METHODS: To assess neurosurgery research in Afghanistan, searches were conducted in databases for articles originating from Afghanistan neurosurgeons and/or neurosurgery departments. We developed a 30-question English-language survey to assess the current state of neurosurgical capacity. Surveys were distributed to neurosurgeons throughout Afghanistan via email with the assistance of our English-speaking Afghan neurosurgical colleagues.
RESULTS: The neurosurgical disease burden of Afghanistan is poorly understood due to the lack of centralized and accessible databases. There are an estimated 124 neurosurgeons in the country based on modeled data. Surveys showed that government hospitals are poorly equipped, with private and military hospitals having access to slightly more modernized equipment but less accessible to the general population. The country lacks neurosurgery research with only 15 papers discovered through database searches deemed relevant to neurosurgery with Afghan affiliations.
CONCLUSIONS: Afghanistan is facing existential humanitarian threats. Developing the country's neurosurgical capacity and general health care capabilities is crucial. Emphasis on training physicians and establishing communication routes, and aid deliverance with the country and its leaders is key to overcoming the many crises it faces.
METHODS: This qualitative study used a phenomenological research design and was conducted from July 2019 to January 2021. A semi-structured topic guide was developed based on literature and the Common-Sense Model of Self-Regulation. We conducted one focus group discussion and 15 in-depth interviews with primary care HCWs. Interviewees were 7 physicians and 11 allied HCWs who tested positive for LTBI by Tuberculin Skin Test or Interferon Gamma Release Assay. Audio recordings were transcribed verbatim and thematic analysis was used to analyse the data.
RESULTS: We found four factors that serve as barriers to HCWs' LTBI treatment uptake. Uncertainties about the need for LTBI treatment, alongside several other factors including the attitude of the treating physician towards treatment, time constraints during clinical consultations, and concerns about the treatment itself. On the other hand, facilitators for LTBI treatment uptake can be grouped into two themes: diagnostic modalities and improving knowledge of LTBI treatment.
CONCLUSIONS: Improving HCWs' knowledge and informative clinical consultation on LTBI and its treatment benefit, aided with a definitive diagnostic test can facilitate treatment uptake. Additionally, there is a need to improve infection control measures at the workplace to protect HCWs. Utilizing behavioural insights can help modify risk perception among HCWs and promote treatment uptake.
METHODS: Four databases; MEDLINE (PubMed), Scopus, ScienceDirect, and EBSCOHost were searched using pre-determined keywords to identify articles published between January 1st, 2013 and February 28th, 2023 that evaluated retention strategies for doctors in LMICs. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure transparency. Relevant studies were identified, screened, and narratively synthesised.
RESULTS: Thirteen articles were included, representing a diverse range of LMICs. Retention strategies were categorised into educational, financial incentives, regulatory, as well as professional and personal support. Approximately 77% (n = 10) of studies reported positive outcomes, another two did not achieve favourable results, while one showed mixed outcomes. An equal number of studies applying single-strategy (n = 5) and combined-strategy (n = 5) approaches reported successful outcomes, especially when focusing on education and/ or regulatory strategies. More notably, international collaboration in education strategies enhanced success rates while compulsory service enforcement by authorities helped retain doctors in underserved areas to address healthcare worker maldistribution. Efficiency in administrative management, regardless of urban or rural locations, also emerged as a key factor of successful retention.
CONCLUSIONS: This review highlighted the effectiveness of different retention strategies for doctors in LMICs and its associated factors. It is imperative to emphasise the lack of a one-size-fits-all solution for this global issue. Thus, a multifaceted, comprehensive approach is essential in producing sustainable health workforce development that ensures optimal health outcomes, especially for populations in underserved areas. Future studies should prioritise pre- and post-intervention comparisons using appropriate indicators to enhance understanding and guide effective interventions for doctor retention.
METHODS: A cross-sectional study was conducted between November 2020 and January 2021. A self-administered questionnaire was distributed to 350 physicians (GPs, residents, specialists, and consultants). Two trained pharmacists distributed the questionnaires in 5 major tertiary governmental hospitals and more than ten private hospitals. Also, private clinics were targeted so that we get a representative sample of physicians at different workplaces.
RESULTS: A total of 270 physicians filled the questionnaire out of 350 physicians approached, with 14 being excluded due to high missing data, giving a final response rate of 73%. Participants had suboptimal knowledge and practices with a high positive attitude toward atherosclerotic cardiovascular diseases risk assessment. The knowledge and practices were higher among consultants, participants from the cardiology department, those with experience years of more than nine years, and those who reported following a specific guideline for cholesterol management or using a risk calculator in their practice. Notably, the risk assessment and counseling practices were lower among physicians who reported seeing more patients per day.
CONCLUSION: Physicians had overall low knowledge, suboptimal practices, and a high positive attitude toward cardiovascular risk assessment. Therefore, physicians' training and continuing medical education regarding cholesterol management and primary prevention clinical practice guidelines are recommended. Also, the importance of adherence to clinical practice guidelines and their impact on clinical outcomes should be emphasized.