5. METODOLOGÍA:
5.5 ACTIVIDADES DEL TALLER
5.5.1 Cortometrajes a trabajar:
Sophie Phelan
Master of Applied Epidemiology Scholar
The Kirby Institute, University of New South Wales, and The Australian National University
BACKGROUND
From Monday 12th June to Friday 16th June 2017, four out of six proposed study sites for the
study “Impact of Mass Drug Administration for Trachoma on the Prevalence of Sexually Transmitted Infections in Fiji” were visited, as arranged by Dr Daniel Faktaufon. This study is currently subject to ethics approval from the Fiji National Health Research and Ethics
Committee (FNHRERC) and the Australian National University Human Ethics Review Committee. The proposed study sites are six antenatal clinics across Fiji, and include a Divisional and Sub- divisional hospital from each Division as follows:
- Central/Eastern Division: Colonial War Memorial Hospital Suva and Nausori Hospital
- Western Division: Lautoka Hospital and Nadi Hospital
- Northern Division: Labasa Hospital and Savusavu Hospital
The above study sites were chosen to achieve a representative sample of the population of Fiji and to ensure that the required amount of urine samples per survey (1000) could be processed in a timely manner. Table 1 shows the numbers of participants that were estimated to be recruited from each ANC by the Investigator group prior to the site visits.
Table 1: Expected number of participants per survey, per ANC site.
ANC Site Expected number of participants per survey
Colonial War Memorial Hospital Suva 300
Nausori Hospital 120
Lautoka Hospital 250
Nadi Hospital 150
Labasa Hospital 150
Savusavu Hospital 60
The purpose of the site visits was to meet with ANC staff in person, introduce the proposed project, and answer any questions clinic staff might have. Additionally, it was important to get an idea of the patient flow through the clinics so that appropriate logistic arrangements could
GeneXpert machines located at Twomey Hospital, Suva, Lautoka Hospital and Labasa Hospital. Permission to investigate this was given by Dr Frank Underwood. Currently there are two GeneXpert machines available to use for this study: one at Mataika House, and one that will be transported to Fiji from the Kirby Institute. However, the more machines available, the more efficient sample processing can be, meaning that results and treatment are delivered to participants in a timely manner.
FINDINGS
This section provides a summary of what was found out at each site. Table 2 shows a summary of the days of Booking Visits, and average numbers of women per Booking Visit per ANC site visited as discussed with ANC staff. On average, each visit took approximately 30 minutes.
Table 2: Summary of ANC days of Booking Visit and average numbers of women per Booking Visit.
ANC Site Days of Booking
Visit
Average number of women per Booking Visit
Average number of women presenting for a Booking Visit per week Colonial War Memorial Hospital Suva Monday to Friday 30-40 150-200
Nausori Hospital Thursday 30-50 30-50
Lautoka Hospital Friday 75-90 75-90
Nadi Hospital Thursday 30-40 30-40
Labasa Hospital Wednesday 30-40 30-40
Savusavu Hospital Wednesday 30-40 30-40
Colonial War Memorial Hospital, Suva
CWM was visited on Monday 12th of June. Dr Daniel provided a tour around the Labour Ward
and Antenatal Clinic, and introduced Sister Mitka. The waiting area in the ANC was large and could seat approximately 50 people. The area for conducting the initial paper work for the Booking Visits consisted of four open style booths and a table that could easily conduct four booking visits, meaning that at peak times 8 or more booking visits could be conducted at once. Sister Mitka noted that the Booking Visit usually takes all day, with women arriving in the morning and completing their paperwork (Booking Folder) first of all. This proceeded to be the norm for all ANCs visited. Following this, the women go on to visit other rooms in the ANC and CWM to go through a series of clinical tests for the Booking Visit. Sister Mitka also noted that urine samples are no longer collected.
Nausori Hospital
Nausori Hospital was visited on Friday 16th of June. Dr Vini Kalougivaki introduced Staff Mary.
Mary gave a tour of the Booking Visit waiting area which was a small room that could seat approximately 20 people. On Booking Visit days, women wait in turn and then proceed to a table at the front of the room where they go through the Booking Folder with the ANC nurse one at a time. Mary also noted that urine samples are no longer collected.
Twomey Hospital Laboratory
Twomey Hospital Laboratory was visited on Friday 16th of June. Mr Uraiya from Mataika House
Laboratory conducted the tour and introduced the ladies responsible for running the
GeneXpert. The GeneXpert in use at Twomey Hospital Laboratory was donated by the Global Fund for use in the TB Program. As Twomey Hospital is a specialist TB Hospital, the ladies noted that the GeneXpert has samples running all day, Monday-Friday, with a large backlog of
samples. Therefore, it won’t be possible to use the GeneXpert at Twomey Hospital Laboratory for this study.
Lautoka Hospital
Lautoka Hospital was visited on Thursday 15th of June. Sister Luisa and Sister Veena showed
Sophie around the ANC waiting area. A midwife from Australia, Felicity, was working at Lautoka and was interested to hear about the study as well. The ANC waiting area looked big enough to seat about 40 people, with enough desk space to conduct the initial paperwork for two Booking Visits at a time. The Sisters noted that while Booking Visits are usually conducted on a Friday, women often come in on other days for their Booking Visits and the staff at Lautoka ensure that they are looked after. The sisters also noted that urine samples are no longer collected.
Lautoka Hospital Laboratory
Lautoka Hospital Laboratory was visited on Thursday 15th of June. Ritam was in Suva for a
workshop, so Ritam’s colleague Markita kindly assisted on the day. The GeneXpert in Lautoka was in use during the visit and it could be seen that only three out of four modules were working. The staff responsible for the GeneXpert were not around at the time. The next step is to confirm how frequently the Lautoka GeneXpert is used to analyse TB samples.
Nadi Hospital
Nadi Hospital was visited on Thursday 15th of June. Dr Lice provided a tour of the Maternity
ward and Antenatal Clinic waiting area. The waiting area looked as if it could seat 20 people maximum. A small table at the front could seat one patient at a time to go through the paperwork required for the Booking Folder. Dr Lice noted that urine samples are no longer taken at Nadi.
Labasa and Savusavu Hospitals
An update was provided over email for the hospitals in the North. Rejieli Vuniduvu, Surveillance Officer for the Northern Division provided the information given in Table 2, and noted that urine samples are collected at the first booking for high risk mothers.
SUMMARY
Based on the numbers of women presenting for Booking Visits estimated by the ANC clinic staff and the days allocated for Booking Visits, study methods will have to either allow more time for sample collection from clinics like Nausori, Nadi and the Northern Division, or adjust the numbers of samples to be collected from each clinic.
All ANCs had a waiting area large enough for our study midwives to conduct the group information sessions for our studies. Seeing as the ANC visit takes all day, and most patients arrive in the morning, it would be best for our study midwives to conduct a few information sessions each Booking Visit morning.
Some ANCs such as Lautoka and CWM had enough room to conduct more than one Booking Visit at once. This is important to consider when allocating numbers of study midwives to each ANC, as we would be wise to allocate more midwives to clinics with higher patient flow to make use of these numbers.
Access to the GeneXpert at Lautoka is currently being determined. We also need to investigate how often the GeneXpert at Labasa is used to analyse TB samples. While the GeneXpert at Twomey is overwhelmed with TB analyses, two GeneXperts are available for this study: one at Mataika House and one to be transported from Australia.
Finally, all ANC staff were very interested in our study. They were all extremely welcoming and said they were happy to help in any way. It was a great experience to meet with them and discuss the proposed study.