Suboptimal Knowledge Research Articles

Assessment and evaluation of nutrition education among physicians in a tertiary paediatric specialist hospital: The need for improved clinical nutrition teaching

Background Nutrition education is one the essential components of any paediatric residency training. However, many paediatricians world-wide have suboptimal knowledge in core clinical nutritional topics. The purpose of our study is to assess the perceived effectiveness of nutrition training among physicians, including paediatric residents, paediatric trainees and paediatricians; identify areas of need for additional education resources and the preferred method of teaching for nutritional topics for medical education. Material and Methods A survey-questionnaire was sent to our physicians in our centre to assess general nutrition education via self-assessment of current nutritional knowledge across 12 distinct topics; importance of teaching amongst these topics and the preferred method of teaching. Results A total of 64 physicians completed the survey with an overall response rate of 88%. Most responders reported having average or above-average knowledge base in all nutritional topics except for nutritional aspects of special diets. Poorest knowledge base (either below average or poor) was reported in special diet ( n = 38, 59.4%), inflammatory bowel disease ( n = 17, 26.6%) and gastrointestinal allergy ( n = 16, 25.0%). There was strong interest in additional teaching needs for the topics of failure to thrive ( n = 38, 59.4%), nutritional assessment ( n = 34, 53.1%) and infant feeding ( n = 31, 48.4%). Most popular teaching methods were clinical case review (31.7%) followed by didactic lectures (29.8%) for overall clinical nutritional education. Conclusions Physicians identified gaps in their nutrition knowledge base and multiple topics were identified for additional nutrition education. Preferred methods of teaching for nutritional education were clinical case reviews and didactic lectures.

Knowledge and attitudes of rural healthcare providers regarding domestic violence against women: a systematicreview.

Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas. This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women. Systematic review developed at Universidade Federal de Uberlândia. We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool. Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%. The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice. This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

Assessing healthcare professionals' perceptions of pain concepts and beliefs.

Healthcare professionals deliver pain education, yet their perception of pain experiences is not well understood, which can affect their interactions with patients in pain. This study explored Korean healthcare professionals' perceptions of the usefulness of assessing pain concepts and beliefs and the importance of domains identified in the pain literature. This descriptive cross-sectional study employed an online survey administered to nurses, physical therapists, and physicians, including the Neurophysiology of Pain Questionnaire, Tampa Scale for Kinesiophobia, and related optional open-ended questions. Most participants acknowledged the importance and usefulness of assessing understanding of pain concepts but anticipated patients' difficulty comprehending items assessing biological mechanisms underlying pain. Participants questioned the items' accuracy, indicating their limited pain knowledge and the necessity of reducing literacy demands. The critical domains of pain education were learning about pain, external factors influencing pain, and pain as a form of protection. Participants had suboptimal pain knowledge but emphasized decreasing literacy demands of pain neurophysiology items. Additionally, it is necessary to develop and implement a pain education program to improve pain-related knowledge and provide educational content for healthcare professionals encountering patients in pain.

HIV- related knowledge, attitude, practices, and stigma among healthcare providers caring for HIV in Jordan: Identification of several organizational challenges

BackgroundThere is a paucity of data on Healthcare Providers (HCPs) caring for people living with HIV in Jordan. ObjectiveWe aimed to understand HCPs’ knowledge, attitude, stigma, and practices, to assess the gaps in HIV care in Jordan. MethodsWe conducted recorded in-depth interviews with all five HCPs working at the only HIV Service Center in Jordan, using semi-structured questions in 2021. Content analysis was performed. ResultsSeveral organizational challenges were identified. Only one had received HIV training. All were uncertain of updated recommendations with little knowledge of international guidelines, vertical transmission, contraception, sexually transmitted infections (STIs), non-communicable diseases (NCDs), and prophylaxis. Four HCPs perform counseling, focusing on easing anxieties, risk modification, and the importance of treatment adherence. However, their counseling on contraception, risk of transmission, STIs, and NCDs is inadequate, and they have little-to-no experience with prophylaxis. Most had a positive attitude towards people living with HIV, especially HCPs working at the center the longest, encouraging marriage and reproduction. Most do not approve of mandatory testing, or of breaching patient confidentiality. They repetitively described risky behavior as ‘immoral behavior’, empathizing more with patients who caught HIV through blood transfusion or birth, and demonstrating embedded stigmatized beliefs. They reported people living with HIV experience anticipated stigma and stigma by their general community including by other HCPs. ConclusionThis is the first study on HCPs caring for people living with HIV in Jordan. It highlights the suboptimal knowledge, practices, and stigma which improve with greater participatory exposure to HIV care. HCPs had an overall positive attitude, more evident in HCPs working at the clinic the longest.

Knowledge assessment of women of reproductive age on birth defects: a descriptive cross-sectional study in Kenya.

birth defects are defined as structural or functional congenital malformations occurring during intrauterine and detectable prenatally, at birth, or later. Birth defects-awareness creation among women of reproductive age would help in preventing the occurrence of birth defects of known aetiology worldwide. Thus, this study aimed to assess the birth defects knowledge of women of reproductive age. we adopted a descriptive cross-sectional study design in eleven purposively selected public hospitals. The study population comprised women with children under five years, and attending child-welfare clinics at the study hospitals. Descriptive analyses consisting of means, standard deviations, medians, and ranges were used to summarize continuous variables, whereas, percentages and proportions were used to summarize categorical variables. the median age of the study participants was 26 years with a mean of 27 (Standard Deviation=5, Range=17-42). A majority (77%) achieved at least a secondary level of education, while the median gravidity was 2 with a mean of 2 (Standard Deviation=1, Range; 1-8). The study participants' knowledge was above average (67%), implying in every 10 of reproductive age 3 had sub-optimal knowledge of birth defects. women of reproductive age were substantially deficient in birth defects knowledge in the county. Thus, we would like to recommend to public health policymakers and health care providers to formulate short health messages on birth defects tailored to women attending child welfare and antenatal clinics at all levels of health care including community health services in the county.

Knowledge and perception of antimicrobial resistance and antimicrobial stewardship among healthcare students in Nigeria.

Assessment of knowledge and perception of healthcare students regarding antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) would facilitate more effective education of these future prescribers. To assess knowledge and perception of AMR and AMS among healthcare students in Nigerian universities. This was a questionnaire-based, cross-sectional survey of medical, nursing and pharmacy undergraduate students from November 2019 to January 2020, using both paper and electronic modes of self-administration. A total of 335 students participated in the survey. Mean age of respondents was 23±3 years; 114 (34.4%) were in their 5th year of study. Most (78.9%) of the respondents agreed that widespread use of antimicrobials promotes AMR. Only 70 (21.1%) were aware that poor hand hygiene promotes AMR; 45.9% (42.7%, 37.3% and 57.7% for medicine, nursing and pharmacy respectively, p = 0.007) agreed that AMR is promoted by substandard quality of antimicrobials. Majority (94.3%) perceived AMR as a worldwide problem. Over half (60.8%) were not familiar with the term 'antimicrobial stewardship'. Eleven (3.3%) and 122 (36.9%) rated their AMS knowledge as 'very good' and 'poor' respectively. Nigerian healthcare students had suboptimal knowledge of AMR and AMS. Current undergraduate healthcare curriculum should be reviewed to incorporate AMS principles.

Leveraging Tacit Knowledge for Teacher Performance in Vocational Schools After-Break

Purpose – The primary objective of this study is to examine the utility of tacit knowledge in enhancing the performance of vocational school teachers who have experienced a career hiatus. Additionally, it seeks to investigate strategies for vocational schools to provide improved support to their teachers in leveraging tacit knowledge to enhance performance, particularly through the promotion of work engagement. Furthermore, the study aims to present a framework for vocational school managers, facilitating the explicit articulation of teachers' tacit knowledge, thereby contributing to the creation and dissemination of new knowledge through effective knowledge management. Design/methodology/approach – In order to gather data for this research, an explanatory survey methodology is employed, with the study's focus directed towards vocational education teachers in the region of West Java. A meticulously chosen sample size of 360 teachers is selected, guided by specific experience criteria and employment within the foundation overseeing the Private vocational school. Structural equation modeling (SEM) serves as the chosen method for hypothesis testing in this study. Findings – This study finds that teacher work engagement serves as a crucial mediator in the relationship between tacit knowledge and performance among vocational school teachers. It is observed that increased tacit knowledge may unexpectedly lead to reduced teacher performance, emphasizing the complexity of this relationship. Tacit knowledge is identified as a valuable resource for addressing workplace demands within vocational education. Moreover, it exerts a significant influence on the motivation process of teachers, subsequently impacting their engagement and overall performance. Interestingly, engagement plays a mitigating role, counteracting the negative effects of suboptimal tacit knowledge utilization by teachers, allowing them to achieve better performance, although not always reaching their full potential based on their rich experiences. Consequently, work engagement emerges as a key mediator, facilitating the translation of tacit knowledge into effective teaching outcomes. These findings shed light on the intricate dynamics of tacit knowledge, engagement, and performance in vocational education, providing valuable insights for educators and policymakers. Originality/value – The originality of this research manifests in its concentrated exploration of the application of tacit knowledge to enhance the performance of vocational school teachers, particularly those who have taken a hiatus in their careers. Additionally, the study introduces a fresh perspective to the realm of vocational education by highlighting the potential outcomes of making teachers' tacit knowledge explicit, with a particular emphasis on work engagement and knowledge management. This novel approach contributes valuable insights to the field, paving the way for further exploration and development.

Assessment of the Baby-Friendly Hospital Initiative showed suboptimal knowledge and a low exclusive breastfeeding rate in Ogun State, Nigeria.

Implementing the Baby-Friendly Hospital Initiative (BFHI) programme has been fraught with challenges globally. The study aimed to assess the implementation of the BFHI and breastfeeding practices in healthcare facilities in Ogun State, Nigeria. It was a questionnaire-based cross-sectional study carried out between August and October 2019 among 100 healthcare workers and 110 mothers from health facilities in Ijebu-Ode Local Government Area of Ogun State, Nigeria. Nearly two-thirds (61.0%) of the healthcare workers were community health workers while the others were nurses. Less than a quarter (23.8%) of the healthcare workers had ever attended breastfeeding educational programmes since they started working. About half of the healthcare workers had good knowledge, attitude and practice of BFHI. Nurses had a significantly better practice of BFHI than community health workers. Understaffing was a major limitation to the implementation of BFHI. The mothers had an exclusive breastfeeding rate of 47%. The knowledge, attitude, and practice of BFHI were suboptimal and the exclusive breastfeeding rate among the mothers was low. There is a need to improve staff strength, training and re-training of staff, as well as regular monitoring and evaluation of healthcare facilities on the implementation of BFHI.

Factors Contributing to the Comprehensive Use of Food Labels in Jordan

Food labels are low-cost, informational tools that can help curb the spread of diet-related non-communicable diseases. This study described consumers’ knowledge, attitudes, and practices related to food labels in Jordan and explored the relationship between knowledge and attitude with comprehensive use of food labels. A cross-sectional, online survey assessed Jordanian adult consumers’ ability to comprehend the nutritional contents of food labels (knowledge score), their attitudes towards food labels (attitude scale), and how frequently they used different parts of food labels (practice scale). Multivariate logistic regression models assessed predictors of comprehensive use of food labels. A total of 939 adults participated in the study. Total mean scores for the practice scale (14 questions), attitude scale (8 questions), and knowledge score (4 questions) were 49.50 (SD, 11.36; min, 5; max, 70), 29.70 (SD, 5.23; min, 5; max, 40), and 1.39 (SD, 1.33; min, 0; max, 4), respectively. Comprehensive users of food labels (26.4%) were more likely female, responsible for grocery shopping, and had higher mean knowledge and attitude scores. Jordanian consumers seem to have good practices and attitudes related to food label use but suboptimal knowledge regarding content. Future interventions should focus more on enhancing knowledge and awareness related to food labels.

Infection prevention knowledge and practices among healthcare workers at a health facility in Makurdi, Benue State, Nigeria.

The ongoing COVID-19 pandemic has highlighted the critical importance of infection prevention practices among healthcare workers. Prioritizing this crucial aspect of healthcare can mitigate the spread of infectious diseases and ensure the well-being of our healthcare heroes and their communities. The purpose of the research was to investigate the knowledge and practice of infection prevention and control. The study was a cross-sectional study that used self-administered paper-based questionnaires. The study sample of 316 eligible healthcare workers was selected using stratified sampling. Data was entered into EPI Info version 7.2 and exported to SPSS version 27 for analysis. The ethics committees of the university and the hospital approved the study. The majority of participants 116 (36.7%) were nurses. The mean age was 34.79 years ± 8.37, 118 (37.30%) were male while 198 (62.7%) were female. Only 169 (53.9%) knew the recommended duration for hand washing. 132 (41.8%) of healthcare workers believed needles should be recapped following use. Healthcare workers were twice as likely to wash their hands before contact and five times more likely to wash their hands after contact with a patient, their bedding, or after a procedure (AOR 1.82, 95% CI 1.04-3.20), (AOR 4.51, 95% CI 1.76-11.54) respectively. Personal protective equipment (PPEs) were twice as likely to be unavailable (AOR 2.39, 95% CI 1.31-4.37). The findings revealed suboptimal knowledge and practice of hand hygiene indicating the need for healthcare workers to be trained on Infection Prevention and Control. PPE(s) must be provided for healthcare workers to improve compliance with IPC practices.

Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review.

This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.

A Moderating Role of Gender in Online Health Information Seeking Behaviors for Colorectal Cancer Knowledge among Korean Americans Aged 50 to 75 Years

ABSTRACT Korean Americans have consistently reported the underutilization of colorectal cancer (CRC) screening, despite their high rates of CRC incidence and mortality. Research has indicated suboptimal CRC knowledge in Korean Americans as one of the main barriers to their recommended CRC screening. Also, research has shown the potential of online health information seeking (OHIS) to improve cancer knowledge and gender-based differences in the link between OHIS and cancer knowledge. Thus, this study aimed to examine the association between OHIS and CRC knowledge and the moderating effect of gender in this association among Korean Americans. A cross-sectional survey with purposive sampling was conducted of 421 Korean Americans aged 50–75 years in the Southeastern U.S. Three-step hierarchical multiple-regression analyses were performed to investigate if three blocks of variables—Block 1: control variables (sociodemographics and health-related information), Block 2: independent variables (OHIS and gender), and Block 3: an (OHIS × gender) interaction term—significantly reduce unexplained variance in CRC knowledge. The analyses showed that the final model fits best accounting for 29.3% of the variance in CRC knowledge. Also, the analyses showed that OHIS was positively associated with CRC knowledge and gender moderated the association between OHIS and CRC knowledge. The findings close the knowledge gap existing in the body of literature on the connection of OHIS to CRC knowledge in Korean Americans. The findings also extend the understanding of gender-specific approaches leveraging OHIS for CRC prevention education among Korean Americans.

Patient's knowledge regarding radiation exposure from various imaging modalities: a pilot study.

To determine patients' knowledge about ionising radiation used in diagnostic imaging and whether they were adequately informed about the procedure they were referred to. A cross-sectional study was conducted at the University Hospital Merkur, Zagreb, Croatia during 2019-20. A questionnaire with 14 questions was given to patients in waiting rooms for imaging examinations. Statistical analysis was conducted using the standard software package. Chi-square with Yates correction was used to determine differences in patients' answers between those who received the explanation about the procedure and those who did not. The differences depending on the educational level were also evaluated. The survey was completed by 374 participants (200 women, 174 men) with a mean age of 55.45±15.92y. Of all patients, 8.63% had no formal education or only finished elementary school, 52.83% had finished high school and 38.55% had a college or a higher degree. The referring physicians informed 63.66% of participants about the radiological exam they were being referred to, and 226 thought that the given explanation was sufficient. Most patients knew that some radiological procedures use ionising radiation. Only 47.37% of respondents correctly identified MRI as a non-ionising method, whereas 37.40% of participants recognised chest X-ray as the modality with the lowest radiation dose. Higher-educated patients had better knowledge of radiological procedures and the potential risks. The study demonstrated suboptimal patients' knowledge about ionising radiation, and additional efforts in their education are needed.

Suboptimal Knowledge and Care of Patients with Acute Coronary Syndrome Among Nurses Working in Selected Hospitals in Addis Ababa, Ethiopia 2021.

Acute Coronary Syndrome is the leading cause of morbidity and mortality in developing nations including Ethiopia. As frontline healthcare providers, nurses need to be prudent in handling cases of acute coronary syndrome. However, nurses' knowledge and practice of acute coronary syndrome are not well-known across Ethiopia. Thus, this study aimed to assess knowledge, practice, and associated factors regarding the care of acute coronary syndrome among acute care nurses working at selected hospitals in Addis Ababa, Ethiopia. Institution-based descriptive cross-sectional study design was conducted from February to March among 252 purposively selected nurses working in tertiary hospitals of Addis Ababa, Ethiopia. A pretested and structured questionnaire was used for data collection. Data were entered into Epi-Data 4.6 and exported to SPSS version 25. Both descriptive and inferential statistics were used to describe and test the association between selected variables. P-values < 0.05 were declared as significant factors for the outcome variable. Out of 252 nurses, (52%) had good knowledge, and (44.4%) had good practice towards care of Acute Coronary Syndrome. Being a master's degree [AOR=3.801, (95% CI:1.314-10.996), P =0.014] and having guidelines [AOR= 10.998, (95% CI:2.478-48.805), P =0.002] were significantly associated with nurse's good knowledge of ACS. While having a master's degree [AOR=4.258, (95% CI:1.676-10.820), P=0.002] and getting in-service training [AOR= 1.902, (95% CI:1.022-3.539), P = 0.042] were significantly associated with nurse's good level of practice. In this study, nurses had inadequate knowledge and practice regarding the care of Acute Coronary Syndrome. Nurses' educational level, presence of clinical practice guidelines, and getting training were determinant factors associated with good knowledge and practice. Therefore, organizational and nursing educational support are needed to improve this gap by providing short- and long-term training, and updated evidence-based clinical practice guidelines should be available for all acute care nurses.

Challenges in the care of patients with RET-altered thyroid cancer: a multicountry mixed-methods study

BackgroundThe discovery of driver oncogenes for thyroid carcinomas and the identification of genomically targeted therapies to inhibit those oncogenes have altered the treatment algorithm in thyroid cancer (TC), while germline testing for RET mutations has become indicated for patients with a family history of RET gene mutations or hereditary medullary TC (MTC). In the context of an increasing number of selective RET inhibitors approved for use, this paper aims to describe challenges and barriers affecting providers’ ability to deliver optimal care for patients with RET-altered TC across the patient healthcare journey.MethodsA mixed-method educational and behavioral needs assessment was conducted in Germany (GER), Japan (JPN), the United Kingdom (UK), and the United States (US) prior to RET-selective inhibitor approval. Participants included medical oncologists (MO), endocrinologists (EN) and clinical pathologists (CP) caring for patients affected with TC. Data collection tools were implemented in three languages (English, German, Japanese). Qualitative data were coded and thematically analyzed in NVivo. Quantitative data were analyzed via frequency and crosstabulations in SPSS. The findings presented here were part of a broader study that also investigated lung cancer challenges and included pulmonologists.ResultsA total of 44 interviews and 378 surveys were completed. Suboptimal knowledge and skills were self-identified among providers, affecting (1) assessment of genetic risk factors (56%, 159/285 of MOs and ENs), (2) selection of appropriate genetic biomarkers (59%, 53/90 of CPs), (3) treatment plan initiation (65%, 173/275 of MOs and ENs), (4) management of side effects associated with multitargeted tyrosine kinase inhibitors (78%, 116/149 of MOs and ENs), and (5) transfer of patients into palliative care services (58%, 160/274 of MOs and ENs). Interviews underscored the presence of systemic barriers affecting the use of RET molecular tests and selective inhibitors, in addition to suboptimal knowledge and skills necessary to manage the safety and efficacy of targeted therapies.ConclusionThis study describes concrete educational needs for providers involved in the care of patients with RET-altered thyroid carcinomas. Findings can be used to inform the design of evidence-based education and performance improvement interventions in the field and support integration into practice of newly approved RET-selective inhibitors.

Knowledge-enhanced event relation extraction via event ontology prompt

Identifying temporal and subevent relationships between different events (i.e., event relation extraction) is an important step towards event-centric natural language processing, which can help understand how events evolve and potentially facilitate many downstream tasks, such as timeline generation and event knowledge graph construction. Existing work has extensively leveraged external knowledge to improve the performance of relation extraction. Despite the progress made, the current knowledge-enhanced approach still has some shortcomings, e.g., knowledge missing, knowledge noise, and suboptimal knowledge injection. In this paper, we propose OntoEnhance, a novel event relation extraction framework that fuses semantic information from event ontologies to enhance event representation. Specifically, we first inject the latent knowledge in the event ontology into the prompt text to address the issue of knowledge missing. Then a dual-stack attention fusion mechanism is further introduced to enhance the injection of key knowledge to alleviate knowledge noise. In order to prevent the knowledge in the event ontology from being wrongly dominated, we use the event direction induction mechanism to obtain the event context-based relational sequence representation. Finally, a gate mechanism is used to fuse ontology-based knowledge and context-based event features dynamically. Extensive experiments demonstrate that OntoEnhance outperforms all comparison baselines by a large margin on all four datasets under both standard and few-shot settings.

Assessing Essential New-Born Care Knowledge, Skills and Associated Factors among Nurses/Midwives in Zanzibar: A Cross-Sectional Study.

Essential newborn care (ENC) is one of the significant strategies for neonatal survival, especially immediately after delivery. Nurses and midwives are the key healthcare providers who care for neonates immediately after birth, their knowledge and skills on ENC are very important for the preventable causes of neonatal deaths. Therefore, this study aimed to assess essential newborn care knowledge and skills among nurses/midwives in Zanzibar. A hospital-based analytical cross-sectional study that included 246 nurses-midwives was conducted in Zanzibar from January to February 2021. The purposive sampling method was used to select district and regional hospitals. Simple random sampling was used to select primary health facilities. A systematic random sampling technique was used to select study participants. A standard structured self-administered questionnaire was used. Predictors of knowledge and skills of ENC were determined using Binary Logistic regression under multivariate analysis using SPSS version 23.0. P<.05 was considered to be significant. Among the total (246) participants, 89 (36.2%) and 66 (26.8%) had adequate knowledge and appropriate skills of ENC, respectively. Having a BSc in Nursing (AOR = 8.83, 95%CI = 2.00-38.96) and the presence of guidelines (AOR = 3.52, 95%CI = 1.59 -7.80) were significantly associated with knowledge of ENC. Residing in Pemba (AOR = 0.30, 95%CI = 0.11-0.80), availability of staff (AOR = 0.80, 95%CI = 0.02-0.32), adequate knowledge (AOR = 2.80, 95%CI = 1.15-6.84) were factors significantly associated with ENC skills. Generally, nurses-midwives had suboptimal knowledge and skills on essential newborn care. Nurses-midwives are in urgent need of positive supportive supervision and low-dose- high-frequency skills training in ENC for the prevention of neonatal morbidity and mortality. Also, policymakers should be aware of this gap and should plan necessary interventions to close the gap to resecure newborns' survival.

Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria.

The postnatal period is a critical in the lives of mothers and babies due to the risk of maternal and perinatal morbidity and mortality. According to the Nigeria Demographic Health Survey 2018, only 38% of women and 42;% of newborns received a postnatal check in the first 2 days after birth. The World Health Organisation (WHO) recommends that postpartum women should have contact with healthcare providers within 24h, at day 3, days 10-14 and 6 weeks post-delivery. Multiple postnatal clinic (PNC) visits will allow assessment and prompt treatment of complications arising from delivery. This study assessed the attitude of postpartum women towards multiple PNC schedule. This descriptive cross-sectional study assessed the attitude of postpartum women towards multiple PNC schedules. A total of 167 respondents participated in the study and data was collected using a semi-structured interviewer administered questionnaire. Information on awareness, knowledge and purpose of postnatal care, preference for multiple schedules and the timing of postnatal care visits were obtained. Data was analysed using IBM SPSS version 23; and the level of significance was set at p<0.05. Of the respondents, 71.9% had poor or incorrect knowledge. About 87.4% perceived PNC as beneficial; and that mothers and newborns should be seen at least three times (47.9%) in the postnatal period. A high proportion of women were willing to come for PNC on day 3 (74.3%), days 10-14 (86.2%) and six weeks postpartum (91.6%). Also, 69.5% were willing to come for multiple PNC visits. Parity was significantly associated with willingness to attend multiple PNC visits. Despite suboptimal knowledge of the components of postnatal care services, postpartum women have a good attitude to postnatal care and are willing to attend scheduled and multiple PNC schedules. However, fewer women wanted the multiple PNC schedules. Health education and quality postnatal care will enhance postpartum surveillance with prompt detection and treatment of maternal and neonatal complications to forestall life-threatening complications or mortality.

The effect of Health Education on the knowledge, attitude and uptake of Malaria Preventive Practices among Caregivers of Under-Fives in Nigeria : a systematic review

The elimination of malaria by 2030 is one of the targets of the Sustainable Development Goals. However, malaria remains a public health issue causing morbidity and mortality especially among under-fives in sub-Saharan African countries like Nigeria. Suboptimal health knowledge and poor preventive practices for malaria are prevalent in Nigeria.&#x0D; This study determined the effect of health education on the knowledge, attitude, and uptake of malaria preventive practices among caregivers of under-fives in Nigeria.&#x0D; The Cochrane Library guidelines and the PRISMA checklist were used to conduct a systematic review. PubMed, ProQuest, CINAHL and Cochrane Library were the electronic databases used to search for literature published between 2000 and 2022. The initial search yielded 475 studies but only eight of them met the inclusion criteria.&#x0D; At baseline only 3% to 48.4% of the respondents in the experimental group had good knowledge of malaria prevention. This proportion increased after the intervention with findings ranging from 55.8% to 88.7%. The proportion of respondents in the experimental group with good attitude towards malaria prevention increased from 60.5% at baseline to 97.4% after the intervention. Only 16% to 40% of the respondents in the experimental group had good preventive practices against malaria at baseline. After the intervention, the proportion increased (72.6% to 100%). The changes observed in the study (experimental) group were statistically significant i.e., p&lt;0.05. The findings in the control groups were comparable to the study group at baseline however there was no statistically significant increase at the end of the study.&#x0D; Health education has been found to improve knowledge, attitude towards and preventive practices for malaria. In order to achieve effective control of malaria a comprehensive approach needs to be instituted.

Accelerating Fuzzy Actor–Critic Learning via Suboptimal Knowledge for a Multi-Agent Tracking Problem

Multi-agent differential games usually include tracking policies and escaping policies. To obtain the proper policies in unknown environments, agents can learn through reinforcement learning. This typically requires a large amount of interaction with the environment, which is time-consuming and inefficient. However, if one can obtain an estimated model based on some prior knowledge, the control policy can be obtained based on suboptimal knowledge. Although there exists an error between the estimated model and the environment, the suboptimal guided policy will avoid unnecessary exploration; thus, the learning process can be significantly accelerated. Facing the problem of tracking policy optimization for multiple pursuers, this study proposed a new form of fuzzy actor–critic learning algorithm based on suboptimal knowledge (SK-FACL). In the SK-FACL, the information about the environment that can be obtained is abstracted as an estimated model, and the suboptimal guided policy is calculated based on the Apollonius circle. The guided policy is combined with the fuzzy actor–critic learning algorithm, improving the learning efficiency. Considering the ground game of two pursuers and one evader, the experimental results verified the advantages of the SK-FACL in reducing tracking error, adapting model error and adapting to sudden changes made by the evader compared with pure knowledge control and the pure fuzzy actor–critic learning algorithm.