Critical Analysis and Critical Analysis and Development of a Nursing Development of a Nursing

Leadership InitiativeLeadership Initiative

Christina KleinChristina Klein

AbstractAbstract Examination of a global population issueExamination of a global population issue - malaria in Mali- malaria in Mali - impact on children under 5 years- impact on children under 5 years - potential effects on region and global - potential effects on region and global

community community Critical analysis of current health initiativesCritical analysis of current health initiatives - methods for malaria prevention, control, and - methods for malaria prevention, control, and

treatment treatment Development of a new initiativeDevelopment of a new initiative - new approach to address malaria in Mali- new approach to address malaria in Mali - leadership role of nursing- leadership role of nursing

Purpose and ObjectivesPurpose and Objectives Nursing leadership and global initiativesNursing leadership and global initiatives - challenges and opportunities for nursing in - challenges and opportunities for nursing in

global healthglobal health - mission of national and international agencies- mission of national and international agencies - leadership role of nursing in global health- leadership role of nursing in global health

Major TopicsMajor Topics Malaria in children under age five in MaliMalaria in children under age five in Mali - economic, social, cultural, and environmental - economic, social, cultural, and environmental

factorsfactors Health care system in MaliHealth care system in Mali - vital and health statistics in Mali- vital and health statistics in Mali Major organizations involvedMajor organizations involved - current initiatives- current initiatives Nursing’s roleNursing’s role - a creative approach to influence change - a creative approach to influence change

MaliMali

Environmental FactorsEnvironmental Factors - located in Western Africa- located in Western Africa - landlocked- landlocked - mostly desert- mostly desert - subtropical to arid climate- subtropical to arid climate - rainy seasons occurs from June-November- rainy seasons occurs from June-November - limited access to clean water, food, sanitation, - limited access to clean water, food, sanitation,

electricity, adequate housing, refrigerationelectricity, adequate housing, refrigeration

MaliMali

Social FactorsSocial Factors - population approximately 15,000,000- population approximately 15,000,000 - 48% of population is under 15 years old- 48% of population is under 15 years old - over two million are children under five years- over two million are children under five years - one in five children die before their fifth birthday- one in five children die before their fifth birthday - high illiteracy rate- high illiteracy rate - 24% of girls and 40% of boys attend school- 24% of girls and 40% of boys attend school - religion is mostly Muslim- religion is mostly Muslim

MaliMali

Social FactorsSocial Factors - women give birth to an average of 6.6 children- women give birth to an average of 6.6 children - population growth 2.3% per year- population growth 2.3% per year - traditional birth control practice is absent- traditional birth control practice is absent - average age of first child birth is 17 years- average age of first child birth is 17 years - access to education, basic resources, and - access to education, basic resources, and

standards of living reduce age of first child birthstandards of living reduce age of first child birth - access to prenatal/antenatal/postpartum care is - access to prenatal/antenatal/postpartum care is

lowlow

MaliMali Economic FactorsEconomic Factors - average daily income is less than one US - average daily income is less than one US

dollar/day or $270/anually dollar/day or $270/anually - main exports are cotton, livestock, & gold- main exports are cotton, livestock, & gold - poverty rate 40%- poverty rate 40% - unemployment rate 30%- unemployment rate 30%

MaliMali

Economic FactorsEconomic Factors - occupations include farming, fishing, & - occupations include farming, fishing, &

agricultureagriculture - deforestation, soil erosion, drought, - deforestation, soil erosion, drought,

desertification, poor access to drinkable water desertification, poor access to drinkable water account for high unemployment rateaccount for high unemployment rate

- long work days- long work days

MaliMali

Cultural FactorsCultural Factors - women are primary care takers - women are primary care takers - uncommon for women to disobey husbands- uncommon for women to disobey husbands - one parent households are common- one parent households are common - children often run household & care for younger - children often run household & care for younger

siblings while parents work in fieldsiblings while parents work in field

MaliMali

Cultural FactorsCultural Factors - official language is French but 30 different - official language is French but 30 different

languages are present in Malilanguages are present in Mali - community interaction through music and story - community interaction through music and story

telling telling - football, basketball, volleyball for playtime- football, basketball, volleyball for playtime - use of medicine men, herbalists, religious - use of medicine men, herbalists, religious

leaders for health issues is commonleaders for health issues is common

Malaria in MaliMalaria in Mali

MalariaMalaria - accounts for half of all out-patient visits- accounts for half of all out-patient visits - primary cause for morbidity & mortality in - primary cause for morbidity & mortality in

children under five yearschildren under five years - occurs more often during rainy season- occurs more often during rainy season - caused by bite from a parasite infected - caused by bite from a parasite infected

mosquitomosquito

Malaria in MaliMalaria in Mali MalariaMalaria - Plasmodium falciparum causes most severe - Plasmodium falciparum causes most severe

form if malaria & is commonly found in Maliform if malaria & is commonly found in Mali - children under five at risk due to immature - children under five at risk due to immature

immune systemimmune system - infected mothers can pass malaria to infant - infected mothers can pass malaria to infant

before or during deliverybefore or during delivery

Health Care System in MaliHealth Care System in Mali

Central levelCentral level - provides highest level of care- provides highest level of care - five national reference hospitals- five national reference hospitals - one maternal & child health hospital- one maternal & child health hospital - located in Bamako the nation’s capital- located in Bamako the nation’s capital IntermediateIntermediate - six regional hospitals- six regional hospitals

Health Care System in MaliHealth Care System in Mali

Local levelLocal level - 59 district health centers and 1050 community - 59 district health centers and 1050 community

health centers health centers - run by community health associations- run by community health associations - provide basic care- provide basic care - more accessible to poor people- more accessible to poor people

Health Care System in MaliHealth Care System in Mali ServicesServices - individual-oriented curative- individual-oriented curative - preventative outreach- preventative outreach - promotional- promotional Vital and health care statisticsVital and health care statistics - ratio of physicians to patient as high as five to - ratio of physicians to patient as high as five to

100,000100,000 - ratio is eight times higher in urban areas- ratio is eight times higher in urban areas - local government only involved in outreach & - local government only involved in outreach &

preventative servicespreventative services

Health Care System in MaliHealth Care System in Mali Vital and health care statisticsVital and health care statistics - 2.1 million cases of malaria seen in 2010- 2.1 million cases of malaria seen in 2010 - 3006 were fatal- 3006 were fatal - 64% of fatal cases were children under age five- 64% of fatal cases were children under age five - projected cost is $120 billion to prevent, - projected cost is $120 billion to prevent,

diagnose, & treatdiagnose, & treat

Major OrganizationsMajor Organizations President’s Malaria Initiative (PMI)President’s Malaria Initiative (PMI) - reduce burden of disease- reduce burden of disease - promote healthy living- promote healthy living - improve malaria prevention & treatment mainly - improve malaria prevention & treatment mainly

for children & pregnant womenfor children & pregnant women - 1.2 million dollar plan- 1.2 million dollar plan

Major OrganizationsMajor Organizations United nations Children’s Emergency Fund United nations Children’s Emergency Fund

(UNICEF)(UNICEF) - improve conditions in which children live- improve conditions in which children live - support programs that improve access clean - support programs that improve access clean

water, sanitation, educationwater, sanitation, education - protect children from exploitation & trafficking- protect children from exploitation & trafficking - reduce poverty level- reduce poverty level - improve malaria prevention, diagnosis, & - improve malaria prevention, diagnosis, &

treatmenttreatment

Major OrganizationsMajor Organizations Ministry of Health (MOH)Ministry of Health (MOH) - strengthened current health care systems- strengthened current health care systems - improved quality of care in local health centers- improved quality of care in local health centers - reduced infant mortality- reduced infant mortality - strengthened mother-child care- strengthened mother-child care

Major OrganizationsMajor Organizations World Bank, Ministerial Leadership Initiative, World Bank, Ministerial Leadership Initiative,

Health Systems 20/20Health Systems 20/20 - developed community-based health insurance- developed community-based health insurance - improved & redesigned inactive mutual health - improved & redesigned inactive mutual health

organizationsorganizations USAID and NGOsUSAID and NGOs - supply products to prevent malaria - supply products to prevent malaria

transmissiontransmission

Current InitiativesCurrent Initiatives

Insecticide treated nets (ITNs)Insecticide treated nets (ITNs) - provide inexpensive protection for three to five - provide inexpensive protection for three to five

yearsyears - repels, disables, & kills mosquitoes- repels, disables, & kills mosquitoes - in 2010 ITN use increased to 70% in children - in 2010 ITN use increased to 70% in children

under fiveunder five Seasonal malaria chemoprevention (SMC)Seasonal malaria chemoprevention (SMC) - reduced incidence of malaria by 65%- reduced incidence of malaria by 65% - caused significant drop in hospitalizations- caused significant drop in hospitalizations

Current InitiativesCurrent Initiatives Artemisinin-based combination therapies (ACTs) Artemisinin-based combination therapies (ACTs)

& Rapid Diagnostic Testing (RDT)& Rapid Diagnostic Testing (RDT) - RDT done free of charge for children with fever- RDT done free of charge for children with fever - ACT given to treat malaria free of charge for - ACT given to treat malaria free of charge for

children under five & pregnant womenchildren under five & pregnant women - ACT stock outs common- ACT stock outs common - ACT use remains low at 8%- ACT use remains low at 8%

Current InitiativesCurrent Initiatives

Indoor residual spraying (IRS)Indoor residual spraying (IRS) - uses DDT- uses DDT - provide coverage for six months- provide coverage for six months - 97% of homes have been sprayed- 97% of homes have been sprayed Genetically Modified MosquitoesGenetically Modified Mosquitoes - unable to transmit the malaria parasite- unable to transmit the malaria parasite - still being studied for safety & cost - still being studied for safety & cost

effectivenesseffectiveness

Current InitiativesCurrent Initiatives

Mosquito eating fish larvaeMosquito eating fish larvae - live in same pools of water & hatch at the same - live in same pools of water & hatch at the same

time as mosquito larvaetime as mosquito larvae - come back year after year- come back year after year - not enough evidence to support its use in - not enough evidence to support its use in

malaria controlmalaria control

Developing A Creative InitiativeDeveloping A Creative Initiative The first stepsThe first steps - increase awareness in culture & human rights- increase awareness in culture & human rights - address issues of social justice, resource - address issues of social justice, resource

allocation, human diversity, & technologyallocation, human diversity, & technology - collaborate with international organizations - collaborate with international organizations - understand & respect community values, - understand & respect community values,

needs, & desiresneeds, & desires - provide opportunities for economic growth & - provide opportunities for economic growth &

independenceindependence

A New InitiativeA New Initiative

What’s in a drumWhat’s in a drum - oldest form of communication- oldest form of communication - African ritual to celebrate life & mourn death- African ritual to celebrate life & mourn death - djembe is drum used by male African priests- djembe is drum used by male African priests - source of entertainment & community building- source of entertainment & community building - reduces stress & chronic pain- reduces stress & chronic pain - boosts the immune system in the presence or - boosts the immune system in the presence or

absence of diseaseabsence of disease

A New InitiativeA New Initiative Why Drum Therapy?Why Drum Therapy? - promotes healing, self-expression & - promotes healing, self-expression &

empowerment through rhythmempowerment through rhythm - access a higher power & release negative - access a higher power & release negative

feelings & emotional traumafeelings & emotional trauma - maintains physical, mental, & spiritual health- maintains physical, mental, & spiritual health - intersects with all races, religions, sexes, & - intersects with all races, religions, sexes, &

culturescultures - promotes connectedness within a community- promotes connectedness within a community

A New InitiativeA New Initiative

Drum CirclesDrum Circles - require little to no musical skill- require little to no musical skill - drums can be made for simple, recycled - drums can be made for simple, recycled

materialmaterial - done in a group setting- done in a group setting - evoke creativity, enhance leadership skills, & - evoke creativity, enhance leadership skills, &

promote acceptance promote acceptance - response to rhythm is basic to human - response to rhythm is basic to human

functioningfunctioning - advocates co-operation & collaboration- advocates co-operation & collaboration

The Nurse’s RoleThe Nurse’s Role

Education Education - trust established, needs identified- trust established, needs identified - malaria prevention & early treatment- malaria prevention & early treatment Finance & EconomicsFinance & Economics - adopt a drum program sponsored by Remo- adopt a drum program sponsored by Remo - drum making with recycled pesticide containers- drum making with recycled pesticide containers - funding from The Bill & Melinda Gates Foundation - funding from The Bill & Melinda Gates Foundation Involvement of International Nursing OrganizationsInvolvement of International Nursing Organizations - International Council of Nurses- International Council of Nurses

The Nurse’s RoleThe Nurse’s Role

MethodsMethods - travel by bike to communities after work day - travel by bike to communities after work day - groups of 10-15 children/women- groups of 10-15 children/women - use of local musicians to help lead drum circles- use of local musicians to help lead drum circles - empowering women & children through rhythm- empowering women & children through rhythm - provide a fun & safe environment for learning - provide a fun & safe environment for learning

and change through drumming and drum circlesand change through drumming and drum circles

The Nurse’s RoleThe Nurse’s Role Collaboration with WHO, USAID, UNICEF, & Collaboration with WHO, USAID, UNICEF, &

PMIPMI - track demographic, epidemiological, health - track demographic, epidemiological, health

transitions, & malaria incidencetransitions, & malaria incidence EffectivenessEffectiveness - improvement in health, reduction in poverty, - improvement in health, reduction in poverty,

better access to resources, economic better access to resources, economic independenceindependence

- social response - social response - empower people versus entitle- empower people versus entitle

The Nurse’s RoleThe Nurse’s Role International Nursing OrganizationsInternational Nursing Organizations - policy making- policy making - legislation- legislation - nursing practice- nursing practice - public safety- public safety - documentation- documentation - scope of practice- scope of practice - standards of care- standards of care

Summary and ConclusionsSummary and Conclusions Quality of careQuality of care - improvements in access to basic needs - improvements in access to basic needs - influence of change & social justice through opportunity, - influence of change & social justice through opportunity,

hope, & healing hope, & healing Global burden of diseaseGlobal burden of disease - increasing awareness - increasing awareness - conservation of precious resources- conservation of precious resources - providing better opportunities for nursing in poor, under - providing better opportunities for nursing in poor, under

developed countriesdeveloped countries - reduce migration of nurses in poor countries by - reduce migration of nurses in poor countries by

providing opportunities, incentives, & leadership skills providing opportunities, incentives, & leadership skills

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