• The Association of Integrated Management of Childhood Illness' Asthma Management Protocol and Asthma Control in Omani Children 2-5 years Old

      Al Amri, Warda; Ogbolu, Yolanda; Johantgen, Mary E. (2018)
      Background: Oman had the highest asthma prevalence and severity in children among Eastern Mediterranean countries. Despite national implementation of Integrated Management of Childhood Illness (IMCI) asthma protocol, reports show no improvement in asthma-related hospital admissions among children aged 1-4 years. IMCI asthma treatment protocol implementation and factors affecting asthma control are understudied. Purpose: Describe characteristics of IMCI asthma management protocol implementation (medication, counselling, and specialist referral); explore multilevel factors associated with asthma control in children attending IMCI clinics; and analyze trends in acute care visits (emergency department [ED] and hospital admissions) by asthmatic children and their characteristics during one year follow-up. Methods: Retrospective cohort study of Omani children aged 2-5 years in Muscat was conducted using electronic health data (2012-2015). Asthma control was measured by number of exacerbations requiring visits to the health center, emergency care or hospitalization within one year of asthma index diagnosis. Generalized linear mixed-effects modelling was used to account for the clustering of children within health centers. Results: Mean age was 2.8 years, predominantly male (63.2%) and originally from Muscat (96.2%). On index diagnosis day, 61.2% were given reliever medications, and on discharge 47.1% were prescribed controller medications. Most (74%) children had well-controlled asthma that was highly associated with being treated in a health center with higher proportion of IMCI training (Adj. OR= 3.0; 95% CI =1.34, 6.73; p <0.01), and receiving short acting β2-agonists for acute management at index diagnosis (Adj. OR=2.4; 95% CI=1.38-4.09). There was limited data for specialist referrals and counselling. Majority of children with ED visits were infrequent attenders (94.1%), however, a small percentage had high acute care utilization (e.g. 21 visits/year). Conclusion: IMCI is designed to improve health outcomes of young children. A high proportion of children treated in IMCI clinics achieved well-controlled asthma. Training of physicians improved asthma outcomes, but specific components in the IMCI asthma management protocol need more reinforcement and further exploration. Utilizing prevention quality indicators to screen for implementation of IMCI components is recommend. Longitudinal investigation of multilevel factors (patient, family, practice, and health care system) associated with childhood asthma control in Oman is needed.
    • A Comparative Study of Preventive Healthcare Behaviors Among African Immigrant Women (AIW) and African American Women (AAW): Barriers and Facilitators of Cervical Cancer Prevention

      Kuffour-Manu, Vera Akosua; Ogbolu, Yolanda; Johantgen, Mary E. (2018)
      Abstract Background: Early screening, detection, and treatment of cervical pre-cancerous cells could prevent up to 80% of cervical cancers and reduce cervical cancer mortality by 52% globally. In the United States cervical cancer incidence has decreased by as much as 50% over the past 40 years due to widespread utilization of preventive health services. Yet, health disparities in cervical cancer persist among African immigrant women (AIW) and African American women (AAW) in the US. There is limited research exploring the barriers and facilitators of preventive health services for AIW and AAW. Purpose: To explore perceived barriers and facilitators, and lived experiences of AIW and AAW related to cervical cancer prevention services. Methods: A qualitative study included 14 AIW and 14 AAW, residing in the Washington, DC-Baltimore Metropolitan area. Purposive sampling technique was used to recruit participants from churches,community center, grocery stores and a radio station. A semi-structured interview guide and a demographic questionnare were used for data collection. Data were analyzed using the Intepretative Phenomenological Analysis Method. Nvivo software was used to organize and code the data. Results: The mean age of participants was 41.1(11.9), with most of the women being college educated (93%), with health insurance (96%) that paid for cervical cancer prevention (89%). Many (79%) had not received HPV vaccine and 82% had a pap smear within 1-4years. AIW and AAW data were triangulated and revealed few differences between the groups. Six broad themes emerged grounded in the Health Belief Model. Barriers identified included limited knowledge and awareness of HPV infection, risk, and vaccines; myths related to abstinence, fear, and cleanliness of healthcare facilities; lack of trust and reliance on God for healing. Facilitators included the need to feel safe and healthy; prevent and treat disease; utilize informal and formal support systems; and receive recommendation from providers and public health education related to preventive services. Conclusion: Study findings can be used to mitigate barriers and enhance facilitators to develop culturally tailored interventions for AAW and AIW. The active engagement of health providers, the community and faith based partners can be leveraged to strengthen the development of prevention research.
    • Neonatal Mortality in Nigeria: The Impact of Nurse Work Organization

      Ogbolu, Yolanda; Johnson, Jeffrey V. (2011)
      Neonatal Mortality in Nigeria: The Impact of Nurse Work Organization Yolanda Ogbolu, Doctor of Philosophy, 2011 Dissertation Directed by: Jeffrey V. Johnson, PhD, Professor, Director of Office of Global Health Background: The 4th Millennium Developmental Goal (MDG-4) commits the international community to reduce child mortality by two-thirds between 1990 and 2015. Neonatal mortality accounts for 30-40% of worldwide child mortality. Globally, 99% of these deaths occur in low and middle income countries, like Nigeria. In developing countries nurses are the backbone of the health care system, however, there is a scarcity of research examining how nurses contribute to reducing neonatal mortality. Although, nurse organization factors, such as nurse staffing and the nurse practice environment have demonstrated significant relationships with patient outcomes in resource rich countries, these findings cannot be generalized to the developing countries of Sub-Saharan Africa. Purpose: The purpose of this study was to examine associations between nurse work organization factors with nursing care practices and inpatient neonatal mortality in Nigeria. Methods: Utilizing Aiken's Work Organization and Outcomes Theoretical Framework, a cross-sectional, organizational study was conducted in 27 Nigerian hospitals. MCH nurses (n=223) completed anonymous surveys to collect data on their care processes, the practice environment, and staffing characteristics. Hospital administrators (n=27) were also surveyed using the WHO Safe Motherhood Assessment Tool to collect data on the availability of material resources and facility level in-patient neonatal mortality data. Results: This study revealed extremely high patient to nurse ratios, a severe lack of neonatal material resources, and high neonatal mortality rates across the various levels of care. Staffing was found to be significantly associated with neonatal mortality. However, the direction was reversed from earlier studies using the Aiken model. The Nurse Practice Environment and the Nursing Care Processes scales both lacked variation in this sample and no significant relationships were detected between the scales and neonatal mortality. Conclusions: This study provides descriptive data on the work environment of nurses and presents evidence of poor nurse staffing, lack of material resources, and significant variations in neonatal mortality across levels of care. This study was the first, to our knowledge, to assess the nurse work organization using the Aiken model in sub-Saharan Africa.