Infectious disease and trauma were highly represented in this Mozambican PICU, and overall mortality was high compared with high-income countries. With this knowledge, targeted collaborative projects in Mozambique can now be created and modified. Further research is needed to monitor the potential benefits of such interventions.
BACKGROUND In Mozambique, there is a limited supply of blood and elevated risks for transmission of infections. Prior studies have documented that many transfusions in Mozambique are potentially avoidable. Transfusion training workshops with a survey and exam were held for providers to understand their perceptions and to improve knowledge and clinical practice. STUDY DESIGN AND METHODS Health care providers completed a survey and a knowledge assessment. The Wilcoxon signed rank test was utilized to compare the relative importance of each factor in the survey, and pre- and posttraining exam scores were compared using Fisher’s exact test. RESULTS A total of 216 health care providers participated; the majority worked in a referral hospital (74%) and reported transfusing blood at least once per week (56%). Most acknowledged the limited blood supply and transfusion risks. Providers rated low hemoglobin (Hb) levels and pallor as significantly important indications for transfusion (p < 0.001). They were more likely to transfuse with age under 5 years when compared to other ages (p < 0.01). The three most potentially influential factors for transfusion practice were increased reliability of the blood supply, education about transfusion indications, and assessment of perfusion. Before training, the majority of participants identified an incorrect Hb threshold for preoperative or critically ill patients. Overall exam scores improved from a mean of 58% to 74% (p < 0.001). CONCLUSIONS Mozambican providers were knowledgeable about the risks of blood transfusions. Preoperative patients, the critically ill, and children appear to be at highest risk for receiving an avoidable blood transfusion. These results will help guide planning for future provider training.
Background: The HIV/AIDS epidemic has become a point of important political concern for governments especially in Sub-Saharan Africa. Clinical and public health interventions to curb the epidemic can be greatly enhanced with the strategic support of political leaders. Objective: We analyzed the role of national political leadership in large-scale HIV/AIDS communications campaigns in 14 countries in Sub-Saharan Africa. Methods: We primarily reviewed grey and white literature published from 2005–2014. We further triangulated data from in-person and phone interviews with key public health figures. Results: A number of themes emerged supporting political leaders’ efforts toward HIV/AIDS program improvement, including direct involvement of public officials in campaign spearheading, the acknowledgment of personal relationship to the HIV epidemic, and public testing and disclosure of HIV status. Areas for future improvement were also identified, including the need for more directed messaging, increased transparency both nationally and internationally and the reduction of stigmatizing messaging from leaders. Conclusions: The political system has a large role to play within the healthcare system, particularly for HIV/AIDS. This partnership between politics and the health must continue to strengthen and be leveraged to effect major change in behaviors and attitudes across Sub-Saharan Africa.
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