KAIRUKI UNIVERSITY REPOSITORY
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Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory
(BMC health services research, 2024-09-13) Kalabamu,Florence S.
Background In low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare provid-ers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Educa-tion (PACE), an adaptive learning program to enhance provider competency in Tanzania’s guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal imple-mentation strategies in LMIC settings are unknown.
Objectives (1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential.
Methods Mixed-methods study involving healthcare providers at three facilities. Quantitative data was collectedusing the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered
through in-depth interviews (IDIs) and focus groups discussions (FGDs).
Results Eighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrat-ing that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study’s focus on PACE’s initial implementation.
Conclusion This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanza-nian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges
as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation.
Xpert Breast Cancer STRAT4 Assay using fine-needle aspiration biopsy samples in a resource-constrained setting: a prospective diagnostic accuracy study
(The Lancet Oncology, 2024-10-03) Vuhahula,Edda A.M.
Summary
Background
Use of fine-needle aspiration biopsy (FNAB) specimens on Xpert Breast Cancer STRAT4 Assay (STRAT4; Cepheid, Sunnyvale, CA, USA), a CE-marked in-vitro diagnostic medical device, could potentially increase access to breast cancer biomarker testing in resource-constrained settings. We aimed to assess the performance of a research use-only version of STRAT4 using FNAB specimens in Tanzania.
Methods
In this prospective diagnostic accuracy study, patients aged 18 years or older with palpable breast masses presenting to the FNAB Clinic at Muhimbili National Hospital (Dar es Salaam, Tanzania) were recruited consecutively. Patients who were pregnant, lactating, or had a previous diagnosis of breast cancer were excluded. STRAT4 testing was performed on off-label FNAB samples using four protocols: the 1 × protocol (using the standard lysate method) on FNAB smears (1 × FNAB), quick lysis and Maui protocols (both on FNAB smears), and the 1 × protocol on formalin-fixed paraffin-embedded (FFPE) cell block material (1 × cell block). For 1 × FNAB and 1 × cell block, tissue was processed using FFPE lysis reagent, incubated at 80°C with proteinase K, and followed by addition of 95% or higher ethanol. Quick lysis was processed using FFPE lysis reagent and 95% or higher ethanol, whereas Maui was processed using a proprietary research-use only lysis reagent. The primary outcomes were overall concordance, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of STRAT4 as compared with immunohistochemistry or immunohistochemistry plus fluorescence in-situ hybridisation performed on cell blocks using clinically validated protocols in a Clinical Laboratory Improvement Amendments-accredited laboratory at the University of California, San Francisco (San Francisco, CA, USA).
Findings
Between Nov 29, 2017, and Dec 17, 2020, 208 patients were enrolled. Of 208 cases, 51 (25%) were excluded from analysis because of insufficient tissue in the cell block or absent cell blocks, leaving 157 participants (all female) for analysis. For oestrogen receptor, 1 × FNAB had the best performance, with an overall concordance of 95% (95% CI 90–100), sensitivity of 94% (85–100), specificity of 97% (90–100), and AUC of 0·96 (0·81−1·00). For progesterone receptor, 1 × cell block had the best overall performance (overall concordance 89% [95% CI 84–95], sensitivity 91% [82–99], and specificity 89% [81–97], with an AUC of 0·93 [0·89−0·99]) and 1 × FNAB performed the best among the smear protocols, with a concordance of 84% (95% CI 74–93), sensitivity of 63% (43–82), specificity of 97% (92–100), and AUC of 0·91 (0·72−0·97). For HER2, Maui had the highest agreement, with an overall concordance of 93% (95% CI 89–98), sensitivity of 96% (88–100), specificity of 92% (87–98), and AUC of 0·95 (0·98–1·00). For Ki67, Maui had the best performance of smear protocols, with a concordance of 73% (95% CI 64–82), sensitivity of 70% (58–81), specificity of 81% (66–96), and AUC of 0·80 (0·54−0·82).
Interpretation
Processing FNAB samples with STRAT4 is feasible in Tanzania, and performance for the oestrogen receptor is robust. Further optimisation of STRAT4 for FNAB has the potential to improve timely access to breast cancer diagnostics in resource-constrained settings.
Funding
US National Institutes of Health; UCSF Global Cancer Program, Helen Diller Family Comprehensive Cancer Center; UCSF Department of Pathology; and Cepheid.
Healthcare Providers’ Utilization of Nonpharmacological Methods in Managing Labor Pain: An Integrative Review
(Pain Management Nursing, 2024-09-07) Haruna,Tausi S.
Background: The management of labor pain is a critical aspect of maternal care, with implications for the
well-being of both the mother and the newborn. Nonpharmacological pain management (NPPM) offers a
safe and more accessible option to labor pain management in African healthcare settings.
Objective: This review aims to determine the facilitators of and barriers to using NPPM during labor
among healthcare professionals (HCPs) in Africa.
Methods: This integrative review was done using articles that focused on NPPM and published between
2013 and 2023. Databases searched include PubMed, CINAHL, SCOPUS, and EMBASE. Content analysis was
done independently by two reviewers using inductive coding to generate categories.
Findings: Three main themes emerged: Perceived barriers to the utilization of NPPM among HCPs, cate-
gories that emerged under this theme include lack of training, resource limitation, lack of priority, cultural
norms and beliefs, and lack of awareness. The second theme is potential facilitators to the utilization of
NPPM among HCP, the categories generated include healthcare provider’ knowledge, positive attitude of
healthcare providers, family support, infrastructure/working environment, experiences of HCPs, and client
preferences. The third theme that emerged is the most utilized methods of NPPM among HCPs, with
back massage and psychological support being the most used, whereas music and exercise were the least
NPPM methods used by HCPs.
Recommendations and implications for care: The findings from this study show that the attitudes and
knowledge of HCPs about NPPM can either be a facilitator or a barrier in its utilization. In the clinical
setting, HCPs need to be sensitized on the benefits of using these methods of pain management during
labor to encourage use. Interventions designed based on the findings from this study can promote a more
holistic approach to labor pain management in African healthcare settings.
Overcoming Cultural Barriers to Managing Labor Pain Among Tanzanian Women Using Non-pharmacological Interventions
(Pain Management Nursing, 2025-01-25) Shidende,P.; Msenga,Ummy T.
Managing labor pain effectively is crucial for ensuring positive maternal health outcomes. In Tanzania, cultural barriers often hinder the acceptance and utilization of non-pharmacological pain management interventions. This clinical consultation explored strategies for overcoming these cultural barriers to improve labor pain management among Tanzanian women using non-pharmacological interventions. A comprehensive literature review of existing research on non-pharmacological pain management techniques and cultural influences on pain perception and management was conducted, and an observed case study regarding the need to utilize nonpharmacological pain management interventions was also added.
Studies indicated that non-pharmacological interventions such as massage, breathing techniques, and relaxation methods are effective and can be culturally adapted to fit Tanzanian women's beliefs and practices. Key barriers to use using these interventions include lack of awareness, limited access to training for healthcare providers, and cultural stigmas associated with pain expression. Successful strategies to overcome these barriers involve community education, involvement of traditional birth attendants, training healthcare providers in cultural competence, and engaging community leaders and family members. Future research should further explore the cultural adaptation and effectiveness of these interventions to ensure their sustainable integration into maternal care practices in countries with limited resources.
Midwives’ perceived knowledge, perceptions, and experiences of managing paternal postnatal depression in Tanzania: A qualitative descriptive study
(Midwifery, 2025-01-21) Shidende,P.
Background: Paternal postnatal depression (PPND) is an under-recognized condition that affects new fathers’psychological and emotional well-being, which may impact family dynamics, work performance, and childcare.
Despite its significance, there is limited awareness and understanding of its management and implications among midwives, especially in Africa.
Aims: To explore midwives’ experiences of managing PPND in Tanzania.
Methods: A qualitative descriptive study explored Tanzanian midwives’ perceived knowledge, perceptions, and experience in PPND. Twenty-two midwives were purposively sampled from two hospitals in Dar-es-Salaam,
Tanzania, to participate in two focus group discussions. Following Elo and Kyng¨as’ (2008) framework, quali-tative content analysis was employed to identify and interpret patterns in the data.
Results: The midwives acknowledged PPND as significant and frequently encountered but overlooked. They identified risk factors like family health, socioeconomic status, and economic issues alongside emotional,
physical, and behavioral symptoms in fathers. Challenges in managing PPND among midwives stem from insufficient resources, systemic obstacles, and societal stigma. Further, societal misconceptions could worsen
PPND. To treat PPND, midwives used strategies including interprofessional collaboration, counseling, and ed-ucation, though they emphasized the need for better training and resources.
Conclusion: While midwives in Tanzania recognized PPND and its impact, there was a pressing need for specialized training and systemic changes to better support affected fathers. Enhancing midwives’ knowledge
and skills, addressing cultural and societal stigmas, and improving healthcare infrastructure were crucial to effectively managing PPND.