and patients with cancer showed lower competency, indicating areas for training improvement. The interviews, conducted with ten pharmacists, revealed three main themes: (1) Confidence and competence in anticoagulant prescribing and optimisation, (2) Evaluation of the training programme's effectiveness, and (3) Professional growth and career development. Pharmacists reported greater confidence in managing DOACs post-training, though challenges remained in patient engagement and collaboration with GPs lacking DOAC knowledge. Discussion / Conclusion The evaluation proved a positive impact on pharmacists' competency and confidence in DOAC management. Suboptimal monitoring practices in Lambeth highlighted the need for this training programme and its crucial role in improving patient outcomes. Limitations include a small interview sample and potential biases in self-reported evaluations. A longitudinal study is recommended to assess long-term impacts. Ongoing training and systematic data collection are essential, and similar training should be extended to other healthcare professionals.

Patterns of handwashing among healthcare workers in APIN Public Health initiatives supported states in Southwest Nigeria

BackgroundEffective hand hygiene is crucial for preventing healthcare-associated infections (HAIs) among healthcare workers (HCWs) and patients. This study aimed to assess handwashing practices among HCWs providing routine HIV care to People Living with HIV (PLHIV) and to compare hand hygiene patterns among clinical and non-clinical health workers in APIN Public Health Initiatives-supported states in Southwest Nigeria.MethodsA cross-sectional study was conducted among HCWs providing routine HIV care to PLHIV in selected healthcare facilities across APIN-supported states (Oyo, Ogun, and Ondo) from January to June 2024. Data on handwashing patterns and compliance factors were collected using a semi-structured questionnaire. A total of 588 respondents were recruited using multi-stage stratified cluster sampling. Descriptive analysis was performed, hand hygiene patterns among clinical and non-clinical health workers were compared, and chi-square statistics determined the associations, with a p-value of < 0.05 considered significant.ResultsThe study found that 56.5% of participants had good awareness of handwashing practices, and 54.6% demonstrated good compliance. Additionally, 65.5% reported washing hands before and after routine activities. Handwashing awareness (60.3%) and compliance (60.5%) rates were highest among clinical professionals. Major barriers to handwashing included inadequate water supply, lack of materials, being too busy, and forgetfulness. Profession was significantly associated with hand hygiene awareness (odds ratio [OR] = 1.504, confidence interval [CI] = 1.075–2.104), while age (OR = 0.613, CI = 0.442–0.851) and profession (OR = 1.888, CI = 1.347–2.645) were significantly associated with compliance.ConclusionThe study highlights suboptimal handwashing practices among healthcare workers, with non-clinical workers demonstrating lower awareness and compliance to hand hygiene standards compared to clinical staff despite working in the same environment. Therefore, future tailored training sessions and interventions should be prioritized for non-clinical health workers.

Factors associated with exclusive breast feeding among mothers in formal employment in Dar es Salaam, Tanzania: a cross-sectional study

ObjectivesIn Tanzania, only 45% of babies are still exclusively breast feeding at 4–5 months of age and maternal employment contributes to suboptimal breastfeeding practices. The objective of this study was...