Onesmus Gachuno

Training tomorrow’s global health leaders: applying a transtheoretical model to identify behavior change stages within an intervention for health leadership development

Training health professionals in leadership and management skills is a key component of health systems strengthening in low-resource settings. The importance of evaluating the effectiveness of these programs has received increased attention over the past several years, although such evaluations continue to pose significant challenges. This article presents evaluation data from the pilot year of the Afya Bora Fellowship, an African-based training program to increase the leadership capacity of health professionals. Firstly, we describe the goals of the Afya Bora Fellowship. Then, we present an adaptation of the transtheoretical model for behavior change called the Health Leadership Development Model, as an analytical lens to identify and describe evidence of individual leadership behavior change among training participants during and shortly after the pilot year of the program. The Health Leadership Development Model includes the following: pre-contemplation (status quo), contemplation (testing and internalizing leadership), preparation – (moving toward leadership), action (leadership in action), and maintenance (effecting organizational change). We used data from surveys, in-depth interviews, journal entries and course evaluations as data points to populate the Health Leadership Development Model. In the short term, fellows demonstrated increased leadership development during and shortly after the intervention and reflected the contemplation, preparation and action stages of the Health Leadership Development Model. However, expanded interventions and/or additional time may be needed to support behavior change toward the maintenance stages. We conclude that the Health Leadership Development Model is useful for informing health leadership training design and evaluation to contribute to sustainable health organizational change.

Depression during pregnancy and preterm delivery: a prospective cohort study among women attending antenatal clinic at Pumwani Maternity Hospital

BackgroundPreterm birth occurs among 9.6% of births worldwide and is the leading cause of long-term neurodevelopmental disabilities among children and also responsible for 28% of neonatal deaths. No single etiological factor is responsible for preterm birth, but various risk factors have been identified. Prior studies have reported that compromised maternal mental health occurring during pregnancy may lead to various adverse obstetric outcomes.ObjectiveTo determine whether antenatal depression is significantly associated with preterm delivery in a low resource hospital sample from the suburbs of Nairobi.Methods292 women attending the antenatal clinic at Pumwani Maternity Hospital in Nairobi meeting the study criteria were recruited. The Edinburgh Postnatal Depression Scale was administered to screen for depression. A clinical cutoff score of 10 and above was regarded as possible depression. Thereafter, a clinical interview together with the Patient Health Questionnaire-9 was administered to evaluate the participants on DSM-V criteria for major depressive disorder. Only 255 of the women were successfully followed-up to delivery with an attrition rate of 12.7%. Records of gestation at delivery and birth weight were collected at second contact.Data analysisPreterm birth was associated with various demographic, psychosocial and medical variables. Relative risks were estimated via log binomial regression analysis to determine whether depression was a risk factor for preterm birth.ResultsOf the 255 participants, 98(38.4%) found to have depressive symptoms and 27(10.7%) delivered preterm. The risk of delivering preterm was 3.8 times higher among those with depressive symptoms.ConclusionThere is a positive association between antenatal depression and preterm delivery. This highlights the importance of screening for mental health disorders in the antenatal period as a means to reduce adverse obstetric outcomes.

Medical Education Partnership Initiative gives birth to AFREhealth

Francis Omaswa, Elsie Kiguli-Malwadde, Peter Donkor, James Hakim, Milliard Derbew, Sarah Baird, Seble Frehywot, Onesmus Wairumbi Gachuno, Steve Kamiza, Isaac Ongubo Kibwage, Kein Alfred Mteta, Yakub Mulla, Fitzhugh Mullan, Jean B Nachega, Oathokwa Nkomazana, Emilia Noormohamed, Vincent Ojoome, David Olalaye, Sandy Pillay, Nelson K Sewankambo, and Marietjie de Villiers African Centre for Global Health and Social Transformation, 13B Acacia Avenue, Kampala 9974, Uganda (FO, EK-M, VO); Kwame Nkrumah University of Science and Technology, Kumasi, Ghana (PD); University of Zimbabwe, Harare, Zimbabwe (JH); Addis Ababa University, Addis Ababa, Ethiopia (MD); George Washington University, Washington, DC, USA (SB, SF, FM); University of Nairobi, Nairobi, Kenya (OWG, IOK); University of Malawi, College of Malawi, Chichiri, Malawi (SK); Kilimanjaro Christian Medical University College, Moshi Tanzania (KAM); University of Zambia, Lusaka, Zambia YM); Stellenbosch University, Stellenbosch, South Africa (JBN, MdV); University of Botswana, Gaberone, Botswana (ON); Universidade Eduardo Mondlane, Maputo, Mozambique (EN); University of Ibadan, Ibadan, Nigeria (DO); University of KwaZulu-Natal, Durban, South Africa (SP); and Makerere University, Kampala, Uganda (NKS)

Interprofessional Fellowship Training for Emerging Global Health Leaders in Africa to Improve HIV Prevention and Care: The Afya Bora Consortium

&NA; HIV continues to challenge health systems, especially in low‐ and middle‐income countries in Sub‐Saharan Africa. A qualified workforce of transformational leaders is required to strengthen health systems and introduce policy reforms to address the barriers to HIV testing, treatment, and other HIV services. The 1‐year Afya Bora Consortium Fellowship in Global Health capitalizes on academic partnerships between African and U.S. universities to provide interprofessional leadership training through classroom, online, and service‐oriented learning in 5 countries in Africa. This fellowship program prepares health professionals to design, implement, scale‐up, evaluate, and lead health programs that are population‐based and focused on prevention and control of HIV and other public health issues of greatest importance to African communities and health service settings. Afya Bora nurse fellows acquire leadership attributes and competencies that are continuously and systematically tested during the entire program. This multinational training platform promotes interprofessional networks and career opportunities for nurses.

Training tomorrow's leaders in global health: impact of the afya bora consortium fellowship on the careers of its alumni.

BackgroundEffective leadership is a cornerstone of successful healthcare delivery in resource limited settings throughout the world. However, few programs in Africa prepare healthcare professionals with the leadership skills vital to the success of the healthcare systems in which they work. One such program, the Afya Bora Consortium Fellowship in Global Health Leadership, has been training health professionals since 2011. The purpose of this study was to assess what career changes, if any, the Afya Bora Fellowship’s alumni have experienced since completing the fellowship, and to describe those changes.MethodsThe Afya Bora Fellowship is a multidisciplinary, one-year training program that teaches health professionals leadership skills through didactic and experiential learning in four African countries. Between January 2011 and June 2013 the consortium trained 42 nurses and doctors. In November 2013, an electronic survey was sent to all alumni to assess their performance in the workplace post-fellowship.ResultsThirty-one (74 %) of 42 alumni completed surveys. Twenty-one (68 %) reported changes to their position at work; of those, sixteen (76 %) believed the change was due to participation in the fellowship. All alumni reported improved performance at work, and cited the application of a wide range of fellowship skills, including leadership, research, communication, and mentoring. Twenty-six (84 %) alumni spearheaded improvements in their workplaces and almost all (97 %) remained in contact with colleagues from the fellowship. Among the respondents there were five publications, nine manuscripts in preparation, and three international conference presentations.ConclusionsAfya Bora alumni overwhelmingly reported that the one year fellowship positively influenced both their work and career trajectory. Training health professionals in leadership skills through didactic modules with the opportunity to apply learned skills at attachment sites in the Afya Bora Fellowship has an impact on performance in the workplace and the potential to improve long-term institutional capacity.

Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness

Background Globally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model. Objective-method We compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial. Findings Although most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%. Significance Comparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade’s intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted.

The Medical Education Partnership Initiative (MEPI): Innovations and Lessons for Health Professions Training and Research in Africa

MEPI was a

Correction to: Depression during pregnancy and preterm delivery: a prospective cohort study among women attending antenatal clinic at Pumwani Maternity Hospital

130 million competitively awarded grant by President’s Emergency Plan for AIDS Relief (PEPFAR) and National Institutes of Health (NIH) to 13 Medical Schools in 12 Sub-Saharan African countries and a Coordinating Centre (CC). Implementation was led by Principal investigators (PIs) from the grantee institutions supported by Health Resources and Services Administration (HRSA), NIH and the CC from September, 2010 to August, 2015. The goals were to increase the capacity of the awardees to produce more and better doctors, strengthen locally relevant research, promote retention of the graduates within their countries and ensure sustainability. MEPI ignited excitement and stimulated a broad range of improvements in the grantee schools and countries. Through in-country consortium arrangements African PIs expanded the programme from the 13 grantees to over 60 medical schools in Africa, creating vibrant South–South and South–North partnerships in medical education, and research. Grantees revised curricular to competency based models, created medical education units to upgrade the quality of education and established research support centres to promote institutional and collaborative research. MEPI stimulated the establishment of ten new schools, doubling of the students’ intake, in some schools, a three-fold increase in post graduate student numbers, and faculty expansion and retention. Sustainability of the MEPI innovations was assured by enlisting the support of universities and ministries of education and health in the countries thus enabling integration of the new programs into the regular national budgets. The vibrant MEPI annual symposia are now the largest medical education events in Africa attracting global participation. These symposia and innovations will be carried forward by the successor of MEPI, the African Forum for Research and Education in Health (AFREhealth). AFREhealth promises to be more inclusive and transformative bringing together other health professionals including nurses, pharmacists, and dentists.

Factors Influencing the Utilization of Anti-Retroviral Drugs by HIV Positive Pregnant Women in Busia District, Busia County

Following the publication of the original article [1], the authors reported the following typesetting errors:

Clinician attendance and delivery practices at hospital-based vaginal deliveries in Western Kenya

1 Senior Nursing officer, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya. 2 Senior Lecturer, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya. 3 Department of Social Studies, St. Pauls’ University, Nairobi, Kenya. 4 Senior Lecturer, Department of Obstetrics and Gynaecology, University of Maryland, USA. 5 Nursing, Department of Nursing, University of Maryland, USA. 6 Department of Obstetrics and Gynaecology, University of Nairobi, Kenya. 7 Research Grants Officer, University of Nairobi, Kenya. 8 Senior Lecture, Department of Microbiology, University of Nairobi, Kenya. 9 Professor, Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi, Kenya.