Contracting out to improve the use of clinical health services and health outcomes in low-and middle-income countries.

There is growing interest in how different forms of knowledge can strengthen policy-making in low-and middleincome country (LMIC) health systems. Additionally, health policy and systems researchers are increasingly aware of the need to design effective institutions for supporting knowledge utilisation in LMICs. To address these interwoven agendas, this scoping review uses the Arskey and O'Malley framework to review the literature on knowledge utilisation in LMIC health systems, using eight public health and social science databases. Articles that described the process for how knowledge was used in policy-making, specified the type of knowledge used, identified actors involved (individual, organisation or professional), and were set in specific LMICs were included. A total of 53 articles, from 1999 to 2016 and representing 56 countries, were identified. The majority of articles in this review presented knowledge utilisation as utilisation of research findings, and to a lesser extent routine health system data, survey data and technical advice. Most of the articles centered on domestic public sector employees and their interactions with civil society representatives, international stakeholders or academics in utilising epistemic knowledge for policy-making in LMICs. Furthermore, nearly all of the articles identified normative dimensions of institutionalisation. While there is some evidence of how different uses and institutionalisation of knowledge can strengthen health systems, the evidence on how these processes can ultimately improve health outcomes remains unclear. Further research on the ways in which knowledge can be effectively utilised and institutionalised is needed to advance the collective understanding of health systems strengthening and enhance evidence-informed policy formulation.

Objective Vesico-vaginal fistula (VVF) involves the pathological communication between the urinary bladder and vagina, possible complications arising from urinary tract infection merits consideration. This study seeks to evaluate significant bacteriuria among VVF clients. SettingThe setting was the South east Fistula Centre, Abakaliki, Ebonyi State, Nigeria. PopulationThis was a total population study of all consenting HIV negative VVF clients. MethodThis cross-sectional study assessing asymptomatic bacteriuria was conducted among 109 HIV negative VVF clients using standard microbiological technique. Haematological and anthropometric parameters were also assessed. ResultsThe prevalence of asymptomatic bacteriuria was 76.1% and the highest prevalence was among clients aged 21-30years (90.3%), those who have had more than seven deliveries (85.0%) and those whose labour duration lasted above 48hours (76.7%). The prevalence of bacteriuria was least among women with VVF for less than a year. The prevalence was highest among patients with intra cervical fistula (83.3%). Bacteriuria prevalence was highest among women of blood group AB (100%). The rate was higher among women whose heights were > 1.53metres and whose weights were < 51kilogram. Six different bacterial species isolated include E. coli (41.0%), Proteus species (21.7%), and Klebsiella species (18.1%). Though the bacterial isolates were resistance to many of the antibiotics assessed, the highest level of resistance was observed with perfloxacin, cotrimoxazole, while the highest level of susceptibility was with Ciprofloxacin. ConclusionThe prevalence of bacteriuria in this study is rather high and should not be neglected in the management of VVF clients.

Introduction community volunteers have limited skills but are an important link between the community and health facilities. We determined the effect of a capacity building intervention on knowledge of malaria control and attitudes towards community involvement among female community volunteers as part of a larger community-based intervention study on pregnant women and children under five. Methods we conducted a before and after intervention study (no randomization or controls) among female community volunteers in Amagu community in Abakaliki Local Government Area. The intervention consisted of training sessions on knowledge of malaria and its control. The training took the form of lectures, role plays and practical demonstrations. Supportive supervision by trained community health extension workers was also provided during their field work. We compared pre-training test and post-training test scores after six months interval and analysed the data using paired t test at 5% level of significance with EPI INFO software version 7.2.3. Results the mean age of the participants was 28.5(± 6.0) years. All had a minimum level of secondary education. There was significant improvement in the mean scores of their knowledge of malaria signs and symptoms (p < 0.001), preventive measures (p < 0.001) and appropriate drug treatment (p < 0.001) in the post-training test when compared with the pre-training test. The overall mean knowledge scores pre and posttest were 147.8 and 169.8 respectively (p < 0.001) out of a maximum achievable score of 195. Also there was significant improvement in the perception of the participants on community involvement in promoting referral of pregnant women with fever (p = 0.001), the use of intermittent preventive therapy with sulphadoxine-pyrimethamine (p = 0.048) and funding initiatives to sustain activities (p = 0.037). Conclusion capacity building of female community volunteers coupled with supportive supervision by trained community health workers improved the female community volunteers´ knowledge of malaria, its control and their perception of community involvement in control activities. It is recommended that the use of community volunteers as a low cost health resource can be explored further for incorporation into existing policies on malaria control in resource constrained environments.

IntroductionHealth workers have increasingly become victims of workplace violence. However, negligible action has been given to developing workplace violence (WPV) prevention programs in hospital settings in low-middle-income countries. An effective workplace violence prevention program is crucial for preventing violence and managing the consequences of incidents. This study assessed management staff perspectives on intervention strategies for workplace violence prevention in a tertiary health facility in Nigeria.MethodsA qualitative study design was employed to explore the intervention strategies for preventing and managing workplace violence at a tertiary health facility in southeast Nigeria. Six focus group discussions were conducted with thirty-eight management-level staff. The interview transcripts were manually coded according to six predefined constructs of workplace violence: creating interdisciplinary harmony and WPV experiences, causes, prevention, program/policy contents, and implementation strategies. A manual thematic analysis approach was adopted, and the results were presented as narratives.ResultsThe findings revealed recognition, welfare, administrative control, and security as vital strategies for the WPV prevention program. The participants agreed that unanimity among staff could be promoted through respect for all cadres of staff and for people’s perspectives (creating interdisciplinary harmony). Assaults and staff intimidation/victimization (experiences), attributed to unethical/poor health workers’ behaviour and ethnic discrimination (causes), were viewed as preventable by ensuring patients’/caregivers’ welfare through respectful and timely care and staff’s welfare through incentives/remunerations and discouraging intimidation (prevention strategies). Furthermore, the staff expressed that the WPV program should employ administrative controls, including instituting WPV policy/unit, codes of ethics, and standard operating procedures across all workplace facets (program/policy contents), which should be implemented through awareness creation, enforcement of sanctions, and provision of appropriate and adequate security presence in the hospital (policy implementation strategies).ConclusionRespect, patient/staff welfare, administrative control, and security are strong mechanisms to prevent workplace violence in tertiary hospitals. Hospital management should institutionalize workplace violence prevention programs/policies and ensure compliance.