Africa health care problems lack evidence-based examination

By STTI Editors | 7/8/2015

Shortage of funding and doctorally prepared nurses.

While most African people receive their health care from nurses or midwives, a new Columbia University School of Nursing study finds that widespread, persistent, and serious health care problems in African countries have not been extensively examined by clinical nursing and midwifery research—indicating a clear gap between the region’s health care needs and knowledge necessary to adequately address them.
 
Columbia_Dohrn_SFWResearchers at Columbia University School of Nursing, University of Nairobi School of Nursing Science, University of Malawi/Kamuzu College of Nursing, and FUNDISA collaborated on the study, which was published in the International Journal of Nursing Studies. Findings were presented 8 July at an international meeting of nurse leaders from 13 sub-Saharan African countries in Nairobi, Kenya, along with similar supporting research studies. The meeting was conducted under the auspices of Columbia University’s Office of Global Initiatives and WHO Collaborating Center for Advanced Practice, directed by Jennifer Dohrn, DNP, CNM.
 
A review of nursing and midwifery research literature conducted in African countries over a 10-year period found that many widespread health care problems in African countries were not investigated by the published research, including infectious disease other than HIV and noncommunicable diseases such as malnutrition, diarrheal disease, hypertension, and diabetes. Study authors suggest that nursing and midwifery research focusing on health care diseases and conditions in Africa has been influenced by the agendas of funding sources.
 
“Because of the profound shortage of both broad-based funding and nurse and midwifery researchers in many African countries, there is a serious unfilled need for expanded evidence-based knowledge that will lead to healthier patients and reduce unnecessary or ineffective treatments,” says lead author Carolyn Sun, a PhD candidate at Columbia Nursing.
 
The published paper, “Clinical Nursing and Midwifery Research in African Countries: a Scoping Review,” examined 73 articles published in 35 journals that met researchers’ criteria of being conducted by nurses or midwives and that include data obtained in countries or regions within the African continent, published in peer-reviewed journals between 1 January 2004 and 15 September 2014. The most frequent topics of research were midwifery/maternal/child health (43 percent of the articles), patient experience (38 percent), and HIV/AIDS/ STIs (36 percent). Further, 27 articles addressed the nursing shortage in Africa, which is primarily due to emigration of nurses to high-income countries for higher pay. (Some articles covered one or more of these topics.)
 
Studies were heavily weighted toward South Africa, with 58 research studies from that country among the published articles. Also, the majority of studies were qualitative and exploratory as opposed to rigorous quantitative analysis. Most journal articles were published in countries outside Africa, suggesting that clinical nursing and midwifery research is in its developmental stages in most African countries.
 
Columbia_Larson_SFW“Evidence-based research provides a blueprint to guide health care providers and decision makers to prioritize health care issues and identify the best clinical care practices to address them,” says Elaine Larson, PhD, RN, FAAN, CIC, associate dean for research at Columbia University School of Nursing, who was also an author of the paper. “Our findings also indicate that achieving a blueprint for health care nursing research is further complicated by the limited research capacity among nurse and midwife researchers.”
 
Previous research has found that while there is some capacity for education and training of additional doctorally prepared nurses in a few African countries—such as South Africa, Malawi, and Kenya—the vast majority of countries are still in the beginning stages of professional nursing development, especially advanced training of nurses.
 
“In agreement with key leaders in research in African countries, our findings suggest that if nursing practice is to expand in African countries, more emphasis on and funding for clinical research relevant to the important clinical needs confronting practicing nurses and midwives and determined by regional and local leadership is essential,” Sun says. “Maximizing formal training in research techniques and mentoring are clearly required as well.”
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