{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:18:43Z","timestamp":1785417523136,"version":"3.56.0"},"reference-count":36,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T00:00:00Z","timestamp":1765843200000},"content-version":"unspecified","delay-in-days":349,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2732494X25102489_as1\">\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate healthcare workers\u2019 (HCWs) providing tuberculosis (TB) services knowledge, attitudes, and practices (KAP) regarding infection prevention and control (IPC), assess barriers and facilitators to TB IPC implementation and adherence, and evaluate existing TB IPC policies at public health facilities in Namibia\u2019s \/\/Karas region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102489_as2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Concurrent mixed-methods design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102489_as3\">\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Public healthcare facilities in Namibia\u2019s \/\/Karas region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102489_as4\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Quantitative data were collected using an online questionnaire distributed via email and social media platforms to HCWs providing TB services. Descriptive statistics were used to summarize respondent characteristics and KAP scores, followed by bivariate analysis using the Pearson \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      test (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .05) to assess associations between knowledge scores and respondent characteristics. Focus group discussions (FGDs) were conducted with TB focal persons from District Coordinating Committees, transcribed, and analyzed thematically using a 6-phased approach. Data collection spanned 8 months (April 17\u2013November 10, 2023).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102489_as5\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      HCWs demonstrated good knowledge (91.2%) and positive attitudes (85.3%) toward TB IPC, with practice scores less optimal (61.8%). Knowledge was associated with district (\n                      <jats:italic>P<\/jats:italic>\n                      = .001), department (\n                      <jats:italic>P<\/jats:italic>\n                      = .036), and education level (\n                      <jats:italic>P<\/jats:italic>\n                      = .010). Staff shortages were the most cited barrier, and training emerged as a key facilitator. FGDs confirmed the implementation of TB IPC policies at institutional level and revealed barriers, including inadequate infrastructure, limited resources, stigmatization, and lack of managerial support. Facilitators included effective communication, health education, and personal protective equipment availability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25102489_as6\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Strengthening TB IPC requires investment in infrastructure, training, consistent monitoring, and policy enforcement. Targeted IPC interventions can address key barriers and improve adherence across public health facilities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ash.2025.10248","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:25:53Z","timestamp":1765880753000},"source":"Crossref","is-referenced-by-count":1,"title":["TB infection prevention and control at public health facilities in \/\/Karas region, Namibia"],"prefix":"10.1017","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6978-4418","authenticated-orcid":false,"given":"Nicolett Muzuki","family":"Nyambe","sequence":"first","affiliation":[{"name":"Namibia University of Science and Technology (NUST)"},{"name":"Ministry of Health and Social Services"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4796-1445","authenticated-orcid":false,"given":"Carolie","family":"Cloete","sequence":"additional","affiliation":[{"name":"Namibia University of Science and Technology (NUST)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0180-6017","authenticated-orcid":false,"given":"Andrit","family":"Lourens","sequence":"additional","affiliation":[{"name":"Namibia University of Science and Technology (NUST)"},{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town (UCT)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,12,16]]},"reference":[{"key":"S2732494X25102489_ref34","volume-title":"Tuberculosis Infection Prevention and Control Policies, Practices, and the Risk of TB Infection among Healthcare Workers","author":"Islam","year":"2023"},{"key":"S2732494X25102489_ref27","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2020.1755030"},{"key":"S2732494X25102489_ref35","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/828939"},{"key":"S2732494X25102489_ref7","unstructured":"7. Mulokoshi, T. Assessing the effectiveness of tuberculosis infection control in public healthcare facilities in the Khomas region. The University of Namibia, 2019. Available from: https:\/\/repository.unam.edu.na\/items\/103b62db-c2cc-4e3c-82f4-42f90f5ecf30"},{"key":"S2732494X25102489_ref9","unstructured":"9. Shaanika, AN. An investigation into the knowledge of nurses about tuberculosis in the Southern regions of Namibia. Stellenbosch University 2022. Available from: https:\/\/scholar.sun.ac.za\/server\/api\/core\/bitstreams\/fe69dcdd-5eb2-4f37-bb4f-e315fc59b58a\/content"},{"key":"S2732494X25102489_ref29","doi-asserted-by":"publisher","DOI":"10.4102\/phcfm.v6i1.597"},{"key":"S2732494X25102489_ref17","unstructured":"17. Kateta, E. , Knowledge, Attitudes and practices of patients diagnosed with tuberculosis related to tuberculosis treatment adherence in Keetmanshoop district, Namibia. The University of Namibia. 2018. Available from: https:\/\/repository.unam.edu.na\/items\/0cb32780-a4bd-423d-8309-93e5eeac39d0."},{"key":"S2732494X25102489_ref32","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-11-262"},{"key":"S2732494X25102489_ref3","doi-asserted-by":"publisher","DOI":"10.5539\/gjhs.v17n1p38"},{"key":"S2732494X25102489_ref11","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.53862.2"},{"key":"S2732494X25102489_ref21","unstructured":"21. Ministry of Health and Social Services (MoHSS). National Guidelines for the Management of Tuberculosis. 4th ed. 2019. 220p."},{"key":"S2732494X25102489_ref30","doi-asserted-by":"publisher","DOI":"10.1080\/09709274.2015.11906905"},{"key":"S2732494X25102489_ref14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246923"},{"key":"S2732494X25102489_ref23","volume-title":"IBM SPSS Statistics for Windows, Version 28.0","year":"2021"},{"key":"S2732494X25102489_ref18","unstructured":"18. Karas census regional profile. 2011. Available from: https:\/\/cms.my.na\/assets\/documents\/p19dptss1r6qqq76pcp1ssp46tn.pdf."},{"key":"S2732494X25102489_ref22","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2828-4"},{"key":"S2732494X25102489_ref8","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-1740-7"},{"key":"S2732494X25102489_ref19","unstructured":"19. Ministry of Health and Social Services (MoHSS). Locations -Namibia Master Health Facility List. 2018. Available from: https:\/\/mfl.mhss.gov.na\/location-manager\/locations\/view\/10522."},{"key":"S2732494X25102489_ref28","unstructured":"28. Software Development GmbH. Atlas.ti. Software Development GmbH, 2023."},{"key":"S2732494X25102489_ref6","first-page":"100588","article-title":"Association of knowledge and practice of tuberculosis infection prevention and control policies among health care personnel at a regional hospital, in Gauteng province of South Africa","volume":"19","author":"Masuku","year":"2023","journal-title":"Int J Africa Nurs Sci [Internet]"},{"key":"S2732494X25102489_ref10","article-title":"Attitudes and preventive practices regarding tuberculosis among healthcare workers and patients in India: A mixed-method study","volume":"16","author":"Shihora","year":"2024","journal-title":"Cureus"},{"key":"S2732494X25102489_ref13","first-page":"62","article-title":"Barriers and facilitators to healthcare workers\u2019 adherence with infection prevention and control guidelines for respiratory infectious diseases: A rapid qualitative evidence synthesis","volume":"33","author":"Houghton","year":"2021","journal-title":"Emergencias"},{"key":"S2732494X25102489_ref31","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-016-0344-8"},{"key":"S2732494X25102489_ref1","unstructured":"1. World Health Organization. 2024 Global tuberculosis report. Geneva, 2024. Available from: https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2024"},{"key":"S2732494X25102489_ref24","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-05156-y"},{"key":"S2732494X25102489_ref5","doi-asserted-by":"publisher","DOI":"10.1055\/a-1241-4321"},{"key":"S2732494X25102489_ref4","unstructured":"4. World Health Organization (WHO) Tuberculosis incidence (per 100 000 population). Namibia, WHO Global Health Observatory, 2025. Available from: https:\/\/data.who.int\/countries\/516."},{"key":"S2732494X25102489_ref15","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-016-1601-5"},{"key":"S2732494X25102489_ref16","unstructured":"16. Namibia Statistics Agency. Namibia Population and Housing Census. 2023. Available from: https:\/\/nsa.org.na\/census\/."},{"key":"S2732494X25102489_ref33","article-title":"Implementation fidelity of tuberculosis infection prevention and control practices in three hospitals with the highest notified tuberculosis cases in Bhutan: a mixed method study","volume":"4","author":"Gyem","year":"2020","journal-title":"J Glob Health Rep"},{"key":"S2732494X25102489_ref26","doi-asserted-by":"publisher","DOI":"10.5116\/ijme.4dfb.8dfd"},{"key":"S2732494X25102489_ref36","first-page":"42","article-title":"Infection prevention and control; reference manual for health care facilities with limited resources","volume":"12","author":"Curless","year":"2021","journal-title":"Jhpiego"},{"key":"S2732494X25102489_ref25","first-page":"38","article-title":"Knowledge and practice of tuberculosis infection control by healthcare workers at National Tuberculosis and Leprosy Training Centre, Zaria, Northwest Nigeria","volume":"1","author":"Ajayi","year":"2018","journal-title":"Acta Scientific Medical Sciences"},{"key":"S2732494X25102489_ref2","volume-title":"The Development of Africa Social Indicators Research Series","author":"Anaemene","year":"2018"},{"key":"S2732494X25102489_ref12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0241039"},{"key":"S2732494X25102489_ref20","unstructured":"20. Ministry of Health and Social Services. Tuberculosis Infection Prevent and Control Guidelines. 3rd edition. 2021. Available from: https:\/\/www.afro.who.int\/countries\/namibia\/publication\/infection-prevention-and-control-guidelines-3rd-edition."}],"container-title":["Antimicrobial Stewardship &amp; Healthcare Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2732494X25102489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:25:58Z","timestamp":1765880758000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2732494X25102489\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"alternative-id":["S2732494X25102489"],"URL":"https:\/\/doi.org\/10.1017\/ash.2025.10248","relation":{},"ISSN":["2732-494X"],"issn-type":[{"value":"2732-494X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e341"}}