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Nsojo A, George L, Mwasomola D, Tawete J, Mbotwa CH, Mweya CN, Mwakyula I. Prescribing patterns of antimicrobials according to the WHO AWaRe classification at a tertiary referral hospital in the southern highlands of Tanzania. Infect Prev Pract 2024; 6:100347. [PMID: 38405014 PMCID: PMC10883815 DOI: 10.1016/j.infpip.2024.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/07/2024] [Indexed: 02/27/2024] Open
Abstract
Background Antimicrobial consumption continues to rise globally and contributes to the emergence and spread of antimicrobial resistance. This study aimed to evaluate antimicrobial prescribing patterns in a selected tertiary hospital in Tanzania. Methods This cross-sectional study was conducted for one year (September 2021-September 2022) at Mbeya Zonal Referral Hospital, a public hospital in the southern highlands zone of Tanzania. Data on clinical diagnosis, laboratory tests, prescribed antimicrobials, and prescribers' designations were collected through a custom eMedical system, aligning antimicrobials with the WHO's 2021 AWaRe classification. Descriptive analysis was performed to assess the pattern of antimicrobial prescriptions. Results Of 2,293 antimicrobial prescriptions, 62.41% were ACCESS, 37.42% were WATCH, and 0.17% fell in the RESERVE categories. Metronidazole, accounting for 23.8%, was the most commonly prescribed antimicrobial. More than 50% of the ACCESS and WATCH prescriptions were justified by laboratory diagnosis and were predominantly prescribed by clinicians. A very small proportion of prescriptions (<1%) were informed by culture and sensitivity (C/S) testing. The Paediatric department had the majority of WATCH prescriptions (72.2%). Conclusion The prescribing patterns at the study hospital generally align with WHO AWaRe guidelines, potentially mitigating antimicrobial resistance. Nevertheless, the scarcity of culture and sensitivity testing is a concern that warrants targeted improvement.
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Affiliation(s)
- Anthony Nsojo
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P. O. Box 608, Mbeya, Tanzania
- Mbeya Zonal Referral Hospital, P. O. Box 419, Mbeya, Tanzania
| | | | | | - Joseph Tawete
- Mbeya Zonal Referral Hospital, P. O. Box 419, Mbeya, Tanzania
| | - Christopher H. Mbotwa
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P. O. Box 608, Mbeya, Tanzania
| | - Clement N. Mweya
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P. O. Box 608, Mbeya, Tanzania
- Mbeya Medical Research Centre, National Institute for Medical Research, P. O. Box 2410, Mbeya, Tanzania
| | - Issakwisa Mwakyula
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, P. O. Box 608, Mbeya, Tanzania
- Mbeya Zonal Referral Hospital, P. O. Box 419, Mbeya, Tanzania
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Osei Afriyie D, Loo PS, Kuwawenaruwa A, Kassimu T, Fink G, Tediosi F, Mtenga S. Understanding the role of the Tanzania national health insurance fund in improving service coverage and quality of care. Soc Sci Med 2024; 347:116714. [PMID: 38479141 DOI: 10.1016/j.socscimed.2024.116714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/19/2024] [Accepted: 02/20/2024] [Indexed: 04/20/2024]
Abstract
Health insurance is one of the main financing mechanisms currently being used in low and middle-income countries to improve access to quality services. Tanzania has been running its National Health Insurance Fund (NHIF) since 2001 and has recently undergone significant reforms. However, there is limited attention to the causal mechanisms through which NHIF improves service coverage and quality of care. This paper aims to use a system dynamics (qualitative) approach to understand NHIF causal pathways and feedback loops for improving service coverage and quality of care at the primary healthcare level in Tanzania. We used qualitative interviews with 32 stakeholders from national, regional, district, and health facility levels conducted between May to July 2021. Based on the main findings and themes generated from the interviews, causal mechanisms, and feedback loops were created. The majority of feedback loops in the CLDs were reinforcing cycles for improving service coverage among beneficiaries and the quality of care by providers, with different external factors affecting these two actions. Our main feedback loop shows that the NHIF plays a crucial role in providing additional financial resources to facilities to purchase essential medical commodities to deliver care. However, this cycle is often interrupted by reimbursement delays. Additionally, beneficiaries' perception that lower-level facilities have poorer quality of care has reinforced care seeking at higher-levels. This has decreased lower level facilities' ability to benefit from the insurance and improve their capacity to deliver quality care. Another key finding was that the NHIF funding has resulted in better services for insured populations compared to the uninsured. To increase quality of care, the NHIF may benefit from improving its reimbursement administrative processes, increasing the capacity of lower levels of care to benefit from the insurance and appropriately incentivizing providers for continuity of care.
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Affiliation(s)
- Doris Osei Afriyie
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Switzerland; University of Basel, Switzerland.
| | - Pei Shan Loo
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Switzerland; University of Basel, Switzerland.
| | - August Kuwawenaruwa
- Health Systems, Impact Evaluation and Policy Group, Ifakara Health Institute, Dar Es Salaam, United Republic of Tanzania.
| | - Tani Kassimu
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Switzerland; University of Basel, Switzerland; Health Systems, Impact Evaluation and Policy Group, Ifakara Health Institute, Dar Es Salaam, United Republic of Tanzania.
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Switzerland; University of Basel, Switzerland.
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Switzerland; University of Basel, Switzerland.
| | - Sally Mtenga
- Health Systems, Impact Evaluation and Policy Group, Ifakara Health Institute, Dar Es Salaam, United Republic of Tanzania; Institute of Health and Wellbeing, University of Glasgow, Ireland, UK.
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Adhikari B, Bayo M, Peto TJ, Callery JJ, Tripura R, Dysoley L, Mshamu S, Gesase S, von Seidlein L, Dondorp AM. Comparing the roles of community health workers for malaria control and elimination in Cambodia and Tanzania. BMJ Glob Health 2023; 8:e013593. [PMID: 38070880 PMCID: PMC10729139 DOI: 10.1136/bmjgh-2023-013593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
The reduction of deaths from malaria in sub-Saharan Africa (SSA) is stalling, whereas many countries in Southeast Asia are approaching malaria elimination. We reviewed the role of community health worker (CHW) programmes in malaria control and elimination between regions, with a more detailed description of the programmes in Tanzania and Cambodia. Compared with Tanzania, Cambodia has a much more developed CHW network, which has been pivotal in the near elimination of malaria. In Tanzania, the malaria burden has remained similar over the last decade and treatment continues to rely on healthcare facilities, which provide more limited access to early diagnosis and treatment. Overall, the proportion of malaria cases treated by CHWs is substantially lower in SSA than in Southeast Asia. Even though networks of CHWs are resource intensive and malaria epidemiology differs substantially between countries, there is a strong case for expanding CHW networks in rural SSA to improve early access to effective malaria treatment and reduce the malaria burden.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Makhily Bayo
- Faculty of Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - James J Callery
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Rupam Tripura
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Lek Dysoley
- C.N.M National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Salum Mshamu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
- CSK Research Solutions, Mtwara, Tanzania
| | - Samwel Gesase
- Korogwe Research Laboratory, National Institute for Medical Research, Tanga, Tanzania
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK, Oxford, UK
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Campbell White A, Campbell White OC. Corruption is making people sick. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:290-305. [PMID: 38117744 DOI: 10.2989/16085906.2023.2270483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
Abstract
According to Transparency International, of the US$7.5 trillion spent globally on health each year, US$500 billion is lost to corruption.1 This article deals with the topic of corruption in the health sector in sub-Saharan Africa with a focus on how it affects persons living with HIV and their families. It begins with a definition of corruption and outlines the types of activities, people and institutions that fall within that definition in the context of HIV/AIDS. Examples are provided of what happens in practice and the types of persons (in terms of their societal roles) who yield to corruption, and how and why they commit it. The effects of corruption in health and in the fight against HIV/AIDS are then considered, drawing on published research on the costs to institutions and society. For example, HIV prevalence among women is higher than men, yet their reliance on health services plagued by corruption makes them vulnerable to abuse, blocking access to vital contraceptive, HIV testing, and reproductive and child health services. Attention is then focused on the factors that encourage the adoption of corrupt practices and what approaches have been taken to try to counter them. This includes a review and analysis of the steps that have been taken to strengthen compliance, governance and accountability and why attempts to deal with corruption have met with little success. This article suggests a new approach - harnessing digitalisation - to combat corruption more quickly and effectively, pointing out that corruption is both a major factor contributing to inefficiency and is harming peoples' health. This article aims to raise interest and renew efforts in fighting corruption in health.
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Katundu DR, Hannink G, Lyimo JG, Rovers M, van Heerbeek N. Usage and parental knowledge of antibiotics in children undergoing (adeno) tonsillectomy in northern Tanzania. Pan Afr Med J 2023; 46:59. [PMID: 38223875 PMCID: PMC10787135 DOI: 10.11604/pamj.2023.46.59.41190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Antimicrobial Resistance (AMR) is a growing concern globally, mostly being contributed by a limited understanding of antibiotic utilization as a result of inappropriate acquisition and prescription. Parental awareness is essential in optimizing their usage and preserving the effectiveness of these crucial medications. The current study investigates the usage and parental knowledge of antibiotics in children undergoing (adeno) tonsillectomy ((A)TE) in Northern Tanzania. Methods a cross-sectional survey was conducted among parents/caregivers of children who underwent (A)TE in Northern Tanzania. A modified and well-structured questionnaire, which was adapted from a World Health Organization (WHO) questionnaire and used to assess the parents´ knowledge of antibiotics and antibiotic use. Results the study included 157 participants. About 54% of the children under the age of 5 years. As of 88% of children had already received antibiotics prior to surgery, 92% of the used antibiotics were prescribed by a clinician, and 5% of parents to used leftovers antibiotics for their children. While 88% of the parents reported adhering to prescriptions, 8% of reported buying the same antibiotic (as prescribed before) without consulting a clinician again when their children are sick. Conclusion the use of antibiotics, including broad-spectrum antibiotics, was found to be high in our study group. Parents demonstrate a relatively good understanding of antibiotic usage. It is plausible to speculate that a higher prevalence of non-insured, unemployed, and less educated parents may lead to an increased incidence of misuse and misinterpretation of antibiotics.
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Affiliation(s)
- Denis Robert Katundu
- Department of Otolaryngology, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
- Department of Otolaryngology, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Department of Otolaryngology, Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Jesca Godlisten Lyimo
- Department of Otolaryngology, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
- Department of Otolaryngology, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Maroeska Rovers
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Niels van Heerbeek
- Department of Otolaryngology, Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
- Department of Otolaryngology, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Department of Otolaryngology, Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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Mori AT. Mandatory health insurance for the informal sector in Tanzania-has it worked anywhere! FRONTIERS IN HEALTH SERVICES 2023; 3:1247301. [PMID: 37849823 PMCID: PMC10577424 DOI: 10.3389/frhs.2023.1247301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
Many countries in sub-Saharan Africa are struggling to expand voluntary health insurance schemes to raise finances toward achieving universal health coverage. With more than three-quarters of the population without any insurance, the government of Tanzania has unsuccessfully tried to pass a Bill proposing a mandatory, nationwide scheme to cover the large and diverse informal sector. The Bill proposed an annual premium of ∼150 USD for a household of six or 65 USD per person. Studies in Tanzania and Kenya have shown that the majority of people in the informal sector are unwilling and unable to pay premiums as low as 4 USD, mostly due to poverty. Mandatory health insurance for the informal sector is not common in this region, mostly because it is difficult to enforce. Successful insurance schemes have included significant subsidies from tax revenues. Tanzania should not seek to raise funds for health through an unenforceable insurance scheme but rather should consider a largely tax-funded scheme for the informal sector. Contributions through low-cost voluntary schemes can enhance social contracts, reduce out-of-pocket expenditure, and promote efficient utilization. In addition, progressive health taxes should be imposed on harmful products (tobacco, alcohol, sugary drinks, etc.) to raise more funds while addressing the increasing burden of non-communicable diseases. Furthermore, efficiency in the use of scarce health resources should be promoted through realistic prioritization of public services, the use of Health Technology Assessment, and strategic purchasing.
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Affiliation(s)
- Amani Thomas Mori
- Bergen Center for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- National Institute of Medical Research, Muhimbili Research Center, Dar es Salaam, Tanzania
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Osetinsky B, Fink G, Kuwawenaruwa A, Tediosi F. Investigating sustainability challenges for the National Health Insurance Fund in Tanzania: a modelling approach. BMJ Open 2023; 13:e070451. [PMID: 37597863 PMCID: PMC10441117 DOI: 10.1136/bmjopen-2022-070451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023] Open
Abstract
OBJECTIVE This study aimed to model the long-term cost associated with expanding public health insurance coverage in Tanzania. DESIGN, SETTING AND PARTICIPANTS We analysed the 2016 claims of 2 923 524 beneficiaries of the National Health Insurance Fund in Tanzania. The analysis focused on determining the average cost per beneficiary across 5-year age groups separated by gender, and grouped by broad health condition categories. We then modelled three different insurance coverage scenarios from 2020 to 2050 and we estimated the associated costs. OUTCOME MEASURES Average cost per beneficiary and the projected financing requirements, projected from 2020 to 2050. RESULTS The analysis revealed that the average per beneficiary cost for insurance claims was $38.58. Among males over 75 years, the average insurance claims costs were highest, amounting to $125. The total estimated annual cost of claims in 2020 was $151 million. Under the status quo coverage scenario, total claims were projected to increase to $415 million by 2050. Increasing coverage from 7% to 50% would result in an additional financing requirement of $2.27 billion. If coverage would increase by 10% annually, reaching 56% of the population by 2050, the additional financing need would amount to $2.84 billion. CONCLUSION This study highlights the critical importance of assessing the long-term financial viability of health insurance schemes aimed to cover large segments of the population in low-income countries. The findings demonstrate that even without expansion of coverage, financing requirements for insurance will more than triple by 2050. Furthermore, increasing coverage is likely to substantially escalate the cost of claims, potentially requiring significant government or external contributions to finance these additional costs. Policymakers and stakeholders should carefully evaluate the sustainability of insurance schemes to ensure adequate financial support for expanding coverage and improving healthcare access in low-income settings.
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Affiliation(s)
- Brianna Osetinsky
- Epidemiology and Public Health, University of Basel, Basel, Switzerland
- Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Günther Fink
- Epidemiology and Public Health, University of Basel, Basel, Switzerland
- Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - August Kuwawenaruwa
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Tanzania
| | - Fabrizio Tediosi
- Epidemiology and Public Health, University of Basel, Basel, Switzerland
- Household Economics and Health Systems Research Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Vysochyna A, Vasylieva T, Dluhopolskyi O, Marczuk M, Grytsyshen D, Yunger V, Sulimierska A. Impact of Coronavirus Disease COVID-19 on the Relationship between Healthcare Expenditures and Sustainable Economic Growth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3049. [PMID: 36833742 PMCID: PMC9966937 DOI: 10.3390/ijerph20043049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
The coronavirus disease (COVID-19) pandemic led to a catastrophic burden on the healthcare system and increased expenditures for the supporting medical infrastructure. It also had dramatic socioeconomic consequences. The purpose of this study is to identify the empirical patterns of healthcare expenditures' influence on sustainable economic growth in the pandemic and pre-pandemic periods. Fulfilment of the research task involves the implementation of two empirical blocks: (1) development of a Sustainable Economic Growth Index based on public health, environmental, social, and economic indicators using principal component analysis, ranking, Fishburne approach, and additive convolution; (2) modelling the impact of different kinds of healthcare expenditures (current, capital, general government, private, out-of-pocket) on the index using panel data regression modelling (random-effects GLS regression). Regression results in the pre-pandemic period show that the growth of capital, government, and private healthcare expenditures positively influence sustainable economic growth. In 2020-2021, healthcare expenditures did not statistically significantly influence sustainable economic growth. Consequently, more stable conditions allowed capital healthcare expenditures to boost economic growth, while an excessive healthcare expenditure burden damaged economic stability during the COVID-19 pandemic. In the pre-pandemic period, public and private healthcare expenditures ensured sustainable economic growth; out-of-pocket healthcare expenditures dominantly contributed to the pandemic period.
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Affiliation(s)
- Alina Vysochyna
- Academic and Research Institute of Business, Economics and Management, Sumy State University, 40007 Sumy, Ukraine
| | - Tetiana Vasylieva
- Academic and Research Institute of Business, Economics and Management, Sumy State University, 40007 Sumy, Ukraine
- Department of Applied Social Sciences, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Oleksandr Dluhopolskyi
- Faculty of Economics and Management, West Ukrainian National University, 46020 Ternopil, Ukraine
- Institute of Public Administration and Business, WSEI University, 20-209 Lublin, Poland
| | - Marcin Marczuk
- Institute of Public Administration and Business, WSEI University, 20-209 Lublin, Poland
| | - Dymytrii Grytsyshen
- Faculty of National Security, Law and International Relations, Zhytomyr Polytechnic State University, 10005 Zhytomyr, Ukraine
| | - Vitaliy Yunger
- Faculty of National Security, Law and International Relations, Zhytomyr Polytechnic State University, 10005 Zhytomyr, Ukraine
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