On the front line: Health professionals and system preparedness for Zika virus in Peru

Abstract

Objectives:To analyze the initial healthcare response to the Zika virus in Piura, Peru, and assess the perceptions of midwives and nurses regarding their role in prevention of Zika virus and management of congenital Zika syndrome (CZS). Methods:This ethnographic study used a rapid qualitative assessment design. Data were collected through a focus group with midwives and in-depth interviews with midwives (n=11) and nurses (n=5). Results: The focus of the early Zika virus response in Piura was on pregnant women and vector control. Midwives received some training on Zika-related care during the early response. Nurses did not receive any Zika-specific training. Neither nurses nor midwives were trained in neonatal CZS surveillance. Midwives were clear about the value and feasibility of incorporating Zika virus surveillance in their daily work, however nurses were not. They referred to lack of training and appropriate tools as limitations. Confusion about Zika virus and CZS symptomatology and effects persisted in both groups. Concerns about their own personal risk influenced the ways they engaged with Zika virus prevention in the community.Conclusion: Long-term management of endemic Zika virus in Piura will require the engagement of both nurses and midwives as primary care providers. K E Y W O R D S

Uncertainties, Fear and Stigma: Perceptions of Zika Virus among Pregnant Women in Spain

“…There are several studies reporting perceptions and knowledge gaps in pregnant women exposed to ZIKV in endemic areas [ 12 , 16 , 17 , 18 , 19 ]; access to the healthcare system, specifically to sexual and reproductive health services for women living in endemic settings [ 20 , 21 , 22 ]; perceptions of ZIKV among women, not necessarily during gestation [ 9 , 23 ]; the general public living in endemic settings [ 11 ]; knowledge and attitudes among travelers to the U.S.A. [ 24 ] and to Brazil [ 25 ]; and perceptions of ZIKV among healthcare professionals [ 26 ]. The previously mentioned studies are very diverse in design, methodology and population under study, as are in their results and conclusions.…”

Nurses at the frontline of public health emergency preparedness and response: lessons learned from the HIV/AIDS pandemic and emerging infectious disease outbreaks

“… 56 In many affected areas, particularly rural and remote areas, and socioeconomically susceptible urban communities, nurses formed the backbone of services providing Zika virus disease treatment, management of Zika-related birth defects, and prevention education for high-risk individuals, such as pregnant women. 57 , 58 , 59 Retrospective analyses of the response efforts suggest the slow dissemination of emerging scientific evidence and evolving practice recommendations impeded the mitigation of Zika virus disease. 58 , 59 In particular, nurses and other health-care providers in remote and medically underserved areas reported inadequate preparation in providing quality patient education and care for susceptible populations.…”

“… 57 , 58 , 59 Retrospective analyses of the response efforts suggest the slow dissemination of emerging scientific evidence and evolving practice recommendations impeded the mitigation of Zika virus disease. 58 , 59 In particular, nurses and other health-care providers in remote and medically underserved areas reported inadequate preparation in providing quality patient education and care for susceptible populations. 59 , 60 To address this challenge, the University of California, San Francisco, CA, USA, established a Zika response nurse coordinator during the height of the outbreak in 2016.…”

“… 58 , 59 In particular, nurses and other health-care providers in remote and medically underserved areas reported inadequate preparation in providing quality patient education and care for susceptible populations. 59 , 60 To address this challenge, the University of California, San Francisco, CA, USA, established a Zika response nurse coordinator during the height of the outbreak in 2016. 61 , 62 This role included provision of subject matter expertise to health-care providers in the region, development of infrastructure for Zika testing, and patient education resources, and represents an important case example for broad adoption.…”

“…Delays in the dissemination and adaptation of evolving evidence-based practice recommendations and medical innovations to under-resourced and peripheral health facilities that largely rely on nurses for health-care delivery have hindered infectious disease response efforts. 58 , 59 , 60 , 73 Designated coordinating centres for support of remote health-care providers, particularly as infrastructure for increasing reach of evolving evidence in care, are needed. Features that allow for widespread use by nurses in peripheral health facilities should be prioritised in the development of new medical technologies, including considerations such as transport and refrigeration, suitability for outpatient procedures, and usability without specialised training.…”