Browsing by Author "Kvalsund MP"

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    A qualitative study of factors resulting in care delays for adults with meningitis in Zambia.
    (2022-Dec-02) Elafros MA; Bwalya C; Muchanga G; Mwale M; Namukanga N; Birbeck GL; Chomba M; Mugala-Mulenga A; Kvalsund MP; Sikazwe I; Saylor DR; Winch PJ; Department of Neurology, University of Michigan, Ann Arbor, 48109 Michigan, USA.; Department of Neurology, University of Rochester, Rochester, 14642 New York, USA.; Department of Internal Medicine, University of Zambia, School of Medicine, 10101 Lusaka, Zambia.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205 Maryland, USA.; Maryland Global Initiatives Corporation (MGIC), Lusaka, Zambia.; University Teaching Hospitals Children's Hospital, 10101 Lusaka, Zambia.; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.; University of Lusaka, 10101 Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, 10101 Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Meningitis causes significant mortality in regions with high comorbid HIV and TB. Improved outcomes are hindered by limited understanding of factors that delay adequate care. METHODS: In-depth interviews of patients admitted to the University Teaching Hospital with suspected meningitis, their caregivers, doctors and nurses were conducted. Patient/caregiver interviews explored meningitis understanding, treatment prior to admission and experiences since admission. Provider interviews addressed current and prior experiences with meningitis patients and hospital barriers to care. A conceptual framework based on the Three Delays Model identified factors that delayed care. RESULTS: Twenty-six patient/caregiver, eight doctor and eight nurse interviews occurred. Four delays were identified: in-home care; transportation to a health facility; clinic/first-level hospital care; and third-level hospital. Overcrowding and costly diagnostic testing delayed outpatient care; 23% of patients began with treatment inside the home due to prior negative experiences with biomedical care. Admission occurred after multiple clinic visits, where subsequent delays occurred during testing and treatment. CONCLUSIONS: Delays in care from home to hospital impair quality meningitis care in Zambia. Interventions to improve outcomes must address patient, community and health systems factors. Patient/caregiver education regarding signs of meningitis and indications for care-seeking are warranted to reduce treatment delays.
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    A qualitative study of patient, caregiver, doctor and nurse views of factors influencing lumbar puncture uptake in Zambia.
    (2022-Apr-04) Elafros MA; Belessiotis-Richards C; Birbeck GL; Bond V; Sikazwe I; Kvalsund MP; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, 10101, Zambia.; Department of Neurology, University of Michigan, Ann Arbor, MI 48105, USA.; University Teaching Hospitals, Children's Hospital, Lusaka, 10101, Zambia.; Camden and Islington NHS Foundation Trust, London, NW1 OPE, UK.; Department of Neurology, University of Rochester, Rochester, NY 14642, USA.; Department of Psychiatry, University College London, London, W1T 7BN, UK.; Centre for Infectious Disease Research in Zambia, Lusaka, 10101, Zambia.; Zambart, School of Public Health, University of Zambia, Lusaka, 10101, Zambia.; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Uptake of lumbar puncture (LP) remains low in regions with a high prevalence of central nervous system (CNS) infections like Zambia. Efforts to improve uptake are hindered by limited understanding of factors influencing LP uptake. METHODS: Semistructured qualitative interviews were conducted with patients with suspected CNS infection, caregivers, doctors and nurses at the University Teaching Hospitals in 2016. Questions focused on LP experiences, knowledge, the consent process and health system barriers to LP among patients with an LP indication. Interviews were transcribed, translated to English and analysed using a thematic approach. RESULTS: We recruited 24 adult patients, 36 caregivers of adult patients, 63 caregivers of paediatric patients, 20 doctors and 30 nurses (173 in total). LP barriers arose from both patients/caregivers and health providers and included community apprehension about LP, proxy (family) consensus consent practices, competing clinical demands, wariness of patient/caregiver responses, limitations in consumables and time to complete the LP. This could result in consent not being obtained correctly. LP enablers included patient/caregiver perceived LP utility, provider comfort with LP and in-person counselling. CONCLUSIONS: LP uptake is a complex sociocultural process influenced by patient, healthcare and community-level factors. Interventions to improve uptake must address multiple barriers to be successful.