“What-We-Know” and “What-We-Need-to-Know” About Health Care in Africa: A Columbia University School of Nursing Study Explores the Gap

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A recent review of the nursing and midwifery research literature conducted in African countries over a ten-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 non-communicable diseases such as malnutrition, diarrheal disease, hypertension and diabetes. The authors of the study suggest nursing and midwifery research focusing on health care diseases and conditions in Africa have been influenced by the agendas of funding sources.

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“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.

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 the knowledge necessary to adequately address them.

The study, published in the International Journal of Nursing Studies, was conducted in collaboration by researchers at the Columbia University School of Nursing, University of Nairobi School of Nursing Science, University of Malawi/Kamuzu College of Nursing, and FUNDISA, and was presented at an international meeting of nurse leaders from Sub-Sahara African countries on July 8 in Nairobi, Kenya, along with other similar supporting research studies.

A review of the nursing and midwifery research literature conducted in African countries over a ten-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 non-communicable diseases such as malnutrition, diarrheal disease, hypertension and diabetes. The authors of the study suggest nursing and midwifery research focusing on health care diseases and conditions in Africa have 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” said the study’s 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 which met the researchers’ criteria of being conducted by nurses or midwives and included data obtained in African countries or regions within the African continent, published in peer reviewed journals between January 1, 2004 and September 15, 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, primarily due to emigration of nurses to other, high-income countries for higher pay. (Some articles covered one or more of these topics.)
In addition, studies were heavily weighted toward South Africa, which was included 58 times in the published articles. Also, the majority of studies were qualitative and exploratory as opposed to rigorous quantitative analysis, and the bulk of journals came from countries outside Africa, suggesting that clinical nursing and midwifery research is in its developmental stages in most African countries.

“Evidence-based research provides a blueprint to guide health care providers and decision makers prioritize health care issues and identify the best clinical care practices to address them,” says Elaine Larson, PhD, 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 the education and training of more 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 development of the nursing profession, 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,” said Sun. “Maximizing formal training in research techniques and mentoring are clearly required as well.”

The findings will be presented and discussed at a conference of nursing leaders from 13 sub-Saharan African nations in Nairobi Kenya on July 8 and 9 jointly sponsored by Columbia University School of Nursing and Columbia Global Centers | Africa (Nairobi).

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