Browsing by Author "Hatfield, Jennifer"
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Item Open Access Call to Action for Nurses/Nursing(2016-04-06) Premji, Shahirose S.; Hatfield, JenniferThe 13 million nurses worldwide constitute most of the global healthcare workforce and are uniquely positioned to engage with others to address disparities in healthcare to achieve the goal of better health for all. A new vision for nurses involves active participation and collaboration with international colleagues across research practice and policy domains. Nursing can embrace new concepts and a new approach—“One World, One Health”—to animate nursing engagement in global health, as it is uniquely positioned to participate in novel ways to improve healthcare for the well-being of the global community. This opinion paper takes a historical and reflective approach to inform and inspire nurses to engage in global health practice, research, and policy to achieve the Sustainable Development Goals. It can be argued that a colonial perspective currently informs scholarship pertaining to nursing global health engagement. The notion of unidirectional relationships where those with resources support training of those less fortunate has dominated the framing of nursing involvement in low- and middle-income countries. This paper suggests moving beyond this conceptualization to a more collaborative and equitable approach that positions nurses as cocreators and brokers of knowledge. We propose two concepts, reverse innovation and two-way learning, to guide global partnerships where nurses are active participants.Item Open Access Evaluation of the Accuracy and Health Provider Perceptions of Malaria Rapid Diagnostic Tests at a Rural Tanzania Hospital(2010) Chernick, Adam; Buntain, Bonnie; Allen, Lisa; Manyama, Mange; Hatfield, JenniferItem Open Access Is it home delivery or health facility? Community perceptions on place of childbirth in rural Northwest Tanzania using a qualitative approach(2020-05-06) Konje, Eveline T; Hatfield, Jennifer; Kuhn, Susan; Sauve, Reginald S; Magoma, Moke; Dewey, DeborahAbstract Background In low and middle-income countries, pregnancy and delivery complications may deprive women and their newborns of life or the realization of their full potential. Provision of quality obstetric emergency and childbirth care can reduce maternal and newborn deaths. Underutilization of maternal and childbirth services remains a public health concern in Tanzania. The aim of this study was to explore elements of the local social, cultural, economic, and health systems that influenced the use of health facilities for delivery in a rural setting in Northwest Tanzania. Methods A qualitative approach was used to explore community perceptions of issues related to low utilization of health facilities for childbirth. Between September and December 2017, 11 focus group discussions were conducted with women (n = 33), men (n = 5) and community health workers (CHWs; n = 28); key informant interviews were conducted with traditional birth attendants (TBAs; n = 2). Coding, identification, indexing, charting, and mapping of these interviews was done using NVIVO 12 after manual familiarization of the data. Data saturation was used to determine when no further interviews or discussions were required. Results Four themes emerge; self-perceived obstetric risk, socio-cultural issues, economic concerns and health facility related factors. Health facility delivery was perceived to be crucial for complicated labor. However, the idea that childbirth was a “normal” process and lack of social and cultural acceptability of facility services, made home delivery appealing to many women and their families. In addition, out of pocket payments for suboptimal quality of health care was reported to hinder facility delivery. Conclusion Home delivery persists in rural settings due to economic and social issues, and the cultural meanings attached to childbirth. Accessibility to and affordability of respectful and culturally acceptable childbirth services remain challenging in this setting. Addressing barriers on both the demand and supply side could result in improved maternal and child outcomes during labor and delivery.Item Open Access Late initiation and low utilization of postnatal care services among women in the rural setting in Northwest Tanzania: a community-based study using a mixed method approach(2021-07-02) Konje, Eveline T.; Hatfield, Jennifer; Sauve, Reg; Kuhn, Susan; Magoma, Moke; Dewey, DeborahAbstract Background Maternal and newborn mortality is high immediately after childbirth and up to 42 days postnatally despite the availability of interventions. Postnatal care is crucial in preventing mortality and improving the health of women and newborns. This prospective cohort study investigated the initiation and utilization of postnatal care at health facilities and explored users’ and providers’ perspectives on utilization of postnatal care services. Methods A sequential explanatory mixed method was used involving women who were followed from the 3rd trimester of pregnancy to 3–4 months postnatally in Northwest, Tanzania. From January to December 2018, a door-to-door survey was conducted 3–4 months postnatally among 1385 of these women. A convenience sample of women and community health workers participated in focus group discussions, and traditional birth attendants and nurses participated in key informant interviews to complement quantitative data. Data analyses were conducted using STATA version 13 and NVIVO version 12. Study findings Approximately, one half of participants attended postnatal care within 42 days after delivery. Postnatal care seeking within 48 h after delivery was reported by 14.6 % of the participants. Women who attended antenatal care at least four times, delivered at health facilities or experienced delivery-related complications were more likely to seek postnatal care. Limited knowledge on the postnatal care services and obstetric complications after childbirth, and not being scheduled for postnatal care by health providers negatively influenced services uptake. Overwhelming workload and shortages of supplies were reported to hinder the provision of postnatal care services. Conclusions Utilization of postnatal care services remains low in this setting as a result of a number of disparate and complex factors that influence women’s choices. Provision of effective postnatal care is hindered by lack of supplies, staffing, and inadequate infrastructure. To ensure accessibility and availability of quality services in this setting, both demand and supply sides factors need to be addressed.Item Open Access Missed opportunities in antenatal care for improving the health of pregnant women and newborns in Geita district, Northwest Tanzania(2018-10-05) Konje, Eveline T; Magoma, Moke T N; Hatfield, Jennifer; Kuhn, Susan; Sauve, Reginald S.; Dewey, Deborah MAbstract Background Despite the significant benefits of early detection and management of pregnancy related complications during antenatal care (ANC) visits, not all pregnant women in Tanzania initiate ANC in a timely manner. The primary objectives of this research study in rural communities of Geita district, Northwest Tanzania were: 1) to conduct a population-based study that examined the utilization and availability of ANC services; and 2) to explore the challenges faced by women who visited ANC clinics and barriers to utilization of ANC among pregnant women. Methods A sequential explanatory mixed method design was utilized. Household surveys that examined antenatal service utilization and availability were conducted in 11 randomly selected wards in Geita district. One thousand, seven hundred and nineteen pregnant women in their 3rd trimester participated in household surveys. It was followed by focus group discussions with community health workers and pregnant women that examined challenges and barriers to ANC. Results Of the pregnant women who participated, 86.74% attended an ANC clinic at least once; 3.62% initiated ANC in the first trimester; 13.26% had not initiated ANC when they were interviewed in their 3rd trimester. Of the women who had attended ANC at least once, the majority (82.96%) had been checked for HIV status, less than a half (48.36%) were checked for hemoglobin level, and only a minority had been screened for syphilis (6.51%). Among women offered laboratory testing, the prevalence of HIV was 3.88%, syphilis, 18.57%, and anemia, 54.09%. In terms of other preventive measures, 91.01% received a tetanus toxoid vaccination, 76.32%, antimalarial drugs, 65.13%, antihelminthic drugs, and 76.12%, iron supplements at least once. Significant challenges identified by women who visited ANC clinics included lack of male partner involvement, informal regulations imposed by health care providers, perceived poor quality of care, and health care system related factors. Socio-cultural beliefs, fear of HIV testing, poverty and distance from health clinics were reported as barriers to early ANC utilization. Conclusion Access to effective ANC remains a challenge among women in Geita district. Notably, most women initiated ANC late and early initiation did not guarantee care that could contribute to better pregnancy outcomes.Item Open Access Participatory knowledge mobilization: a gender analysis characterizing the understandings of mother-‐to-‐child HIV transmission in Maasai women and outreach healthcare workers in rural Tanzania(2012-07-30) Birks, Lauren; Hatfield, JenniferIn sub-‐Saharan Africa, women of childbearing age are particularly vulnerable to HIV/AIDS. Historically, efforts to mitigate HIV/AIDS among these women have been limited to high-‐risk groups, such as female sex workers and intravenous drug users. Such efforts lack a gendered perspective, and therefore do not account for power differentials and patriarchal structures that influence women’s ability to access healthcare, to make healthcare-‐related decisions, and to access health information. Gender inequities such as limited access to HIV care and treatment services, decreased ability to negotiate safe sexual encounters, and lack of access to family planning, are all factors that increase HIV prevalence among women. For Maasai women, residing in the Ngorongoro Conservation Area, Northern Tanzania, gender inequities are amplified by polygamy and a patriarchal social structure. Women are largely excluded from opportunities for education and lack autonomy when it comes to health decision-‐making. Knowledge of HIV is limited, and maternal health services remain limited and underutilized. My research objectives were to investigate Maasai women’s knowledge of HIV and PMTCT in order to assist Endulen Hospital with delivering HIV and PMTCT services. I used participatory action research and gender analysis methodologies to explore and describe women’s experiences with HIV and PMTCT. As the research process unfolded, salient inequities in health and welfare of Maasai women became evident. Women clearly emphasized that while HIV and PMTCT were of concern to their community, maternal health and women’s specific health were of paramount concern to them. Through the process of action research, my participants and I formed a women’s group that shared each other’s experiences of living with gender-‐based inequities. We examined the consequences of these inequities, and discussed possible modes of action that could attenuate the oppressive burden these women carry everyday.Item Open Access Participatory science and innovation for improved sanitation and hygiene: process and outcome evaluation of project SHINE, a school-based intervention in Rural Tanzania(2017-02-07) Hetherington, Erin; Eggers, Matthijs; Wamoyi, Joyce; Hatfield, Jennifer; Manyama, Mange; Kutz, Susan; Bastien, SheriAbstract Background Diarrheal disease is a major cause of mortality and morbidity in low and middle income countries with children being disproportionately affected. Project SHINE (Sanitation & Hygiene INnovation in Education) is a grassroots participatory science education and social entrepreneurship model to engage youth and the wider community in the development of sustainable strategies to improve sanitation and hygiene. Methods Based in rural and remote Tanzania, this pilot study engaged pastoralist high-school students and communities in the development and evaluation of culturally and contextually relevant strategies to improve sanitation and hygiene. Using a train-the-trainer approach, key activities included teacher workshops, school-based lessons, extra-curricular activities, community events and a One Health sanitation science fair which showcased projects related to water, sanitation and hygiene in relation to human and animal health. The process and outcome of the study were evaluated through qualitative interviews and focus group discussions with diverse project participants, as well as pre- and post- questionnaires completed by students on knowledge, attitudes and practices concerning sanitation and hygiene. Results The questionnaire results at baseline and follow-up showed statistically significant improvements on key measures including a decrease in unhygienic behaviors, an increase in the perceived importance of handwashing and intention to use the toilet, and increased communication in the social network about the importance of clean water and improved sanitation and hygiene practices, however there were no significant changes in sanitation related knowledge. Qualitative data highlighted strong leadership emerging from youth and enthusiasm from teachers and students concerning the overall approach in the project, including the use of participatory methods. There was a high degree of community engagement with hundreds of community members participating in school-based events. Sanitation science fair projects addressed a range of pastoralist questions and concerns regarding the relationship between water, sanitation and hygiene. Several projects, such as making soap from local materials, demonstrate potential as a sustainable strategy to improve health and livelihoods in the long-term. Conclusions The Project SHINE model shows promise as an innovative capacity building approach and as an engagement and empowerment strategy for youth and communities to develop locally sustainable strategies to improve sanitation and hygiene.Item Open Access Plagiocephaly in Calgary, Alberta, Canada: Incidence, Risk Factors and Follow-Up(2011) Mawji, Aliyah Abdulrasul; Vollman, Ardene Louise Robinson; Hatfield, JenniferItem Open Access Promoting equitable global health research: a policy analysis of the Canadian funding landscape(2017-08-29) Plamondon, Katrina; Walters, Dylan; Campbell, Sandy; Hatfield, JenniferAbstract Background Recognising radical shifts in the global health research (GHR) environment, participants in a 2013 deliberative dialogue called for careful consideration of equity-centred principles that should inform Canadian funding polices. This study examined the existing funding structures and policies of Canadian and international funders to inform the future design of a responsive GHR funding landscape. Methods We used a three-pronged analytical framework to review the ideas, interests and institutions implicated in publically accessible documents relevant to GHR funding. These data included published literature and organisational documents (e.g. strategic plans, progress reports, granting policies) from Canadian and other comparator funders. We then used a deliberative approach to develop recommendations with the research team, advisors, industry informants and low- and middle-income country (LMIC) partners. Results In Canada, major GHR funders invest an estimated CA$90 M per annum; however, the post-2008 re-organization of funding structures and policies resulted in an uncoordinated and inefficient Canadian strategy. Australia, Denmark, the European Union, Norway, Sweden, the United Kingdom and the United States of America invest proportionately more in GHR than Canada. Each of these countries has a national strategic plan for global health, some of which have dedicated benchmarks for GHR funding and policy to allow funds to be held by partners outside of Canada. Key constraints to equitable GHR funding included (1) funding policies that restrict financial and cost burden aspects of partnering for GHR in LMICs; and (2) challenges associated with the development of effective governance mechanisms. There were, however, some Canadian innovations in funding research that demonstrated both unconventional and equitable approaches to supporting GHR in Canada and abroad. Among the most promising were found in the International Development Research Centre and the (no longer active) Global Health Research Initiative. Conclusion Promoting equitable GHR funding policies and practices in Canada requires cooperation and actions by multiple stakeholders, including government, funding agencies, academic institutions and researchers. Greater cooperation and collaboration among these stakeholders in the context of recent political shifts present important opportunities for advancing funding policies that enable and encourage more equitable investments in GHR.Item Open Access Public Health Interventions and Harmful Unintended Consequences: Towards a typology and understanding of underlying factors to inform intervention planning.(2014-04-23) Scott, Lisa Kathleen Allen; Hatfield, JenniferBackground: Despite systematic inclusion of unintended harm evaluation and reporting in evidence-based medicine, this concept remains relatively unexplored in evidence-based public health. As harmful unintended consequences (UC) continue to emerge from well-meaning public health interventions (PHI), evidence of both the complex pathway to the generation of harmful UC and the types of harmful UC to be evaluated and reported are essential for public health planners and evaluators. This dissertation aims to address this gap by advancing both the theoretical and practical knowledge on this underrepresented topic. Objective: To develop a theoretical and practical foundation for identification and mitigation of harmful UC associated with PHI so that planning frameworks may be adapted for use in various contexts. Methods and Results: A scoping review was conducted to describe a typology and underlying factors associated with PHI harmful UC. The typology included consideration of physical, psychosocial, cultural, economic and environmental unintended harms. Next, a realist review was undertaken to investigate the usefulness of Merton’s (1936) underlying factors of UC, namely - ignorance, error, basic values, immediate interest and self-defeating prophecy for understanding how and why harmful UC associated with weight-focused PHI occur. When applied to weight-focused PHI, Merton’s theoretical framework, together with two emergent mechanisms of reductionism and false premises provide explanatory usefulness and subsequently were used to generate a conceptual framework for PHI associated harmful UC. The resulting framework was then examined using the population health approach as a lens to look critically at harmful UC associated with the presumptive diagnosis and treatment of malaria high-risk strategy. Finally, using the WHO (2009) systems thinking framework as a guide, practical discussion questions were proposed for a transdisciplinary group of public health planners to consider when attempting to reduce harmful UC associated with well-meaning PHI. Conclusions: This research provides important advancements in both harmful UC theoretical understanding and practical steps that can be implemented by public health planners to improve the ability to anticipate, rather than simply react to harmful UC associated with PHI.Item Open Access Soil transmitted helminth infection in primary school children varies with ecozone in the Ngorongoro Conservation Area, Tanzania(2021-03-10) Eltantawy, Manar; Orsel, Karin; Schroeder, Ashley; Morona, Domenica; Mazigo, Humphrey D.; Kutz, Susan; Hatfield, Jennifer; Manyama, Mange; van der Meer, FrankAbstract Background Soil-transmitted helminthiasis is a neglected tropical disease, thriving in environments of poverty and disadvantage. Our objective was to determine the prevalence and intensity of four soil transmitted helminths (STH) among primary school children in the Ngorongoro Conservation Area (NCA), Tanzania. Methods A cross-sectional study was performed between May 15th and June 2nd, 2014. Six of 20 primary schools were chosen, based on elevation, designated low elevation ecozone (LEE) or high elevation ecozone (HEE). A total of 340 children from standards one to four were recruited. Height and weight of each child was determined and body mass index (BMI) was calculated. Stool samples were analyzed using the Kato-Katz, Wisconsin, and Baermann techniques to detect STH eggs and larvae. An interviewer-administered questionnaire on socio-demographic variables was used to capture information from the school’s headmaster and a checklist was used to assess sanitation facilities. Results STHs identified included Ascaris (presumably lumbricoides), Trichuris (presumably trichiura), hookworms (presumably Ancylostoma duodenale and/or Necator americanus), and Strongyloides (presumably stercoralis). The overall prevalence of STH infection was 29.0% in LEE and 34.0% in HEE. Prevalence was 34.3% and 28.2% in males versus females, respectively. Ascaris sp. were only identified in HEE, prevalence of Trichuris sp. and hookworms were significantly higher in HEE compared to LEE, and Strongyloides spp. prevalence was lower in HEE. Intensity of Trichuris sp. was significantly higher in HEE and lower for hookworms. We did not detect a significant relationship between BMI and helminth intensity; however, BMI was lower in lower elevations and in males vs. females. Sanitation practices are taught at the schools, but challenges were identified when implementing. Latrine facilities were available and latrine-cleaning routines were practiced; however, hand washing practices were challenging due to restricted water availability. Conclusions Significant differences in prevalence in HEE and LEE exist, and STH infections are still very common among school children suggesting that anthelminthic intervention and education may be necessary in this region. Based on this outcome, the study area in the NCA would be classified as a medium risk area, where periodic treatment recommendations should be based on prevalence estimations in the different ecozones. Trial registration Ethics approval was obtained from the Catholic University of Health and Allied Sciences (CUHAS; Lake Zone Institutional Review Board MR/53/100/307)); the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary in Canada (Study ID REB14-0127); the National Institute of Medical Research (NIMR) of Tanzania; and the Tanzania Commission for Science and Technology (COSTEC).Item Open Access The Context of Maternal and Child Health Services in Northwest Tanzania: Missed Opportunities for Preventing Maternal and Perinatal Mortality in Rural Communities(2020-08-10) Konje, Eveline; Dewey, Deborah; Magoma, Moke Tito Nyambita; Hatfield, Jennifer; Kuhn, Susan; Sauve, RegThe problem: In low- and middle-income countries, women and newborns are faced with premature death due to the lack of safe and timely antenatal, natal, postnatal and newborn care. In Tanzania, maternal and newborn mortality remains high. Health care across the maternal and child continuum of care is recognized to improve survival among women and newborns; however, there are significant differences between rural and urban areas in quality of services and utilization. The overall aim of this dissertation was to investigate the context of maternal and child health services for preventing maternal and perinatal mortality in rural communities in Geita district Northwest Tanzania. Methods: We conducted a prospective population-based study that involved 1714 pregnant women in their third trimester and followed them to 3-4 months postnatally. A mixed methods study design was utilized to capture quantitative and qualitative data. Different stakeholders, namely women, male partners, traditional birth attendants, community health workers, and nurses in charge of reproductive and child health units participated in focus group discussions and key informant interviews. STATA versions 13 and 15 were used to analyze quantitative data while NVIVO 12 was used for qualitative data. Conclusions: Maternal and child mortality rates in this rural area of Tanzania remained high and delivery at a health care facility is not associated with improved perinatal mortality. Early initiation and uptake of antenatal, natal, and postnatal care are not commonly practiced in this setting due to a complex set of factors at the individual, community, and health facility levels. Accessibility, availability, affordability, and acceptability of effective maternal health care remains a challenge among women in rural Geita district, Tanzania. Provision of effective services across the maternal continuum of care is hindered by lack of supplies, staffing, and inadequate infrastructure as well as sociocultural constructs related to gender roles and normative beliefs surrounding pregnancy and childbirth. These findings suggest that in this rural district in Tanzania there are missed opportunities to prevent maternal and infant mortality and morbidity, and improve maternal and child health outcomes, which could partly explain persisting high mortality among women and newborns.Item Open Access Women and leadership in the profession of law: A discursive approach(2000) Hatfield, Jennifer; Radtke, H. Lorraine