Unravelling the complexity of research capacity strengthening for health professionals in low- and middle-income countries: A concept analysis.

AIMS: Research capacity strengthening (RCS) is crucial in enhancing healthcare outcomes, particularly in low- and middle-income countries (LMICs), which face challenges due to limited resources, unequal access to care and the need for evidence-based decision-making. We seek to move beyond a surface-level understanding of RCS, unearthing the core attributes, the factors that precede its implementation and the transformative outcomes it generates within the LMIC healthcare landscape. DESIGN: This study employs the Walker and Avant approach to concept analysis to comprehensively explore the dimensions and attributes of RCS as it pertains to allied and public health professionals in LMICs, propose empirical referents and suggest an operational definition. DATA SOURCES: Ovid MEDLINE, Embase, CINAHL and Cochrane CENTRAL were searched from inception to 27 July 2023, to identify studies on RCS in LMICs. The Walker and Avant approach to concept analysis was selected because it provides a framework for systematically examining and clarifying the meaning and implications of RCS. This method involves a structured process of defining RCS, identifying its attributes, antecedents, consequences and cases, and ultimately providing a clear understanding of its meaning and implications. Identifying empirical referents offers measurable indicators that researchers and policymakers can use to assess the effectiveness of RCS initiatives in LMICs. CONCLUSION: RCS for health professionals in LMICs involves a sustainable process that equips them with essential research skills, fostering the ability to conduct high-quality research and improve healthcare delivery in resource-constrained settings. IMPLICATIONS: RCS aims to empower health professionals to apply evidence-based practices, reduce disparities and enhance the well-being of populations in LMICs. IMPACT: Ultimately, a concept analysis of RCS empowers us to harness the full potential of research to enhance healthcare delivery, improve patient outcomes and advance the well-being of populations worldwide.

High Prevalence of Low Birth Weight Babies Born to Pregnant Women Referred to a District Hospital in Rural Zambia.

OBJECTIVES: Low birthweight (LBW) is a significant public health problem in sub-Saharan Africa and LBW in rural Zambia is high. Our study explored the prevalence of LBW for newborns whose mothers were referred from a rural health center to a district referral hospital in Lundazi, Zambia. METHODS: A five-month retrospective record review of Ministry of Health data was performed to examine birthweight characteristics of a convenience sample of newborns from ten facilities referring to one district hospital (n = 234). RESULTS: Among all cases, 21% (n = 49) of newborns were LBW. For LBW newborns, 73% (n = 36) were preterm with mothers having a pregnancy duration of less than 37 weeks. Newborns whose mothers experienced twin pregnancies (p = .021) and prolonged labor (p = .033) were more often LBW. However, regression models demonstrated no difference among newborns with and without LBW for prolonged labor (p = .344) and twin pregnancies (p = .324) when controlling for variables that could interact with the maternal-newborn delivery outcomes. CONCLUSIONS: for Practice Healthcare providers and policy makers need to address the short and long-term effects of LBW throughout the lifecycle in rural Zambia. More maternal-newborn health research is needed to understand the underlying socioeconomic, social, and cultural determinants influencing LBW in rural Zambia.

Maternal knowledge of essential newborn care in rural Zambia.

Maternity waiting homes (MWHs) may offer an intervention to improve newborn outcomes in rural Zambia. This study compared maternal knowledge of newborn care for women referred from facilities with and without MWHs. Topics assessed included: (1) umbilical cord care; (2) thermal and skin care; (3) nutrition, and; (4) prevention of diarrhea, and; (5) newborn danger signs prompting care-seeking. A two-group comparison design with a convenience sample was employed using a face-to-face interviews at one district hospital. Descriptive, inferential, and multivariate analyses were employed to compare knowledge. Overall, mothers demonstrated newborn care knowledge in accordance with World Health Organization (WHO) guidelines for newborn health and there were no significant differences in maternal knowledge of newborn care practices among MWH and non-MWH users. Younger mothers more often did not know about umbilical cord care, newborn skin care, and newborn danger signs. MWH users went more often for antenatal care than non-MWH users. In both groups, we found as the number of ANC visits increases, odds of answering "Don't know" decreases. This study is the first to assess maternal newborn care knowledge and MWH use in rural Zambia. Both MWH users and non-users in the rural district were knowledgeable about essential newborn care.

Newborn Outcomes and Maternity Waiting Homes in Low and Middle-Income Countries: A Scoping Review.

Objectives Decreasing neonatal morbidity and mortality remains a challenge in low resource settings. Maternity waiting homes (MWHs) may offer a way to better provide perinatal obstetric care and improve newborn outcomes. The purpose of this scoping review is to examine the impact of MWHs on newborn outcomes and to inform the development of targeted interventions and services to decrease neonatal mortality. Methods A literature search of four databases in the fields of nursing, medicine and global health was conducted yielding a total of 11 articles included for the review. Results Results indicate studies with extremely limited qualitative or quantitative measures of the impact of MWHs on neonatal health. Conclusions An exceptionally wide gap in knowledge on the outcomes of neonates born at MWHs was identified through this scoping review of the scientific literature. The review illustrates the need for more research to understand the effectiveness of MWHs on newborn morbidity and mortality. An increased focus on the study of MWHs for improving newborn outcomes in low resource settings merits immediate attention.

Reproductive Concerns and Associated Factors Among Adolescent and Young Adult Cancer Survivors in Uganda: A Hospital-Based Cross-Sectional Study.

Purpose: Reproductive health (RH) is a critical issue among cancer survivors worldwide. However, in developing countries where RH services for patients with cancer are often lacking, reproductive concerns among adolescent and young adult (AYA) survivors remain uncertain. In this study, we assessed the reproductive concerns of AYA cancer survivors in a resource-limited context of Uganda. Methods: We collected data from AYA cancer survivors at two facilities in Uganda using an interviewer-administered questionnaire. Descriptive statistics were calculated, one-way analysis of variance was used for intergroup comparisons, and multiple regressions were used to test for predictors of reproductive concerns. Results: A total of 110 AYA cancer survivors, with a median age of 20 years (interquartile range [IQR], 18-22), were interviewed. More than half (53.6%) of the respondents were males. The median time since cancer diagnosis was 19 months (IQR, 13.0-35.0). Almost all (91.8%) respondents had a future desire to have children, but only 15.5% received reproductive counseling. The mean total score for the reproductive concern subscales was highest for the fertility concern, followed by the information-seeking and health-related concerns. Reproductive counseling, desire to have children, and respondents' age were the factors influencing reproductive concern. Conclusions: The study shows a strong desire for biological parenthood with very low reproductive counseling among AYA cancer survivors, who remain concerned about their fertility, information needs, and health. This outcome underscores the need to integrate RH services into resource-limited cancer care settings.

Partnering to Improve Mentorship Capacity for Ugandan Reproductive Health Researchers: Program Description and Evaluation.

Mentorship is essential to health researchers in achieving their full potential and advancing public health. In most low-resource settings, there is a paucity of training on how to be a successful mentor. The Center for International Reproductive Health Training at the University of Michigan conducted and evaluated a workshop at two universities in Uganda for mentors of new reproductive health research grant awardees. The program aimed to strengthen mentors' mentorship skills and to identify ways to foster institutional support for mentoring. Mentors rated their post-training skills using a 5-point Likert scale (not skilled to extremely skilled) immediately and 3 months after the training. Ten of 19 mentors who participated in the training completed the evaluation. The majority were 41 to 50 years old, male, midcareer faculty. Immediately after the training, mentors rated themselves (mean ± SD) highest in knowledge of research ethics (4.4 ± 0.5), fostering independence in mentees (4.3 ± 0.9), and understanding the benefits of mentoring (3.9 ± 1.1). Mentors felt least confident in fostering institutional change to support mentorship (3.3 ± 0.8), communication (3.5 ± 0.5), and overcoming adversity (3.5 ± 0.8). The two most important things the mentors learned were how to appreciate and manage diversity and how they can benefit from mentorship. Barriers to mentoring that persisted after the program ended included lack of time and institutional resources. Enhancing mentorship training opportunities will foster a generation of scientists who are more supported, skilled, and productive in research, leading to better reproductive and public health outcomes in their communities.

Scoping review of qualitative studies on family planning in Uganda.

Family planning (FP) is an essential component of public health programs and significantly impacts maternal and child health outcomes. In Uganda, there is a need for a comprehensive review of the existing literature on FP to inform future research and programmatic efforts. This scoping review aims to identify factors shaping the use of FP in Uganda. We conducted a systematic search of eight scholarly databases, for qualitative studies on FP in Uganda. We screened the titles and abstracts of identified articles published between 2002-2023 and assessed their eligibility based on predefined criteria. We extracted data from the 71 eligible studies and synthesized the findings using thematic analysis and the Ecological Systems Theory (EST) individual, interpersonal, community, institutional, and policy-level determinants. Findings reveal the interplay of factors at different socio-ecological levels influencing family planning decisions. At the individual level, the most common determinants related to the EST were knowledge and attitudes of FP. Interpersonal dynamics, including partner communication and social support networks, played pivotal roles. Community-level factors, such as cultural norms and accessibility of services, significantly influenced family planning practices. Institutional and policy-level factors, particularly a healthcare system's quality and policies, also shaped use. Other themes included the intersection of HIV/AIDS on FP practice and Ugandan views of comprehensive abortion care. This scoping review underscores the intricate socio-ecological fabric shaping FP in Uganda. The findings highlight the need for targeted interventions to increase knowledge and awareness of FP, improve access to services, and address social and cultural norms that discourage contraceptive use. Policymakers and program implementers should also consider gender dynamics and power imbalances in FP programs to ensure they are equitable and effective.

Strengthening healthcare delivery in Rwanda: Implementation science training for reproductive health researchers.

BACKGROUND: Addressing the gap between research and practice is crucial for enhancing reproductive healthcare outcomes. In Rwanda and other low- and middle-income countries, bolstering health researchers' implementation science (IS) capacity is essential. We present a pre-post-intervention study assessing the influence of an intensive IS training program on Rwandan reproductive health researchers' perceived IS knowledge and self-efficacy in applying IS in their own research. METHODS: To introduce IS principles, we held a one-day training for a diverse cohort of 25 sexual and reproductive health researchers in Rwanda. The training encompassed modules on IS concepts, methodologies, and practical applications. Pre- and post-training assessments gauged changes in participants' perceived IS knowledge and self-efficacy in applying IS in their own work. RESULTS: The study revealed a significant improvement in self-efficacy related to performing IS related tasks. Researchers reported heightened confidence in designing and implementing evidence-based interventions. In terms of perceived knowledge, participants retained what they learned at 4 months. The training fostered a collaborative learning environment, encouraging participants to exchange ideas and experiences. CONCLUSION: Targeted training in IS appears to enhance reproductive health researchers' capacity to translate research into practice, potentially leading to improved healthcare outcomes in Rwanda. Moving forward, we advocate for the Ministry of Health to establish structures for IS research agenda-setting, particularly for sexual and reproductive health and rights. Ideally, universities, health systems, and research institutions will incorporate IS capacity strengthening into their routine activities. Ongoing training is crucial to reinforce and expand IS knowledge. Our findings are expected to inform future interventions and guide policy development.

Lessons learnt from a scientific peer-review training programme designed to support research capacity and professional development in a global community.

High-quality peer-reviewer training open to researchers across the globe has the potential to improve the published literature, however, this type of training is not widely available. In this paper, we describe an online peer-reviewer training programme, highlight its effectiveness in building peer review and writing skills, and discuss challenges and lessons learnt. This training programme, open to researchers across the globe, acquaints participants with challenges to and inequities in publishing and educates them about writing effective peer reviews. A focal point is how to provide specific and respectful feedback to help authors get accepted for peer review at an academic journal. Forty-nine participants from or residing in six continents completed the training. All programme evaluation respondents agreed that the orientation helped them gain a better understanding of their role as a peer reviewer at Pre-Publication Support Service. Most agreed that the training was helpful in improving their peer-review skills, and that the training was helpful in improving their writing skills. Participants wanted more networking and collaboration opportunities with other peer reviewers, inclusion of a qualitatively researched example paper and improved communication about the required time commitment. Our online programme with multiple time options was geographically inclusive but internet connectivity was challenging for some participants. Peer-reviewer training programmes can help researchers build their peer review and writing skills and enhance participants' understanding of disparities in publishing. Integrating a geographically diverse group of researchers has the potential to enrich the discussions and learning in such a programme.

Lyme Disease Knowledge, Practices, and Vaccine Acceptability Among Nurse Practitioners in Pediatric Practice.

INTRODUCTION: Lyme disease (LD) is a major public health problem in the United States. Given its incidence and geographic expansion, nurse practitioners (NPs) will likely encounter patients with this condition. METHOD: NPs were invited to participate in an electronic survey via email, newsletter, and social media posts. The 31-question survey collected information on provider characteristics, clinical scenario decisions, resources used, and vaccine sentiment for LD. RESULTS: Survey participants (n = 606) were primarily cisgender female (75%) and aged 30-49 years (62%). Responding to six hypothetical clinical scenarios, only 31% of participants answered most questions correctly. If an LD vaccine becomes available, 39% said they would incorporate it into practice; 48% would seek further information before deciding. DISCUSSION: Additional education on LD prevention, diagnosis, and treatment is needed for NPs. Increasing provider awareness of current guidelines and developing tailored resources for NPs may improve patient care.

Scoping review of qualitative studies investigating reproductive health knowledge, attitudes, and practices among men and women across Rwanda.

BACKGROUND: Research efforts in Rwanda to improve sexual and reproductive health and rights (SRHR) are increasing; however, comprehensive literature reviews on SRHR are limited. This scoping review examines individual and contextual factors shaping knowledge, attitudes, and practices in the domains of: 1) family planning, 2) abortion care, and 3) other SRHR in Rwanda. Recognizing that individual, community, and societal factors influence RH, this review is guided by Bronfenbrenner's Ecological Systems Theory. METHODS: Eligible studies were conducted in Rwanda, included males and/or females of any age, and were published within the past 20 years. Studies reporting views of only healthcare or other professionals were excluded. RESULTS: Thirty-six studies were included. The majority addressed individual and contextual considerations. At the individual level, studies explored knowledge about SRHR problems while at the interpersonal level, the support and attitudes of men and community members for adolescent SRHR were investigated. In terms of healthcare organization, maternal health practices, increased access to family planning programs, and the need for sexually transmitted infection programs was explored. At the social and cultural level, researchers investigated beliefs and traditional gender roles. Regarding public health policy, studies mentioned promoting and increasing funding for SRHR and reducing gender inequities. CONCLUSION: Our findings can inform SRHR research programs, public health campaigns, and policy advances in Rwanda.

Viability of an urban maternity waiting home in Kumasi, Ghana: A qualitative needs assessment.

BACKGROUND: Maternity waiting homes, usually located in rural, low-resource settings, may increase access to skilled care during delivery and ultimately improve maternal-newborn outcomes. Although there are studies exploring maternity waiting homes in rural settings, little is known about interest in and viability of maternity waiting home use in urban environments. OBJECTIVE: The purpose of this study was to conduct a qualitative needs assessment about establishing a maternity waiting home as a health system strengthening intervention in urban Kumasi, Ghana. DESIGN: We conducted an exploratory qualitative needs assessment about the community beliefs, values, and interest in maternity waiting homes as a health system strengthening intervention to improve maternal-newborn outcomes. A semi-structured interview guide was based on several domains from the Tailored Implementation for Chronic Diseases checklist. Latent content analysis was used to analyze the data and elicit themes. SETTING: Data were collected in late 2019 in urban Kumasi, Ghana near a large government hospital and in the community. PARTICIPANTS: Using purposive and snowball sampling, individual interviews (n = 14) were conducted with community stakeholders and key decision makers, and 8 focus group discussions were conducted with women of childbearing age (n = 38) and family members (n = 38). FINDINGS: Three major overarching themes were identified: (1) Urban maternity waiting homes are perceived to provide a unique benefit; (2) Urban maternity waiting homes are anticipated to be successful, and; (3) barriers to establishing an urban maternity waiting home may prevent prompt action. There is community buy-in and engagement for building and using urban maternity waiting homes but they are not able to identify concrete sources of funding to pay for the physical construction of the home. KEY CONCLUSIONS: There is overwhelming support for building and using maternity waiting homes as a health system strengthening intervention to improve maternal-newborn outcomes in urban Kumasi, Ghana. Participants perceive maternity waiting homes as providing unique benefits to improve maternal-newborn health and anticipate that maternity waiting homes would be a successful intervention. Participants identified financial barriers to establishing an urban maternity waiting home that might prevent timely implementation. IMPLICATIONS FOR PRACTICE: Findings highlight interest in mobilizing resources to establish maternity waiting homes in an urban setting. To overcome potential barriers to roll-out, attention needs to be focused on securing funding to build an urban maternity waiting home in Kumasi. As health policy shifts towards women delivering in larger-volume facilities typically located in big cities, there is potential for maternity waiting homes to be implemented in urban settings throughout sub-Saharan Africa to maximize positive health outcomes.

Environmental Risk Factors for Childhood Cancer in an Era of Global Climate Change: A Scoping Review.

INTRODUCTION: Contemporary research about environmental risk factors in an era of global climate change to inform childhood cancer prevention efforts is disjointed. Planetary pediatric providers need to establish a better understanding of how the postnatal environment influences childhood cancer. Authors conducted a scoping review of recent scientific literature with the aim of understanding the environmental risk factors for childhood cancer. METHOD: Ovid Medline, CINAHL, and Scopus databases were searched with results limited to the English language with publication years 2010-2021. Two independent reviewers screened 771 abstracts and excluded 659 abstracts and 65 full-text articles on the basis of predefinedcriteria. RESULTS: The scoping review identified 47 studies about environmental risk factors for childhood cancer with mixed results and limited consensus in four main categories, including air pollution, chemical exposures, radiation, and residential location. DISCUSSION: Research by collaborative international groups of planetary health researchers about environmental risk factors is needed to inform global health policy for childhood cancer prevention efforts.

Agness Mseteka: Maternity Waiting Home Caretaker and Protector of Pregnant Women in Rural Zambia.

To share her story, we interviewed Agness Mseteka about her experience as a maternity waiting home (MWH) caretaker at the district hospital in rural Lundazi, Zambia. Maternity waiting homes, also known as mother's shelters, are structures built near healthcare facilities to minimize the critical barrier of distance to accessing maternal health services. Agness' story highlights the central role caretakers play in contributing to the successful implementation and sustainability of MWH interventions. Agness is well positioned to be an agent of positive change by bringing health education to pregnant women. An important lesson learned from Agness' story is the need for future research to explore the sustainability of MWHs and long-term effectiveness of income generating activities by the community after the completion of externally funded implementing programs.

Feasibility of establishing a network of community health workers to support care of people with sickle cell disease in Kumasi, Ghana.

Globally, sickle cell disease (SCD) is a common, yet often neglected, non-communicable disease. Community health worker (CHW) interventions have been shown to improve outcomes for chronic diseases but have not been evaluated with SCD. This study assessed the interest in and feasibility of establishing a network of CHWs to support care of people with SCD in Kumasi, Ghana. Using in-depth interviews with key stakeholders (N = 15) identified through purposive and snowball sampling from January to March 2020, we gathered focused information about interest in and feasibility of establishing a network of CHWs. Respondents were chosen for their knowledge and oversight of health services for people with SCD. Latent content analysis was used to examine the data. Participants expressed interest in establishing a network of CHWs to better support care for people with SCD. Three primary themes emerged from the data: (1) support by CHWs could be beneficial for people with SCD; (2) using existing CHW networks for SCD services would be best; and (3) funding of expanded CHW network might be a problem. We advocate for the mobilization of resources to expand the current network of CHWs to include a focus on SCD in Kumasi, Ghana. Participants believe that it is feasible to use CHWs to improve care outcomes of people with SCD. There is potential for findings from this exploratory project to be adapted and implemented in other settings throughout sub-Saharan Africa, as well as areas of higher income countries where there are higher proportions of people living with sickle cell.

The Call for Global Health Research Mentorship for Doctorally Prepared Nurses in Low- and Middle-Income Countries.

Limited research about nursing mentorship in low- and middle-income countries (LMICs) is holding science back. This article describes the strengths and challenges associated with global health research mentorship for doctorally prepared nurses whose scholarship focuses on LMICs. Using reflexive narrative accounts from current and former nurse mentors and nurse mentees who participated in a NIH-funded global health doctoral research program, emerging themes revealed the perspectives of mentors and mentees, producing a global health mentoring model for nursing research mentorship relevant to LMICs. Identified themes, which applied across roles and primary affiliations, included 1) collaborative mentor-mentee relationships and 2) enthusiasm for global health nursing. Our global health nursing research mentor-mentee interaction systems conceptual model focuses on nursing science mentoring in LMICs incorporating interpersonal, institutional, and cultural factors. We describe successful components of global nurse researcher mentorship and summarize directions for future research in the field. Our model can be used to create more effective mentee-centered mentoring for nurses or health professionals conducting global research. To advance science, we encourage doctorally prepared nurses to support mentee-centered research mentorship experiences that are sensitive to the unique needs of interdisciplinary global health scholarship.

Caregiver Perception of Sickle Cell Disease Stigma in Ghana: An Ecological Approach.

INTRODUCTION: Sickle cell disease (SCD) stigma is a major community health issue. The challenges of caring for someone with SCD can be overwhelming. We explored stigma and related factors for caregivers of pediatric patients with SCD in Kumasi, Ghana. METHOD: Guided by the Ecological Systems Theory, we used in-depth interviews with a semistructured guide to learn about the perception of stigmatization for Ghanaian caregivers of patients with SCD. RESULTS: Overall, participants were knowledgeable about SCD. We identified three themes, including (1) blame for SCD, (2) public misconception about SCD, and (3) shame for the financial burden of SCD. DISCUSSION: Findings demonstrate the need to design an SCD stigma reduction program for caregivers, families, and the community. Providers need to consider SCD stigma and interaction with multiple ecological levels, including the family, community, health care system, culture, and health policy in Ghana. Findings can be used as a catalyst to explore the reduction of stigmatization in other sub-Saharan countries.

Stigma Associated With Sickle Cell Disease in Kumasi, Ghana.

INTRODUCTION: People with sickle cell disease (SCD) often face stigmatization in Ghana and elsewhere in Africa. Research is needed to understand whether it is necessary to design an SCD stigma reduction program in the Ghanaian setting. The aim of this study was to explore the perception of stigmatization for adults with SCD in Kumasi, Ghana. METHODOLOGY: Using in-depth qualitative interviews, researchers conducted a phenomenological study to investigate the perception of stigmatization for people with SCD in Kumasi, Ghana. Snowball and purposive sampling was used to identify the participants. RESULTS: Participants (n = 12) were mostly female, Akan, and Christian. Researchers categorized three main themes: (a) Feelings of social isolation, (b) Fear of disclosure, and (c) Bullying about physical appearance. DISCUSSION: The findings highlight the need to develop effective strategies to counteract stigma. Transcultural health care providers can implement stigma reduction interventions that might be applicable throughout Africa where findings are likely to resonate with patients with SCD.

How maternity waiting home use influences attendance of antenatal and postnatal care.

As highlighted in the International Year of the Nurse and the Midwife, access to quality nursing and midwifery care is essential to promote maternal-newborn health and improve survival. One intervention aimed at improving maternal-newborn health and reducing underutilization of pregnancy services is the construction of maternity waiting homes (MWHs). The purpose of this study was to assess whether there was a significant change in antenatal care (ANC) and postnatal care (PNC) attendance, family planning use, and vaccination rates before and after implementation of the Core MWH Model in rural Zambia. A quasi-experimental controlled before-and-after design was used to evaluate the impact of the Core MWH Model by assessing associations between ANC and PNC attendance, family planning use, and vaccination rates for mothers who gave birth to a child in the past 13 months. Twenty health care facilities received the Core MWH Model and 20 were identified as comparison facilities. Before-and-after community surveys were carried out. Multivariable logistic regression were used to assess the association between Core MWH Model use and ANC and PNC attendance. The total sample includes 4711 mothers. Mothers who used the Core MWH Model had better ANC and PNC attendance, family planning use, and vaccination rates than mothers who did not use a MWH. All mothers appeared to fare better across these outcomes at endline. We found an association between Core MWH Model use and better ANC and PNC attendance, family planning use, and newborn vaccination outcomes. Maternity waiting homes may serve as a catalyst to improve use of facility services for vulnerable mothers.