Patients presenting in major tuberculosis (TB) centres in two Australian metropolitan hospitals and three central hospitals in Malawi were interviewed for health and other information, including their satisfaction with nursing care. The main objective of the study was to investigate differences in satisfaction rates among ethnically similar and different patients coming from two dissimilar health systems. A multivariable Generalized Estimating Equations model was constructed to identify sociodemographic and health-related factors associated with dissatisfaction, while focusing on ethnic differences between and within each country. The Australian and Malawian patients were similar in age, gender, marital status, and employment. However, the Malawians were mostly inpatients, with recurrent TB episodes, and were more seriously ill with impaired physical and mental wellbeing. Nonetheless, being Australian was more associated with dissatisfaction observed in all components of care. However, Australian ethnic minorities were less dissatisfied than their Anglo-Saxon or European counterparts, being more similar to Malawian patients irrespective of the health care provided. Our study suggests that patients coming from similar ethnic backgrounds may express similar satisfaction irrespective of the health system they belong to.

Introduction:The 2020 COVID-19 crisis affected all sectors, including education. This study explored the experiences and challenges faced by tertiary students in the United Arab Emirates when they were suddenly required to transition from traditional classroom learning to E-learning following the outbreak of COVID-19. Methods: This cross-sectional study used mixed methods to collect and analyse qualitative and quantitative data. The participants were Nursing students involved in clinical training. Results: Most students (87%) reported inexperience with studying via E-learning. Challenges encountered included the lack of privacy, Internet connection issues, problems with the teaching platform and communication difficulties. Some students also reported that instructors were slow at responding to their needs. The lack of robust internet coverage was a major overarching issue that affected communication, students' engagement, preparedness for E-learning, and other challenges. Discussion: This study is significant because it highlights the challenges experienced by Nursing Students during the rapid transition from traditional education to e-learning. It enables the faculty to understand and support students during the time of crisis. Communication with students needs to be streamlined for successful E-learning. Authorities should provide more essential infrastructure such as reliable and stable Internet connectivity to strengthen the E-learning approach.

Background: The health status of the Sub-Saharan African (SSA) countries is well below that of the rest of the world. Coupled with low per capita income, these countries have agreed and committed themselves to raising their health status equitable standard by addressing United Nations (UN) Sustainability Development Goal number 3 (SDG3) by 2030. Addressing SDG3 requires increased and equitable funding for universal health coverage, healthcare infrastructure, efficient resource allocation, improved priority setting, reduction in corruption, and other strategies. However, what is urgently needed to improve priority setting processes or meaningful health system reform, among other things. There is therefore a need for the exploration of the economic and non-economic (which includes social justice) explicit criteria that ought to form the normative framework for Decision Making. These explicit criteria include efficiency, burden of disease, equality (strict egalitarianism), equity, and explicit criteria. Methods: The ultimate aim was to identify explicit values/principles/criteria that can be used to formulate an ideal normative framework to be used to guide decision Making so as to improve SDG3 in SSA. We synthesized selected literature on the normative frameworks for priority setting processes in health in SSA was undertaken, and the explicit criteria which, ought to guide these frameworks were identified. The form of the Social Welfare function and its principles was identified. Results and Conclusions: The framework and its explicit criteria for priority setting in the SSA countries that ought to be adopted in order to improve their SDG3 was identified—Non-Welfarist framework. This framework allows utility, health and other important social values/attributes/principles to enter the normative SWF. It is argued that such a framework ought to be specified empirically and concurrently by the decision-makers and members of the community representatives. Community representatives ought to be recognized as legitimate claimants of the resources determined, and should therefore be allowed to have a role in specifying the arguments in the SWF and what weights to be attached to the stated arguments. This implies that the selection of options in decision-making should focus on maximizing benefit and minimizing the opportunities forgone as stated in the framework.

Purpose: Antibiotic resistance is spreading at an alarming rate globally, mainly because of antibiotics misuse. The World Health Organization developed guidelines for the rational use of antibiotics to prevent antibiotic misuse and reduce the potential development of antibiotic resistance. Although many countries adhere to these guidelines and have contextualized them to their needs, data on antibiotics use are limited in African countries, particularly in South Sudan. This study explored prescription patterns and use of antibiotics at Juba Teaching Hospital (JTH) to clarify the potential for antibiotic resistance in South Sudan. Materials and Methods:We conducted a retrospective, cross-sectional study of archived patient data from 2016 to determine the prevalence of inappropriate antibiotics use at JTH. We used methodology developed in a previous study to assess the appropriate use of antibiotics. The study sample comprised 384 files. After reviewing and cleaning the files, 316 files were included in our analyses. This study was approved by the South Sudan Ministry of Health Ethics Review Board (approval number: MoH/ERB 51/2018) and all procedures were consistent with the Declaration of Helsinki. Results: Antibiotics use was highest in the medical ward (75.4%). Most antibiotics prescriptions were for infectious diseases (23.7%), followed by ailments affecting the digestive system (19.9%). Commonly prescribed antibiotics were ceftriaxone (21.2%) and metronidazole (20.0%). The mean number of antibiotics prescribed per patient encounter was 2.09 (95% confidence interval: 1.98-2.19). Most files (n=233, 70.57%) demonstrated incorrect use of antibiotics with 78.8% (n=249) of prescriptions being inappropriate (misuse). Conclusion:This study revealed a high level of inappropriate antibiotics use at JTH despite the existence of local guidelines, which suggested there was an increased risk for antibiotic resistance. Therefore, it is necessary to introduce antibiotic stewardship activity, along with continuous national surveillance. Enforcement of guidelines to reduce irrational antibiotics use may reduce the risk for antibiotic resistance.

Background Institutions of higher learning are persistently struggling with issues of academic dishonesty such as plagiarism, despite the availability of university policies and guidelines for upholding academic integrity. Methodology This was a descriptive qualitative study conducted on 37 students of a Healthcare Ethics course at an Australian tertiary institution from February 2016 to October 2018. The purpose of the study was to explore the reasons for plagiarism detected the TurnitinR plagiarism checking software and extensive review of manuscripts. The interviews were conducted in private rooms and in strict confidence. Thematic analysis was manually done. Results Four major themes namely, lack of interest; pressure of time with competing priorities; lack of understanding of the policy on academic honesty, and “the determined students” were identified. Sub themes under lack of interest were lack of preparation and effort, low self-efficacy, poor studying techniques, and convenience of internet sources. Under pressure of time, the subthemes were, misplaced priorities, procrastination, high workloads, poor planning, competing interests, and the perception of availability of time at the start of the semester. Regarding lack of understanding of the policy on academic honesty, the subthemes identified were, lake of awareness of plagiarism, lack of awareness of acceptable similarity, conflicting messages from tutors and confusion with high school learning. The determined students were those that either made all effort to reduce plagiarism but still remained high, used the another language at home other than English, had poor paraphrasing techniques or lacked resources for English language editing. Conclusion There are varied and diverse reasons for plagiarism. There is a need to systematically reinforce and educate students on issues pertaining to academic dishonesty and their associated implications.

Background: The emergence and spread of antibiotic resistance occurred at an alarming rate globally, and has limited the use of antibiotics for preventing and treating infectious diseases. Failure to follow guidelines and protocols for antibiotic use for rational therapeutics and infection control has led to overuse and misuse of antibiotics. However, there is paucity of data on the current pattern of antibiotics prescribing for hospitalised patients in South Sudan, which is among the youngest countries in the world. Therefore, this study aimed to explore the prescription and use of antibiotics at Juba Teaching Hospital (JTH) in South Sudan.Methods:A retrospective cross-sectional study was conducted among JTH inpatients between January and December 2016. A sample of 316 files from the medical and surgical wards were extracted using probability sampling proportional to ward size. Extracted files were reviewed to determine the pattern of antibiotics administration. Data on indications for antibiotic use were also collected. All data were entered twice and analysed using STATA version 13.0.Results: In all reviewed files, patients received treatment with antibiotics. Antibiotic use was highest in the medical ward (75.4%). Conditions in which antibiotic use was most prevalent were infectious and parasitic diseases (23.7%) and diseases of the digestive system (19.9%). The top three antibiotics prescribed were ceftriaxone (21.2%), metronidazole (20.0%) and amoxicillin (11.5%). The majority of patients (40.2%) were treated with two antibiotics. Conclusions: This study revealed a high level of inappropriate antibiotics use at JJTH. Furthermore, there is non-adherence to national/international guidelines in administration of these antibiotics among doctors. It is necessary to introduce antibiotic stewardship activity, along with continuous national surveillance and enforcement to reduce irrational antibiotics use and the associated risk for antibiotic resistance.

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