KNOWLEDGE, ATTITUDE AND PRACTICE OF DISEASE PREVENTION AMONG HEALTH-TALK GIVING HEALTHCARE WORKERS IN PRIMARY HEALTH CENTERS AT OSOGBONAME: MURAINA OLUWAKEMI AZEEZATMATRIC NUMBER: PBH/2015/0087CHAPTER TWOOUTLINE2.0Literature review2.1Definitions and overview2.2Healthy Lifestyle among primary healthcare workers2.3Factors influencing performance of health workers and strategies for improvement2.4Health care professionals’ attitudes regarding patient safety2.5Health care workers knowledge on nutritional assessment 2.6How poor attitude of health workers is killing health care delivery2.1.Definition and overviewAccording to World Health Report 2006, Health workers are people whose job it is to prevent, protect and improve the health of their communities. Together these health workers, in all their diversity, make up the global health workforce. The study explains the size and distribution of the workforce, and some of its features. It shows that there are limited numbers of health workers to meet health needs, but that shortages are not universal, even across countries with limited resources. The study then considers how much it would cost to scale up training to meet this shortfall and pay health workers subsequently. This study defines health workers to be people whose primary goal is to enhance health. This meaning extends from WHO’s definition of the health system as comprising activities whose primary goal is to improve health. They make important contributions and are stakeholders to the efficient and effective functioning of most health systems.2:2 Healthy lifestyles among primary health care workersA healthy lifestyle is an important factor of preventive medicine, and its relationship to healthy living has become increasingly clear over the years (Dal Poz et al., 2006; Willett et al., 2006). Despite minor variations, there is now a consensus that healthy lifestyle consists of healthy diet, being physically active, never smoking, and body mass index (BMI) less than 30 kg/m2 ( Ford et al., 2009).Healthcare workers own lifestyle habits and interests in lifestyle behavior have been shown to positively affect their attitudes and counseling practices (Morishita et al., 2014; Biernat et al., 2012). Several studies have been carried out over the last few years worldwide to assess one or more of lifestyle parameters among physicians, nurses, or both, but there is a lack of studies assessing all four lifestyle items among healthcare professionals in Saudi Arabia. In Poland (Lobelo et al.,2009) found that the minority of medical personnel practices a high level of physical activity.2.3 Factors influencing performance of health workers and strategies for improvementPoor performance of service providers leads to inaccessibility of care and inappropriate care, which contribute to reduced health outcomes as people are not using services or are mistreated due to harmful practices. The final study of the Joint Learning Initiative clearly shows the importance of the workforce in performing services by stating that health workers’ number, quality and type of professionalism determine output and productivity, that they manage the other resources, that the largest percentage of the health budget is spent on health workers and they influence progress (, accessed 7 June 2006).There is poor performance results due to shortage of staffs, or from staff not providing care according to standards and not attending to the needs of the community and patients. As Hughes et al. state: “Most performance problems can be attributed to unclear expectations, skills deficit, resource or equipment shortages or a lack of motivation” (Hughes et al., 2002). These factor cause failing in health system; low salaries, difficult working and living conditions and inappropriate training. This report considers performance to be a combination of staff being available, competent, productive and responsive (WHO, 2006). It allows the matter to be dealt with more easily.2.4Health care professionals’ attitudes regarding patient safetyProfessional attitudes regarding patient’s safety and related issues are an important part of what is often called a hospital’s safety culture (Thomas et al., 2005; Nieva and Sorra, 2003). An organization’s safety culture consists of components concerning healthcare provider attitudes about organizational factors such as safety climate and morale, work environment factors such as staffing levels and managerial support, team factors such as teamwork and supervision, and staff factors such as overconfidence and being overly self-assured (Sexton et al., 2006). An understanding of nurses’ perceptions and expectations regarding adverse events is therefore essential for the implementation of appropriate strategies to manage nursing care. In this sense, the beliefs, values and organizational culture of registered nurses (RNs) are important aspects to be considered (De Freitas et al., 2011). Ethical issues are integral to the topic of patient safety because it is known that millions of patients worldwide suffer injury or death every year as a result of unsafe medical practices and care, and patients are mostly harmed due to preventable causes that they receive during health care in hospital settings (Chioma, 2011). Health care professionals may know that their role is important in the delivery of care and they should have positive attitudes towards patient safety. 2.5Health care workers knowledge on nutritional assessment There was significantly low level of knowledge on nutritional parameters used for evaluated during nutritional assessment among the health workers. Only 29.52%, of the respondents had knowledge that weight loss and growth curve dropping downwards was an essential indicator for nutritional needs while merely 28.57% of the health workers had knowledge that children failure to gain weight followed by flattening of growth curve had high nutritional needs. Merely, 12.38% of the respondent had knowledge that change of caregivers and home circumstances had impact on nutritional status of a child. In a study carried out in hospitals, health centers and dispensaries in Morogoro Urban district, Tanzania 53% of the health workers had poor knowledge on nutritional assessment of children attending the hospitals (Moses, 2010). A study conducted by Yalcin et al. (Yalcin et al., 2013) in Ghana, only 0.3% of the health practitioners had receive knowledgeable training through a workshop programme on pediatric nutrition assessment. About 6.0% of the practitioners explained that they had received their knowledge through reading academic journals (Yalcin et al., 2013). In some studies healthcare workers have attested that nutrition assessment education was not taken serious in the medicals schools (Yalcin et al., 2013). Poor insufficient health education regarding nutrition assessment is one of the core causes of poor identification of nutritional requirements for the patients. Health care practitioners working at pediatric unit has the primary role to give a proper health education regarding nutritional assessment (Mowe et al., 2008; Yalcin et al., 2013). The knowledge on classification of nutritional status was assessed among the health care workers. Severe malnutrition was the most used indicator (56.06%) followed by Poor weight (15.15%) in classification of children nutritional needs. Previous studies have also showed that malnutrition is the main indicator of nutritional needs of children. It was observed, in a study carried out in Hawassa, Ethiopia indicated that 86% of the health care workers used malnutrition chat to classify nutritional status of the children (Tafese and Shele, 2015). A study carried in Maputo on anthropometric indicators of nutritional status implications malnutrition over stunted and wasted growth was highly used for nutrition classification (Prista et al., 2003). In Mbeere South Sub-County, it was reported that malnutrition followed by height-for-age and weight-for height was most frequently used for classification of nutritional status of children (Badake et al., 2014). In Ntungamo district hospital, weight, MUAC and Height at 31%, 18% and 3% respectively, were the most used indicators for most for nutritional classification (Nekatebeb et al., 2013). In current study, only 1.52% of the respondents used wasting, height, weight and age for nutritional classification. However, a previous study has reported that about 88% and 81% health workers used weight and height/length respectively for assessment nutrition status (Kamenwa, 2014). The most used parameter for nutrition assessment in Kisoro District hospitals, Uganda included MUAC, Edema, pallor and weight at 100% while height was the least used factor at 55% (Nekatebeb et al., 2013). In the health centers’ having pediatric units in the South-western Uganda, pallor was the most assessed at 100% followed by edema (96%) and weight (93%) while length and MUAC at 32% and 25% respectively (Nekatebeb et al., 2013).2.6 How poor attitude of health workers is killing health care delivery.Today, the impact of the negative attitude of healthcare workers in providing care in public and private hospitals in Nigeria is particularly worrisome. Years of poor attitudinal problem particularly in the public sector has further endangered and put lives of patients in critical conditions. Investigation by good health weekly shows that attitudinal problem is at every level of care. All cadres of healthcare providers are guilty of this negative attitude, even at the slightest provocation. It does not follow, whether a dying patient is in for emergency room treatment or a laboratory test or any appointment for that matter, the negative attitude seems to have become a way of life, doing more harm than good to the health sector. It appears health workers tend to quickly forget they are employed only because of the patient- “to care for patients, to ensure that the human person is maintained in the best possible state of good health in terms of their mental, physical and spiritual wellbeing.REFERENCESDal Poz MR, Kinfu Y, Dräger S, Kunjumen T, Diallo K. Counting health workers: definitions, data, methods and global results. Geneva, World Health Organization, 2006 (background paper for The world health report 2006; available at: http://www.who. int/hrh/documents/en/).Willett WC, Koplan JP, Nugent R, Dusenbury C, Puska P, Gaziano TA. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al, editors. Disease Control Priorities in Developing Countries. 2nd ed. Washington (DC): World Bank; 2006. p. 833-850.Kurth T, Moore SC, Gaziano JM, Kase CS, Stampfer MJ, Berger K, et al. Healthy lifestyle and the risk of stroke in women. Arch Intern Med 2006; 166: 1403-1409. Ford ES, Bergmann MM, Kröger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Arch Intern Med 2009; 169: 13551362. Morishita Y, Numata A, Miki A, Okada M, Ishibashi K, Takemoto F, et al. Primary care physicians’ own exercise habits influence exercise counseling for patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 2014; 15: 48.Biernat E, Poznańska A, Gajewski AK. Is physical activity of medical personnel a role model for their patients. Ann Agric Environ Med 2012; 19: 707-710.Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counseling practices. Br J Sports Med 2009; 43: 89-92.CHIOMA OBINNA ,SEPTEMBER 2011 “VANGUARD NEWS NIGERIA”Joint Learning Initiative (2004). Human resources for health: overcoming the crisis. Cambridge, Global Equity Initiative/ Harvard University Press (, accessed 7 June 2006).Hughes RL, Ginnett RC, Curphy GJ (2002). Leadership, enhancing the lessons of experience. New York, McGraw-Hill/IrwinWHO (2006). World health report 2006. Working together for health. Geneva, World Health Organization (, accessed 25 April 2006).. Thomas EJ, Sexton JB, Neilands TB, Frankel A, Helmreich RL. The effect of executive walk rounds on nurse safety climate attitudes: a randomized trial of clinical units. BMC Health Serv Res. 2005;5:28.Nieva VF, Sorra J. Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care. 2003;12(Suppl 2:ii):17–23.Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, Roberts PR, Thomas EJ. The Safety Attitudes Questionnaire: psychometric Properties, Benchmarking Data, and Emerging Research. BMC Health Serv Res. 2006;6(1):44De Freitas GF, Hoga LA, Fernandes Mde F, González JS, Ruiz MC, Bonini BB. Brazilian registered nurses perceptions and attitudes towards adverse events in nursing care: a phenomenological study. J Nurs Manag. 2011;19:331–8.Moses H (2010) Nutrition knowledge, attitude and practice of professional health workers in Morogoro urban district. Sokoine University of Agriculture, Morogoro, TanzaniaYalcin N, Cihan A, Gundogdu H, Ocakci AF (2013) Nutrition knowledge level of nurses. J Health Sci 7: 99-108.Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, et al. (2008) Insufficient nutritional knowledge among health care workers? Clin Nutr 27: 196-202Tafese and Shele (2015) Knowledge, attitude and practice towards malnutrition among health care workers in Hawassa City, Southern Ethiopia. Glob J Public Health Res 1: 1-8.Prista A, Maia JAR, Damasceno A, Beunen G (2003) Anthropometric indicators of nutritional status: Implications for fitness, activity, and health in school-age children and adolescents from Maputo, Mozambique. Am J Clin Nutr 77: 952-959Badake QD, Maina I, Mboganie MA, Muchemi G, Kihoro EM, et al. (2014) Nutritional status of children under five years and associated factors in Mbeere South District, Kenya. Afr Crop Sci J 22: 799-806.Nekatebeb HMA, Kappos K, Pomeroy A, Kyenkya M, DeAgostino A, et al. (2013) Report on findings from an assessment of nutrition assessment, counseling, and support (NACS) services in South-western Uganda. Washington DC: USAID/Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) ProjectKamenwa JN (2014) Knowledge and practices of health care workers in kenyatta national hospital as regards nutritional status and needs of hiv infected children (Doctoral dissertation, University of Nairobi), Kenya.

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