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  • 1.
    Andersson, Gunnel
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kaboru, Berthollet Bwira
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. The Centre for Women’s, Family and Child Health, Faculty of Health Sciences, Buskerud & Vestfold University, College, Kongsberg, Norway.
    Namegabe, Edmond Ntabe
    Faculty of Community Health and Development, Université Libre des Pays des Grands Lacs, Goma, Congo Democratic Republic.
    Health Workers’ Assessment of the Frequency of and Caring for Urinary and Fecal Incontinence among Female Victims of Sexual Violence in the Eastern Congo: An Exploratory Study2015In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 5, p. 354-360Article in journal (Refereed)
    Abstract [en]

    Background: Throughout the long war that the Democratic Republic of Congo (DRC) has endured,women and children have been depicted as the primary victims of widespread sexual violence. Insome settings women have been raped in entire villages, with devastating physical and psychologicalconsequences, which include sexually transmitted infections such as HIV, trauma and fistulas,as well as social isolation and involuntary pregnancies. The aim of this study was to assess theprevalent perceptions of health professionals on the magnitude of urine and/or fecal incontinenceamong assaulted women, caused by sexual violence, as well as the opinions regarding the type ofcare provided to affected women.

    Methods: The study was part of a larger pilot study that had across-sectional design and a descriptive approach, which explored health professionals’ views regarding their own levels of competence at responding to the health needs of victims of sexual violence, in the form of a semi-structured questionnaire.

    Results: 104 health workers responded to the questionnaire. Nurses reported seeing raped women more frequently on a day-to-day basis (69.2%), in comparison to medical doctors and social workers (11.5%). Urinary incontinence was common according to 79% of health workers, who estimated that up to 15% of the women affected experienced huge amounts of urine leakage. Only 30% of the care seekers underwent in depth investigations, but the majority of the victims were not offered any further examination or appropriate treatments.

    Conclusion: Urinary and fecal incontinence due to urogenital or colorectalfistulas among women exposed to sexual violence is a common in the specified setting, but lack of systematic investigation and appropriate treatment means that the quality of life of the victims may be negatively affected. An improvement in the ability of health workers to manage these complex diagnoses is urgently needed, as well as adequately equipping health services in the affected settings.

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  • 2.
    Carlsson, Marie
    et al.
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Johansson, Stina
    School of Health and Medical Sciences, Örebro University, Sweden.
    Eale, Remy-Paul Bosela
    International Leadership University (ILU), Bujumbura, Burundi.
    Kaboru, Berthollet Bwira
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nurses’ roles and experiences with enhancing adherence to tuberculosis treatment among patients in Burundi: a qualitative study2014In: Tuberculosis Research and Treatment, ISSN 2090-150X, E-ISSN 2090-1518, Vol. 2014, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Background

    In TB control, poor treatment adherence is a major cause of relapse and drug resistance. Nurses have a critical role in supporting patients in TB treatment process. Yet, very little research has been done to inform policymakers and practitioners on nurses’ experiences of treatment adherence among patients with TB.

    Aim.

    To describe nurses’ experiences of supporting treatment adherence among patients with tuberculosis in Burundi.

    Method

    The study adopted qualitative approach with a descriptive design. A purposive sampling was performed. Eight nurses were selected from two TB treatment centers in Burundi. Content analysis was used to analyze the data.

    Result

    According to the nurses,most patients complete their treatment. Educating patients, providing the medication, observing and following up treatment, and communicating with the patients were the key tasks by nurses to support adherence. Causes for interruption were medication-related difficulties, poverty, and patients’ indiscipline. Treatment adherence could also be affected by patients’ and nurses’ feelings. Providing transportation and meals could enhance treatment compliance.

    Conclusion

    Nurses are critical resources to TB treatment success. In a poverty stricken setting, nurses’ work could be facilitated and adherence further could be enhanced if socioeconomic problems (transportation and nutritional support) were alleviated.

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  • 3.
    Kaboru, Berthollet Bwira
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Active referral: an innovative approach to engaging traditional healthcare providers in TB control in Burkina Faso2013In: Healthcare policy [ Politiques de santé ], ISSN 1715-6572, Vol. 9, no 2, p. 51-64Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: The involvement of traditional healthcare providers (THPs) has been suggested among strategies to increase tuberculosis case detection. Burkina Faso has embarked on such an attempt. This study is a preliminary assessment of that model.

    METHODS: Qualitative data were collected using unstructured key informant interviews with policy makers, group interviews with THPs and health workers, and field visits to THPs. Quantitative data were collected from program reports and the national tuberculosis (TB) control database.

    RESULTS AND ANALYSIS: The distribution of tasks among THPs, intermediary organizations and clinicians is appealing, especially the focus on active referral. THPs are offered incentives based on numbers of suspected cases confirmed by health workers at the clinic, based on microscopy results or clinical assessment. The positivity rate was 23% and 9% for 2006 and 2007, respectively. The contribution of the program to national case detection was estimated at 2% for 2006. Because it relied totally on donor funding, the program suffered from irregular disbursements, resulting in periodic decreases in activities and outcomes.

    CONCLUSIONS: The study shows that single interventions require a broader positive policy environment to be sustainable. Even if the active referral approach seems effective in enhancing TB case detection, more complex policy work and direction, domestic financial contribution and additional evidence for cost-effectiveness are needed before the approach can be established as a national policy.

  • 4.
    Kaboru, Berthollet Bwira
    Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Uncovering the potential of private providers' involvement in health to strengthen comprehensive health systems: a discussion paper.2012In: Perspectives in Public Health, ISSN 1757-9139, E-ISSN 1757-9147, Vol. 132, no 5, p. 245-52Article in journal (Refereed)
    Abstract [en]

    Health systems strengthening (HSS) is being increasingly recognized as a strategic cross-cutting issue in all World Health Organization (WHO) work. Health systems comprise six building blocks: service delivery; medical products, vaccines and technologies; health workforce; health systems financing; health information system; and leadership and governance. Public-private mix (PPM) approaches or partnerships consist of initiatives aimed at increasing collaboration and improving the relationships between public-public, public-private and private-private health providers. An important component of PPM is the clear distribution of tasks between the different providers involved in the provision of health care. In practice, most PPM initiatives are disease-specific and are often related to the health service delivery block mentioned above. Although there is widespread consensus that PPM initiatives are typically of an HSS nature, efforts to make explicit the links between PPM and health systems building blocks are rather uncommon. The present paper aims to identify - in order to facilitate operationalization - potential aspects linking PPM to health systems building blocks, using a few experiences from tuberculosis control and beyond. The paper targets policymakers, donors and health systems scientists and ends with a call for more aware and innovative leadership, for increased support of PPM initiatives covering various building blocks, and for more operational research.

  • 5.
    Kaboru, Berthollet Bwira
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Borneskog, Catrin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Namegabe, Edmond Ntabe
    Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma, Democratic Republic of the Congo.
    Knowledge and attitudes towards sexual violence in conflict-affected rural communities in the Walikale District, DR Congo: implications for rural health services2014In: Annals of Public Health and Research, ISSN 2378-9328, Vol. 1, no 2, p. 1009-Article in journal (Refereed)
    Abstract [en]

    Sexual violence has become endemic in the Democratic Republic of Congo (DRC), but the perspectives of rural communities of the scourge remain poorly researched. This study aims to describe the attitudes and knowledge of rural communities in regard to sexual violence, its occurrence and associated problems in rural communities in the Itebero/Walikale district in the DRC. A descriptive cross-sectional design was adopted, and a structured questionnaire used. Four hundred respondents participated, representing a group of ten villages populated by a total of 10,000 inhabitants. The respondents stated that perpetrators were often men from their own village. The fields were cited as being the place where most of the assaults occurred. A substantial proportion of the respondents lacked sufficient knowledge of the health outcomes of sexual violence. HIV infection and unwanted pregnancies were the most feared consequences. The victims of violence either experienced compassion or suffered rejection, depending on the community groups. Victims were mostly supported by women from their community, followed by husbands, relatives and authorities. Health facilities were the primary sources of support for victims. Rural health facilities need to revolutionise their health education strategies to improve the current situation.

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  • 6.
    Kaboru, Berthollet Bwira
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Borneskog, Catrin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Adolfsson, Annsofie
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Namegabe, Edmond Ntabe
    Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma, Democratic Republic of the Congo.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    “Qualified but not competent enough”: Healthworkers’ assessment of their competence in relation to caring for sexually abused women in Eastern Democratic Republic of Congo2015In: Journal of Nursing Education and Practice, ISSN 1925-4040, E-ISSN 1925-4059, Vol. 5, no 8, p. 26-32Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess health professionals’ opinions of their competence levels in responding to health needs of victims of sexual violence. This study used a cross-sectional design with a descriptive approach. A total of 104 physicians, nurses and social workers participated in the study. The data was collected using a questionnaire consisting of open and close-ended questions.  Overall, 75% of the respondents were university graduates, but only a quarter of them felt they have adequate competence to care for these women; 36% had difficulties with general health assessment of assaulted women. The results indicated that nurses are critical professionals in caring for victims of sexual violence, that they see these women more than any other professional category. However, they are more likely than other categories to report being incompetent. Access to continued education was difficult, and more so for clinically-oriented health professionals than for others social professionals. Human resources capacity strengthening and particularly that of nurses will be the key investment in addressing assaulted women’s health needs in this region. Clinical researchers are called to identify rapid methods to reinforce nurses’ capacity and role in such a context with deprived health systems.

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  • 7.
    Kaboru, Berthollet Bwira
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of International Health (IHCAR), Department of Publ ic Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Falkenberg, Torkel
    Division of International Health (IHCAR), Department of Publ ic Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Studies of Complementary Medicine, Division of International Health (IHCAR), Department of Public Health Sciences and Division of Nursing, Department of Neurobiology, Caring Sciences and So ciety, Karolinska Institutet, Stockholm, Sweden.
    Ndubani, Phillimon
    nstitute of Economic and Social Research (INESOR), University of Zambia, Lusaka, Zambia.
    Höjer, Bengt
    Division of International Health (IHCAR), Department of Publ ic Health Sciences, Karolinska Institutet, Stockholm, Sweden; Dalarna University College, Falun, Sweden.
    Vongo, Rodwell
    Traditional Health Practi tioners Association of Zambia (THPAZ), Lusaka, Zambia.
    Brugha, Ruairi
    London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
    Faxelid, Elisabeth
    Division of International Health (IHCAR), Department of Publ ic Health Sciences, Karolinska Institutet, Stockholm, Sweden; Division of Reproductive and Perinatal Care, Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Can biomedical and traditional health care providers work together?: Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care. A cross-sectional study2006In: Human resources for health, ISSN 1478-4491, Vol. 4, no 16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs). The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs) and HIV/AIDS.

    METHODS: We conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs) and 144 traditional health practitioners (THPs) who reported attending to patients with STIs and HIV/AIDS.

    RESULTS: The study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants) on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs.

    CONCLUSION: There is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However, there are missed opportunities. The lack of collaborative framework integrating maternal health with STIs and HIV/AIDS care is at odds with the needed comprehensive approach to HIV/AIDS control. Also, considering the current human resources crisis in Zambia, substantial policy commitment is called for to address the legislative obstacles and the stigma reported by THPs and to provide an adequate distribution of roles between all partners, including traditional health practitioners, in the struggle against HIV/AIDS.

  • 8.
    Kaboru, Berthollet Bwira
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Falkenberg, Torkel
    Centre for Studies of Complementary Medicine, Division of International Health (IHCAR), Department of Public Health Sciences and Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Ndulo, Jane
    Institute of Economic and Social Research (INESOR), University of Zambia, Lusaka, Zambia.
    Muchimba, Maureen
    Institute of Economic and Social Research (INESOR), University of Zambia, Lusaka, Zambia.
    Solo, Kashita
    Traditional Health Practitioners Association of Zambia (THPAZ), Lusaka, Zambia.
    Faxelid, Elisabeth
    Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Division of Reproductive and Perinatal Care, Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Communities' views on prerequisites for collaboration between modern and traditional health sectors in relation to STI/HIV/AIDS care in Zambia2006In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 78, no 2-3, p. 330-339Article in journal (Refereed)
    Abstract [en]

    Traditional, complementary and alternative medicine (TM/CAM) is globally increasing in popularity. The World Health Organization (WHO) has advocated for the integration of TM/CAM in national public health policies to enhance health care resources. Interest in collaboration between traditional and biomedical health sectors has been renewed in attempts to strengthen control of the AIDS epidemic. However, studies exploring communities' views on the prerequisites for such collaboration are inexistent.

    We conducted 21 focus group discussions with community members in two Zambian urban centres (Ndola and Kabwe) to explore their perspectives on preconditions for useful collaboration between traditional and modern health workers in the management of STIs and HIV/AIDS.

    This study shows that laypersons' perspectives can be rich and inform complex policy issues. Five categories indicating key areas of actions were identified, including protection of traditional medicine and of compensation of healers, education of both groups of providers and adequate community involvement. The respect for some degree of secrecy in traditional medicine was also called for.

    As part of efforts to strengthen available resources for better care of STI/HIV/AIDS, this study provides policymakers, researchers and practitioners with an outline of fundamentals in terms of needed crucial changes at health policy level, among providers and in the community for sustainable collaboration between modern and traditional health practitioners.

  • 9.
    Kaboru, Berthollet Bwira
    et al.
    Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Muchimba, Maureen
    Institute of Economic and Social Research (INESOR), University of Zambia, Lusaka, Zambia.
    Falkenberg, Torkel
    Centre for Studies of Complementary Medicine, Division of International Health (IHCAR), Department of Public Health Sciences, Stockholm; Division of Nursing, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet.
    Höjer, Bengt
    Dalarna University College, Falun.
    Faxelid, Elisabeth
    Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm; Division of Reproductive and Perinatal Care, Department of Women and Child Health, Karolinska Institutet.
    Quality of STIs and HIV/AIDS care as perceived by biomedical and traditional health care providers in Zambia: are there common grounds for collaboration?2008In: Complementary Therapies in Medicine, ISSN 0965-2299, E-ISSN 1873-6963, Vol. 16, no 3, p. 155-62Article in journal (Refereed)
    Abstract [en]

    Objective: To explore biomedical and traditional health care providers' (BHPs and THPs, respectively) perceptions of good quality of care and opinions on weaknesses in the services they provide to patients with STIs and HIV/AIDS.

    Methods: Using data from a cross-sectional survey, we post-coded two open-ended questions related to THPs' and BHPs' perceptions on good quality of care and on provided care. The post-coding was done following Donabedian's framework of assessment of quality of care, and allowed transformation of qualitative data into quantitative. The analysis is based on comparison of frequencies, proportions and subsequent chi-square tests and odds ratios.

    Setting: Ndola and Kabwe, Zambia Main measures: Proportions of responses from 152 BHPs and 144 THPs.

    Results: Substantial proportions of providers from both sectors perceived drugs availability (63% of BHPs and 70% of THPs) and welcoming attitude (73% of BHPs and 64% of THPs) as important components of good quality care. BHPs were more likely than THPs to mention proper examination, medical management (provider's technical ability) and explanation of causes and prognosis of the disease as important. More THPs than BHPs cited short waiting time and cost of care. A majority of BHPs (87%) and of THPs (80%) reported deficiencies in their STIs and HIV/AIDS-related services. Both groups regarded training of providers and nutritional support and health education to patients as lacking. None of the THPs alluded to voluntary counselling and testing (VCT) or supportive/home-based care as aspects needing improvement.

    Conclusion: Drugs availability and welcoming attitude were two aspects of quality highly valued by THPs and BHPs. Future collaborative interventions need to respond to aspects of joint concern including training of providers, nutritional support and health education to patients. Further, there is an imperative of expanding and adapting VCT, home-based care and palliative care to THPs for better care of STIs and HIV/AIDS.

  • 10.
    Kaboru, Berthollet Bwira
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Namegabe, Edmond Ntabe
    Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma, Democratic Republic of the Congo.
    Geographical, health systems’ and sociocultural patterns of tb/hiv co-infected patients’ health seeking behavior in a conflict affected setting: the case of Eastern Democratic Republic of Congo2013In: Journal of Community Medicine and Health Education, ISSN 2161-0711, Vol. 4, no 1, p. 1-6Article in journal (Other academic)
    Abstract [en]

    Background: The Democratic Republic of Congo (DRC) is one of the high burden TB countries. The country has been affected by a political conflict for more than 15 years now. HIV prevalence has been increasing in the country too. Detection and care of TB/HIV co-infected cases is a major problem in the country. Aim: This study aimed at describing patterns of health seeking behaviors among patients with TB/HIV regarding their choice of health facilities for integrated TB/HIV care in the Goma and surrounding health districts.

    Methods: The methods used included a cross-sectional descriptive survey with TB/HIV co-infected patients and qualitative interviews of health workers.

    Results: The study found that geographical residence did not play a major role in choice of facility for care by patients infected with TB and HIV. Many patients shun facilities which are close and seek care relatively far away. Instead of geographical proximity, availability of drugs and welcoming attitudes determined the choice of integrated care facilities. Also, fear for discrimination and stigmatization in the community result into patients in this area concealing their infection; rather, they claim being victim of empoisoning.

    Conclusion: Sustained decentralization of integrated TB/HIV services through better programs’ coordination and community involvement to address misconceptions about TB and HIV and stigmatization are essential to promote uptake of TB/HIV services and retain patients in treatment.

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    TB/HIV coinfection patterns
  • 11.
    Kaboru, Berthollet Bwira
    et al.
    Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Ndubani, Phillimon
    Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia.
    Falkenberg, Torkel
    Centre for Studies of Complementary Medicine, Division of International Health, Department of Public Health Sciences and Division of Nursing, Department of Neurobiology, Caring Science and Society, Karolinska Institutet, Stockholm.
    Pharris, Anastasia
    Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Muchimba, Maureen
    Institute of Economic and Social Research, University of Zambia, Lusaka, Zambia.
    Solo, Kashita
    Traditional Health Practitioners Association of Zambia, Lusaka, Zambia.
    Höjer, Bengt
    Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm; Dalarna University College, Falun.
    Faxelid, Elisabeth
    Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    A Dialogue-Building Pilot Intervention Involving Traditional and Biomedical Health Providers Focusing on STIs and HIV/AIDS Care in Zambia2008In: Complementary Health Practice Review, ISSN 1533-2101, Vol. 13, no 2, p. 110-126Article in journal (Refereed)
    Abstract [en]

    Collaboration between traditional and biomedically trained health workers is regarded as key in HIV/AIDS control. However, few studies have focused on exploring ways of enhancing this collaboration. Using a pre- and postintervention questionnaire, the authors assessed changes in attitudes to and practices of collaboration among 19 biomedical and 28 traditional health care providers following a 12-month dialogue-building intervention in Ndola, Zambia. The intervention consisted of peer group discussions, interactive group discussions, training sessions, and peer-influenced networking. The results show that although both groups of providers had fairly positive attitudes toward each other before the intervention, further improvements in attitudes were observed after the intervention. Referrals between the two sectors and cross visits increased. However, some attitudes to collaboration became more negative and cautious after the intervention. Dialogue-building interventions involving traditional and biomedical providers are not only feasible but also complex. Intersectoral collaboration needs time and coordination between all relevant actors in the community. Adapted from the source document.

  • 12.
    Kaboru, Berthollet Bwira
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Ogwang, Brenda. A.
    Division of Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Namegabe, Edmond Ntabe
    Faculté des Sciences de Santé et Developpement Communautaires, Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo.
    Mbasa, Ndemo
    Faculté des Sciences de Santé et Developpement Communautaires, Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo.
    Kabunga, Deka Kambale
    Inspection Provinciale de la Santé, Goma, Democratic Republic of Congo.
    Karafuli, Kambale
    Faculté des Sciences de Santé et Developpement Communautaires, Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo.
    TB/HIV co-infection care in conflict-affected settings: a mapping of health facilities in the Goma area, Democratic Republic of Congo2013In: International Journal of Health Policy and Management, ISSN 2322-5939, Vol. 1, no 3, p. 207-211Article in journal (Other academic)
    Abstract [en]

    Background HIV/AIDS and Tuberculosis (TB) are major contributors to the burden of disease in sub-Saharan Africa. The two diseases have been described as a harmful synergy as they are biologically and epidemiologically linked. Control of TB/HIV co-infection is an integral and most challenging part of both national TB and national HIV control programmes, especially in contexts of instability where health systems are suffering from political and social strife. This study aimed at assessing the provision of HIV/TB co-infection services in health facilities in the conflict-ridden region of Goma in Democratic Republic of Congo.  

    Methods A cross-sectional survey of health facilities that provide either HIV or TB services or both was carried out. A semi-structured questionnaire was used to collect the data which was analysed using descriptive statistics.  

    Results Eighty facilities were identified, of which 64 facilities were publicly owned. TB care was more available than HIV care (in 61% vs. 9% of facilities). Twenty-three facilities (29%) offered services to co-infected patients. TB/HIV co-infection rates among patients were unknown in 82% of the facilities. Only 19 facilities (24%) reported some coordination with and support from concerned diseases’ control programmes. HIV and TB services are largely fragmented, indicating imbalances and poor coordination by disease control programmes.  

    Conclusion HIV and TB control appear not to be the focus of health interventions in this crisis affected region, despite the high risks of TB and HIV infection in the setting. Comprehensive public health response to this setting calls for reforms that promote joint TB/HIV co-infection control, including improved leadership by the HIV programmes that accuse weaknesses in this conflict-ridden region.

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    TB/HIV coinfection
  • 13.
    Kaboru, Berthollet Bwira
    et al.
    Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Uplekar, Mukund
    Lönnroth, Knut
    Engaging informal providers in TB control: what is the potential in the implementation of the WHO Stop TB Strategy? A discussion paper.2011In: World health & population, ISSN 1718-3340, Vol. 12, no 4, p. 5-13Article in journal (Refereed)
    Abstract [en]

    The World Health Organization (WHO) Stop TB Strategy calls for involvement of all healthcare providers in tuberculosis (TB) control. There is evidence that many people with TB seek care from informal providers before or after diagnosis, but very little has been done to engage these informal providers. Their involvement is often discussed with regard to DOTS (directly observed treatment - short course), rather than to the implementation of the comprehensive Stop TB Strategy. This paper discusses the potential contribution of informal providers to all components of the WHO Stop TB Strategy, including DOTS, programmatic management of multi-drug-resistant TB (MDR-TB), TB/HIV collaborative activities, health systems strengthening, engaging people with TB and their communities, and enabling research.The conclusion is that with increased stewardship by the national TB program (NTP), informal providers might contribute to implementation of the Stop TB Strategy. NTPs need practical guidelines to set up and scale up initiatives, including tools to assess the implications of these initiatives on complex dimensions like health systems strengthening.

  • 14.
    Katshiete Mbuisi Eale, Brigitte
    et al.
    Örebro University, School of Health Sciences.
    Andersson, Gunnel
    Örebro University, School of Health Sciences.
    Ntabe Namegabe, Edond
    Université libre des Pays des Grands Lacs, Goma, Democratic Republic of the Congo.
    Kaboru, Berthollet Bwira
    Adolfsson, Annsofie
    Örebro University, School of Health Sciences.
    Ordeals of sexually violated women and access to comprehensive healthcare: A case study of victims of sexual violence in North Kivu, Eastern Congo2018In: Journal of women´s reproductive health, ISSN 2381-862X, Vol. 2, no 1, p. 23-34Article in journal (Refereed)
    Abstract [en]

    Background: The impact of sexual violence in any community is extremely devastating and women in the Eastern part of the Congo are no exception. Sexual violence not only affects the health of women, but it impacts their social life within the community too.

    Objective: The study aims to investigate the experiences of female victims of sexual violence in accessing medical care in North Kivu.

    Design: An interpretive, phenomenological approach was used for this inductive and qualitative study. In-depth informant interviews were the main data collection tool. Open-ended questions were used during the interviews in order to garner more information from the interviewees. Heidegger’s approach was utilized in analyzing the collected data.

    Results: The analyzed and interpreted results of the data indicated that survivors of sexual violence are engaged in an ongoing struggle. The victims demonstrated immense resilience despite the lack of comprehensive medical care and have continued to reassemble their broken lives. In order to present the outcomes of the research in a succinct and coherent manner, the outcomes are categorized into five sub-themes: managing worries and shame; regaining happiness; healing and restoration; the need for professional assistance and struggles in daily life.

    Conclusion: The study provides an understanding of the recovery processes of survivors of sexual violence in North Kivu, with important insights into dimensions that rehabilitation programs should take into consideration.

  • 15.
    Mulindwa Nsiyi, Tharcisse
    et al.
    Former Senior HIV Clinical Care Officer, Family Health International, ZPCTII Project, Solwezi, Zambia.
    Harrison, N’guni
    Ministry of Community Development,Mother and Child Health, Solwezi, Zambia.
    Phiri, Ernest
    Family Health International, ZPCTII Project, Solwezi, Zambia.
    Brezovsek, Andrea
    School of Public Health, University of Lorraine, Nancy, France.
    Kaboru, Berthollet Bwira
    Integration of Family Planning in HIV/AIDS Program in Solwezi District, Northwestern Zambia: Status and Perspectives2015In: Public Health Research, ISSN 2167-7263, E-ISSN 2167-7247, Vol. 5, no 4, p. 103-108Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess the status of Family Planning (FP) service uptake through its integration in HIV program for identification of determinants of its low use in Solwezi district of Zambia. Comparative quantitative FP/HIV data was gathered during quality improvement process from database at Zambia Prevention Care and TreatmentPartnership (ZPCT) Consortium for 2012 and 2013. Qualitative data was collected using semi-structured interviews with 29professionals, at the main urban clinic in the district, from January to June 2013. Two key indicators were assessed: HIV/FPreferrals at facility level and male partners’ involvement in seeking HIV/FP services. Referrals between HIV and FP servicesduring the first semester of 2013 increased by 1.0% compared to 2012, whilst male involvement in integrated FP/HIV services remained stagnant at 11%. Low male involvement in FP/HIV service was linked to busy spouses’ work schedules(74%), and lack of knowledge (16%). FP/HIV couple counseling was offered on selected clinic days in 74%, whilst lackof policy implementation encouraging male involvement was noted in 58% of responses. Fear of FP side effects (89%), longdistances to the clinic (74%), lack of adequate health information on FP (17%) and unavailability of the preferred FP method(11%) were essential obstacles to service accessibility. Internal systems improvement indicated slight progress incross-referrals reported. Interventions on the demand side are required, such as in strengthening male involvement in FP/HIVservice. FP services in the district would also benefit from increased variety of accessible FP methods.

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    fulltext
  • 16.
    Munyanga Mukungo, Sylvain
    et al.
    Regional School of Public Health, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo.
    Kaboru, Berthollet Bwira
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Intensive TB Case Finding in Unsafe Settings: Testing an Outreach Peer Education Intervention for Increased TB Case Detection among Displaced Populations and Host Communities in South-Kivu Province, Democratic Republic of Congo2014In: Journal of Tuberculosis Research, ISSN 2329-8448, Vol. 2, p. 160-167Article in journal (Refereed)
    Abstract [en]

    Introduction: The Democratic Republic of Congo (DRC) is one of the high-burden TB countries in the world. The most affected provinces were North and South Kivu where displacements of the population favor transmission of infections. Delays in diagnosis are often causes for excessive mortality among TB patients. Aim of the Study: The study aimed to test an intervention designed to increase detection of TB cases in internally displaced persons and their host communities in South Kivu province. Methods: The project used a quasi-experimental method, with prospective data collection every six months. Two peri-urban districts were selected and designated as intervention and control districts respectively. Twenty peer educators were selected among prospective TB suspects who sought care in health facilities. The peer educators were trained and encouraged to actively influence, identify and refer potential TB suspects to health centers. The data on new TB suspects seen and cases diagnosed in both districts were collected and compared over two and a half years period. Results: This pilot study has demonstrated that the intervention has had some positive effects on both the number of persons suspected with TB who were diagnosed using either microscopy or clinical assessment. Even in terms of case detection, the study demonstrated that the number of cases detected in the intervention district was at least twice the number of cases detected in the control district. Conclusion:  Nonprofessional educators can influence TB case detection even in unstable settings, but their effectiveness is dependent on the security situation. National TB control programs need to adapt community mobilization strategies to local developments even in unsafe settings.

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    Active TB case finding in conflict-affected settings
  • 17.
    Nsitou, Bernice Mesmer
    et al.
    Department of Cardiology and Internal Medicine Center Hospital, Brazzaville, Congo; University of Brazzaville, Brazzaville, Congo; Ministry of Health and Population, Brazzaville, Congo.
    Ikama, Méo Stéphane
    Department of Medicine Faculty of Health Sciences, University Marien Ngouabi, Brazzaville, Congo.
    Drame, Bousso
    Health and Population Department World Bank, Dakar, Senegal.
    Kaboru, Berthollet Bwira
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Patients-related predictors of poor adherence to antihypertensive treatment in Congo-Brazzaville: a cross-sectional study2013In: Global Journal of Medicine and Global Health, ISSN 2277-9604, Vol. 2, no 5, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Studies suggest that poor adherence to hypertension treatment is responsible for about two-thirds of uncontrolled hypertension, leading to complications such as stroke. Yet, patients-associated factors explaining poor adherence to antihypertensive treatment in Africa remains under-researched. This study aimed at assessing the level of compliance in hypertensive patients and identifying patients-related predictors of poor compliance. The study was a prospective cross-sectional. The data was collected during a six-month period. Participants were recruited from outpatients’ departments in three urban hospitals in Congo-Brazzaville. Bivariate and multivariate analyses (using T-test and chi-2) were performed to identify predictors of poor compliance. In total, 212 hypertensive patients were included. Their mean age was 58.3 ± 10.6 years (range 34 – 81). Compliance was poor in 69 (32.5%) and good or fair in 143 cases (67.5%). Bivariate analysis indicated several patient-related factors that could predict poor adherence. However, after adjustment by logistic regression, only knowledge of the treatment and perception of the severity of complications of hypertension showed statistically significant associations with poor compliance (p =0.0170 and p=0.0373 respectively). Efforts to enhance patients’ awareness about hypertension’s treatment and severity of the complications associated with the disease are called for in this particular context.

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    Antihypertensive
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