A pre and post comparison study was carried out in the field practice area of M.S. Ramaiah Medical College Bangalore, Karnataka to assess the impact of educational intervention on the knowledge of mothers of under five children on home management of diarrhoeal diseases. Sample of 225 mothers were included in the study. The study was conducted in 3 stages. Stage I--initial knowledge, attitude and practice of mothers was assessed. Stage II--one to one educational intervention was conducted and supported by audiovisual aids and live demonstration. Stage III--included post intervention knowledge, attitude and practice after 2 months and 2 years. After the educational intervention, there was significant improvement on knowledge of mothers regarding definition of diarrhoea (P < 0.001), signs of dehydration (P < 0.001), awareness of ORS solution (P < 0.001), correct preparation of ORS solution (P < 0.001), shelf-life of ORS solution (P < 0.001), seeking health care (P < 0.001) and rational drug therapy during diarrhoea (P < 0.001). McNemar test was used to find out the change in knowledge before and after the educational intervention. The overall knowledge scores improved significantly after 2 months (P < 0.001) as well as 2 years (P < 0.001) of the educational intervention. Though the proportion of mothers retaining the knowledge at the end of 2 years dropped, yet there was significant improvement (P < 0.001) when compared to the baseline study.
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Background: As of July 1, 2019, ~18% of all cases in the Ebola virus disease (EVD) outbreak in the Democratic Republic of Congo (DRC) were healthcare-associated (ie, nosocomial) infections (HAIs) and healthcare worker (HCW) infections. Although progress has been achieved, gaps remained in infection prevention and control (IPC), specifically, a need to reinforce standardized, evidence-based IPC practices to effectively address HAIs. The Ministry of Health (MOH), in collaboration with partners, developed an IPC tool kit consisting of >70 documents (ie, terms of reference, standard operating procedures, training modules, etc) to improve HCW IPC knowledge and practices at healthcare facilities among staff. The tool kit incorporated international IPC standards, DRC-specific experiences, and best practices. Thus, it serves as a technical and operational package, covering general guidance (standard precautions) and EVD specific issues. Methods: A decentralized rollout approach was used to disseminate the tool kit content at the various health-system levels over several months. Initially, national-level training of trainers was held, followed by subnational-level training of IPC supervisors and key IPC implementers, and lastly, training of healthcare facility (HCF) IPC focal persons. The 5-day training adhered to the MOH standard of 60% theory and 40% practice. Participants completed evaluations before and after training; changes in knowledge between the pre- and posttraining tests were analyzed and the results of the statistical tests were reported (P < .05 was considered statistically significant). Results: In total, 294 IPC supervisors were trained across 7 subnational commissions. Data were analyzed for 138 participants. Participants were 60.9% IPC supervisors, 8% WASH supervisors, and 31% others. MOH representation was 52.9% The average results before the test were 66% (19.8 of 30), the average posttest results were 72% (21.6 of 30)—a significant improvement. The worst-performing pretest IPC domain was IPC approach, and facility closure was the worst performing for posttest. As of November 11, 15.7% of all cases were HAIs. Conclusions: The IPC training program initiated during an outbreak can increase knowledge and potentially improve practices and confidence. An association with the downward HAI trend is yet to be validated. The MOH anticipates that this tool kit will be the go-to resource for future Ebola outbreaks and that it will be incorporated into the preservice medical curriculum to ensure a resilient heath system.Funding: NoneDisclosures: None
Background: With >3,000 cases and 2,000 deaths, the current outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) is the second-largest reported EVD outbreak in history. Healthcare-associated transmission of EVD has been a persistent amplifier of transmission due, in part, to fragility of the healthcare system, lack of basic infection prevention and control (IPC) infrastructure, and large number of healthcare facilities (HCFs). A central component of the strategy to rapidly strengthen IPC in HCFs is the provision of IPC supervisors to oversee standardized risk assessments and improvements and provide mentorship to HCF staff. To support these activities, we designed skills based training for IPC supervisors. Methods: Staff recruited by the Ministry of Health (MoH) to strengthen IPC are part of an outbreak-specific cadre known as IPC supervisors. IPC supervisors, who originally lacked technical knowledge and mentoring experience, were trained to provide technical support and mentorship to staff at HCFs, with the objective of improving IPC-related processes and behaviors. A competency-based training course was designed by conducting informal assessments of IPC supervisors during daily tasks to identify areas for performance improvement. We developed competencies based on activities designated for IPC supervisors according to MoH guidelines. We planned an iterative training rollout to allow for continuous, real-time modifications based on lessons learned throughout the implementation phase. Results: Although IPC supervisors displayed technical knowledge of IPC recommendations, we observed large gaps in implementation. IPC supervisors frequently failed to recognize behaviors that are high-risk for infection transmission. In addition, IPC supervisors lacked the ability to develop prioritized action plans and to implement interventions aimed at rapidly improving IPC practices. The course, designed as an interactive, skills-based training, is rooted in instructional design principles and addresses 4 key competencies: risk recognition and prioritization, IPC assessment completion, action plan development, and effective leadership and communication. The course will be pilot tested in the DRC to an audience of 25 IPC supervisors. Conclusions: In an outbreak setting, strong mentorship and problem-solving skills are needed to support effective implementation of IPC quality improvement. Trainings that are informed by field experiences and teach problem-solving, coaching, and communication skills are critical and can be developed rapidly. The strategy employed by the Ministry of Health to rapidly achieve IPC capacitation at HCFs might be adapted for use in future outbreaks.Funding: NoneDisclosures: None
Background: Population policies, family planning and welfare programmes undertaken by the Government of India, have led to continuous decrease in the fertility rate but sustainability and target of net reproduction rate 1 is not yet achieved. With increase trend of adopting the permanent method of contraception by eligible couples, the preferences of tubectomy over vasectomy is still remarkable. Hence, the present study is taken up to find Knowledge, Attitude and Practice regarding sterilization and factors influencing it.Methods: A cross-sectional study is conducted in the year 2017 among eligible couples who have completed their family size or pregnant women who came for second confinement to Vydehi Institute of Medical Sciences and Research Centre and Shreyas Maternity Home, Hoskote and Shreyas maternity home are included. An institutional ethics committee (IEC) is given on vasectomy, the better method of sterilization and responses are recorded.Results: A total 92.6% couples were aware of permanent family planning methods. Among them only 30.6% couples are aware of vasectomy. There is a significant association between number of children in a family and to undergo sterilization (p=0.02) method. Reason for not choosing vasectomy are unawareness (49.3%) and social stigma (38%) mainly. 11 couples (7.3%) changed their opinion to undergo vasectomy after giving an IEC.Conclusions: Many couples were knowledgeable about tubectomies and opted for it. Only a small number of couples changed their opinion from tubectomy to vasectomy after being given an IEC.
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