Grace Omoni

Clinical Nursing and Midwifery Research Priorities in Eastern and Southern African Countries: Results From a Delphi Survey.

BackgroundBecause of the profound shortage of nurse and midwifery researchers in many African countries, identification of clinical nursing and midwifery research is of highest priority for the region to improve health outcomes. ObjectivesThe aim of this study was to gain consensus from experts on the priorities of clinical nursing and midwifery research in southern and eastern African countries. MethodA Delphi survey was conducted among experts in the region. Criteria for “expert” included (a) a professional nurse, (b) a bachelors degree or higher in nursing, (c) published research, (d) affiliated with a school of nursing with at least a masters level nursing program, and/or (e) identified by the African core collaborators as an expert in the region. A list of candidates was identified through searches of published and gray literature and then vetted by core collaborators in Kenya, Malawi, and South Africa. Core collaborators held leadership roles in a nursing school and a doctoral degree in nursing, had conducted and published nursing research, and resided in an included country. ResultsTwo rounds of the Delphi survey were required to reach consensus. In total, 40 participants completed both rounds, and at least one participant from each country completed both rounds; 73% and 85% response rates were achieved for each round, respectively. Critical clinical research priorities were infectious disease/infection control and midwifery/maternal health topics. These included subtopics such as HIV/AIDS, tuberculosis, maternal health and mortality, infant mortality, and obstetrical emergencies. Many other topics were ranked as important including patient outcomes, noncommunicable diseases, and rural health. DiscussionAreas identified as research priorities were consistent with gaps identified in current literature. As evidenced by previous research, there is a lack of clinical nursing and midwifery research in these areas as well as nurses and midwives trained to conduct research; these priorities will help direct resources to the most essential research needs.

Clinical nursing and midwifery research: grey literature in African countries

Aim This study reviewed grey literature to assess clinical nursing and midwifery research conducted in southern and eastern African countries over the past decade. Background The shortage of published nursing research from African countries severely limits the ability of practicing nurses and midwives to base clinical decisions on solid evidence. However, little is known regarding unpublished or unindexed clinical research (‘grey literature’), a potentially rich source of information. Identifying these sources may reveal resources to assist nurses in providing evidence-based care. Introduction This scoping review of grey literature on clinical nursing and midwifery research in southern and eastern African countries helped to identify gaps in research and assess whether these gaps differ from published research. Methods Systematic searches of grey literature were performed. Research was included if it was conducted by nurses in 1 of 25 southern or eastern African countries, between 2004 and 2014 and included patient outcomes. Data were extracted on location, institution, research topic, institutional connections and author information. Chi-square tests were performed to compare differences between indexed and non-indexed literature. Results We found 262 studies by 287 authors from 17 southern and eastern African countries covering 13 topics. Although all topics were also found in indexed literature and there were statistically significant differences between the number of times, fewer topics were covered in grey literature vs. indexed. Discussion Patient satisfaction and experience and traditional health practices were more likely to be published, whereas chronic disease, assault and paediatric-related research were less often published. Conclusions and Implications for Nursing and Health Policy Generally, there is a paucity of clinical nursing research in this region. This could reflect the shortage of nurses prepared to conduct research in this region. Nurses may find additional resources for evidence in the grey literature. A complete understanding of the state of nursing science in southern and eastern African countries will help nurses and midwives to understand gaps in clinical research knowledge, potentially direct their research to more critical topics, and inform funding bodies and policy-makers of the situation of nursing science in southern and eastern African countries.

Contraception knowledge and practice among fistula patients at referral centers in Kenya

To establish knowledge and practice of contraception among patients presenting with a fistula attending fistula care services at 4 centers in Kenya.

Parents’ and teachers’ views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study

BackgroundTo successfully develop and implement school-based sexual health interventions for adolescent girls, such as screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, it is important to understand parents’ and teachers’ attitudes towards sexual health education and acceptability of sexually transmitted infection (STI) screening interventions.MethodsIn this qualitative study, we approached parents and teachers from three high schools to participate in in-depth interviews (IDIs) and focus-group discussions (FGDs). Parents and teachers were asked about their general knowledge of STIs and sexual health education. In addition, they were asked whether they would support utilizing outreach to schools to facilitate provision of sexual health education and screening for STIs in adolescent girls. Data were audio-recorded, transcribed, and translated into English. An initial coding matrix was developed and refined throughout the coding process. Transcripts were coded by two researchers and analyzed using the content analysis approach.ResultsWe conducted 10 IDIs (5 parents and 5 teachers) and 4 FGDs (2 with parents, 2 with teachers, total of 26 participants). Most parents reported few or no discussions regarding STIs with their adolescent girls. Parents were more comfortable discussing consequences of sexual activity including loss of virginity and the potential for pregnancy. Parents tended to place responsibility for sexual health education with teachers. The teachers, in turn, provided basic sexual and reproductive health education including puberty, abstinence, and overview of STIs. Both parents and teachers found the idea of screening for STIs in adolescent girls to be acceptable, and were comfortable with research staff contacting girls through informational meetings at schools. Parents felt that adolescents’ STI screening results should be shared with their parents.ConclusionIn this African setting, parents and teachers provide limited sexual health education, with a focus on negative consequences including loss of virginity, pregnancy, and risk for STIs. Nonetheless, both parents and teachers were supportive of STI screening for adolescent girls, beginning with school-based informational meetings for the girls. Research and programs that aim to provide STI screening in this setting must offer treatment and address the issue of whether results will be disclosed to parents.

Improving Partograph Training and Use in Kenya Using the Partopen Digital Pen System

This paper presents the findings from two studies of the PartoPen system – a digital pen software application that enhances the partograph, a paper-based labor-monitoring tool used in developing regions. Previous studies have shown that correct use of the partograph significantly reduces pregnancy complications; however, partographs are not always correctly completed due to resource and training challenges. The PartoPen addresses these challenges by providing real-time decision support, instructions, and patient-specific reminders. The preliminary studies described in this paper examine how the PartoPen system affects classroom-based partograph training among nursing students at the University of Nairobi, and partograph completion in labor theater use by nurse midwives at Kenyatta National Hospital in Nairobi, Kenya. Initial results indicate that using the PartoPen system enhances student performance on partograph worksheets, and that use of the PartoPen system in labor wards positively affects partograph completion rates and nurses’ level of expertise using the partograph form.

Screening for Sexually Transmitted Infections in Adolescent Girls and Young Women in Mombasa, Kenya: Feasibility, Prevalence, and Correlates

Introduction As adolescents and young women become sexually active, they are at risk of adverse reproductive health outcomes including sexually transmitted infections (STIs). We assessed feasibility and acceptability of STI screening among 15- to 24-year-old women in Mombasa, Kenya. Methods After sensitization activities, participants were recruited from 3 high schools and 1 university. Study staff conducted informational sessions. Students interested in participating were given consent forms to take home, and invited to visit our clinic for STI screening. During clinic visits, participants completed a self-administered questionnaire and provided a urine specimen for STI testing using a nucleic acid amplification test. Results Between August 2014 and March 2015, 463 high school and 165 university students collected consent forms. Of these, 293 (63%) from high schools versus 158 (95%) from university attended clinic for STI screening (P < 0.001). Of the 150 (33%) who reported any history of insertive vaginal sex, 78 (52.0%) reported condom use at the last sex act, 31 (20.7%) reported using modern nonbarrier contraceptive methods, and 37 (24.7%) reported not using any contraception at the last sex act. Twenty-six (5.8%) participants were diagnosed with STIs (7 [1.6%] Neisseria gonorrhoeae, 16 [3.6%] Chlamydia trachomatis, 3 [0.7%] Trichomonas vaginalis). In multivariable analyses, reporting receptive vaginal sex without a condom was associated with having a laboratory confirmed STI (odds ratio, 6.21; 95% confidence interval, 1.72–22.28). Conclusions These findings support the need for reproductive health interventions to reduce the risk of STIs in a population of adolescent girls and young women in East Africa.

Preparedness and practice of forensic nursing in Kenya.

Forensic nursing has not been adopted in Kenya despite the fact that nurses work in settings requiring this knowledge. The Nursing Council syllabus calls for lectures in forensic nursing but lectures have neither been developed nor are there educators prepared to teach the unit. This study evaluated the preparedness and practice of forensic nursing in Kenya. It adopted a descriptive cross-sectional study design. Self-administered questionnaires, a focused group discussion and a key informant interview were utilized to collect data among 116 randomly sampled nurses from three hospitals and ten nurse educators. Quantitative data was analyzed using the SPSS version 20.0 and results presented using mean, standard deviation, and frequency distribution. P values of 0.05 or less were considered significant. Qualitative data was analyzed using thematic analysis. The results indicated majority of the nurses had no training on forensic nursing science whatsoever even though they handle forensic patients on a daily basis. The nurses perceived training needs for forensic nursing practice included: advanced health assessment, evidence collection and documentation, forensic psychiatry, gender violence, legal implications of forensic nursing, theory and practice in forensic nursing. From these findings it can be concluded that Kenyan nurses lack skills needed to care for forensic patients and they would like to be trained in forensic nursing.

Success Stories: Overcoming Barriers to Research in Southern and Eastern African Countries:

There is an ever-growing need for clinically focused, culturally relevant research on which nurses can base their practice. However, there may not be a concurrent rise in efforts to strengthen infrastructure needed to promote research in developing and low-income countries. In such cases, nurse researchers must find innovative ways to address and overcome barriers to research. This article presents five exemplars of nurses conducting high-quality nursing research in resource-poor settings in southern and eastern Africa. Furthermore, it suggests strategies to address these barriers, such as piggybacking on larger studies, interdisciplinary collaboration, and partnership with influential stakeholders. These tactics may be used to increase research productivity elsewhere.