Master of Public Health - MPH / South Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.

Sammanfattning Bakgrund: Undersköterskor är en stor yrkesgrupp men många är sjukskrivna, ofta relaterat till stress. Att arbeta natt, vilket många undersköterskor gör, är ytterligare en faktor som kan ge upphov till arbetsrelaterad stress. Nattarbetet medför även andra hälsorisker, exempelvis depression, övervikt och kardiovaskulära sjukdomar. Få studier går att finna gällande undersköterskor och nattarbete. Syftet: Syftet var att undersöka hur nattarbetande undersköterskor upplever nattarbetet och på vilket sätt nattarbetet påverkar deras hälsa. Metod: Studien är en kvalitativ intervjustudie med en induktiv ansats. För rekrytering av deltagare användes snöbollsprincipen. Deltagarna intervjuades via telefon och spelades in. Datamaterialet bearbetades genom kvalitativ innehållsanalys.  Resultat: Undersköterskorna upplevde att det var lugnare att jobba nattpass än dag – och kvällspass. Det var extra viktigt med bra samarbete. Nattarbetet var skört när någonting extra, akut, inträffade. De upplevde att de fick försämrad sömn och blev trötta av att arbeta natt. De åt på ett annat sätt än om de enbart arbetade dag- eller kvällspass. Något som ansågs som positivt var att nattarbetet kunde bidra till längre ledigheter vilket uppfattades öka livskvaliteten. Slutsats: De flesta undersköterskor upplevde nattarbetet positivt trots att det påverkade deras hälsa negativt. Fler nattarbetande undersköterskor behövs. Kunskap om undersköterskors sömn och matvanor i förhållande till nattarbete, samt hur nattarbetande undersköterskor upplever sin arbetsmiljö, är viktigt för att motivera förebyggande åtgärder i form av exempelvis medicinska kontroller och utbildning. / Abstract Background: Many assistant nurses are on sick leave due to stress. Some need to work at night, which can be a stress factor. Night shift workers also tend to have problems with obesity and depression. There are few studies about assistant nurses and night shift work. Aim: The aim was to investigate how assistant nurses experience night work and their health. Method: A qualitative interview study with an inductive approach. The snowball principle was used to recruit participants. Data were analyzed through qualitative content analysis approach. Results: Assistant nurses reported that it was calmer to work at night and that cooperation was even more important compared with day or evening- shifts. Working conditions were fragile if something urgent happened. Participants suffered from lack of sleep and had a change in eating habits due to the night- shift work. Night shifts resulted in longer periods of free time which increased quality of life. Conclusion: Most assistant nurses experienced positive experiences of night shift-work, even though it had a negative effect on their health. More night-working assistant nurses are needed. Knowledge about sleep and eating habits, as well as work environment during night shifts, is important to motivate preventive measures, for example medical check-ups and education.

Philosophiae Doctor - PhD / Women living with HIV (WLHIV) desire to bear children. Safe conception (SC) education for informed decision-making to prevent peri-conception HIV infection is needed but not routinely available. Poor SC knowledge, attitude, skills in addition to the absence of a standardised training programme were challenges that limited delivery. This study therefore aimed at developing a training programme for healthcare workers to facilitate SC education among WLHIV. The study adopted the intervention research approach. Both qualitative and quantitative methods were employed.

The 2001 anthrax attacks heightened awareness of the possibility of weaponizing biological agents such as Ebola, anthrax, and smallpox and hence, the Bioterrorism Act of 2002 to prevent biological attacks and reduce bioterrorism threats and vulnerabilities. However, the 2014 Ebola epidemic raised concerns about unpreparedness for bioterrorism within the healthcare community and about secondary infections from healthcare workers. Using Kingdon's conceptualization of multiple streams as the foundation, the purpose of this case study was to explore the nature of bioterrorism threats and the level of preparedness of Emergency Medical Technicians (EMTs) who were involved in the 2014 Ebola epidemic in a New Jersey County for biological attacks and avoidance or reduction of secondary infections. Data were collected from 18 individuals through interviews and from emergency response documents. The data were inductively coded and subjected to thematic analysis. The emergent themes indicated that although there was an abundance of bioterrorism preparedness policies and programs dating back to the 2001 anthrax attacks, the response to the 2014 Ebola epidemic revealed inadequate bioterrorism preparedness practices. The study participants identified insufficient knowledge of bioagents and lack of regular training as factors that prevented enhanced preparedness practices. Participants suggested that improved training opportunities, interagency collaborations, and better funding would improve bioterrorism preparedness practices. The social change implications of this study include increased funding for bioterrorism preparedness to harden EMTs and the creation of public awareness of bioagents for improved 911 calls and emergency response practices.

Användning av mobiltelefoner av hälso- och sjukvårdspersonal i hälso- och sjukvården har blivit allt vanligare. Forskning visar på att mobiltelefoner används av personal i patientnära situationer i syfte att underlätta arbetet. Därmed var syftet med kandidatuppsatsen att undersöka förekomsten av mikroorganismer som följd av bristande rengöringsrutiner av hälso- och sjukvårdspersonalens mobiltelefoner. Studien är skriven som en allmän litteraturstudie. Datainsamlingen har gjorts genom specificerade sökningar i databaserna CINAHL och PubMed. Sökningarna i de båda databaserna resulterade i 13 artiklar, som ligger till grund för resultatet. Resultatet påvisar att bakterier som koagulasnegativa stafylokocker och enterobacter var de vanligast förekommande mikroorganismerna på mobiltelefoner tillhörande hälso- och sjukvårdspersonal. Ytterligare påträffades mikroorganismer som virus. De virus som påträffades var respiratoriskt syncytuevirus (RSV) och adenovirus (AV). Resultatet visar även på brister gällande rengöring av mobiltelefonerna där majoriteten av mobiltelefonerna aldrig rengjordes. / The use of mobile phones by healthcare workers in healthcare settings has become increasingly common. Research shows that healthcare workers use their mobile phones within near contact with patients in order to facilitate their work. Therefor the aim of this candidate essay was to investigate the presence of microorganisms as a result of the lack of cleaning routines of the healthcare workers mobile phones. The study is written as a general literature study. Data collection was done through specific searches in the databases CINAHL and PubMed. Searches in the two databases finally resulted in 13 articles, which are the basis for the result in this study. The result shows that coagulasenegative staphylococcus and enterobacteria was the most occuring microorganisms on the healthcare workers mobile phones. In addition microorganisms as viruses like respiratory syncytial virus (RSV) and adenovirus (AV) was detected on the healthcare workers mobile phones. The result also shows deficiencies regarding the cleaning of the mobile phones where the majority of the mobile phones were never cleaned.

Bakgrund: Att leva med psykisk ohälsa är vanligt förekommande i hela världen och är ett tillstånd som kraftigt ökar. För att en människa ska kunna hantera kriser och svårigheter i livet krävs i grunden god psykisk hälsa, vilken kan påverkas om människans livssituation förändras. Coronaviruset orsakar en allvarlig situation, där social isolering kan påverka den psykiska hälsan.Syfte: Syftet är att beskriva Coronapandemins negativa påverkan på den psykiska hälsan hos vårdpersonal samt dess bakomliggande faktorer.Metod: Examensarbetet utfördes som en litteraturöversikt och baserades på 15 vetenskapliga artiklar. Samtliga artiklar inhämtades från databaserna CINAHL och PubMed och var publicerade mellan år 2020–2021.Resultat: Coronapandemin och de åtgärder som vidtagits har kraftigt påverkat den psykiska folkhälsan i världen, inte minst hos vårdpersonal. Pandemin har hos vårdpersonalen bidragit till depression, ångest, stress, posttraumatiskt stressyndrom och sömnsvårigheter. Bidragande faktorer har varit hög arbetsbelastning, brist på skyddsutrustning, oro för smittspridning, kraftiga arbetsförändringar och påfrestningar utanför arbetet.Slutsats: Coronapandemins påfrestningar på hälso- och sjukvården har påverkat vårdpersonalens psykiska hälsa. Rädslan över att smitta familj, känslan av osäkerhet och hög arbetsbelastning har bidragit till depression, ångest, stress, posttraumatiskt stressyndrom och sömnstörningar. En god fysisk och psykisk hälsa hos vårdpersonal gynnar patientsäkerheten och för att tillhandahålla en säker vård under en pågående kris behöver vårdpersonalens välbefinnande främjas. Vårdpersonal med psykisk ohälsa behöver fångas upp tidigt och få möjlighet till återhämtning under och efter en kris som Coronapandemin. / Background: Mental illness is common throughout the world and is an increasing condition. In order for a person to be able to handle crises and difficulties in life, good mental health is basically required, which can be affected if the person's life situation changes. The Coronavirus causes a serious situation, where social isolation can affect mental health.Aim: To describe the Coronapandemic`s negative impact on the mental health of healthcare workers and its underlying factors.Methods: The thesis was conducted as a literature review based on 15 scientific articles published between 2020-2021.Results: The Coronapandemic and the measures taken have greatly affected the mental health of the world, not least among healthcare workers. The pandemic has contributed depression, anxiety, stress, post-traumatic stress disorder and difficulties sleeping. Contributing factors have been high workload, lack of protective equipment, concerns about the spread of infection, sharp changes in work and stress outside work.Conclusion: Coronapandemic stresses on healthcare have affected the mental health of healthcare workers. The fear of infecting a family, the feeling of insecurity and high workload have contributed depression, anxiety, stress, post-traumatic stress disorder and sleep disorders. Good physical and mental health of healthcare workers promotes patient safety and in order to provide safe care during an ongoing crisis, the well-being of healthcare professionals needs to be promoted. Healthcare workers with mental illness need to be caught early and given the opportunity to recover during and after a crisis such as the Coronapandemic.

Philosophiae Doctor - PhD / This study sought to investigate the information needs of selected HIV and AIDS health organisations in Zimbabwe with a view to proposing a framework for developing an information access platform. ICTs can play a pivotal role in improving access to HIV and AIDS information and in coordinating HIV and AIDS activities in Zimbabwe. However, the development of ICTs in Zimbabwe’s health sector has been haphazard and idiosyncratic to a plethora of HIV and AIDS organisations operating in Zimbabwe. This study proposes a framework for the development of ICTs for accessing HIV and AIDS information in Zimbabwe. The needs-based framework was proposed after evaluating the information needs of healthcare workers and current health information technologies. An integrated theoretical framework incorporating the General System Theory, the Social Construction of Technology theory and the HOT-fit model was used to frame the study.

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Healthcare-associated infections (HAI) are a problem in health care worldwide. In Sweden 7-8% of all patients treated in hospital suffer from an adverse event of varying severity, of which approximately 60,000 from a HAI. Proper hand hygiene is considered the single most important measure to reduce HAI. Despite the importance, adherence to correct hand hygiene routines are lacking among healthcare workers (HCWs). The World Health Organizations (WHO) multimodal promotion strategy promotes areas that need to be addressed in order to change the behaviour of individual HCWs to optimise adherence to hand hygiene and to improve patient safety. These areas include feedback, education, reminders at the workplace and institutional safety climate.  The overall aim of this study was to examine the possibility of adherence to hand hygiene routines and to explore factors that might influence the HCWs adherence.  The study used a descriptive research design made through qualitative method, with focus group interviews, and quantitative method, using a questionnaire survey. Eight focus group interviews were conducted with assistant nurses (n=18), nurses (n=15) and physicians (n=5) and analysed with abductive qualitative content analysis. The questionnaire survey was answered by nurses (n=84) and nursing students in their first semester (n=71) and last semester (n=46) and the data was statistically analysed. The main findings show that there are barriers to hand hygiene adherence and measures to improve these. HCWs highlighted discrepancies regarding how the organisation was supposed to give feedback and how it actually was at the workplace and expressed needs for more direct feedback to improve adherence. The study also found that hygienic knowledge gaps exists among nurses and nursing students regarding causes of HAI and how the risk of contamination of patients and HCWs can be minimized among others. Students at the beginning of the education had a lower level of knowledge than last semester students and registered nurses. The last semester students tended to have the highest level of hand hygiene knowledge.  In conclusion, the key areas presented by WHO’s multimodal promotion strategy to improve adherence all lack the appropriate measures, in some extent. The use of an electronic reminder system could give the means to improve a behaviour as long as the individual integrity is protected and development of curriculums for nursing students and continuing education of nurses is needed to further develop and maintaining knowledge.

No description available.