Joel Ambikile | Trinity College Dublin (original) (raw)
Papers by Joel Ambikile
Factors influencing nursing management of diabetic ketoacidosis patients, 2024
Background The quality of nursing management of diabetic ketoacidosis (DKA) in emergency departme... more Background
The quality of nursing management of diabetic ketoacidosis (DKA) in emergency departments may be associated with either increased or decreased length of hospital stay. Despite that patient with DKA need intensive care unit (ICU) admission, effective initial nursing management of DKA patients at the emergency department is important. Regarding factors influencing the effective management when caring for patients with DKA, it is unknown how Tanzanian nurses perceive these issues. Therefore, this study was aimed to explore nurses’ perceived factors influencing nursing management of DKA patients at emergency medical department (EMD) of two selected referral hospitals in Dar es Salaam, Tanzania.
Methodology
A descriptive qualitative study design was conducted to explore nurses’ perspectives on the factors influencing nursing management of DKA patients. A total of twelve purposively selected nurses participated in in-depth interviews. The interview guide written in Kiswahili was used to collect data. All interviews were audio recorded and transcribed verbatim, and transcripts analyzed using qualitative content analysis.
Findings
Two main themes emerged from the study including facilitators of DKA nursing management and barriers to DKA nursing management. Facilitators of DKA management encompassed three categories including nurses’ knowledge of DKA, the availability of DKA management protocol, and nurses’ skillset to enhance DKA management. On the other hand, barriers to DKA management had eight sub-categories including limited training on DKA management, lack of autonomy, decisions disagreement, delayed electrolyte results, scarcity of medical resources, shortage of nursing staffs, logistics in emergency care, and lack of specific-nursing management guideline.
Conclusion
This study highlights facilitators and barriers to DKA management and underscores the need for comprehensive strategies to overcome these barriers and consolidate the facilitators to improve nurses’ capacity in managing patients with DKA.
Abstract Background: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus ... more Abstract
Background: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus requiring prompt and effective management to prevent adverse outcomes. Despite the increasing burden of diabetes in Africa, limited research focuses on nurses' experiences with DKA management within this context, particularly in Tanzania. This qualitative case study aims to explore nurses' experiences and challenges, on DKA management within the emergency department (ED) of a Regional Referral Hospital (RRHs) in Dar es Salaam Tanzania.
Methodology: A descriptive qualitative study was conducted to understand nurses' experiences in managing patients with diabetic ketoacidosis in the emergency department. A total of 12 purposively selected nurses participated in in-depth interviews. The interview guide written in Kiswahili
was used to collect data. All interviews were audio recorded and transcribed verbatim, and transcripts analyzed using deductive content analysis highlighted by Graneheim and Lundman.
Results: Two main themes emerged from the study including variability in nursing interventions for DKA management and clinical challenges in DKA management. Variability in nursing interventions included three categories variability in correction of dehydrations, correction of hyperglycemia and correction of electrolyte. On other hand clinical challenges identified includes ineffective monitoring and assessment,
nurses’ roles clarity, patients’ culture and religious believes.
Conclusion: These findings underscore the urgent need for standardized training, design strategies to improved adherence to DKA management protocols, and the integration of point-of-care testing (POCT) to enhance timely and effective DKA management.
Keywords: Nursing care diabetes mellitus, Diabetic ketoacidosis, Emergency nursing, Management guidelines
PLOS ONE, Oct 26, 2022
Background Participation in HIV vaccine trials is an essential step towards development of an eff... more Background Participation in HIV vaccine trials is an essential step towards development of an effective preventive vaccine. A Phase I/II HIV vaccine trial enrolls volunteers at low risk of acquiring HIV infection, however a few may still become infected. Understanding the experiences of volunteers who acquired HIV infection while participating in such trials is essential for future research. Here, we describe experiences of HIV infected volunteers in Phase I/II HIV vaccine trials conducted in urban Tanzania.
Journal of Rural Medicine, 2017
Objectives: The factors associated with quality of life (QOL) and anthropometric measurements as ... more Objectives: The factors associated with quality of life (QOL) and anthropometric measurements as outcomes of food consumption were examined among school-age children in Tanzania. Methods: A cross-sectional study was undertaken in September 2013 in Tanzania. Anonymous self-administered questionnaire surveys were conducted in the Kiswahili language among primary school children in the fifth and/or sixth grade aged 10-14 years. The survey probed sociodemographic characteristics such as age, gender, living with family members, number of meals/snacks per day, food consumption in the previous 24 hours, and QOL, as well as anthropometric measurements (height and weight). The Rohrer index was calculated based on height and weight. After presenting the mean and standard deviation (SD) of height, weight, and the Rohrer index score by age and gender, the Rohrer index score was categorized into three groups (low weight, normal weight, and overweight) and analyzed according to sociodemographic characteristics and food consumption using the chi-square test. Furthermore, the QOL score was analyzed using the t test. Multivariate linear regression analysis was used to analyze the associations between the QOL score and sociodemographic characteristics and food consumption. Results: A total of 694 children (male: 312; female: 382) participated in this study. According to the Rohrer index, 273 (39.3%) children were classified as low weight, 353 (50.9%) were normal weight, and 68 (9.8%) were overweight. A total of 459 (66.1%) children reported having had three or more meals and/or snacks on the day before the study. In addition, 127 (18.3%) children had not eaten any protein-rich food on the day before the study, although almost all had eaten at least one carbohydrate-rich food per day. Regardless of region, location, gender, and age, living without parents was associated with short stature (P = 0.010). A high QOL score was associated with having three or more meals and/or snacks per day (P < 0.001). Conclusions: The security of physiological needs such as a guarantee of three meals per day could contribute to higher QOL among underserved children.
Trauma, Violence, & Abuse, Feb 24, 2021
Background: Intimate partner violence (IPV) is a well-known public health problem occurring world... more Background: Intimate partner violence (IPV) is a well-known public health problem occurring worldwide. With a multisectoral approach being emphasized in addressing IPV, the health sector has a key role to play due to many IPV victims who appear in health facilities without their needs being met. A well-designed and implemented IPV curriculum is necessary for effectively training health care professionals to provide quality IPV care and related services. This integrative review was conducted to establish evidence for existing curricular limitations and recommendations for training health care providers to respond to IPV. Methods: A systematic literature search was conducted for studies published from 2000 to 2020 in five databases (PubMed, Science Direct, Cochrane Library, Google, and Scholar). As a criterion, studies that reported curricular limitations in training health care providers/professionals to address IPV were included. A total of 198 studies were identified for screening, with 16 studies meeting the inclusion criteria and included in the review. Findings: Curricular limitations for IPV response training for health care providers were reported in the following areas (themes): time allocated for the training, amount of content in the existing curricula, institutional endorsement for the content, IPV response teachers/facilitators, teaching and learning strategies, and funding to support curricular implementation. Various recommendations to improving IPV response training were provided including guaranteeing the training in all courses, increasing academic capability to teach the content, allocation of funding to improve infrastructure for curriculum development and implementation, comprehensive approaches to teaching, and continuing education for health care providers.
PLOS global public health, Jan 24, 2023
A balance between hospital-based and community-based services is needed to effectively provide me... more A balance between hospital-based and community-based services is needed to effectively provide mental health services for people with mental illness. As an essential part of community mental health services, home-based care plays an important role in meeting patients' needs, and should, therefore, be appropriately provided. To achieve this, there is a need to understand the challenges faced and take relevant actions to address them. This study aimed to explore challenges to home care and support for people with mental illness in Temeke district, Dar es Salaam. We used a descriptive qualitative study approach to explore challenges to home care and support for people with mental illness among patients, their caregivers, and healthcare providers. The purposeful sampling method was used to recruit participants at Temeke hospital, data was collected using in-depth interviews and focus group discussions, and analysis was performed using a content analysis framework. Four main themes highlighting challenges encountered in the provision of home care and support for individuals with mental illness were revealed. They include poor understanding of mental illness, abandonment of patients' care responsibilities, disputes over preferred treatment, and lack of outreach services for mental health. Participants also provided suggestions to improve home care and support for people with mental illness. Home care for people with mental illness is affected by poor knowledge of the mental illness, social stigma, and lack of outreach visits. There is a need for the provision of health education regarding mental illness, stigma reduction programs, and funding and prioritization for outreach home visits to improve home care and support for people with mental illness. Further research is needed to determine the magnitude of these challenges and factors that can facilitate the provision of support in similar settings.
medRxiv (Cold Spring Harbor Laboratory), Jan 11, 2023
The burden of substance use among patients with mental illness is prevalent in developing countri... more The burden of substance use among patients with mental illness is prevalent in developing countries including Tanzania with negative consequences on treatment outcomes. However, the current prevalence of substance use and its associated factors in this population remains unclear in Tanzania.
![Research paper thumbnail of Errata to “Associations among anthropometric measures, food consumption, and quality of life in school-age children in Tanzania”[J Rural Med 12(1): 38-45]](https://attachments.academia-assets.com/109227242/thumbnails/1.jpg)
](Journal of Rural Medicine, 2017
Journal of Global Health, Sep 3, 2022
Background While malaria and neglected tropical disease (NTD) morbidity and mortality rates among... more Background While malaria and neglected tropical disease (NTD) morbidity and mortality rates among children <5 years old have decreased through public health efforts in the United Republic of Tanzania, associations between household environments and disease outcomes are relatively unknown. Methods We conducted latent class analysis (LCA) on 2015-2016 Tanzania Demographic Health Survey data from mothers with children <5 years old (N = 10 233) to identify NTD household risk profiles. The outcome of child NTD was assessed by mothers' reports of recent diarrhoea, cough, treatment for enteric parasites, and fever symptoms. Household-built environment indicators included urban/rural designation, electricity access, water source, cooking fuel, flooring, wall, and roofing materials. External environmental covariates were considered to further differentiate profiles. Results Five profiles were identified in the sample: rural finished walls households (40.2%) with the lowest NTD risk; rural rudimentary households (20.9%) with intermediate-low NTD risk; finished material households (22.5%) with intermediate NTD risk; urban households (14.4%) with intermediate-high NTD risk and high likelihood of enteric parasites; rural finished roof/walls households (2.1%) with the highest overall NTD risk. Conclusions This study is among the first to use LCA to examine household environment characteristics to assess child NTD risk in Tanzania. This paper serves as a framework for community-level rapid NTD risk assessment for targeted health promotion interventions. Over a billion people are impacted by neglected tropical diseases (NTDs) globally [1]. Based on the 2010 Global Burden of Disease Study, an estimated 48 million disability-adjusted life years (DALYs) have been lost to NTDs annually [2] and over 350 000 lives [3]. Much of the burden of NTDs falls on children. Globally, childhood NTDs have both a drastic impact on child health affecting physical and cognitive development and on the global burden of child morbidity and mortality [4]. In the United Republic of Tanzania (henceforth Tanzania), preventable and treatable diseases take the lives of 270 children <5 years of age every day [5]. Childhood mortality in Tanzania varies by geographic region,
Human Resources for Health, Aug 3, 2020
Background: With increasing recognition of intimate partner violence (IPV) as a public health cha... more Background: With increasing recognition of intimate partner violence (IPV) as a public health challenge, nurses and midwives are recognized for their crucial role in providing front-line healthcare services for IPV. This study aimed to evaluate knowledge, attitude, and preparedness related to IPV care provision in health facilities among nurses and midwives in Tanzania. Methods: A self-administered anonymous questionnaire survey was conducted among nurses and midwives working in health facilities in the Mbeya region between December 2018 and January 2019. The questionnaire consisted of questions on their perceived and actual knowledge, attitudes, and preparedness to provide care in relation to IPV. Results: A total of 662 (50.1%) of 1321 nurses and midwives who worked in hospitals and/or health centers in the Mbeya region participated in this study, and 461 (69.6%) completed questionnaires were included in the analysis. The proportion of nurses and midwives with high scores in IPV perceived knowledge, actual knowledge, attitude, and preparedness to provide care was 59.9%, 53.1%, 54.2%, and 54.0%, respectively. Regardless of the type of facility, gender, educational level, and work experience, the use of IPV guidelines was significantly associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.004), and preparedness to provide care (P < 0.001), but not attitude, which was negatively associated (P = 0.048). Regardless of the type of facility, gender, educational level, and work experience, receiving preservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.049), and preparedness to provide care (P = 0.002), but not attitude (P = 0.192). Regardless of the type of facility, gender, educational level, and work experience, inservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.043), and preparedness to provide care (P = 0.001), but not attitude (P = 0.063). Conclusions: Although guidelines and training could improve nurses' and midwives' knowledge and preparedness to provide care regarding IPV, attitudes against IPV care are a challenge. To improve attitudes regarding IPV among front-line nurses and midwives, it is necessary to address concepts of IPV care and sympathy with potential and actual victims of IPV in pre-and in-service training in addition to providing recall-level knowledge.
PLOS Global Public Health
Intimate partner violence has adverse effects on mother’s overall health and prevention of mother... more Intimate partner violence has adverse effects on mother’s overall health and prevention of mother to child HIV transmission. To identify and examine subgroups of mothers experiencing intimate partner violence and the likelihood of HIV testing during antenatal care, we conducted a latent class analysis using data from the Tanzania Demographic and Health Survey 2010 (N = 2,809). Intimate partner violence included mother’s experiences with partners’ controlling behaviors, as well as emotional, physical, and sexual violence. The outcome was mother’s accepting HIV testing offered during their antenatal care visit. Covariates included mother’s level of education, rural/urban residence, and prevention of mother to child HIV transmission talk during antenatal care visit. The latent class analysis indicated a three-class solution was the best model and identified the following profiles: mothers with no experience of intimate partner violence (61% of sample) with a 90.5% likelihood of HIV tes...
Tanzania journal of health research, 2020
Background: Despite the successful conduct of three Phase I/II HIV vaccine trials in Dar es Salaa... more Background: Despite the successful conduct of three Phase I/II HIV vaccine trials in Dar es Salaam, Tanzania, misperception around the trials has been reported. In this study, misperception means incorrect understanding that in Phase I/II HIV vaccine trial, the researchers infected the volunteers with HIV. We describe the magnitude of misperception around HIV vaccine trials and associated factors among participating communities in Dar es Salaam, Tanzania. Methods: We conducted a cross-sectional study that included 605 respondents aged ³18 years from the communities that participated in Phase I/II HIV vaccine trials. These communities comprised of youths, Police and Prison officers. Respondents were interviewed using a pre-tested questionnaire on socio-demographic characteristics, HIV knowledge, and responses to HIV vaccine trial related questions. Results: Of the 605 respondents, 156 (26%) had misperception that the researchers infected the volunteers with HIV during the trials, whi...
PLOS global public health, Jul 14, 2023
Worldwide, the prevalence of mental health, neurological, and substance use (MNS) disorders has b... more Worldwide, the prevalence of mental health, neurological, and substance use (MNS) disorders has been on the rise and remains a significant leading cause of disease burden. Sub-Saharan Africa (SSA) shares a fair burden of MNS with depressive disorders being the most prevalent in this region. A huge treatment gap for MNS exists, with lack of appropriate human resources and expertise for service delivery being one of the key barriers. Pre-service and in-service training plays a vital role in developing human resource for mental health. However, low or lack of career interests in mental health has been documented among students. A cross-sectional study was conducted between April and May 2021 to determine factors influencing career preference in mental health among nursing students and intern nurses at Muhimbili University of Health and Allied Sciences (MUHAS) and Muhimbili National Hospital (MNH) respectively in Dar es Salaam, Tanzania. Sixty-eight (68) nursing students at MUHAS who had covered the mental health nursing course and 83 intern nurses who had rotated at the MNH Psychiatry and Mental Health department participated in the study using consecutive sampling. A pre-tested structured self-administered questionnaire was used to collect data, followed by analysis with version 25 of the Statistical Package for the Social Sciences. The Chi-square test and logistic regression were performed to determine factors associated with career preference. One third (33.1%; n = 50) of participants had career preference in mental health nursing. Living with a person with mental illness (adjusted odds ratio [AOR]: 4.350; 95% CI: 1.958, 9.664; p <0.001), awareness of possible career advancement in mental health (AOR: 16.193; 95% CI: 2.022, 129.653; p = 0.009), awareness of possible income generation in mental health career (AOR: 6.783; 95% CI: 2.295, 20.047; p = 0.001), and satisfaction with psychiatric working environment (AOR: 6.753; 95% CI: 2.900, 15.726; p <0.001), were significantly associated with career preference in mental health. Low mental health career preference among university nursing students and intern nurses jeopardizes the future of the mental health nursing profession and may complicate the already existing shortage of human resource for mental health. The higher learning institutions, health facilities, and the Ministry of Health may need to take deliberate actions to ensure that interest to pursue a career in mental health is built among
Child and Adolescent Psychiatry and Mental Health, 2012
Background: It is estimated that worldwide up to 20 % of children suffer from debilitating mental... more Background: It is estimated that worldwide up to 20 % of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them. Methodology: A qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis. Results: The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with various income generating activities in the family, and extra expenses associated with the child's illness. Conclusion: Caregivers of mentally ill children experience various psychological and emotional, social, and economic challenges. Professional assistance, public awareness of mental illnesses in children, social support by the government, private sector, and non-governmental organizations (NGOs) are important in addressing these challenges.
Non-adherence to Clinic Schedule: One of Non-Medical Factors Associated with Early Hospital Readmission among Heart Failure Patients, 2022
Background Regardless of improvement in the delivery of care and treatment to patients, managemen... more Background Regardless of improvement in the delivery of care and treatment to patients, management of heart failure is still challenging. This is evidenced by increasing rates of both admission and readmission among patients with heart failure. Unlike medical conditions associated with heart failure such as hypertension, myocardial infection, and cardiomyopathy, this study focused on non-medical factors associated with hospital readmission among heart failure patients. Broad Objective The aim of this study was to determine non-medical factors associated with early hospital readmission among heart failure patients at Jakaya Kikwete Cardiac Institute in Tanzania.
Methodology A hospital-based cross-sectional study was conducted among heart failure patients from March to May 2021 at Jakaya Kikwete Cardiac Institute, a tertiary specialized hospital in Eastern Tanzania. Data were collected using a structured questionnaire and analysis was performed using version 20 of the Statistical Package for the Social Sciences. Chi-square test and logistic regression were performed to determine associations, with a p-value of <0.05 considered for statistical significance.
Results A total of 134 heart failure patients with second admission participated in this study. The mean age was 56.3 (SD 14.1), and 71 (53.0%) were females. Thirty-eight (28.4%) patients experienced early readmission (within 30 days after discharge), and non-adherence to clinic visits (AOR: 3.658; 95% CI: 1.549, 8.637; p=0.003) was associated with early readmission.
Conclusion and Recommendations Heart failure is common and is associated with high rate of readmission. Non-adherence to clinic visits is an important factor leading to early hospital readmission. Strategic interventions that address non-adherence to clinic visits may be important in reducing readmissions among heart failure patients.
International Journal of Mental Health Systems, 2017
BMC Psychiatry, 2017
Background: Low and middle income countries face many challenges in meeting mental health needs i... more Background: Low and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population. Methods: A qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software. Results: Three main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients. Conclusion: Health facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.
PLOS ONE
Background Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral chi... more Background Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral childhood disorder. Children with ADHD are difficult to handle due to the symptoms causing great impairments such as inattention, hyperactivity compared to other childhood mental disorders. Having a child with ADHD is a stressful situation as it impacts the whole family. However, little is known about the experiences and challenges of parents caring for children with ADHD in low and middle-income countries such as Tanzania. Thus, this study explored the experiences and challenges of parents caring for children with ADHD in Dar es Salaam, Tanzania. Methods We conducted a qualitative descriptive study involving 16 parents of children with ADHD at Muhimbili National Hospital (MNH). We used the purposive sampling technique to obtain the participants. In-depth interviews, using a semi-structured interview guide, were used to collect data. Audio-recorded data were transcribed, translated, and ana...
Health & Social Care in the Community
Factors influencing nursing management of diabetic ketoacidosis patients, 2024
Background The quality of nursing management of diabetic ketoacidosis (DKA) in emergency departme... more Background
The quality of nursing management of diabetic ketoacidosis (DKA) in emergency departments may be associated with either increased or decreased length of hospital stay. Despite that patient with DKA need intensive care unit (ICU) admission, effective initial nursing management of DKA patients at the emergency department is important. Regarding factors influencing the effective management when caring for patients with DKA, it is unknown how Tanzanian nurses perceive these issues. Therefore, this study was aimed to explore nurses’ perceived factors influencing nursing management of DKA patients at emergency medical department (EMD) of two selected referral hospitals in Dar es Salaam, Tanzania.
Methodology
A descriptive qualitative study design was conducted to explore nurses’ perspectives on the factors influencing nursing management of DKA patients. A total of twelve purposively selected nurses participated in in-depth interviews. The interview guide written in Kiswahili was used to collect data. All interviews were audio recorded and transcribed verbatim, and transcripts analyzed using qualitative content analysis.
Findings
Two main themes emerged from the study including facilitators of DKA nursing management and barriers to DKA nursing management. Facilitators of DKA management encompassed three categories including nurses’ knowledge of DKA, the availability of DKA management protocol, and nurses’ skillset to enhance DKA management. On the other hand, barriers to DKA management had eight sub-categories including limited training on DKA management, lack of autonomy, decisions disagreement, delayed electrolyte results, scarcity of medical resources, shortage of nursing staffs, logistics in emergency care, and lack of specific-nursing management guideline.
Conclusion
This study highlights facilitators and barriers to DKA management and underscores the need for comprehensive strategies to overcome these barriers and consolidate the facilitators to improve nurses’ capacity in managing patients with DKA.
Abstract Background: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus ... more Abstract
Background: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus requiring prompt and effective management to prevent adverse outcomes. Despite the increasing burden of diabetes in Africa, limited research focuses on nurses' experiences with DKA management within this context, particularly in Tanzania. This qualitative case study aims to explore nurses' experiences and challenges, on DKA management within the emergency department (ED) of a Regional Referral Hospital (RRHs) in Dar es Salaam Tanzania.
Methodology: A descriptive qualitative study was conducted to understand nurses' experiences in managing patients with diabetic ketoacidosis in the emergency department. A total of 12 purposively selected nurses participated in in-depth interviews. The interview guide written in Kiswahili
was used to collect data. All interviews were audio recorded and transcribed verbatim, and transcripts analyzed using deductive content analysis highlighted by Graneheim and Lundman.
Results: Two main themes emerged from the study including variability in nursing interventions for DKA management and clinical challenges in DKA management. Variability in nursing interventions included three categories variability in correction of dehydrations, correction of hyperglycemia and correction of electrolyte. On other hand clinical challenges identified includes ineffective monitoring and assessment,
nurses’ roles clarity, patients’ culture and religious believes.
Conclusion: These findings underscore the urgent need for standardized training, design strategies to improved adherence to DKA management protocols, and the integration of point-of-care testing (POCT) to enhance timely and effective DKA management.
Keywords: Nursing care diabetes mellitus, Diabetic ketoacidosis, Emergency nursing, Management guidelines
PLOS ONE, Oct 26, 2022
Background Participation in HIV vaccine trials is an essential step towards development of an eff... more Background Participation in HIV vaccine trials is an essential step towards development of an effective preventive vaccine. A Phase I/II HIV vaccine trial enrolls volunteers at low risk of acquiring HIV infection, however a few may still become infected. Understanding the experiences of volunteers who acquired HIV infection while participating in such trials is essential for future research. Here, we describe experiences of HIV infected volunteers in Phase I/II HIV vaccine trials conducted in urban Tanzania.
Journal of Rural Medicine, 2017
Objectives: The factors associated with quality of life (QOL) and anthropometric measurements as ... more Objectives: The factors associated with quality of life (QOL) and anthropometric measurements as outcomes of food consumption were examined among school-age children in Tanzania. Methods: A cross-sectional study was undertaken in September 2013 in Tanzania. Anonymous self-administered questionnaire surveys were conducted in the Kiswahili language among primary school children in the fifth and/or sixth grade aged 10-14 years. The survey probed sociodemographic characteristics such as age, gender, living with family members, number of meals/snacks per day, food consumption in the previous 24 hours, and QOL, as well as anthropometric measurements (height and weight). The Rohrer index was calculated based on height and weight. After presenting the mean and standard deviation (SD) of height, weight, and the Rohrer index score by age and gender, the Rohrer index score was categorized into three groups (low weight, normal weight, and overweight) and analyzed according to sociodemographic characteristics and food consumption using the chi-square test. Furthermore, the QOL score was analyzed using the t test. Multivariate linear regression analysis was used to analyze the associations between the QOL score and sociodemographic characteristics and food consumption. Results: A total of 694 children (male: 312; female: 382) participated in this study. According to the Rohrer index, 273 (39.3%) children were classified as low weight, 353 (50.9%) were normal weight, and 68 (9.8%) were overweight. A total of 459 (66.1%) children reported having had three or more meals and/or snacks on the day before the study. In addition, 127 (18.3%) children had not eaten any protein-rich food on the day before the study, although almost all had eaten at least one carbohydrate-rich food per day. Regardless of region, location, gender, and age, living without parents was associated with short stature (P = 0.010). A high QOL score was associated with having three or more meals and/or snacks per day (P < 0.001). Conclusions: The security of physiological needs such as a guarantee of three meals per day could contribute to higher QOL among underserved children.
Trauma, Violence, & Abuse, Feb 24, 2021
Background: Intimate partner violence (IPV) is a well-known public health problem occurring world... more Background: Intimate partner violence (IPV) is a well-known public health problem occurring worldwide. With a multisectoral approach being emphasized in addressing IPV, the health sector has a key role to play due to many IPV victims who appear in health facilities without their needs being met. A well-designed and implemented IPV curriculum is necessary for effectively training health care professionals to provide quality IPV care and related services. This integrative review was conducted to establish evidence for existing curricular limitations and recommendations for training health care providers to respond to IPV. Methods: A systematic literature search was conducted for studies published from 2000 to 2020 in five databases (PubMed, Science Direct, Cochrane Library, Google, and Scholar). As a criterion, studies that reported curricular limitations in training health care providers/professionals to address IPV were included. A total of 198 studies were identified for screening, with 16 studies meeting the inclusion criteria and included in the review. Findings: Curricular limitations for IPV response training for health care providers were reported in the following areas (themes): time allocated for the training, amount of content in the existing curricula, institutional endorsement for the content, IPV response teachers/facilitators, teaching and learning strategies, and funding to support curricular implementation. Various recommendations to improving IPV response training were provided including guaranteeing the training in all courses, increasing academic capability to teach the content, allocation of funding to improve infrastructure for curriculum development and implementation, comprehensive approaches to teaching, and continuing education for health care providers.
PLOS global public health, Jan 24, 2023
A balance between hospital-based and community-based services is needed to effectively provide me... more A balance between hospital-based and community-based services is needed to effectively provide mental health services for people with mental illness. As an essential part of community mental health services, home-based care plays an important role in meeting patients' needs, and should, therefore, be appropriately provided. To achieve this, there is a need to understand the challenges faced and take relevant actions to address them. This study aimed to explore challenges to home care and support for people with mental illness in Temeke district, Dar es Salaam. We used a descriptive qualitative study approach to explore challenges to home care and support for people with mental illness among patients, their caregivers, and healthcare providers. The purposeful sampling method was used to recruit participants at Temeke hospital, data was collected using in-depth interviews and focus group discussions, and analysis was performed using a content analysis framework. Four main themes highlighting challenges encountered in the provision of home care and support for individuals with mental illness were revealed. They include poor understanding of mental illness, abandonment of patients' care responsibilities, disputes over preferred treatment, and lack of outreach services for mental health. Participants also provided suggestions to improve home care and support for people with mental illness. Home care for people with mental illness is affected by poor knowledge of the mental illness, social stigma, and lack of outreach visits. There is a need for the provision of health education regarding mental illness, stigma reduction programs, and funding and prioritization for outreach home visits to improve home care and support for people with mental illness. Further research is needed to determine the magnitude of these challenges and factors that can facilitate the provision of support in similar settings.
medRxiv (Cold Spring Harbor Laboratory), Jan 11, 2023
The burden of substance use among patients with mental illness is prevalent in developing countri... more The burden of substance use among patients with mental illness is prevalent in developing countries including Tanzania with negative consequences on treatment outcomes. However, the current prevalence of substance use and its associated factors in this population remains unclear in Tanzania.
Journal of Rural Medicine, 2017
Journal of Global Health, Sep 3, 2022
Background While malaria and neglected tropical disease (NTD) morbidity and mortality rates among... more Background While malaria and neglected tropical disease (NTD) morbidity and mortality rates among children <5 years old have decreased through public health efforts in the United Republic of Tanzania, associations between household environments and disease outcomes are relatively unknown. Methods We conducted latent class analysis (LCA) on 2015-2016 Tanzania Demographic Health Survey data from mothers with children <5 years old (N = 10 233) to identify NTD household risk profiles. The outcome of child NTD was assessed by mothers' reports of recent diarrhoea, cough, treatment for enteric parasites, and fever symptoms. Household-built environment indicators included urban/rural designation, electricity access, water source, cooking fuel, flooring, wall, and roofing materials. External environmental covariates were considered to further differentiate profiles. Results Five profiles were identified in the sample: rural finished walls households (40.2%) with the lowest NTD risk; rural rudimentary households (20.9%) with intermediate-low NTD risk; finished material households (22.5%) with intermediate NTD risk; urban households (14.4%) with intermediate-high NTD risk and high likelihood of enteric parasites; rural finished roof/walls households (2.1%) with the highest overall NTD risk. Conclusions This study is among the first to use LCA to examine household environment characteristics to assess child NTD risk in Tanzania. This paper serves as a framework for community-level rapid NTD risk assessment for targeted health promotion interventions. Over a billion people are impacted by neglected tropical diseases (NTDs) globally [1]. Based on the 2010 Global Burden of Disease Study, an estimated 48 million disability-adjusted life years (DALYs) have been lost to NTDs annually [2] and over 350 000 lives [3]. Much of the burden of NTDs falls on children. Globally, childhood NTDs have both a drastic impact on child health affecting physical and cognitive development and on the global burden of child morbidity and mortality [4]. In the United Republic of Tanzania (henceforth Tanzania), preventable and treatable diseases take the lives of 270 children <5 years of age every day [5]. Childhood mortality in Tanzania varies by geographic region,
Human Resources for Health, Aug 3, 2020
Background: With increasing recognition of intimate partner violence (IPV) as a public health cha... more Background: With increasing recognition of intimate partner violence (IPV) as a public health challenge, nurses and midwives are recognized for their crucial role in providing front-line healthcare services for IPV. This study aimed to evaluate knowledge, attitude, and preparedness related to IPV care provision in health facilities among nurses and midwives in Tanzania. Methods: A self-administered anonymous questionnaire survey was conducted among nurses and midwives working in health facilities in the Mbeya region between December 2018 and January 2019. The questionnaire consisted of questions on their perceived and actual knowledge, attitudes, and preparedness to provide care in relation to IPV. Results: A total of 662 (50.1%) of 1321 nurses and midwives who worked in hospitals and/or health centers in the Mbeya region participated in this study, and 461 (69.6%) completed questionnaires were included in the analysis. The proportion of nurses and midwives with high scores in IPV perceived knowledge, actual knowledge, attitude, and preparedness to provide care was 59.9%, 53.1%, 54.2%, and 54.0%, respectively. Regardless of the type of facility, gender, educational level, and work experience, the use of IPV guidelines was significantly associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.004), and preparedness to provide care (P < 0.001), but not attitude, which was negatively associated (P = 0.048). Regardless of the type of facility, gender, educational level, and work experience, receiving preservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.049), and preparedness to provide care (P = 0.002), but not attitude (P = 0.192). Regardless of the type of facility, gender, educational level, and work experience, inservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.043), and preparedness to provide care (P = 0.001), but not attitude (P = 0.063). Conclusions: Although guidelines and training could improve nurses' and midwives' knowledge and preparedness to provide care regarding IPV, attitudes against IPV care are a challenge. To improve attitudes regarding IPV among front-line nurses and midwives, it is necessary to address concepts of IPV care and sympathy with potential and actual victims of IPV in pre-and in-service training in addition to providing recall-level knowledge.
PLOS Global Public Health
Intimate partner violence has adverse effects on mother’s overall health and prevention of mother... more Intimate partner violence has adverse effects on mother’s overall health and prevention of mother to child HIV transmission. To identify and examine subgroups of mothers experiencing intimate partner violence and the likelihood of HIV testing during antenatal care, we conducted a latent class analysis using data from the Tanzania Demographic and Health Survey 2010 (N = 2,809). Intimate partner violence included mother’s experiences with partners’ controlling behaviors, as well as emotional, physical, and sexual violence. The outcome was mother’s accepting HIV testing offered during their antenatal care visit. Covariates included mother’s level of education, rural/urban residence, and prevention of mother to child HIV transmission talk during antenatal care visit. The latent class analysis indicated a three-class solution was the best model and identified the following profiles: mothers with no experience of intimate partner violence (61% of sample) with a 90.5% likelihood of HIV tes...
Tanzania journal of health research, 2020
Background: Despite the successful conduct of three Phase I/II HIV vaccine trials in Dar es Salaa... more Background: Despite the successful conduct of three Phase I/II HIV vaccine trials in Dar es Salaam, Tanzania, misperception around the trials has been reported. In this study, misperception means incorrect understanding that in Phase I/II HIV vaccine trial, the researchers infected the volunteers with HIV. We describe the magnitude of misperception around HIV vaccine trials and associated factors among participating communities in Dar es Salaam, Tanzania. Methods: We conducted a cross-sectional study that included 605 respondents aged ³18 years from the communities that participated in Phase I/II HIV vaccine trials. These communities comprised of youths, Police and Prison officers. Respondents were interviewed using a pre-tested questionnaire on socio-demographic characteristics, HIV knowledge, and responses to HIV vaccine trial related questions. Results: Of the 605 respondents, 156 (26%) had misperception that the researchers infected the volunteers with HIV during the trials, whi...
PLOS global public health, Jul 14, 2023
Worldwide, the prevalence of mental health, neurological, and substance use (MNS) disorders has b... more Worldwide, the prevalence of mental health, neurological, and substance use (MNS) disorders has been on the rise and remains a significant leading cause of disease burden. Sub-Saharan Africa (SSA) shares a fair burden of MNS with depressive disorders being the most prevalent in this region. A huge treatment gap for MNS exists, with lack of appropriate human resources and expertise for service delivery being one of the key barriers. Pre-service and in-service training plays a vital role in developing human resource for mental health. However, low or lack of career interests in mental health has been documented among students. A cross-sectional study was conducted between April and May 2021 to determine factors influencing career preference in mental health among nursing students and intern nurses at Muhimbili University of Health and Allied Sciences (MUHAS) and Muhimbili National Hospital (MNH) respectively in Dar es Salaam, Tanzania. Sixty-eight (68) nursing students at MUHAS who had covered the mental health nursing course and 83 intern nurses who had rotated at the MNH Psychiatry and Mental Health department participated in the study using consecutive sampling. A pre-tested structured self-administered questionnaire was used to collect data, followed by analysis with version 25 of the Statistical Package for the Social Sciences. The Chi-square test and logistic regression were performed to determine factors associated with career preference. One third (33.1%; n = 50) of participants had career preference in mental health nursing. Living with a person with mental illness (adjusted odds ratio [AOR]: 4.350; 95% CI: 1.958, 9.664; p <0.001), awareness of possible career advancement in mental health (AOR: 16.193; 95% CI: 2.022, 129.653; p = 0.009), awareness of possible income generation in mental health career (AOR: 6.783; 95% CI: 2.295, 20.047; p = 0.001), and satisfaction with psychiatric working environment (AOR: 6.753; 95% CI: 2.900, 15.726; p <0.001), were significantly associated with career preference in mental health. Low mental health career preference among university nursing students and intern nurses jeopardizes the future of the mental health nursing profession and may complicate the already existing shortage of human resource for mental health. The higher learning institutions, health facilities, and the Ministry of Health may need to take deliberate actions to ensure that interest to pursue a career in mental health is built among
Child and Adolescent Psychiatry and Mental Health, 2012
Background: It is estimated that worldwide up to 20 % of children suffer from debilitating mental... more Background: It is estimated that worldwide up to 20 % of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them. Methodology: A qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis. Results: The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with various income generating activities in the family, and extra expenses associated with the child's illness. Conclusion: Caregivers of mentally ill children experience various psychological and emotional, social, and economic challenges. Professional assistance, public awareness of mental illnesses in children, social support by the government, private sector, and non-governmental organizations (NGOs) are important in addressing these challenges.
Non-adherence to Clinic Schedule: One of Non-Medical Factors Associated with Early Hospital Readmission among Heart Failure Patients, 2022
Background Regardless of improvement in the delivery of care and treatment to patients, managemen... more Background Regardless of improvement in the delivery of care and treatment to patients, management of heart failure is still challenging. This is evidenced by increasing rates of both admission and readmission among patients with heart failure. Unlike medical conditions associated with heart failure such as hypertension, myocardial infection, and cardiomyopathy, this study focused on non-medical factors associated with hospital readmission among heart failure patients. Broad Objective The aim of this study was to determine non-medical factors associated with early hospital readmission among heart failure patients at Jakaya Kikwete Cardiac Institute in Tanzania.
Methodology A hospital-based cross-sectional study was conducted among heart failure patients from March to May 2021 at Jakaya Kikwete Cardiac Institute, a tertiary specialized hospital in Eastern Tanzania. Data were collected using a structured questionnaire and analysis was performed using version 20 of the Statistical Package for the Social Sciences. Chi-square test and logistic regression were performed to determine associations, with a p-value of <0.05 considered for statistical significance.
Results A total of 134 heart failure patients with second admission participated in this study. The mean age was 56.3 (SD 14.1), and 71 (53.0%) were females. Thirty-eight (28.4%) patients experienced early readmission (within 30 days after discharge), and non-adherence to clinic visits (AOR: 3.658; 95% CI: 1.549, 8.637; p=0.003) was associated with early readmission.
Conclusion and Recommendations Heart failure is common and is associated with high rate of readmission. Non-adherence to clinic visits is an important factor leading to early hospital readmission. Strategic interventions that address non-adherence to clinic visits may be important in reducing readmissions among heart failure patients.
International Journal of Mental Health Systems, 2017
BMC Psychiatry, 2017
Background: Low and middle income countries face many challenges in meeting mental health needs i... more Background: Low and middle income countries face many challenges in meeting mental health needs in their regions. Treatment of patients with mental disorders is inadequate in most of these countries and majority of individuals with severe mental disorders remain untreated. The bad news is that mental health problems in these countries are on the rise due to socioeconomic challenges being faced. Regardless of guidelines and directives provided by WHO for organizing mental health services, these countries continue to face many challenges in the effort to cater for mental health needs. Such challenges include lack of human resource for mental health especially at primary health care level, inadequate training of human resource for mental health, misplacement of human resource for mental health, lack of drugs, wrong priorities, problematic insurance coverage for mental disorders, and stigma. This study aimed at exploring mental health care and delivery system at Temeke district hospital, and how services were organized to meet the increasing mental health needs of its population. Methods: A qualitative study was conducted at Temeke hospital in Dar es Salaam, involving 7 in-depth interviews with mental health care providers, 7 in-depth interviews with mentally ill patients, and 2 focus group discussions with caregivers. A convenient sampling procedure was used to select participants for the study. All interviews were audio-recorded in Kiswahili and transcribed. A qualitative Content Analysis was used to analyze data after translation with the aid of Nvivo 10 software. Results: Three main themes were identified. These were resource challenges, environmental/system challenges, and satisfaction with mental health services. Temeke health facility faced resource and environmental/system challenges, and there were mixed feelings on satisfaction with services. Funding and priority issues were found to mainly affect delivery of appropriate services to clients. Conclusion: Health facilities that provide mental health services in the community need to be well equipped with necessary resources to meet the vast needs of people they serve. Having a political will, improving the health systems governance for mental health, and priority setting, are necessary to address the challenges experienced in the delivery of mental health services.
PLOS ONE
Background Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral chi... more Background Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral childhood disorder. Children with ADHD are difficult to handle due to the symptoms causing great impairments such as inattention, hyperactivity compared to other childhood mental disorders. Having a child with ADHD is a stressful situation as it impacts the whole family. However, little is known about the experiences and challenges of parents caring for children with ADHD in low and middle-income countries such as Tanzania. Thus, this study explored the experiences and challenges of parents caring for children with ADHD in Dar es Salaam, Tanzania. Methods We conducted a qualitative descriptive study involving 16 parents of children with ADHD at Muhimbili National Hospital (MNH). We used the purposive sampling technique to obtain the participants. In-depth interviews, using a semi-structured interview guide, were used to collect data. Audio-recorded data were transcribed, translated, and ana...
Health & Social Care in the Community