The incidence of non-communicable diseases (NCDs) in developing countries is rising drastically (Bintabara, 2018; Chiwanga, 2016; Cleland et al., 2016; Galson et al., 2017) with a projection of a significant increase in morbidity and mortality by 2030. Most of the NCDs in rural Africa go undiagnosed while the prevalence continues to increase (Chiwanga et al., 2016). The United Nations has stressed the need for more educational and preventive measures in these countries to harness the spread of NCDs such as hypertension (HTN), diabetes (DM), and cardiovascular disease (CVD). Resources and services for these NCDs has already overburdened existing healthcare facilities in countries such as Tanzania with the direst situations existing in the rural areas where 75% of the population of Tanzania resides (Bintabara, 2018; Hall, Hall, Kok, Mallya, & Courtright, 2016). It is estimated that 1.9 million persons in Tanzania have diabetes (Chiwanga, 2016) and 125 million persons will have hypertension by the year 2025 (Galson, et al., 2017). Identification of persons with pre-diabetes should begin early and education for the prevention of disease progression is essential (Chiwanga, 2016). This project aims to provide resources, education, and services to two rural communities in Eastern Tanzania.
In 2017, the XXX school of nursing Tanzanian study abroad program delivered two lab-ready HgbA1C machines to XXX and XXX hospitals in Tanzania. In the summer of 2018, interviews were conducted by a XXX doctoral student with patients whose HgbA1C had been tested to determine the effect of this testing on their disease management. From these interviews, it was found that patients in rural areas of Tanzania have a difficult time making it to the hospitals where the machines are located unless they reside nearby and most if not all who were interviewed had only been tested once at the hospital. By using portable equipment, more patients in the remote catchment areas of surrounding villages will have access for improved care and management of the NCD's. It will enrich nursing students’ study abroad experience, provide them with opportunities to promote community health in Tanzania, and assist the people of rural Tanzania by providing access to care.
Objectives
The school of nursing has sustained a commitment to the communities in Tanzania as evidenced by the HbA1c machine projects for the hospitals in XXX and XXX and clinical placements for students in undergraduate, masters, and doctoral levels over the last two years. Faculty and nursing students who will be returning to Tanzania with the XXX study abroad program in the summer of 2019 will be the primary educators and providers of screening while in Tanzania.
Students will receive education and guidance from faculty prior to departure for Tanzania during course seminars held in the spring of 2019. Students will review pathophysiological concerns related to the NCDs and prepare evidence-based educational materials to be taken to Tanzania for distribution. The educational materials will be printed in both English and Swahili, the native language in Tanzania. The entire project will be created, developed, and implemented by the students with guidance and supervision of faculty. Equipment including portable hand held HbA1C machines and strips will be purchased with grant funds and the students will receive direct training on functionality of the equipment. Manual blood pressure cuffs will also be purchased to screen for hypertension. Oversight of the clinics and referrals for follow up care will be provided by local in-country physicians.
The goal of this project is to provide screening and education in Tanzania to improve the overall health of the community. A second goal, no less important, is to provide a community health experience for pre-licensure and graduate nursing students to improve their global view of healthcare and push the boundaries of their nursing education. The project will be supported by local contacts in XXX and XXX, Tanzania. It is planned that support of this project and the people in rural Tanzania will continue each year with subsequent study abroad courses. Follow up will occur each summer and throughout the year with contacts made in-country.
Procedures
In Tanzania the students will have opportunities to interact with patients and healthcare providers at the XXX Hospital outpatient clinics, in community outreach in local homes, and with a physician at a local clinic for women and children. In the summer of 2018, the medical director of XXX Hospital spoke with XXX faculty about the need for screening and education in the community related to NCDs and requested further involvement of the XXX faculty and students in reaching out and engaging with the community in this manner. A similar request was made by the director of the XXX school in XXX who expressed the deep need in the local rural community for such services. Thus, ample in-country support will be provided in Tanzania for the services to be rendered by faculty and students in-country.
Future Goals
At the completion of the 2019 study abroad program to Tanzania, the co-directors of the program will conduct focus group interviews with the student participants to explore their experiences with educating and promoting health using the equipment, as well as the impact the project had on their nursing practice or future nursing practice. IRB approval will be obtained, and the information will be used to guide future study abroad programs as well as for presentation and publication of what was learned from the experience.
This project will serve as a pilot for future sustained engagement with the rural communities in Tanzania. Future study abroad programs will expand into Kenya as allowed by both the university and the United States State Department focused on NCD in East African countries. The experience and knowledge gained in the summer of 2019 project will guide future interactions with the communities in Tanzania and provide baseline data upon which an external request for future funding will be made.
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