Doctoral Degrees (CHNS)

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Malaria situation in Namibia: A study of vector species and effectiveness of the past and current control strategies in selected parts of Namibia
(University of Namibia, 2005) Kamwi, Richard C.
The distribution of malaria in Namibia is mainly confined to the northern parts of Namibia. Although the malaria vectors were presumed to be Anopheles arabiensis, a member of the Anopheles gambiae group of morphologically similar species, no scientific study had been undertaken to identify the species in Namibia. Given the variable behaviour of this species, in an area where the mainstay for vector control has been indoor residual house spraying (IRS) with 75% DDT wettable powder since the 1960’s, reassessment of the vector species composition and its resting and biting behaviour are absolutely important. In addition to insecticide house spraying, the malaria control included case management with Chloroquine, as the first line treatment for uncomplicated malaria. The general objective of the study was to determine the vector species in malaria transmission, seasonal abundance, behaviour of malaria vectors and efficiency of the diagnostic and treatment procedures and the overall malaria control scenario in Namibia. Two sites were selected for this study based on the demographic, epidemiological and climatic conditions that are believed to represent the various malaria endemic areas in northern Namibia. Malaria vector species were collected from Kalimbeza village, Katima Mulilo district in northeast of Namibia by means of exit window traps of the Muirhead-Thomson design for a year. In addition, Pyrethrum Spray Catches (PSC) were used to collect mosquitoes in Calueque, southern Angola and northern Namibia. Species identification was by means of Polymerase Chain Reaction (PCR). Thick and thin blood smears and body temperatures were collected from suspected malaria patients in Bukalo and Mahenene health centres in order to determine malaria parasite prevalence and malaria episodes caused by Plasmodium falciparum. The therapeutic efficacy study was carried out over 28 days’ follow-up period, in line with the World Health Organization (WHO). Retrospective malaria data for inpatient and outpatient were obtained from the Ministry of Health and Social Services. They were analysed and graphically presented on a map. Analysis of the retrospective malaria statistics in Namibia from 1995 to 2003 showed that, children under the age of five years were more affected by malaria as compared to those above five years. This pattern is similar in all malaria endemic areas because of lack of immunity among the children under the age of five years. Immunity due to malaria is known to build up with age. In non-malaria endemic areas on the other hand, there is usually no significant difference between the different age groups. The highest mean incidence ratio of malaria among the two age groups was observed in Kavango (3.4:1) and Caprivi (3:1) regions. Furthermore, the overall malaria morbidity and mortality rates were exceptionally higher in Kavango regions followed by Omusati and Ohangwena regions. There are two explanations for this finding. Firstly the areas receiving more rains and/or are in proximity to rivers have more malaria than others. The same is true if the areas border with neighbouring countries where there are no prevention interventions in place as a result of either a damaged health system or general lack of resources. This was the case for the three regions. It is therefore important for neighbouring countries to strengthen border coordination for malaria control and prevention as malaria knows no borders. The identification of mosquito specimen by means of Polymerase Chain Reaction (PCR) revealed that the most common vector species in northern Namibia is An. arabiensis (89%). This was the only member of the An. gambiae group of species reported from the present study. Other malaria vector species included An. funestus, which accounted for 1% and the remaining 10% comprised of non-malaria vector species. The study further revealed that there are more An. funestus (36%) in unsprayed areas of Calueque, in southern Angola than An. arabiensis which only accounted for 30%. This confirmed the high endophilic tendency (preference for indoor-resting) of An. funestus, which makes it more amenable to vector control interventions such as indoor residual house-spraying and/or insecticide-treated bednets (ITNs). More An. arabiensis (77%) were identified during the wet season in Andara and Kalimbeza villages than during the dry season (13%). To the contrary, An. funestus species were more abundant during the dry season (6%) compared to 3% collected during the wet season. A chi-square statistic of 67.3, P = 0.000 with 2 degrees of freedom (n = 444) indicate that the two variables (season and species) are not independent. The seasonal distribution of An. arabiensis therefore coincided with the malaria peak season which is during the wet season. Any vector control intervention must therefore be applied just before the wet season to have an impact on the malaria transmission. Out of a total of 1294 mosquitoes belonging to An. arabiensis caught in window traps, only 31% were fully blood fed. These results suggest that some mosquitoes could penetrate into huts but could not rest on walls or roofs of sprayed huts to find sufficient time to land on humans for a blood meal. The possible explanations for this are variable. It could possibly be that the insecticide on the walls (DDT) irritated and/or inhibited feeding of the mosquitoes. A high proportion of unfed female mosquitoes could also be due to lack of insemination during mating before they entered the sprayed huts. Answers to these questions however, were not part of the initial objectives of the present study. The results of the relationship between fevers and clinical malaria on the other hand, revealed no correlation between fevers and clinical malaria. The correlation coefficient between having fever and having a positive blood smear was 0.10 (p = 0.71), indicating that the difference is not statistically significant. Moreover, the Chi-square statistic for reports of fevers and a positive blood smear was also not statistically significant different. For example 72% of the patients who had fever were in fact not having malaria. This means that the statistical test reveals that most patients that were diagnosed to have fever and hence given malarial treatment did not have clinical malaria on the basis of microscopic examination (clinical malaria). The current study therefore indicates that health facilities in Namibia, like elsewhere are wasting a lot of meagre resources through over-diagnosis of patients as malaria. The situation is made worse when patients have to be treated with the more expensive Artemisnin-based combination therapies (ACTs) due to chloroquine and supposedly Sulfadoxine Pyrimethamine failures. This finding calls for the need to use microscopic examination to improve malaria diagnosis in health facilities so that only those positive for malaria are treated with antimalarial drugs. The results of the chloroquine efficacy study demonstrated that Treatment Failure rate was not significantly lower than 25%, which is the cut-off point for detecting resistance. With these results it is clear that chloroquine can no longer be used as a first line drug for the treatment of uncomplicated malaria in Namibia. Based on the findings of the current study and its implications to improve the vector control and case management interventions employed by the National Vector-borne Disease Control Programme in Namibia, the following recommendations are pertinent: 1. There is a need to further explore the presence of An. funestus along the border of Kavango and Angola and that of Caprivi and Zambia. Further investigation is needed to establish whether or not this species is indigenous. The possibility of introduction from Angola and Zambia cannot be completely ruled out thus calling for closer malaria border coordination activities. 2. The proportion of surviving adult blood fed mosquitoes caught in exit window traps is worrying as they can still transmit malaria even in the presence of insecticide residues. The challenge remains for the National Vector-borne Disease Control Programme to further monitor the proportion of vectors resting in-doors and out-doors and based on the respective findings, be able to respond appropriately. 3. The insecticides currently in use (DDT, deltamethrin and permethrin) by the National Vector-borne Disease Control Programme are effective against the local malaria vectors - An. arabiensis and An. funestus group. To ascertain their continued use in Namibia would require the strengthening of the control programme current capacity to monitor insecticide resistance in well chosen sentinel sites across the malaria endemic regions of the country. 4. Malaria is highly over-diagnosed. The MoHSS needs to seriously consider introducing diagnostic facilities at peripheral health facilities to minimize over-diagnosis and wastages of drugs - especially as the current trend is to move towards the more expensive artemisinin-based combination therapy (ACT) as first line treatment for uncomplicated malaria. In non-sprayed villages of southern Angola malaria prevalence is higher than in the neighbouring villages of Namibia where spraying was done. It is important that border coordination is strengthened with neighbouring countries – including the area of vector control. 5. Because of the reduced efficacy of chloroquine, the need to change the treatment policy to combination-based therapies is more imminent than ever before for reasons of efficacy and compliance. 6. Analysis of the retrospective malaria data in the country demonstrated that malaria incidence was highest in Kavango region followed by Omusati, Ohangwena, Oshikoto, Caprivi, Kunene, Otjozondjupa and Oshana respectively. On the other hand, the analysis of mortality data revealed that Kavango, Omusati, Oshikoto, Ohangwena, Oshana and Caprivi regions experience the highest rates in descending order. The data also revealed that the under five-age group in Kavango and Caprivi were three times more frequently affected than the five years and above age groups. This is an indication that malaria is relatively more stable in Kavango and Caprivi regions as compared to other malaria endemic regions. 7. Appraising the role of vector control as one of the key strategies for malaria control in Namibia, it is important that the national capacity to plan, implement, monitor and evaluate the different vector control interventions is strengthened by allocating adequate resources for capacity in entomology and vector control and resources for physical infrastructures and for operations. 8. With the general trend of most malaria endemic countries to decentralize their health services to the lowest administrative levels, it will be necessary for the MoHSS to determine the administrative level to which vector control services could be devolved while ensuring that the impact of key vector control interventions are not compromised.
A model to facilitate male partner involvement in the reproductive health context in Oshikoto region in Namibia
(2010) Amukugo, Hans J.; ;
Developing a guide for baseline salonella agglutinin titres according to age, gender and HIV status in patients attending at hospitals in northern Namibia.
(2012) Chikukwa, Sydney
In Namibia, the Widal test (a blood test that detects level of Salmonella antibodies) is widely used in the diagnosis of typhoid fever. There are no available normal population baseline Salmonella agglutinins titres in Namibia which can be used to come up with country specific diagnostic titres for typhoid fever. The normal population baseline Salmonella agglutinin titre is used as the basis for the interpretation of the Widal test. Since there is no guide, it means that standardization of patient care in Namibia is not possible. The aim of the study was to develop a guide for the interpretation of diagnostic Salmonella agglutinin titres for typhoid fever after performing a Widal test. The objectives of the study were to; determine the prevalence of typhoid fever for age, gender and HIV status among patients attending five hospitals in northern Namibia; establish age, gender and HIV status presumptively diagnostic Salmonella agglutinin titres for the diagnosis of typhoid fever; develop a conceptual framework based on the outcome of the situational analysis; develop a guide for baseline Salmonella agglutinin titres for age, gender and HIV status in patients attending hospitals in northern Namibia and finally to implement, monitor and evaluate the efficacy of the guide on baseline. Blood samples were collected from 400 subjects; 200 males and 200 females, of the 200 males 100 were children (<16years) and of the 200 females 100 were also children (<16years), half of each gender and age group were HIV positive and the other half HIV negative; the blood samples were examined for the presence and levels of Salmonella antibodies by Widal agglutination technique. Standard S. typhi O and H and Salmonella paratyphi AH and BH suspension (FORTRESS) were used as antigens. This study reports that Typhi O and Typhi H titres greater than 80 are diagnostic of typhoid fever in the studied population regardless of age, gender and HIV status. Typhi O titres greater than 40 and Typhi H titres greater than 80 are diagnostic of typhoid fever in HIV positive patients whilst typhi O titres greater than 80 and typhi H titres greater than 40 are diagnostic of typhoid fever in HIV negative patients. The current diagnostic titre for typhoid fever of 160 for both typhi O and typhi H is too high and many typhoid cases are being missed and must be changed urgently, by the adoption of the guide developed by this study. The current Widal procedure should include a 1 in 120 dilution, to give a titre 120 between titre 80 and titre 160, so as to minimise the risk of missing cases of typhoid fever with titres greater than 80 but less than 160. This study has revealed that the current typhoid diagnostic titre of 160 for both typhi O and H is too high. A guide for the interpretation of Widal test has been developed specifically for northern Namibia. The guide can only be used in patients who are older than 2 years as these are capable of forming antibodies. This study has shown that there is a significant association between HIV and Salmonella agglutinin titres. This revelation could be used to lobby for policy change as in revision of treatment and management of HAART (Highly Active Antiretroviral Therapy) and typhoid vaccination policies. This study has shown that typhoid fever is highly prevalent in Northern Namibia and it calls for drastic public health intervention by all stake holders under the leadership of Ministry of Health and Social Services. Laboratories should implement a comprehensive quality assurance program to enhance the validity and reliability of the Widal test. This will improve accurate diagnosis and give the surest way to reverse the deteriorating health status of Namibians.
Strategies to support the utilisation of the nursing process by the registered nurses in local-level primaty health care practice in Namibia
(2013) Iita, Hermine
The purpose of this study was twofold. Firstly to explore and describe the utilization of the Nursing Process by registered nurses in local level Primary health care practice in Namibia with regard to Primary health care delivery during their daily practices and secondly, to develop strategies that would support registered nurses in executing their role and function in this regard. These were prompted by the implementation of a Primary health care approach to health care delivery in the country. The objectives of the study were: To explore and describe the way in which registered nurses in clinics, healthcare centres and outreach posts in the health districts use the nursing process as regards PHC delivery;  To determine how supervisors perceive the utilisation of the nursing process by registered nurses with regard to PHC;  To identify the constraints that registered nurses are faced with when utilising the nursing process with regard to the delivery of PHC;  To develop a conceptual framework on which to base the formulation of relevant strategies,  To incorporate the findings of this study into the development of strategies to support registered nurses in their utilisation of the nursing process with regard to the delivery of PHC;  To validate the appropriateness of these strategies, a multi- phase, quantitative, exploratory, descriptive and contextual design was selected to provide a picture of how registered nurses fulfill their role and function concerning Primary health care (PHC) during their daily practices. The population consisted of two groups. The first group consisted of 239 registered nurses working in Clinics, health Centres and in Outreach Programmes. The second group consisted of 39 registered nurses supervisors, who supervised the registered nurses in these facilities. A survey was used to gather the data through self-report (questionnaire). Two questionnaires were developed, one for registered nurses and the other for immediate supervisors. Quantitative, descriptive analysis was used to summarize and organize data using tables and figures as well as t-test and analysis of variance (ANOVA), where applicable. Five main areas where registered nurses needed support in execution of their roles and functions were revealed from the results. The areas were: Water and sanitation and other environmental health issues; health education and communication including outreach activities; Nutrition and food supply; Community diagnosis and care and Management support or administrative functions in Primary health Care, including research and education of health workers including fellow registered nurses. Strategies to support the utilization of the Nursing Process by registered nurse in local level Primary health care were developed based on the results of the conceptualization. The problem areas were first analysed and synthesized and three overarching strategies were formulated namely, Strategy 1: Addressing the contributing factors to challenges that hinder professional nurses to maximally utilise the nursing process in their daily Primary health care practice; Strategy 2: Strategy regarding research activities to be conducted by registered nurses and Strategy 3: Strategy regarding the managerial or administrative aspects in local level primary health care. Recommendations were made based on the study findings and the strategies formulated.
Guidelines to enhance communication skills of nurses caring for patients diagnosed with Tuberculosis at public health facilities in the Khomas region of Namibia
(2013) Kamenye, Esther
The overarching purpose of this study was to explore and describe how nurses communicate with patients diagnosed with tuberculosis (TB) at public health facilities in the Khomas Region of Namibia, and to develop guidelines for communication that would enhance the communication skills of nurses. To address the purpose of the study, a research project was conducted, which was quantitative, exploratory, descriptive, and contextual in nature. The study was conducted in four phases, starting with an exploration and description of communication process between nurses and patients diagnosed with tuberculosis in Phase 1, followed by the development of a conceptual framework for effective communication in phase two. Phase 3 involved the process of developing guidelines, and Phase 4 focused on the implementation and evaluation of these guidelines. The population and the sample of the study were the same (thirty nurses and thirty patients diagnosed with TB from all the public health facilities in the Khomas Region). The data collection method employed was observation using a checklist, followed by individual semi-structured face-to-face interviews with nurses, and also with the patients diagnosed with tuberculosis. The quality of research and research instrument were determined by its validity and reliability. Data obtained were analysed by using the Epi InfoTM software package, and content analysis. The main findings established that nurses who were caring for patients diagnosed with tuberculosis exhibited inadequate communication skills in the following areas: creating a conducive environment for communication, assessing and understanding the patients’ mood and level of understanding, listening, questioning, constructive feedback, understanding of non-verbal communication, respect, and empathy for patients. The study results also revealed that patients diagnosed with tuberculosis had inadequate knowledge about TB. The majority of patients diagnosed with TB did not know the type of TB they had and they perceived alcohol and smoking as the causes of TB. From the findings, the researcher developed guidelines for communication that were reviewed and validated by the guidelines development group. The nurses were trained to apply guidelines on communication during their daily interaction with patients diagnosed with tuberculosis. Three months after training, evaluation results indicated a significant improvement in reducing the aforementioned communication limitations of the nurses, while the patients’ knowledge of TB was also improving. All patient participants knew that TB was caused by the bacteria/germs, and all of them knew the type of TB they had. The researcher recommends that the TB policymakers integrate these communication guidelines into TB policies, guidelines, and manuals.
Health care needs of displaced women living in Osire refugee camp in Namibia
(2014) Pinehas, L.N.
The aim of the study was to explore the experiences of displaced women living in the Osire refugee camp in Namibia about their health care needs, and to develop health care guidelines that will help to address the identified health care needs of displaced women. A descriptive phenomenological study was used, using face-to-face interviews with participants in response to one question. The following question was asked: What are the health care needs of displaced women living in Osire refugee camp and how should they be addressed? Ten women were interviewed. Theirages ranged between 18 and 58 years. The duration of displacement was longer than 6 months. lnterviews were conducted in Osire Refugee Camp in Namibia. Displaced women were invited to participate in the study on a voluntary basis. The interviews were tape recorded and transcribed verbatim. During the analysis the essence substantiated by the constituents of their experiences regarding their health care needs were identified. The findings of the health care needs of displaced women living in Osire refugee camp reflect that they have a need for restoration of hope and human dignity. A thorough literature review was done and the constituents were re-phrased to form guidelines on how to address the health care needs of displaced women. The guidelines were refined through a Delphi study.
A health education programme to enhance knowledge and communication skills of health care workers serving people living with HIV/AIDS on haart in Namibia
(University of Namibia, 2015) Chipare, Mwakanyadzeni A.
Namibian health care workers (health care workers) are affected in providing quality health care services to people who are living with HIV/AIDS (PLWHA) if they do not have the necessary knowledge, as well as adequate interpersonal communication and counselling skills. In a health care facility set-up, all patients either come from the community or are referred from the wards or other departments by health care workers. The health care worker as a (sender) conveys information (messages) and a patient (receiver) is expected to comprehend these messages and to respond by giving feedback to the sender who, in turn, provides feedback until the communication process is completed. The process should take place in a conducive environment without any interference, such as noise, to allow the swift completion of the communication process. The messages that both parties convey should be clear, accurate, coherent, and concise. The purpose of the study was to develop a health education programme that would enhance the communication skills and knowledge of health care workers serving PLWHA on HAART in Namibia. The intention was to develop a health education programme (HEP) for strengthening these skills. The population comprised two groups, namely health care workers and HAART patients. A purposive sampling method was used for selecting 23 health care workers and 20 HAART patients. Data was collected through focus group discussions with health care workers and in-depth interviews with HAART patients. Tesch in De Vos, Krueger’s and Casey (2009) theories guided the data analysis process. The programme was developed based on themes of the study and implemented by training health care workers and describing recommendations. Trustworthiness validation utilised data credibility, transferability, dependability, and conformability. Ethical measures were observed throughout the study. The researcher conducted the study in four phases. Phase I presented a needs assessment of the health care workers’ experiences in interpersonal communication, counselling skills, HIV / AIDS management and health knowledge of PLWHA on HAART. Phase II represented the conceptual framework to illustrate the study results that were supported by the emerged themes and sub-themes discussed in Phase I of the research. Phase III comprised the development of a health education programme that enhanced knowledge and communication skills of health care workers who serve PLWHA on highly active antiretroviral therapy in Namibia. Phase IV presented the implementation of HEP that included a training workshop for health care workers and an evaluation exercise after the implementation of the programme. Three main themes emerged during data analysis. Theme one indicated that health care workers experienced a lack of sufficient communication skills that was necessary for addressing the health concerns of PLWHA on HAART. Health care workers responses indicated that they had insufficient knowledge and inadequate communication and counselling skills to deal with health needs of the PLWHA on HAART. From their responses, it also transpired that health care institutions experienced a severe shortage of information, education, and communication (IEC) materials and other resources for curbing HIV / AIDS From Theme two, it emerged that health care workers experienced a lack of exposure to knowledge about HIV / AIDS management. It transpired that health care workers were not getting any support from their health institutions in developing knowledge or in-service training on HIV / AIDS management. It was also surprising to note that there were no guidelines that clearly assisted them in engaging or communicating with PLWHA on HAART. There was no structured supervision or quality assurance strategies that guided their superiors in monitoring their performance on the execution of daily activities, specifically in relation to HIV / AIDS Management. Theme three exposed the insufficient availability of health information to PLWHA on HAART. It transpired that HAART patients did not have access to information on HIV / AIDS aspects; such as HIV prevention, adherence to treatment of HIV, blood results, sexual relationships, alcohol abuse, and nutrition. HAART patients also emphasised their need to be empowered in managing self-disclosure, stigmatisation, and discrimination. The health education programme that enhanced the knowledge, as well as the communication and counselling skills of health care workers for communicating successfully with PLWHA on HAART was finally evaluated in accordance with the guidelines of Schiavo and Quinn’s (2007) evaluation process.
A quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia
(University of Namibia, 2015) Nangombe, Julia P.
A quality improvement training programme is important to address the challenges that the health professionals are facing in their quest for quality health care delivery. In Namibia, most health care facilities have not been yielding good results in response to patients’ health care needs. Health care dynamics are complex and inundated with several factors; among others new methods, speed of improving medical science and technology, as well as increasing demands of the clients to address emerging and re-emerging diseases. Health professionals are often criticised for unsatisfactory results due to several challenges sometimes beyond their capacity and knowledge to mitigate and manage. The difficulties experienced cannot be ignored, since there is no specific quality improvement / management training programme to prepare health professionals. Without appropriate training and empowerment of health professionals, health care delivery would continue to yield unsatisfactory results. Thus quality improvement training programme seeks to empower health professionals with knowledge, skills, and aptitudes with the aim of enhancing quality health care delivery. The nature of this study required a clear paradigmatic perspective thus constructivism and interpretivism approaches were adopted. Assumptions such as ontological, epistemological, axiological, methodological and rhetorical were used. Further Practice theory of Dickoff (1968), programme development by Van Niekerk; Kolb’s theory of experiential learning, Deming’s model of quality improvement, quality improvement management policy of the MoHSS and Centre for disease control (CDC) framework for programme evaluation in public health formed a theoretical basis of the study. The research process was carried out in five phases: Phase 1: A mixed method which is a quantitative, qualitative, exploratory, descriptive, and contextual was used. This was done to achieve the objective one (1) and two (2) as part of situational analysis (phase 1). Objective 1: A checklist was used in order determine the present situation of quality health care / service delivery at health care facilities. The target population were the managers in leadership positions, such as deputy permanent secretary, undersecretary, directors, pharmacist, medical superintends, principle medical officers, health programme officers, matron senior officers and others. A total of twenty-one (n = 21) participants which purposively selected comprised of managers in leadership (n = 6) from the MoHSS head office, while (n = 15) were drawn from the health facilities in the Khomas, Kunene, Erongo and Omusati regional health directorates. A part from the demographic data, participants were given opportunity to rate themselves on Likert’s scale with scores ranged from strongly disagree; disagree, agree and do not know on the following variables such policies and guidelines; leadership; human, physical, material and financial resources; patient safety, information as well as monitoring and evaluation. Further participants were given a statements of “yes”, “no” and don’t know on research ethics and utilization of data. SPSS software was as used tool for data analysis. Data were presented in percentage, figures and tables. To ensure reliability, items in the checklist were tested using the Cronbach alpha coefficient for multiple items measured on the Likert’s scale. It was indicated that the items from 1-40 provided a value of 0.95 while the rest of items (measures) was 0.88. For validity, content, criterion and construct were used. The findings of this objective revealed some ambiguities in the availability of policies and guidelines, leadership to facilitate care delivery, health system infrastructure, patient safety, as well as research and information to facilitate quality health delivery. Objective 2: Concentrated on the exploration and description of the experiences of managers in leadership positions and health professionals with regard to quality health care / service delivery at health care facilities. Individual interviews (n = 12) from twenty-one managers in leadership position, as well as focused group discussions (n = 5) that consisted of eight participants for each FGD were implemented. In addition, field notes were conducted. Participants in the FGDs were 40 from health facilities in the above four regional health directorates as indicated above. The regions were selected based geographical location, population density and services delivery namely referral, intermediate and district hospital. Participants were purposively selected. To achieve that exclusion and inclusion criteria were used. Both individual and FGD data were collected until saturation. Data from the transcription of the recorded audiotapes and field notes were analysed using Tech’ steps methods. Independent coder assisted with coding of the results. Various reasoning strategies such inductive, deductive, inferences, reflective and bracketing not only in this objective were used. Five themes and 13 sub- themes were identified that were a basis for the development of the educational programme for health professionals. The themes revealed that the participants’ experienced unavailability of guidelines and structure to facilitate QI and QA; inadequate management of resources; inadequate interpersonal relationships amongst the health workers; an inadequate understanding of QI and QA; as well as poor research and information, monitoring and evaluation, and indicators of monitoring and evaluation. Phase 2: The Practice Oriented Theory of Dickoff (1968) was used as practical guidelines to develop the conceptual framework. This framework was employed during the research and the educational programme development process. During the research process, the agent was the researcher; recipients (Managers / leadership and health professionals); the context (MoHSS head office and healthcare facilities); dynamics (findings for objective one and two); Procedure (research process) and terminus (foundations for development of educational programme). For the educational programme developing process, agent (quality specialist), recipients (health professional), context (health facilities), procedure (training programme for health professionals), dynamics, (challenges hampering successful implementation of the programme) and the terminus (knowledge, skills and abilities acquired through the training programme). Phase 3: During the development of the quality improvement training programme, an adopted version of two main theories was used. The most prominent one was a model by Meyer and Van Niekerk (2008), which was adapted to guide the process of developing the training programme. While Demining’s PDSA model of quality improvements well as quality improvement policy of the MoHSS focused on the content to enhance the findings. Further, Kolb’s experiential and Knowles adult learning theories were used to facilitate the teaching and learning process. The educational programme included the name, purpose / aim, objectives, structure / design, facilitation process, implementation process, and evaluation of the programme this was done inline n with Namibia Qualification Authority (NQA) framework. Phase 4: This phase, focused on developing the guidelines for implementing based on UNFPA while the evaluating the training programme were done in line with CDC framework. These guidelines outlined the process, activities, and elements required for implementing as well evaluating the educational programme for health professionals in Namibia. The study achieved trustworthiness by applying the criteria of dependability, transferability confirmability and credibility (Guba & Lincoln, 1994; Babbie, 2008; Lincoln & Guba 1986; Schwandt, Lincoln, & Guba 2007). Based on the study findings, it was clear that a need existed for a quality improvement training programme to empower health professionals with knowledge, skills, and aptitudes (KSAs) in quality assurance standards and quality improvement processes to facilitate quality health care delivery at the health care facilities (MoHSS). Specific recommendations of the study were highlighted with reference to the responsibilities and roles of different stakeholders for the successful implementation of the programme, as well as the purpose of improving quality health care goals in the MoHSS. The management, health professionals, education, profession of quality improvement, and research have vital roles in contributing to the sustainability of the training programme.
Guidelines for healthcare professionals to manage children with foetal alcohol syndrome at health facilities in Khomas region, Namibia
(University of Namibia, 2017) Goraseb, Marcus
In this study, the researcher explored and described the views of health care professionals who are managing children with foetal alcohol syndrome at public health facilities in the Khomas Region in Namibia. The purpose of this research project was to develop and evaluate foetal alcohol syndrome guidelines. This study was qualitative, explorative, descriptive, and contextual in nature and was conducted in four phases. Phase 1: This phase focused on a situation analysis. The researcher conducted the situation analysis to explore and describe experiences of health care professionals who are providing health care for children with foetal alcohol syndrome at the Katutura State Hospital and the Windhoek Central Hospital in the Khomas Region. The participants were registered nurses, enrolled nurses, medical doctors, and social workers. The researcher used in-depth unstructured interviews to collect data from twelve (n = 12) participants at the Rehoboth District Hospital for a pilot study and from seventeen (n = 17) participants at the Katutura Hospital and the Central Hospital respectively. Six (n = 6) focus group discussions were conducted; two (n = 2) for the pilot study and four at the abovementioned hospitals. Tech’s methods were employed for the data analysis. Four themes and 12 sub-themes were identified. The results of the study were used as basis to develop the FAS guidelines for addressing the challenges experienced by health care professionals. Phase 2: In this phase, the conceptual framework served as guiding tools to develop the guidelines. The essential components identified by Dickoff, James, and Wiedenbach (1968) were used; namely purpose of the activity, and prescription of the activity to the attainment of the set goal. The guidelines included activities from the survey list of Dickoff et al., (1968). These elements were: Agent (researcher), recipient (health care professionals), context (health facilities), dynamics (challenges experienced by the health care professionals in the context of managing FAS, procedure (guidelines for health care professionals to facilitate the management of FAS, and terminus (individual health care professionals’ abilities to manage FAS competently in accordance of their scopes of practice). Phase 3: The third phase dealt with the development of the FAS guidelines for the health care professionals. The researcher utilised the findings from the situation analysis (Phase 1) and the survey list (Phase 2) of Dickoff et al., (1968) as a reasoning map. The content for the guidelines were supplemented with the information adopted from the Centre for Diseases Control (CDC) (2004), and the Canadian guidelines for diagnosis of FAS. The guidelines comprised six components. The first one focused on the general knowledge for health care professionals to understand the management of FAS, while the other components specifically targeted medical doctors, nurses, social workers and psychologist, occupational therapist, as well as speech therapists. The guidelines structure for each group of health care professionals comprised the aim, role, and responsibilities; management of FAS; management of the environment for mother and other family members, as well as strengthening interprofessional collaboration in terms of the treatment of FAS. Phase 4: Phase 4 aimed at evaluating the guidelines for the facilitation of the management of FAS by health professionals in the context of the health care facilities. This was done to ensure the authenticity, accessibility, and utilisation to enable the maintenance of such guidelines. This was done in collaboration with various stakeholders who were experts in the field of each category of health care professionals. The guidelines were evaluated in accordance with the criteria of Chinn and Kramer (1991) to observe how clear, simple, general, accessible, and important the guidelines were. That was achieved by conducting a one-day workshop during which the experts were provided with given guidelines to analyse and afforded an opportunity to give their recommendations for improvement of the guidelines. During Phase 4 of the study, the guidelines for health care professionals were identified with the purpose of facilitating the management of children with FAS. Those guidelines were derived and conceptualised from the challenges that the participants were experiencing in the context of health care facilities. The guidelines observed the parameters of international standard for FAS management. The health care professionals would manage the children with FAS in the context of their respective scopes of practice. The study recommends the incorporation of the study findings in the curricula for various health care professionals the augment their essential training growth during in-service training and continual education interventions. Furthermore, the researcher recommends that research should be conducted to generate new ideas from the mother, the family, and the community in general to explore their challenges since this study has narrowly focused on the needs of health care professionals. This research should be done in various regions. Equally, this study urges policy makers to make provision for implementing the developed guidelines that specifically target various health care professionals in the Ministry of Health and Social Services.
Investigation and development of strategies to strengthen the implementation and governance of Health Research Systems (HRS) in Namibia
(University of Namibia, 2017) Nangombe, Hilma
The overall aim of the study was to investigate the status of HRS in Namibia and to develop strategies that will contribute to strengthening its implementation and governance. This study was conducted within a positivist paradigm which employs quantitative research approach, exploratory, descriptive and non- experimental designs were employed. The study was conducted in 3 phases namely: Phase 1: situational analysis comprised of document review using an adopted WHO checklist in phase 1 A and a survey in phase 1 B. The situation analysis was conducted to explore and describe the current approaches as well as the viewpoints of stakeholders with regard to HRS implementation and governance in Namibia. In addition, it was conducted to identify and describe factors that influence the implementation and governance of HRS in Namibia. The population for phase 1A comprised documents that guide the implementation and management of HRS in Namibia that is, the Research Management Policy which is the official policy document of the Ministry of Health and Social Services. In phase 1A, a checklist was developed based on the attributes set out in the WHO Health Research Systems Analysis Initiative (2010), checklist which is specifically developed to indicate which attributes should be in place per HRS functions which are: stewardship function and ensuring good governance, financing, capacity development, creating and sustaining resources as well as producing and using research findings functions. In phase 1 B, respondents were persons responsible for the coordination of health research in Namibia, or institutions involved in health research (n=67). The population was divided into two sub-populations. The first sub-population included persons from different departments/sectors within the Ministry of Health and Social Services. They are referred to as the ministerial respondents (n=52). The exo- ministerial sub-group comprises respondents/participants from institutions other than the Ministry of Health and Social Services, such as relevant government ministries, offices and agencies (O/M/As), state-owned enterprises, international organisations, tertiary education institutions and agencies of other governments. The constituents of the second subgroup are referred to as exo-ministerial respondents (n=15). The main challenges that were identified from phases 1A and B include: gaps in legislative frameworks including the outdated Research Management Policy (RMP), lack of coordination of health research in the country. Challenges related to the ethic review committees in MoHSS, and the institutional review boards (composition and structure), lack of support and motivation; resources are donor-driven; and absence of an articulated research agenda, no health research vision, priorities. Furthermore, the findings indicated that only a few officials have received training in health research the Namibian government (GRN) is not doing enough to contribute towards the creation and sustaining of resources and human resources capacity development for health research, GRN is not providing incentives to researchers, funding from GRN is not provided in a way that is most appropriate for the country’s research needs. In addition, the findings pointed out that there is a need for promotion and advocacy for HRS, to strengthen different cadre of professionals with the capacity to conceptualise, conduct, analyse, disseminate and translate the findings of various forms of health research, to secure international linkages and technical cooperation in health research. These findings fashioned the basis for conceptualisation in phase 2 and development and verification of strategies in phase 3. Phase 2: In this phase conceptualisation of the key findings on HRS from the study linking them to the Practice Theory of Dickoff, James and Wiedenbach (1968) was done. This practice-oriented theory, essentially, consists of concepts such agent, (the researcher) recipient, (all individuals and groups involved in health research in Namibia), context (the Ministry of Health and Social Services’ internal and external environments), dynamics (challenges that emanated from the study findings), procedures (process followed by the agent in the development of strategies for effective implementation and governance of HRS), and terminus ( implementation and governance of effective and efficient HRS in Namibia through the developed strategies). The conceptualised findings indicate that the issues of concern are mostly related to the context’s internal environment therefore there is a need to create a conducive environment for HRS in the areas of policies and guidelines for HRS; human and financial capacity. The challenges that emanated from the study are summarised under the dynamics as follows and include lack of: legal basis and regulatory mechanisms, coordination mechanisms for health research in the country, research capacity, human capacity development for health research, adequate financial support for the country’s research needs, data dissemination to enhance a data sharing culture, and research ethics committees’ coordination and inability to attract and retain researchers in the public health sector. Phase 3: This phase outlines the procedures followed in developing the strategies after conceptualisation of findings from phases 1 & 2. In addition, the strategies in this study were developed using Howe’s (c@ps), which was developed in 2011. According to the Compass Aligned Performance System each strategy comprises of the following components: key performance indicators strategic objective/s, used to monitor implementation and measure achievement of each strategic objective, strategic objective that are providing directions towards realisation of the proposed strategies, and the proposed actions/critical success factors which are actions to be undertaken in order to achieve the strategic objectives, the compass also allows the developed strategies to be aligned to the values and the vision of the Ministry of Health and Social Services. A one-day meeting was organised with the team of experts where a power point presentation of the proposed strategies was made by the researcher for inputs and finalization of the proposed strategies. The study recommends that MoHSS provide a conducive environment for effective implementation and governance of HRS through effective leadership that guarantees fortification of: policies and guidelines for HRS; human and financial capacity. The research further recommends that MoHSS implement the following: establish a career advancement programme for researchers; provide a market related remuneration package and benefits for researchers; and offer attraction and retention strategies for health research human resources such as introducing incentives for researchers. It is further recommended that a training needs assessment be carried out by MoHSS to identify the training needs on HR at individual, institutional and national levels. Lastly, it is recommended that the developed HRS strategies should be integrated into the overall MoHSS strategic plan.
Development of practical guidelines to promote occupational health and safety for workers in the construction industry in Windhoek, Namibia
(2017) Nghitanwa, Emma M.
The study, which considers that the construction industry is a high risk one due to the physical work demand and nature of the working environment, was conducted to develop practical guidelines for workers and employers that promote occupational health and safety (OHS) in the construction industry in Namibia. The study, conducted at 13 study sites in Windhoek, Namibia, used a quantitative descriptive study method to gather data regarding the OHS status of the construction industry. Data was collected from the 13 study sites using a site interviewer-led questionnaire for 549 construction workers. In addition, both a site inspection checklist and document review checklist were used to collect the data from ten construction sites. A review of documents concerning occupational accidents, diseases and injuries encountered at construction sites that were held by the Ministry of Labour, Industrial relations and Employment creation for the five-year period from April 2011 to March 2016 was carried out. Data was analysed using the Statistical Package for Social Sciences (SPSS) software version 23. The study findings show that most of the workers at the study sites were young and male, with most participants lacking awareness of OHS issues, which may hinder accidents and injuries prevention. It also emerged that occupational hazards are prevalent at the study sites and yet there were poor mechanisms for hazard prevention or mitigation measures. The study notes that there was a high rate of occupational accidents and injuries, as well as a few incidences of health hazards, as indicated by few participants, although there was no documented occupational disease. It is also noted that most study sites do not comply with OHS legislations, such as having OHS policies that indicate the employer’s commitment towards OHS, which placed workers at risk of hazard exposure, occupational accidents, injuries and diseases. Practical guidelines to promote OHS in the construction industry of Windhoek, Namibia are developed as the primary output of this project.
Investigation into Hepatitis B virus prevalence, risk factors and health care workers' awareness in Kavango East And West regions of Namibia
(University of Namibia, 2018) Mhata, Petrus
Available data has shown that most deaths due to liver cancer and cirrhosis are primarily attributed to the complications of Hepatitis B Virus (HBV) infections, globally. Countries ought to have well-documented information on the HBV prevalence and risk factors to be able to understand and interrupt its transmission. In Namibia, data on the HBV prevalence and risk factors are scanty and older than two decades. Also, health care workers’ (HCWs) awareness on the HBV prevention and control are inadequate. The purpose of this study was to investigate HBV prevalence, risk factors and health care workers’ awareness on HBV prevention and control aspects in Kavango East and West (KE&W) regions. The study adopted a quantitative, cross-sectional, descriptive and analytical design. Firstly, the researcher interviewed purposively selected HCWs from the Ministry of Health (17 respondents) and private health clinicians (13 respondents) about their awareness on HBV. Next, all the pre-existing HBV laboratory results from Namibia Institute of Pathology (NIP), January-December 2013 were retrieved and analyzed. Thereafter, a population-based survey, which included 720 randomly selected subject individuals from 20 households in 36 lusters in KE&W regions, was conducted, by interviewing respondents or their caretakers. One drop of blood was drawn from each respondent and was tested for hepatitis B surface antigen, using Uni-Gold HBV rapid diagnostic kits. All the responses were analyzed using the Statistical Package for the Social Science (SPSS) software, version 24. The frequencies, cross-tabulations, logistic regression, bivariate and risk factor analysis were performed. Based on this analysis, the health care workers’ awareness on HBV prevention, were found to be insufficient. The pre-existing HBV laboratory results showed HBV positivity rate of 11.8% nationally, with Kavango region showing the highest prevalence of 16.3%. The HBV prevalence survey in KE&W regions showed an overall prevalence of 7.1% for the two regions combined, but when disaggregated by region, Kavango West showed 12.3%, compared to5.0% of Kavango East. Further analysis has shown a strong association between positive results with rural residents (p=0.007), household contacts or providers of care for HBV infected person (p=0.000), sex work for money (p=0.001) and age at first sex (p=0.002).A predictive model, based on selected variables, whether or not someone is likely to be HBV positive has been developed. The study proposed recommendations to the MoHSS and related stakeholders to develop a strategic plan to combat viral hepatitis in Namibia in general and in KE&W regions in particular.
An educational programme to empower mothers and caregivers on feeding practices of children under the age of 5 years in Oshikoto region, Namibia
(University of Namibia, 2018) Mulenga, Ester
Health facilities do provide mothers with information regarding feeding practice of children under the age of five years. It seems however that the impact of such information is extremely minimal because poor feeding practices remain a problem in Namibia. Such practices contribute to undernutrition in children under the age of five years. The Oshikoto region is among the top five regions with children affected by undernutrition. The purpose of this study was to develop an educational programme to empower mothers, and caregivers, on feeding practices of children under the age of five years in the Oshikoto region. The objectives of the study were: to explore and describe the experiences of mothers, and caregivers, on feeding practices of children under the age of five years; to develop a conceptual framework which formed the basis of an educational programme; to develop an educational programme to empower mothers and caregivers on feeding practices of children under the age of five years; and to implement and evaluate an educational programme. The study was conducted in four phases. A qualitative, exploratory, descriptive and contextual design was utilised in the first phases of this study. The first phase was a situational analysis which explored and described the experiences of mothers and caregivers on feeding practices of children under the age of five years. An unstructured individual in-depth interview was conducted during this phase: fifteen respondents were purposively selected and interviewed. Data were analysed using Tesch`s method of qualitative analysis. Four themes, and fourteen sub-themes, were identified. The study revealed that mothers and caregivers utilise suboptimal feeding practices; they experience factors which influenced feeding practices; they lack nutritional and feeding practices information; they encountered limited resources which influenced feeding practices. The second phase addressed a conceptual framework which guided the development of an educational programme, to empower mothers and caregivers on feeding practices of children under the age of five years, and was based on Dickoff, James and Wiedenbach`s survey list. The third phase concentrated on the development of an educational programme to empower mothers and caregivers. This was done based on the findings from the study and guided by Nicholls` cyclic curriculum development model. The fourth phase covered the programme implementation and evaluation and a two day workshop conducted at the Onandjokwe Intermediate Hospital in the Oshikoto region. This phase was guided by Kolb`s theory of experiential learning and Knowles’ model of andragogy. The workshop was attended by mothers and caregivers of children under the age of five years. The programme was evaluated during and after its implementation; the workshop participants indicated that it was useful and supportive. It is recommended that such programme need to be given to pregnant women and postpartum mothers as this will help them to feed their babies propely and prevent undernutrition.
A model to facilitate the management of sanitation and hygiene practices amongst primary schools in Ohangwena region, Namibia
(University of Namibia, 2018) Shilunga, Anna Panduleni
Schools are great platforms where children can learn hygiene skills, behaviours and practices, and when these become part of children’ daily lives, this may lead to a positive impact in families and communities at large. However, effective hygiene promotion in school can be severely affected if sanitation facilities are not adequately managed. UNICEF indicated that, despite the provision of water to schools in Ohangwena region, there are still a high proportion of schools without sanitation facilities. This study thus purposively focused on Ohangwena region in view of the above discussed challenges. The purpose of this study was to develop and describe a model to facilitate the management of sanitation and hygiene practices among primary schools in Ohangwena region. A mixed method design of quantitative, observational, descriptive, cross-sectional study, as well as a qualitative, exploratory, descriptive, as well as a theory generating design were used in the study. The study was based on four phases. Phase 1: Concept analysis was done by assessing the conditions of sanitation facilities, describing the knowledge, attitudes and practices of schools learners on hygiene practices, and exploring and describing the teachers’ perceptions of hygiene promotion in schools. A three-staged stratified sampling was used to select ten primary schools in five circuits, using a proportionate sampling method. A checklist and a questionnaire were used to collect quantitative data from sanitation facilities and (n=450) school learners in 10 primary schools. Simple random sampling was used to select learners in grades 5, 6 and 7 learners who were seven (7) years and older. Learners gave assent to participate in the study, while parents and teachers, gave permission as ’loco parentis’. Quantitative data were analysed with the Statistical Package for Social Sciences (SPSS) version 23, while Tesch's method of open-coding was used to analyse qualitative data. Teachers were purposively sampled and signed a consent form to participate in the study. Five focus group discussions (FGDs) conducted with teachers to collect were audiotaped and transcribed verbatim. The findings proved that a combination of challenges implicate the management and promotion of sanitation and hygiene practices stemmed from poor collaboration between the schools and parents and inefficient management of resources and facilities in schools, poor knowledge, bad attitudes and practices of learners toward hygiene. The three main concepts of management, collaboration and environment, were identified and analysed. Phase 2 involved the construction of the relationship statements of the model. The conceptual framework based on the three main concepts of analysis and the practice oriented theory by Dickoff et al (1968), was developed. Phase 3, a management of the collaborative environment model, to facilitate the management of sanitation and hygiene practices among primary schools in Ohangwena region, was developed and described. The model was described in terms of its purpose, concepts, definitions, structure, relationships and assumptions. Evaluation was done by expert researchers to validate whether the model brought about the desired outcome necessary to meet the study’s objectives. Phase 4 involved the development of the guidelines to operationalise the model. The guidelines were formulated in terms of objectives, strategies and activities based on the four objectives of the model. Recommendations, in terms of their application to the Ministry of Education, public health and nursing practice, as well as future research, were made
A self-management programme to empower adults suffering from Gout and their caregivers in the Omaheke region, Namibia
(University of Namibia, 2019) Tibinyane, Maria Boraunyane
The prevalence of gout has increased over the last few decades. Of the 291 conditions studied in the Global Burden of Disease (GBD) (2010), gout ranked 138th for disability and 173rd for the overall burden of disability-adjusted life years. Statistics assume that in a population of 71,233 there are 200 people in the Omaheke region suffering from gout (Extrapolation of Prevalence Rate of Gout to Countries and Regions, 2015). This is evidence for a need to optimize management of the disease. This study explores the experience of adults suffering from gout and of their caregivers in the Omaheke region, with the aim of developing a self-management programme to provide participants with education for diet and lifestyle changes for better management of their ill-health. The researcher adopted a qualitative, phenomenological, exploratory, and descriptive approach. Two groups of participants (fourteen adults suffering from gout; and seven caregivers) were interviewed to learn their responses. Those suffering from gout were asked to report their experience of suffering from gout, and the caregivers were asked about their experiences of caring for their relatives. The research questions for those with gout and two caregivers were answered in unstructured individual indepth interviews; five caregivers took part in a focus group discussion. Observations of the participants’ reactions were also noted. During Phase 1 of the research—a situation analysis—the phenomenological approach for collecting data from selected participants was used. The resultant inductive data analysis was used to develop a self-management programme. During Phase 2, the conceptualization framework guided the development of a selfmanagement programme, using the Practice Oriented Theory of Dickoff et al. (1968). During Phase 3—the development of a self-management programme —an adapted version of three theories was used. The most prominent of these was the framework of the Chronic Disease Self-management Programme (CDSMP) which has shown improvements in several areas. The Person-centered Care Theory—based on Carl Rogers’s belief that the person is the expert concerning their needs, and Knowles’s Adult Learner Theory in which the adult learner is seen as self-directed to learn, were theories used to inform the educational process. In Phase 4, in a two-day training workshop the self-management programme was implemented and evaluated. Evaluation occurred immediately after every session and a summative evaluation at the end of the programme, to verify whether its interventions were likely to bring about the desired change among the participants. A programme outcomes evaluation was carried out three months after implementation of the programme. Responses revealed great physical and psychological discomfort from gout, accompanied by disrupted sleep, decreased self-efficacy and social disconnectedness. Information was also seen as important for reducing predisposing factors and managing the illness, and recommendations were made for extending the impacts of the programme.
Modeling stock levels of Malaria rapid diagnostic test kits and nievirapine syrup in Oshana region, Namibia
(University of Namibia, 2019) Magesa, Emmanuel Salvatory
Malaria and HIV/AIDS are two most widely spread diseases in Sub-Saharan Africa. The co-infection is very common in the region, especially in unstable malaria transmission areas with the prevalence of 29.9 - 40%. In Namibia these two diseases are common in northern eastern regions, which are unstable malaria transmission areas. These two diseases affect poorer segments of the population. Individually and biologically Malaria increases viral load of HIV people. The severity of malaria is more in pregnant women and children as well as people live with HIV. Equity access of malaria diagnostic test kits and NVP syrup is critical in control these two epidemic diseases. Given the nature of current conditions, justification exists for a study to develop and demonstrate a mathematical modeling of estimating stock levels, which can establish parameters to prevent stock-outs of mRDT and NVP syrup. The study adopted a mixed-method design in order to provide a broader perspective of modeling of stock levels in public health facilities, which underpins the delivery of mRDT for testing malaria and NVP syrup for PMTCT. In its quantitative aspect, the study adopted a descriptive approach to acquire data from a period of five years retrospectively, in this case 2012 to 2016 inclusive. Data were mainly obtained from Syspro, DHIS and EDT softwares. The data were analysed using SPSS version 23 software, in which time series analysis was applied to determine forecasted consumption of mRDT and NVP syrup. The correlation coefficient and Binary logistic regression were used to identify factors associated with stock-out of mRDT and NVP syrup. Mathematical models of stock levels were developed and validated. The findings showed that due to seasonal variation and other unforeseen variables, the consumption of mRDT and NVP syrup in public health facilities is increasing every quarter, while delivery lead time being a main factor and predictor of stock out. The model developed found to have predictive accuracy of more than 70% in estimating stock levels. The use of this supply models will curb unnecessary costs due to irregular orders. Furthermore, the model will contribute to the prevention of stock out and diseases control. It is a recommendation that similar models should be developed for other medicines such as anti TB, other ARVs and antihypertensive drugs.
A model to facilitate socio-cultural congruent Malaria care: The training of health extension workers in Ohagwena region, Namibia
(University of Namibia, 2019) Uushona, Selma Ingandipewa
The purpose of this study is to explore and describe the socio-cultural factors that influence Malaria prevention and control, conceptualise the study findings by developing the socio- culturally congruent training model, describe and evaluate it in order to assist trainers to incorporate social and cultural information during their theoretical and practical training of HEWs, to improve their competency. The study is descriptive and exploratory in nature, used convergent parallel design in which both quantitative and qualitative carried equal weight and data are collected at the same time from inception to completion of the study. Approximately 220,683 individuals were impacted by this study . Findings were generated from survey using only one questionnaire which was administered to 402 participants, 8 focus group discussions, and 20 in-depth individual interviews, supported by observations from 20 households and respondents who were 18 years or older. Data obtained from the structured questionnaire and checklist were analysed using the statistical package for social sciences (SPSS), and descriptive statistical analysis was applied to summarize quantitative data into easily identifiable relationships and data interpretation. Qualitative data from interviews were analysed with ATLAS. ti software. Thematic analysis was applied using a coding operation aimed at shortening the diversity of memos, quotation groups, and links into fewer content categories. The result of the study indicated that traditional and cultural methods of Malaria prevention is widely available but not applied. Mosquito nets generally available but not used due to the following reasons: 68.7 percent of the respondents felt that nets were expensive, 12.70% indicated not comfortable with using net just to mention a few. The results also revealed important among the other findings that participants perceived traditional and cultural methods of Malaria prevention is widely available but not applied, tumble weed is widely referenced as a herb for Malaria prevention, participants perceived low economic status influence negatively prevention of malaria and access to care, and nets generally available but not affordable and used. The outcome of the study is a Model developed and its operationalization guidelines were established. It is recommended to start training of trainers to facilitate empowerment of Health Extension Workers through collaboration and consultation with relevant authorities to enact integrated curriculum for inclusion of socio-cultural congruent prevention strategy and make it available to donors/NGOs. In addition, the government and funded donor organization to ensure balance in sustain of indigenous knowledge in limited resource setting. Advocate for research collaboration on local traditional practices with social science and western modern care practices by identify local resource used in Malaria prevention.
A novel surveilance framework for tracking and predicting health outcomes of cardiovascular diseases risk factors among people living with HIV initiated on art in Khomas region, Namibia
(University of Namibia, 2021) Mahalie, Roswitha
Cardiovascular diseases (CVDs), the leading cause of death in Africa (57%), has recently been recognised as an essential cause of morbidity and mortality among People Living with HIV (PLHIV). Multiple opportunities exist to address the challenges currently encountered with the epidemiological transition and managing the double burden of CVDs and HIV/AIDS. However, there is no documented link between patients’ previous visits to antiretroviral therapy (ART) clinics and subsequent meaningful interpretation and analysis of data in Namibia. Critical data on the leading causes of death, notably, CVDs, injuries, drug and alcohol use, and risk factor exposures are lacking. Therefore, the study’s purpose was to develop a surveillance framework to enhance the tracking and prediction of health outcomes of cardiovascular diseases risks among PLHIV initiated on ART at health facilities in the Khomas region. The researcher adopted a mixed-methods approach which was conducted in four sequential phases during this study. In Phase I, a qualitative approach with phenomenological study design was implemented to explore current data management practices of CVDs risk factors among PLHIV on ART. Thirteen key informants selected purposively were interviewed, and data were analysed with ATLAS.ti. The qualitative findings informed the retrospective, cross-sectional, quantitative data collection process. Risk factors data captured between 2004 until 2017 were extracted from 529 patient care booklets (PCB) and matched with the electronic Patient Monitoring System (ePMS) of sampled PLHIV initiated on ART. These data elements were entered and analysed in SPSS version 25 using descriptive statistics with bivariate and multivariate analysis. Fragmented data management practices for CVDs preventative care among PLHIV initiated on ART were one of the major findings of the study. Phase II involved the process of concept analysis and the development of the conceptual framework based on the findings of Phase I. Schwartz and Kim’s hybrid model of concept development was used to identify and analyse main concepts of enabling environment, sound data management practices, and evidence-based health outcomes. The Population Health Surveillance theory and Donabedian’s model were used as a basis for the development of the conceptual framework. The novel surveillance framework was developed in Phase III. This phase was primarily guided by the outcome of the study findings and Arthur Samuel’s seminal work on the machine learning model of 1959 such as identifying CVDs risk factors; monitoring calculated risks and measuring health outcomes. The framework was evaluated by experts in health, epidemiology, and health informatics to validate its applicability whilst ensuring that the overall study objectives are met. In Phase IV the guidelines to operationalise the framework was developed based on the core elements as listed in Phase III above. The study concluded that the development of the surveillance framework is effective in enhancing the tracking and prediction of health outcomes of cardiovascular diseases (CVDs) risks among PLHIV initiated on ART in the Khomas region. The study made recommendations for policy and operational level health care workers of the Ministry of Health and Social Services, the public health arena, and future research.
Development of strategies to enhance health-seeking behaviour of parents and caregivers with children under-five years with acute diarrhoea in THE Ohangwena region, Namibia
(University of Namibia, 2022) Francineth, Bauleth M
The study aimed to develop strategies for healthcare professionals and healthcare extension workers (HEWs) to enhance appropriate health-seeking behaviours of parents/caregivers of children under five with diarrhoea in the Ohangwena Region in Namibia. In Namibia, the prevalence of diarrhoea nationally is 17%, responsible for 5% of all deaths in children under five, and is the second leading cause of death. Mortality due to diarrhoea is preventable when appropriate and prompt healthcare is sought on time. However, in Namibia, few studies have been conducted to assess the magnitude and factors associated with health-seeking behaviour. The researcher conducted a study with a convergent parallel mixed-method design between January and March 2019 in Engela District, Ohangwena Region, Namibia. The study comprised four phases. Phase 1: During this phase, the researcher conducted concept analysis. For quantitative data, the researcher used the multistage cluster sampling method. The researchers purposively included only households with children under five, and a total of 530 houses were selected. Structured questionnaires were used to collect quantitative data. The International Business Machines (IBM) Statistical Package for Social Science (SPSS) software version 25 was used to analyse quantitative data. For qualitative data, the researcher purposively selected three doctors, ten nurses, four priests and five traditional healers for key informant interviews. Additionally, the researcher conducted nine focus group discussions (FGD) with 57 HEWs and six FGD with 30 parents/caregivers, and all participants were purposively sampled. All interviews were audiotaped and transcribed verbatim, and Atlas ti was used to analyze qualitative data. The overall prevalence of diarrhoea among children under five was high—23.8%, with informal settlements having the highest prevalence of 48%. Equally, we found evidence showing that 77% of children suffering from diarrhoea had severe malnutrition. Some mothers or caregivers perceived diarrhoea as being associated with spiritual beliefs, traditional beliefs, and myths. Furthermore, most mothers/caregivers (64%) were categorized as having inadequate knowledge of the aetiology, prevention, and ii management of diarrhoea, 84% had poor practices, and 61% admitted to having practised perineal cutting as part of the management of acute diarrhoea. However, the existing guidelines do not reflect aspects aiming to improve parents’ and caregivers’ current practices and health-seeking behaviours. Phase 2: Involved conceptualizing the study's key findings on health-seeking behaviour and linking them to the Dickoff, James, and Wiedenbach’s (1968) practice-oriented theory for development of strategies. Phase 3: Was informed by the factors identified in Phases 1 & 2; Phase 3 outlines the procedures followed in developing the strategies. Furthermore, the strategies in the current study were developed using Howe’s Compass Aligned Performance System (c@ps), created in 2011. The strategies were constructed upon the conceptual framework by using the Delphi process. Phase 4: A team of experts verified the strategies after development. Furthermore, based on the study findings, recommendations were made.

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