1
|
Arsenault C, Wright K, Taddele T, Tadele A, Derseh Mebratie A, Tiruneh Tiyare F, Kosgei RJ, Nzinga J, Holt B, Mugenya I, Clarke-Deelder E, Nega A, Prabhakaran D, Mohan S, Mfeka-Nkabinde NG, Mthethwa L, Haile Mariam D, Molla G, Getachew T, Jarhyan P, Chaudhry M, Kassa M, Kruk ME. The maternal and newborn health eCohort to track longitudinal care quality: study protocol and survey development. Glob Health Action 2024; 17:2392352. [PMID: 39163134 PMCID: PMC11338195 DOI: 10.1080/16549716.2024.2392352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
The MNH eCohort was developed to fill gaps in maternal and newborn health (MNH) care quality measurement. In this paper, we describe the survey development process, recruitment strategy, data collection procedures, survey content and plans for analysis of the data generated by the study. We also compare the survey content to that of existing multi-country tools on MNH care quality. The eCohort is a longitudinal mixed-mode (in-person and phone) survey that will recruit women in health facilities at their first antenatal care (ANC) visit. Women will be followed via phone survey until 10-12 weeks postpartum. User-reported information will be complemented with data from physical health assessments at baseline and endline, extraction from MNH cards, and a brief facility survey. The final MNH eCohort instrument is centered around six key domains of high-quality health systems including competent care (content of ANC, delivery, and postnatal care for the mother and newborn), competent systems (prevention and detection, timely care, continuity, integration), user experience, health outcomes, confidence in the health system, and economic outcomes. The eCohort combines the maternal and newborn experience and, due to its longitudinal nature, will allow for quality assessment according to specific risks that evolve throughout the pregnancy and postpartum period. Detailed information on medical and obstetric history and current health status of respondents and newborns will allow us to determine whether women and newborns at risk are receiving needed care. The MNH eCohort will answer novel questions to guide health system improvements and to fill data gaps in implementing countries.
Collapse
Affiliation(s)
- Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katherine Wright
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tefera Taddele
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ashenif Tadele
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anagaw Derseh Mebratie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Firew Tiruneh Tiyare
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Rose J. Kosgei
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI Wellcome Trust Research Program, Nairobi, Kenya
| | - Bethany Holt
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Irene Mugenya
- Health Economics Research Unit, KEMRI Wellcome Trust Research Program, Nairobi, Kenya
| | - Emma Clarke-Deelder
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, Allschwil, Switzerland
| | - Adiam Nega
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, India
- Centre for Chronic Disease Control, New Delhi, India
| | | | | | - Londiwe Mthethwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Damen Haile Mariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gebeyaw Molla
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Theodros Getachew
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Munir Kassa
- Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Hrzic R, Vogt T. The contribution of avoidable mortality to life expectancy differences and lifespan disparities in the European Union: a population-based study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 46:101042. [PMID: 39286330 PMCID: PMC11402299 DOI: 10.1016/j.lanepe.2024.101042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/19/2024]
Abstract
Background Twenty years after the 2004 European Union (EU) enlargement, life expectancy differences between established (EMS) and new member states (NMS) remain large. Contributing to this gap are deaths that can be avoided through preventive services or adequate medical treatment. We estimate the impact of reducing avoidable mortality on life expectancy and lifespan disparities in the enlarged EU. Methods Using World Health Organization mortality database data, we analysed the potential of reducing avoidable mortality, as defined by Eurostat and the Organisation for Economic Cooperation and Development, to close the mortality gap between NMS and EMS. We decomposed the changes in life expectancy and lifespan disparity by age and cause using linear integral decomposition. Findings Averting all avoidable deaths across the EU from 2005 to 2019 would decrease the average life expectancy gap from 5.8 to 2.4 years in men and 3.3-2 years in women and eliminate the lifespan disparity gap. Had NMS achieved the average EMS avoidable mortality rates during the same period, the average life expectancy gap would have been reduced to 1.8 years in men and 1.6 years in women, and the lifespan disparities gap would have been reversed. Avoidable circulatory and injury-related deaths in middle and older age drove the observed mortality changes. Interpretation Our results suggest that the gap in life expectancy and lifespan disparity across the EU could be reduced by strengthening health systems and investing in averting circulatory and injury-related deaths in middle and older age in NMS. Funding None.
Collapse
Affiliation(s)
- Rok Hrzic
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD, Maastricht, the Netherlands
| | - Tobias Vogt
- Population Research Centre, Faculty of Spatial Sciences, University of Groningen, 9700 AV, Groningen, the Netherlands
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, 576104, India
| |
Collapse
|
3
|
Mwanga JR, Hokororo A, Ndosi H, Masenge T, Kalabamu FS, Tawfik D, Mediratta RP, Rozenfeld B, Berg M, Smith ZH, Chami N, Mkopi NP, Mwanga C, Diocles E, Agweyu A, Meaney PA. Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory. BMC Health Serv Res 2024; 24:1066. [PMID: 39272036 PMCID: PMC11401409 DOI: 10.1186/s12913-024-11554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND In low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Education (PACE), an adaptive learning program to enhance provider competency in Tanzania's guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal implementation strategies in LMIC settings are unknown. OBJECTIVES (1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential. METHODS Mixed-methods study involving healthcare providers at three facilities. Quantitative data was collected using the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs). RESULTS Eighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrating that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study's focus on PACE's initial implementation. CONCLUSION This study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation. Furthermore, the study underscores the value of the NPT as a framework for guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.
Collapse
Affiliation(s)
- Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Adolfine Hokororo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Hanston Ndosi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - Florence S Kalabamu
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Daniel Tawfik
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | - Marc Berg
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Neema Chami
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Namala P Mkopi
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Castory Mwanga
- Pediatric Association of Tanzania, Dar Es Salaam, Tanzania
| | - Enock Diocles
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Ambrose Agweyu
- London School of Hygiene and Tropical Medicine, London, UK
| | - Peter A Meaney
- Stanford University School of Medicine, Palo Alto, CA, USA.
| |
Collapse
|
4
|
Aggarwal S, Simmy S, Mahajan N, Nigam K. Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis. JMIR Form Res 2024; 8:e57384. [PMID: 39255009 DOI: 10.2196/57384] [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: 02/15/2024] [Revised: 06/09/2024] [Accepted: 07/10/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region's intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers' challenges and alternative strategies in Manipur and Nagaland. OBJECTIVE This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. METHODS This study is part of the i-DRONE (Indian Council of Medical Research's Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. RESULTS Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. CONCLUSIONS Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland.
Collapse
Affiliation(s)
| | - Simmy Simmy
- Indian Council of Medical Research, New Delhi, India
| | - Nupur Mahajan
- Indian Council of Medical Research, New Delhi, India
| | - Kuldeep Nigam
- Indian Council of Medical Research, New Delhi, India
| |
Collapse
|
5
|
Valente EP, Mariani I, Bomben A, Morano S, Gemperle M, Otelea MR, Miani C, Elden H, Sarantaki A, Costa R, Baranowska B, König-Bachmann M, Kongslien S, Drandić D, Rozée V, Nespoli A, Abderhalden-Zellweger A, Nanu I, Batram-Zantvoort S, Linden K, Metallinou D, Dias H, Tataj-Puzyna U, D'Costa E, Nedberg IH, Kurbanović M, de La Rochebrochard E, Fumagalli S, Grylka-Baeschlin S, Handra CM, Zaigham M, Orovou E, Barata C, Szlendak B, Zenzmaier C, Vik ES, Liepinaitienė A, Drglin Z, Arendt M, Sacks E, Lazzerini M. Health workers' perspectives on the quality of maternal and newborn health care around the time of childbirth: Results of the Improving MAternal Newborn carE in the EURO Region (IMAgiNE EURO) project in 12 countries of the World Health Organization European Region. J Glob Health 2024; 14:04164. [PMID: 39238363 PMCID: PMC11377968 DOI: 10.7189/jogh.14.04164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
Background Health workers' (HWs') perspectives on the quality of maternal and newborn care (QMNC) are not routinely collected. In this cross-sectional study, we aimed to document HWs' perspectives on QMNC around childbirth in 12 World Health Organization (WHO) European countries. Methods HWs involved in maternal/neonatal care for at least one year between March 2020 and March 2023 answered an online validated WHO standards-based questionnaire collecting 40 quality measures for improving QMNC. A QMNC index (score 0-400) was calculated as a synthetic measure. Results Data from 4143 respondents were analysed. For 39 out of 40 quality measures, at least 20% of HWs reported a 'need for improvement', with large variations across countries. Effective training on healthy women/newborns management (n = 2748, 66.3%), availability of informed consent job aids (n = 2770, 66.9%), and effective training on women/newborns rights (n = 2714, 65.5%) presented the highest proportion of HWs stating 'need for improvement'. Overall, 64.8% (n = 2684) of respondents declared that HWs' numbers were insufficient for appropriate care (66.3% in Portugal and 86.6% in Poland), and 22.4% described staff censorship (16.3% in Germany and 56.7% in Poland). The reported QMNC index was low in all countries (Poland median (MD) = 210.60, interquartile range (IQR) = 155.71, 273.57; Norway MD = 277.86; IQR = 244.32, 308.30). The 'experience of care' domain presented in eight countries had significantly lower scores than the other domains (P < 0.001). Over time, there was a significant monthly linear decrease in the QMNC index (P < 0.001), lacking correlation with the coronavirus disease 2019 (COVID-19) pandemic trends (P > 0.05). Multivariate analyses confirmed large QMNC variation by country. HWs with <10 years of experience, HWs from public facilities, and midwives rated QMNC with significantly lower scores (P < 0.001). Conclusions HWs from 12 European countries reported significant gaps in QMNC, lacking association with COVID-19 pandemic trends. Routine monitoring of QMNC and tailored actions are needed to improve health services for the benefit of both users and providers. Registration ClinicalTrials.gov NCT04847336.
Collapse
Affiliation(s)
- Emanuelle Pessa Valente
- World Health Organization Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Ilaria Mariani
- World Health Organization Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Arianna Bomben
- World Health Organization Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Sandra Morano
- Medical School and Midwifery School, Genoa University, Genoa, Italy
| | - Michael Gemperle
- Institute of Midwifery and Reproductive Health, School of Health Professions, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- SAMAS Association, Bucharest, Romania
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Antigoni Sarantaki
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Porto, Portugal
- Lusófona University, HEI-Lab: Digital Human-Environment Interaction Labs, Lisboa, Portugal
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Sigrun Kongslien
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Norway
| | - Daniela Drandić
- International Confederation of Midwives (ICM), Hague, Netherlands
- Roda - Parents in Action, Zagreb, Croatia
| | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques, Paris, France
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Obstetrics, Foundation IRCCS San Gerardo dei Tintori Monza, Italy
| | - Alessia Abderhalden-Zellweger
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Ioana Nanu
- Social Obstetrics and Paediatric Research Unit, National Institute for Mother and Child Health Alessandrescu Rusescu, Bucharest, Romania
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dimitra Metallinou
- Department of Midwifery, Faculty of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Heloísa Dias
- Regional Health Administration of the Algarve, IP (ARS - Algarve), Portugal
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | | | | | - Elise de La Rochebrochard
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques, Paris, France
| | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Obstetrics, Foundation IRCCS San Gerardo dei Tintori Monza, Italy
| | - Susanne Grylka-Baeschlin
- Institute of Midwifery and Reproductive Health, School of Health Professions, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | | | - Mehreen Zaigham
- Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Institution of Clinical Sciences Lund, Lund University, Lund and Skane University Hospital, Malmö, Sweden
| | - Eirini Orovou
- Department of Midwifery, School of Health Sciences, University of Western Macedonia, Ptolemaida, Greece
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisboa, Portugal
- Associação Portuguesa Pelos Direitos da Mulher na Gravidez e Parto, Lisbon, Portugal
| | - Beata Szlendak
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | | | - Eline Skirnisdottir Vik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
| | - Alina Liepinaitienė
- Faculty of Natural Sciences, Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
- Faculty of Medicine, Kauno Kolegija Higher Education Institution, Kaunas, Lithuania
- Republican Siauliai County Hospital, Siauliai, Lithuania
| | - Zalka Drglin
- National Institute of Public Health, Ljubljana, Slovenia
| | - Maryse Arendt
- Professional association of the Lactation Consultants in Luxembourg, Luxembourg, Luxembourg
| | - Emma Sacks
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marzia Lazzerini
- World Health Organization Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
6
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. Clin Exp Nephrol 2024; 28:835-846. [PMID: 38970648 PMCID: PMC11341759 DOI: 10.1007/s10157-024-02518-2] [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] [Accepted: 05/13/2024] [Indexed: 07/08/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
Collapse
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, 105 W 8th Avenue, Suite 250 E, Spokane, WA, 99204, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Cranford, USA
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Cranford, USA
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Harbin, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | |
Collapse
|
7
|
Shi H, Chen L, Wei Y, Chen X, Zhao Y. Improving maternal healthcare further in China at a time of low maternal mortality. BMJ 2024; 386:e078640. [PMID: 39214541 PMCID: PMC11359839 DOI: 10.1136/bmj-2023-078640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Huifeng Shi
- Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Centre for Obstetrical and Gynaecological Diseases, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
| | - Lian Chen
- Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Centre for Obstetrical and Gynaecological Diseases, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Centre for Obstetrical and Gynaecological Diseases, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
| | - Xu Chen
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- Nankai University Maternity Hospital, Tianjin, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obstetrics, Beijing, China
- National Clinical Research Centre for Obstetrical and Gynaecological Diseases, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
| |
Collapse
|
8
|
Serafica R, Reyes AT, Cacciata MC, Kawi J, Leyva EWA, Sy FS, Evangelista LS. Bridging the Gap: Reducing Health Inequities in Access to Preventive Health Care Services in Rural Communities in the Philippines. J Transcult Nurs 2024:10436596241271270. [PMID: 39193813 DOI: 10.1177/10436596241271270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
INTRODUCTION We used an implementation science framework to investigate perceived health inequities in preventive health care initiatives in rural communities in the Philippines. We also identified health equity-focused quality improvement strategies. METHODS Three health care providers and 12 barangay clinic patients were interviewed. RESULTS Patient interviews showed that social determinants of health, respect, and attitudes toward health care providers affected patient empowerment to engage in self-management for noncommunicable diseases (NCDs). Health care providers identified six challenges in managing NCDs: (a) inefficient work processes; (b) staffing shortages; (c) insufficient access to low-cost medications; (d) inadequate primary preventive health education from the schools; (e) health care not considered a priority; and (f) lack of local government support. DISCUSSION Inadequate preventive health care and education intensify health access and resource inequities in rural communities in the Philippines. A multi-sectoral plan may improve rural health infrastructure and education toward improving health care access and decreasing care disparities.
Collapse
|
9
|
Moon D, Jeon J, Park J, Choi MH, Kim MH, Choi H. Universal health coverage saves more lives among severely ill COVID-19 patients: A difference-in-differences analysis of individual patient data in South Korea. Health Res Policy Syst 2024; 22:116. [PMID: 39169364 PMCID: PMC11337885 DOI: 10.1186/s12961-024-01212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 08/09/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Universal health coverage (UHC) ensures affordability of a variety of essential health services for the general population. Although UHC could mitigate the harmful effects of coronavirus disease 2019 (COVID-19) on patients and their socioeconomic position, the debate on UHC's scope and ability to improve health outcomes is ongoing. This study aimed to identify the impact of UHC policy withdrawal on the health outcomes of South Korea's severely ill COVID-19 patients. METHODS We used a propensity score matching (PSM) and difference-in-differences combined model. This study's subjects were 44,552 hospitalized COVID-19 patients contributing towards health insurance claims data, COVID-19 notifications and vaccination data extracted from the National Health Information Database and the Korea Disease Control and Prevention Agency from 1 December 2020 to 30 April 2022. After PSM, 2460 patients were included. This study's exposures were severity of illness and UHC policy change. The primary outcome was the case fatality rate (CFR) for COVID-19, which was defined as death within 30 days of a COVID-19 diagnosis. There were four secondary outcomes, including time interval between diagnosis and hospitalization (days), length of stay (days), total medical expenses (USD) and the time interval between diagnosis and death (days). RESULTS After the UHC policy's withdrawal, the severely ill patients' CFR increased to 284 per 1000 patients [95% confidence interval (CI) 229.1-338.4], hospitalization days decreased to 9.61 days (95% CI -11.20 to -8.03) and total medical expenses decreased to 5702.73 USD (95% CI -7128.41 to -4202.01) compared with those who were not severely ill. CONCLUSIONS During the pandemic, UHC may have saved the lives of severely ill COVID-19 patients; therefore, expanding services and financial coverage could be a crucial strategy during public health crises.
Collapse
Affiliation(s)
- Daseul Moon
- Busan Center for Infectious Disease Control & Prevention, Pusan National University Hospital, Busan, Republic of Korea
| | - Jeangeun Jeon
- Department of Sociology, Yonsei University, Seoul, Republic of Korea
| | - Jieun Park
- Department of Sociology, Yonsei University, Seoul, Republic of Korea
| | - Min-Hyeok Choi
- Department of Preventive and Occupational & Environmental Medicine, Pusan National University Medical College, Yangsan, Republic of Korea
- Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Myoung-Hee Kim
- Center for Public Health Data Analytics, National Medical Center, F8, 251 Eulj-Ro, Jung-Gu, Seoul, 04564, Republic of Korea.
| | - Hongjo Choi
- Division of Health Policy and Management, Korea University College of Health Science, Room 369, B-Dong Hana-Science Building 145 Anam-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
| |
Collapse
|
10
|
Gutierrez JP, Castañeda A, Agudelo-Botero M, Martínez-Valle A, Knight M, Lozano R. Performance evaluation of Mexico's health system at the national and subnational level, 1990-2019: an analysis of the Health Access and Quality Index. Public Health 2024; 236:7-14. [PMID: 39154589 DOI: 10.1016/j.puhe.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES This study aimed to comprehensively evaluate Mexico's health system performance from 1990 to 2019 utilising the Health Access and Quality Index (HAQI) as a primary indicator. STUDY DESIGN A retrospective ecological analysis was performed using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) study and the National Population Council (CONAPO). METHODS HAQI values for 1990, 2000, 2010, 2015, and 2019 were examined for each state in Mexico and three age groups (young, working, and post-working). Additionally, the marginalisation index was employed to assess inequalities in the HAQI distribution across states. The concentration index of the HAQI for each year was estimated, and the efficiency of states in producing the HAQI was evaluated using a data envelopment approach. RESULTS Through the analysis of national and subnational data, results indicated an overall improvement in healthcare access and quality during the study period. Although differences in the HAQI value related to state marginalisation decreased from 1990 to 2015, by 2019, the inequality had returned to a level comparable to 2000. Efficiency in producing health (HAQI values) exhibited substantial heterogeneity and fluctuations in the ranking order over time. States such as Nuevo León consistently performed well, while others, such as Guerrero, Chihuahua, Mexico City, and Puebla, consistently underperformed. CONCLUSIONS The findings from this study emphasise the necessity for nuanced strategies to address healthcare disparities and enhance the overall system performance. The study provides valuable insights for ongoing discussions about the future of Mexico's healthcare system, aiming to inform evidence-based policy decisions and improve the nationwide delivery of healthcare services.
Collapse
Affiliation(s)
- J P Gutierrez
- Center for Policy, Population & Health Research, School of Medicine, National Autonomous University of Mexico, México City, Mexico
| | - A Castañeda
- Department of Public Health, School of Medicine, National Autonomous University of Mexico, México City, Mexico
| | - M Agudelo-Botero
- Center for Policy, Population & Health Research, School of Medicine, National Autonomous University of Mexico, México City, Mexico
| | - A Martínez-Valle
- Center for Policy, Population & Health Research, School of Medicine, National Autonomous University of Mexico, México City, Mexico
| | - M Knight
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - R Lozano
- Department of Public Health, School of Medicine, National Autonomous University of Mexico, México City, Mexico; Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
| |
Collapse
|
11
|
Benedetto V, De Vita E, Nuti S. Setting priorities in outpatient cardiovascular care to guarantee equitable access: the case of Tuscany region. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:11. [PMID: 39177938 DOI: 10.1007/s43999-024-00047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 07/15/2024] [Indexed: 08/24/2024]
Abstract
Universal healthcare systems orient their actions towards promoting, restoring, and improving public health with a particular focus on the need to guarantee equitable access to care. Unwarranted variation in healthcare delivery poses significant challenges to health systems globally, impacting quality of care, financial sustainability, and equity of access. It is therefore important to assist healthcare management in measuring unwarranted variation in order to prioritise intervention strategies to ensure continuity of care and equity. Through an investigation of geographical variation in visit rates and waiting times, the study identifies vulnerable health districts which need priority interventions for patients with cardiovascular disease in the Tuscany region (Italy). Furthermore, a benchmarking-based method for identifying a quantitative estimate of the supply gap to be reduced is proposed. Results illustrate variation in visit rates and waiting times across local health districts in 2021, with some districts experiencing substantially lower rates and longer waiting times compared to the regional median. To address this gap, two targeted interventions aimed at increasing visit volumes and reduced waiting times through advanced training activities, technology integration, and multidisciplinary collaborations are presented. This study contributes to the topic of unwarranted variation by highlighting the necessity of tailored interventions to address diverse healthcare challenges across heterogeneous geographical areas. As healthcare systems globally navigate evolving complexities, the findings and tools presented here offer valuable guidance for policymakers and managers, aiming towards more equitable, efficient, and responsive healthcare services.
Collapse
Affiliation(s)
- Vera Benedetto
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy.
| | - Erica De Vita
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy
| | - Sabina Nuti
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy
| |
Collapse
|
12
|
Zuo C, Cai L, Li Y, Ding C, Liu G, Zhang C, Wang H, Zhang Y, Ji M. The Molecular Mechanism of Radix Paeoniae Rubra.-Cortex Moutan. Herb Pair in the Treatment of Atherosclerosis: A Work Based on Network Pharmacology and In Vitro Experiments. Cardiovasc Toxicol 2024; 24:800-817. [PMID: 38951468 DOI: 10.1007/s12012-024-09881-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/10/2024] [Indexed: 07/03/2024]
Abstract
Radix Paeoniae Rubra. (Chishao, RPR) and Cortex Moutan. (Mudanpi, CM) are a pair of traditional Chinese medicines that play an important role in the treatment of atherosclerosis (AS). The main objective of this study was to identify potential synergetic function and underlying mechanisms of RPR-CM in the treatment of AS. The main active ingredients, targets of RPR-CM and AS-related genes were obtained from public databases. A Venn diagram was utilized to screen the common targets of RPR-CM in treating AS. The protein-protein interaction network was established based on STRING database. Biological functions and pathways of potential targets were analyzed through Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses. Cytoscape was used to construct the drug-compound-target-signal pathway network. Molecular docking was performed to verify the binding ability of the bioactive ingredients and the target proteins. The endothelial inflammation model was constructed with human umbilical vein endothelial cells stimulated with ox-LDL, and the function of RPR-CM in treating AS was verified by CCK-8 assay, enzyme-linked immunosorbent assay, and qPCR. In this study, 12 active components and 401 potential target genes of RPR-CM were identified, among which quercetin, kaempferol and baicalein were considered to be the main active components. A total of 1903 AS-related genes were identified through public databases and four GEO datasets (GSE57691, GSE72633, GSE6088 and GSE199819). There are 113 common target genes of RPR-CM in treating AS. PPI network analysis identified 17 genes in cluster 1 as the core targets. Bioinformatics analysis showed that RPR-CM in AS treatment was associated with multiple downstream biological processes and signal pathways. PTGS2, JUN, CASP3, TNF, IL1B, IL6, FOS, STAT1 were identified as the core targets of RPR-CM, and molecular docking showed that the main bioactive components of RPR-CM had good binding ability with the core targets. RPR-CM extract significantly inhibited the levels of inflammatory factors TNF-α, IL-6, IL-1β, MCP-1, VCAM-1 and ICAM-1 in HUVECs, and inhibited endothelial inflammation. This study revealed the active ingredients of RPR-CM, and identified the key downstream targets and signaling pathways in the treatment of AS, providing theoretical basis for the application of RPR-CM in prevention and treatment of AS.
Collapse
Affiliation(s)
- Caojian Zuo
- Department of Cardiology, Lianshui People's Hospital, Kangda College of Nanjing Medical University, Lianshui County, No 6, Hongri East Avenue, Huai'an, 223400, Jiangsu, China.
- Department of Cardiology, Shanghai Deji Hospital, Qingdao University, Shanghai, 200331, China.
| | - Lidong Cai
- Department of Cardiology, School of Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Ya Li
- Department of Cardiology, School of Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Chencheng Ding
- Department of Cardiology, Shanghai Deji Hospital, Qingdao University, Shanghai, 200331, China
| | - Guiying Liu
- Department of Cardiology, Shanghai Deji Hospital, Qingdao University, Shanghai, 200331, China
| | - Changmei Zhang
- Department of Cardiology, Shanghai Deji Hospital, Qingdao University, Shanghai, 200331, China
| | - Hexiang Wang
- Department of Cardiology, Shanghai Deji Hospital, Qingdao University, Shanghai, 200331, China
| | - Yang Zhang
- Department of Cardiology, Shanghai Deji Hospital, Qingdao University, Shanghai, 200331, China
| | - Mingyue Ji
- Department of Cardiology, Lianshui People's Hospital, Kangda College of Nanjing Medical University, Lianshui County, No 6, Hongri East Avenue, Huai'an, 223400, Jiangsu, China
| |
Collapse
|
13
|
Naseralallah L, Koraysh S, Aboujabal B, Alasmar M. Interventions and impact of pharmacist-delivered services in perioperative setting on clinically important outcomes: a systematic review and meta-analysis. Ther Adv Drug Saf 2024; 15:20420986241260169. [PMID: 39091467 PMCID: PMC11292727 DOI: 10.1177/20420986241260169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/20/2024] [Indexed: 08/04/2024] Open
Abstract
Background The perioperative arena is a unique and challenging environment that requires coordination of the complex processes and involvement of the entire care team. Pharmacists' scope of practice has been evolving to be patient-centered and to expand to variety of settings including perioperative settings. Objectives To critically appraise, synthesize, and present the available evidence of the characteristics and impact of pharmacist-led interventions on clinically important outcomes in the perioperative settings. Design A systematic review and meta-analysis. Methods We searched PubMed, Embase, and CINAHL from index inception to September 2023. Included studies compared the effectiveness of pharmacist-led interventions on clinically important outcomes (e.g. length of stay, readmission) compared to usual care in perioperative settings. Two independent reviewers extracted the data using the DEPICT-2 (Descriptive Elements of Pharmacist Intervention Characterization Tool) and undertook quality assessment using the Crowe Critical Appraisal (CCAT). A random-effect model was used to estimate the overall effect [odds ratio (OR) for dichotomous and standard mean difference (SMD) for continuous data] with 95% confidence intervals (CIs). Results Twenty-five studies were eligible, 20 (80%) had uncontrolled study design. Most interventions were multicomponent and continuous over the perioperative period. The intervention components included clinical pharmacy services (e.g. medication management/optimization, medication reconciliation, discharge counseling) and education of healthcare professionals. While some studies provided a minor description in regards to the intervention development and processes, only one study reported a theoretical underpinning to intervention development. Pooled analyses showed a significant impact of pharmacist care compared to usual care on length of stay (11 studies; SMD -0.09; 95% CI -0.49 to -0.15) and all-cause readmissions (8 studies; OR 0.60; 95% CI 0.39-0.91). The majority of included studies (n = 21; 84%) were of moderate quality. Conclusion Pharmacist-led interventions are effective at improving clinically important outcomes in the perioperative setting; however, most studies were of moderate quality. Studies lacked the utilization of theory to develop interventions; therefore, it is not clear whether theory-derived interventions are more effective than those without a theoretical element. Future research should prioritize the development and evaluation of multifaceted theory-informed pharmacist interventions that target the whole surgical care pathway.
Collapse
Affiliation(s)
- Lina Naseralallah
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
- School of Pharmacy, Institute of Clinical Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Birmingham, UK
| | - Somaya Koraysh
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Bodoor Aboujabal
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - May Alasmar
- Department of Pharmacy, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
14
|
Juma D, Stordal K, Kamala B, Bishanga DR, Kalolo A, Moshiro R, Kvaløy JT, Manongi R. Readiness to provide comprehensive emergency obstetric and neonatal care: a cross-sectional study in 30 health facilities in Tanzania. BMC Health Serv Res 2024; 24:870. [PMID: 39085821 PMCID: PMC11290101 DOI: 10.1186/s12913-024-11317-0] [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: 01/10/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Despite the global progress in bringing health services closer to the population, mothers and their newborns still receive substandard care leading to morbidity and mortality. Health facilities' capacity to deliver the service is a prerequisite for quality health care. This study aimed to assess health facilities' readiness to provide comprehensive emergency obstetric and newborn care (CEmONC), comprising of blood transfusion, caesarean section and basic services, and hence to inform improvement in the quality of care interventions in Tanzania. METHODS A cross-sectional assessment of 30 CEmONC health facilities implementing the Safer Births Bundle of Care package in five regions of Tanzania was carried out between December 2020 and January 2021. We adapted the World Health Organization's Service Availability and Readiness Assessment tool to assess amenities, equipment, trained staff, guidelines, medicines, and diagnostic facilities. Composite readiness scores were calculated for each category and results were compared at the health facility level. For categorical variables, we tested for differences by Fisher's exact test; for readiness scores, differences were tested by a linear mixed model analysis, taking into account dependencies within the regions. We used p < 0.05 as our level of significance. RESULTS The overall readiness to provide CEmONC was 69.0% and significantly higher for regional hospitals followed by district hospitals. Average readiness was 78.9% for basic amenities, 76.7% for medical equipment, 76.0% for diagnosis and treatment commodities, 63.6% for staffing and 50.0% for guidelines. There was a variation in the availability of items at the individual health facility level and across levels of facilities. We found a significant difference in the availability of basic amenities, equipment, staffing, and guidelines between regional, and district hospitals and health centres (p = 0.05). Regional hospitals had significantly higher scores of medical equipment than district hospitals and health centers (p = 0.02). There was no significant difference in the availability of commodities for diagnosis and treatment between different facility levels. CONCLUSION Facilities' readiness was inadequate and varied across different levels of the facility. There is room to improve the facilities' readiness to deliver quality maternal and newborn care. The responsible authorities should take immediate actions to address the observed deficiencies while carefully choosing the most effective and feasible interventions and monitoring progress in readiness.
Collapse
Affiliation(s)
- Damas Juma
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania.
- Manyara Regional Secretariat, Manyara, Tanzania.
| | - Ketil Stordal
- Department of Pediatric Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Benjamin Kamala
- Department of Research, Haydom Lutheran Hospital, Manyara, Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Dunstan R Bishanga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Albino Kalolo
- Department of Public Health, St. Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Robert Moshiro
- Department of Research, Haydom Lutheran Hospital, Manyara, Tanzania
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Rachel Manongi
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| |
Collapse
|
15
|
Dlangalala T, Musekiwa A, Mashamba-Thompson T. Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa. PLoS One 2024; 19:e0307149. [PMID: 39024321 PMCID: PMC11257344 DOI: 10.1371/journal.pone.0307149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024] Open
Abstract
Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson's pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.
Collapse
Affiliation(s)
- Thobeka Dlangalala
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
| | | |
Collapse
|
16
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know Into What We Do. Am J Hypertens 2024; 37:640-649. [PMID: 39004933 PMCID: PMC11247168 DOI: 10.1093/ajh/hpae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | |
Collapse
|
17
|
Koricho MA, Dinsa GD, Khuzwayo N. Cost-effectiveness of implementing performance-based financing for improving maternal and child health in Ethiopia. PLoS One 2024; 19:e0305698. [PMID: 39008471 PMCID: PMC11249211 DOI: 10.1371/journal.pone.0305698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/04/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Performance Based Financing (PBF) supports realization of universal health coverage by promoting bargaining between purchasers and health service providers through identifying priority services and monitoring indicators. In PBF, purchasers use health statistics and information to make decisions rather than merely reimbursing invoices. In this respect, PBF shares certain elements of strategic health purchasing. PBF implementation began in Ethiopia in 2015 as a pilot at one hospital and eight health centers. Prior to this the system predominantly followed input-based financing where providers were provided with a predetermined budget for inputs for service provision. The purpose of the study is to determine whether the implementation of PBF is cost-effective in improving maternal and child health in Ethiopia compared to the standard care. METHODS The current study used cost-effectiveness analysis to assess the effects of PBF on maternal and child health. Two districts implementing PBF and two following standard care were selected for the study. Both groups of selected districts share common grounds before initiating PBF in the selected group. The provider perspective costing approach was used in the study. Data at the district level were gathered retrospectively for the period of July 2018 to June 2021. Data from health service statistics were transformed to population level coverages and the Lives Saved Tool method used to compute the number of lives saved. Additionally for purpose of comparison, lives saved were translated into discounted quality-adjusted life years. RESULTS The number of lives saved under PBF was 261, whereas number of lives saved under standard care was 194. The identified incremental cost per capita due to PBF was $1.8 while total costs of delivering service at PBF district was 8,816,370 USD per million population per year while the standard care costs 9,780,920 USD per million population per year. QALYs obtained under PBF and standard care were 6,118 and 4,526 per million population per year, respectively. CONCLUSIONS The conclusion made from this analysis is that, implementing PBF is cost-saving in Ethiopia compared to the standard care. LIMITATIONS OF THE STUDY Due to lack of district-level survey-based data, such as prevalence and effects on maternal and child health, national-level estimates were used into the LiST tool.There may be some central-level PBF start-up costs that were not captured, which may have spillover effects on the existing health system performance that this study has not considered.There may be health statistics data accuracy differences between the PBF and non-PBF districts. The researchers considered using data from records as reported by both groups of districts.
Collapse
Affiliation(s)
- Mideksa Adugna Koricho
- School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa
- Oromia Health Bureau, Addis Ababa, Ethiopia
- Department of Global Health and Population Harvard T. H. Chan School of Public Health, Fenot Associates, Addis Ababa, Ethiopia
| | - Girmaye Deye Dinsa
- School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Global Health and Population Harvard T. H. Chan School of Public Health, Fenot Associates, Addis Ababa, Ethiopia
- Department of Public Health and Health Policy, College of Health Sciences, Haramaya University, Harar, Ethiopia
- Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
| | - Nelisiwe Khuzwayo
- School of Nursing and Public Health, Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
18
|
Zaidi S, Errami A, Belkhou I, Elkhaldi M, Ailal F, Benhsaien I, Adnane F, Amenzoui N, Abkari A, Bousfiha AA. Impact of COVID-19 on child tuberculosis hospitalization. LA TUNISIE MEDICALE 2024; 102:410-414. [PMID: 38982965 PMCID: PMC11358780 DOI: 10.62438/tunismed.v102i7.4923] [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: 03/08/2024] [Accepted: 05/12/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Morocco has made remarkable progress in the fight against tuberculosis, but the Covid-19 pandemic has affected tuberculosis control worldwide, with notable fluctuations in tuberculosis epidemiology during and after the pandemic. AIM To describe the impact of the Covid-19 pandemic on the rate of hospitalization for tuberculosis and its different localizations in children. METHODS We conducted a retrospective study based on the analysis of medical records of TB patients hospitalized within the Children's Hospital in Casablanca, during the periods before (2018-2019), during (2020) and after (2021-2022) Covid-19 quarantine. RESULTS Throughout the study period (2018-2022), the total number of patients hospitalized in our department was 7390, including 283 children were hospitalized for tuberculosis, with a mean age of 6 years. Before the Covid-19 pandemic, the average number of tuberculosis cases was 49 per year, of which the percentage of pulmonary tuberculosis was 32% and extra-pulmonary tuberculosis 68%. The number of cases was 23 per year during the quarantine period, with a percentage of pulmonary tuberculosis of 26% and extra-pulmonary tuberculosis of 74%. After the quarantine period, this number rose to 81 cases per year, of which 21% were pulmonary tuberculosis and 79% extrapulmonary tuberculosis (pleural tuberculosis was predominant in 44.1% of cases). CONCLUSION These results are consistent with data published by the World Health Organization, and with the findings of another study we carried out on the impact of COVID-19 on hospital admissions for acute lower respiratory tract infections. It is very likely that the reduction in the number of tuberculosis cases during the quarantine period is due to social distancing, which leads to a reduction in the transmission of tuberculosis between people as well as to the disruption of the national tuberculosis control program in Morocco, when positive cases are identified.
Collapse
Affiliation(s)
- Sanae Zaidi
- Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Casablanca Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Abderrahmane Errami
- Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Casablanca Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ikbal Belkhou
- Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Casablanca Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Pediatric Gastroenterology Unit, CHU Ibn Rochd, Faculty of Medicine, A.Harouchi Hospital CHU Ibn Rochd Casablanca, Morocco
| | - Meryem Elkhaldi
- Children Infectious and Clinical Immunology department Casablanca Children's Hospital, Ibn Rochd University Hospital. Casablanca, Morocco
| | - Fatima Ailal
- Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Casablanca Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Children Infectious and Clinical Immunology department Casablanca Children's Hospital, Ibn Rochd University Hospital. Casablanca, Morocco
| | - Ibtihal Benhsaien
- Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Casablanca Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Children Infectious and Clinical Immunology department Casablanca Children's Hospital, Ibn Rochd University Hospital. Casablanca, Morocco
| | - Fatima Adnane
- Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Casablanca Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Children Infectious and Clinical Immunology department Casablanca Children's Hospital, Ibn Rochd University Hospital. Casablanca, Morocco
| | - Naima Amenzoui
- Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Casablanca Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Children Infectious and Clinical Immunology department Casablanca Children's Hospital, Ibn Rochd University Hospital. Casablanca, Morocco
| | - Abdelhak Abkari
- Pediatric Gastroenterology Unit, CHU Ibn Rochd, Faculty of Medicine, A.Harouchi Hospital CHU Ibn Rochd Casablanca, Morocco
| | - Ahmed Aziz Bousfiha
- Laboratory of Clinical Immunology, Inflammation and Allergy (LICIA), Casablanca Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Children Infectious and Clinical Immunology department Casablanca Children's Hospital, Ibn Rochd University Hospital. Casablanca, Morocco
| |
Collapse
|
19
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WW, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: translating what we know into what we do. J Bras Nefrol 2024; 46:e2024E007. [PMID: 38991207 PMCID: PMC11239182 DOI: 10.1590/2175-8239-jbn-2024-e007en] [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: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 07/13/2024] Open
Abstract
Historically, it takes an average of 17 years for new treatments to move from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. Now is the time to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions are diagnosed worldwide, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because it is often silent in the early stages. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from the patient to the clinician to the health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
Collapse
Affiliation(s)
- Valerie A. Luyckx
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Zurich, Switzerland
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, Renal Division, Boston, Massachusetts, USA
- University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Inland Northwest Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington, Department of Medicine, Nephrology Division, Seattle, Washington, USA
| | - Dina Abdellatif
- Cairo University Hospital, Department of Nephrology, Cairo, Egypt
| | - Ricardo Correa-Rotter
- National Medical Science and Nutrition Institute Salvador Zubiran, Department of Nephrology and Mineral Metabolism, Mexico City, Mexico
| | - Winston W.S. Fung
- University of Hong Kong, Prince of Wales Hospital, Department of Medicine and Therapeutics, The Chinese Shatin, Hong Kong, China
| | - Agnès Haris
- Péterfy Hospital, Nephrology Department, Budapest, Hungary
| | - Li-Li Hsiao
- Harvard Medical School, Brigham and Women’s Hospital, Department of Medicine, Renal Division, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussel, Belgium
| | | | - Stefanos Roumeliotis
- Aristotle University of Thessaloniki, AHEPA University Hospital Medical School, 2nd Department of Nephrology, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- University of Nigeria, College of Medicine, Department of Medicine, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussel, Belgium
| | - Siu-Fai Lui
- The Chinese University of Hong Kong, Jockey Club School of Public Health and Primary Care, Division of Health System, Policy and Management, Hong Kong, China
| | - Vassilios Liakopoulos
- Aristotle University of Thessaloniki, AHEPA University Hospital Medical School, 2nd Department of Nephrology, Thessaloniki, Greece
| | | | | |
Collapse
|
20
|
Dey T, Shah MG, Baba A, Mugo N, Thommesen T, Vivilaki V, Boniol M, Alam N, Dibley M, Okoro D, Tenhoope-bender P, Triantafyllou T, Langlois EV. Reproductive, maternal, newborn, child and adolescent health services in humanitarian and fragile settings: A mixed methods study of midwives' and women's experiences. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003384. [PMID: 38959267 PMCID: PMC11221643 DOI: 10.1371/journal.pgph.0003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/31/2024] [Indexed: 07/05/2024]
Abstract
Insufficient progress has been made to reduce morbidity and mortality for women, children and adolescents particularly in Humanitarian and Fragile settings (HFS). Midwives play a critical and unique role in ensuring communities receive quality and safe essential sexual, reproductive, maternal, newborn, child, and adolescent health services. A lack of knowledge exists on the availability and experiences of midwifery services in HFS. This manuscript provides an overview of the midwifery density in HFS and a synthesis of the experiences of women receiving midwifery care, and barriers and facilitators for midwives providing essential SRMNCAH services in HFS. Guided by an expert committee, a concurrent mixed methods approach was applied, using secondary analysis of primary quantitative and qualitative data sources. Quantitative analysis of the global distribution of midwives compared to fragility was undertaken. Qualitative analysis of experiences of receipt and provision of midwifery care was undertaken across four settings providing humanitarian care. There is a critically low density of midwives in humanitarian and fragile settings. Sub-Saharan Africa accounts for the highest levels of fragility yet lowest density of midwives able to provide SRMNCAH services. Lack of finances both constrains midwives from effectively providing services and prevent communities from utilising services. Sub-optimal working conditions through rising workloads, insufficient and/or inconsistent resources were frequently reported to impede midwives from providing care in HFS. Uniquely for HFS, threats to the safety and security of midwives to conduct their work was widely reported. Key facilitators identified included, complex adaptive health system designs to respond effectively to the rapidly changing HFS environment, realisation of supporting "power, agency and status" as instrumental for midwives to provide quality care and promotion of community-centric approaches may enable continuity of care and uptake of essential SRMNCAH services. Midwives are critical to protect the health and well-being of communities. They require urgent protection and prioritisation in HFS areas where the need is greatest.
Collapse
Affiliation(s)
- T. Dey
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - M. G. Shah
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - A. Baba
- Institut Panafricain de Santé Communautaire, Aru, Democratic Republic of Congo
| | - N. Mugo
- NSW Health, Priority population Unit, Integrated and community health, Cumberland Hospital, New South Wales, Sydney, Australia
| | - T. Thommesen
- Stavanger University Hospital, Stavanger, Norway
| | - V. Vivilaki
- International Confederation of Midwives (ICM), The Hague, The Netherlands
| | - M. Boniol
- World Health Organization (WHO), Geneva, Switzerland
| | - N. Alam
- University of Sydney, Sydney, Australia
| | - M. Dibley
- University of Sydney, Sydney, Australia
| | - D. Okoro
- United Nations Population Fund (UNFPA), New York, United States of America
| | - P. Tenhoope-bender
- United Nations Population Fund (UNFPA), New York, United States of America
| | | | - E. V. Langlois
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| |
Collapse
|
21
|
Kruk ME, Sabwa S, Lewis TP, Aniebo I, Arsenault C, Carai S, Garcia PJ, Garcia-Elorrio E, Fink G, Kassa M, Mohan S, Moshabela M, Oh J, Pate MA, Nzinga J. Population assessment of health system performance in 16 countries. Bull World Health Organ 2024; 102:486-497B. [PMID: 38933481 PMCID: PMC11197641 DOI: 10.2471/blt.23.291184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. Methods We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. Findings In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Conclusion Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments.
Collapse
Affiliation(s)
- Margaret E Kruk
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Shalom Sabwa
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Todd P Lewis
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Ifeyinwa Aniebo
- Ministry of Health and Social Welfare of Nigeria, Abuja, Nigeria
| | - Catherine Arsenault
- Milken Institute School of Public Health, George Washington University, WashingtonDC, USA
| | - Susanne Carai
- WHO Office on Quality of Care and Patient Safety, Athens, Greece
| | | | | | - Günther Fink
- University of Basel and Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | - Mosa Moshabela
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | |
Collapse
|
22
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris Á, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Fai Lui S, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Indian J Nephrol 2024; 34:281-290. [PMID: 39156847 PMCID: PMC11328056 DOI: 10.25259/ijn_145_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 08/20/2024] Open
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston WS Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ágnes Haris
- Department of Nephrology, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Chennai, Tamil Nadu, India
| | - Siu Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | |
Collapse
|
23
|
Chowdhury K, Sinha S, Ahmad R, Lugova H, Mehta M, Kumar S, Haque M. Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review. Cureus 2024; 16:e65808. [PMID: 39092382 PMCID: PMC11293072 DOI: 10.7759/cureus.65808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024] Open
Abstract
Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.
Collapse
Affiliation(s)
- Kona Chowdhury
- Department of Pediatrics, Enam Medical College Hospital, Dhaka, BGD
| | - Susmita Sinha
- Department of Physiology, Enam Medical College Hospital, Dhaka, BGD
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Halyna Lugova
- Department of Medicine and Health Sciences, UCSI (University College Sedaya International) University Bandar Springhill Campus, Port Dickson, MYS
| | - Miral Mehta
- Department of Pedodontics and Preventive Dentistry, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Department of Research, Karnavati Scientific Research Center (KSRC) School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| |
Collapse
|
24
|
Navarro-Jimenez E, Saturno-Hernández P, Jaramillo-Mejía M, Clemente-Suárez VJ. Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:764. [PMID: 39062214 PMCID: PMC11274674 DOI: 10.3390/children11070764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 07/28/2024]
Abstract
Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality).
Collapse
Affiliation(s)
| | | | - Marta Jaramillo-Mejía
- Facultad de Ciencias de la Salud, Departamento de Salud Pública y Medicina Comunitaria, Universidad Icesi, Cali 760031, Colombia;
| | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
| |
Collapse
|
25
|
Tsuei SHT, Kerrissey MJ, Bauhoff S. How personnel diversity and affective bonds affect performance-based financing: a moderator analysis of a difference-in-difference estimator. Int J Qual Health Care 2024; 36:mzae050. [PMID: 38857071 PMCID: PMC11196191 DOI: 10.1093/intqhc/mzae050] [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: 09/24/2023] [Revised: 04/09/2024] [Accepted: 06/09/2024] [Indexed: 06/11/2024] Open
Abstract
To spur improvement in health-care service quality and quantity, performance-based financing (PBF) is an increasingly common policy tool, especially in low- and middle-income countries. This study examines how personnel diversity and affective bonds in primary care clinics affect their ability to improve care quality in PBF arrangements. Leveraging data from a large-scale matched PBF intervention in Tajikistan including 208 primary care clinics, we examined how measures of personnel diversity (position and tenure variety) and affective bonds (mutual support and group pride) were associated with changes in the level and variability of clinical knowledge (diagnostic accuracy of 878 clinical vignettes) and care processes (completion of checklist items in 2485 instances of direct observations). We interacted the explanatory variables with exposure to PBF in cluster-robust, linear regressions to assess how these explanatory variables moderated the PBF treatment's association with clinical knowledge and care process improvements. Providers and facilities with higher group pride exhibited higher care process improvement (greater checklist item completion and lower variability of items completed). Personnel diversity and mutual support showed little significant associations with the outcomes. Organizational features of clinics exposed to PBF may help explain variation in outcomes and warrant further research and intervention in practice to identify and test opportunities to leverage them. Group pride may strengthen clinics' ability to improve care quality in PBF arrangements. Improving health-care facilities' pride may be an affordable and effective way to enhance health-care organization adaptation.
Collapse
Affiliation(s)
- Sian Hsiang-Te Tsuei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, room 1104, Boston, MA 02115, United States
- Department of Family Practice, University of British Columbia, David Strangway Bldg 5950 University Blvd 3rd Floor, Vancouver, BC V6T 2A1, Canada
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Michaela June Kerrissey
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Kresge 3rd & 4th Floors, 677 Huntington Avenue, Boston, MA 02115, United States
| | - Sebastian Bauhoff
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, room 1104, Boston, MA 02115, United States
| |
Collapse
|
26
|
Bogale B, Scambler S, Mohd Khairuddin AN, Gallagher JE. Health system strengthening in fragile and conflict-affected states: A review of systematic reviews. PLoS One 2024; 19:e0305234. [PMID: 38875266 PMCID: PMC11178226 DOI: 10.1371/journal.pone.0305234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/28/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature. METHODS We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet's 'high-quality health system framework'. RESULTS Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the 'foundations' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation. CONCLUSION The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.
Collapse
Affiliation(s)
- Birke Bogale
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
- Department of Dental and Maxillofacial Surgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sasha Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
| | - Aina Najwa Mohd Khairuddin
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jennifer E. Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
| |
Collapse
|
27
|
Feng H, Liu G, Li L, Ren X, Jiang Y, Hou W, Liu R, Liu K, Liu H, Huang H. Quantitative Proteomics Reveal the Role of Matrine in Regulating Lipid Metabolism. ACS OMEGA 2024; 9:24308-24320. [PMID: 38882153 PMCID: PMC11170650 DOI: 10.1021/acsomega.3c09983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 06/18/2024]
Abstract
Hyperlipidemia (HLP) is a prevalent systemic metabolic disorder characterized by disrupted lipid metabolism. Statin drugs have long been the primary choice for managing lipid levels, but intolerance issues have prompted the search for alternative treatments. Matrine, a compound derived from the traditional Chinese medicine Kushen, exhibits anti-inflammatory and lipid-lowering properties. Nevertheless, the mechanism by which matrine modulates lipid metabolism remains poorly understood. Here, we investigated the molecular mechanisms underlying matrine's regulation of lipid metabolism. Employing quantitative proteomics, we discovered that matrine increases the expression of LDL receptor (LDLR) in HepG2 and A549 cells, with subsequent experiments validating its role in enhancing LDL uptake. Notably, in hyperlipidemic hamsters, matrine effectively lowered lipid levels without affecting body weight, which highlights LDLR as a critical target for matrine's impact on HLP. Moreover, matrine's potential inhibitory effects on tumor cell LDL uptake hint at broader applications in cancer research. Additionally, thermal proteome profiling analysis identified lipid metabolism-related proteins that may interact with matrine. Together, our study reveals matrine's capacity to upregulate LDLR expression and highlights its potential in treating HLP. These findings offer insights into matrine's mechanism of action and open new avenues for drug research and lipid metabolism regulation.
Collapse
Affiliation(s)
- Huixu Feng
- School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing 210203, China
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Guobin Liu
- School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing 210203, China
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Luhan Li
- School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Xuelian Ren
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Yue Jiang
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Wanting Hou
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Ruilong Liu
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Kun Liu
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Hong Liu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - He Huang
- School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing 210203, China
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmaceutical Science and Technology, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou 310024, China
- Shandong Laboratory of Yantai Drug Discovery, Bohai Rim Advanced Research Institute for Drug Discovery, Yantai 264117, China
| |
Collapse
|
28
|
Iuliano A, Burgess RA, Shittu F, King C, Bakare AA, Valentine P, Haruna I, Colbourn T. Linking communities and health facilities to improve child health in low-resource settings: a systematic review. Health Policy Plan 2024; 39:613-635. [PMID: 38619140 PMCID: PMC11145907 DOI: 10.1093/heapol/czae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/22/2024] [Accepted: 04/12/2024] [Indexed: 04/16/2024] Open
Abstract
Community-facility linkage interventions are gaining popularity as a way to improve community health in low-income settings. Their aim is to create/strengthen a relationship between community members and local healthcare providers. Representatives from both groups can address health issues together, overcome trust problems, potentially leading to participants' empowerment to be responsible for their own health. This can be achieved via different approaches. We conducted a systematic literature review to explore how this type of intervention has been implemented in rural and low or lower-middle-income countries, its various features and how/if it has helped to improve child health in these settings. Publications from three electronic databases (Web of Science, PubMed and Embase) up to 03 February 2022 were screened, with 14 papers meeting the inclusion criteria (rural setting in low/lower-middle-income countries, presence of a community-facility linkage component, outcomes of interest related to under-5 children's health, peer-reviewed articles containing original data written in English). We used Rosato's integrated conceptual framework for community participation to assess the transformative and community-empowering capacities of the interventions, and realist principles to synthesize the outcomes. The results of this analysis highlight which conditions can lead to the success of this type of intervention: active inclusion of hard-to-reach groups, involvement of community members in implementation's decisions, activities tailored to the actual needs of interventions' contexts and usage of mixed methods for a comprehensive evaluation. These lessons informed the design of a community-facility linkage intervention and offer a framework to inform the development of monitoring and evaluation plans for future implementations.
Collapse
Affiliation(s)
- Agnese Iuliano
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Rochelle Ann Burgess
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Funmilayo Shittu
- Department of Paediatrics, University of Ibadan, CW23+FJV University College Hospital, Queen Elizabeth I I Road, Agodi, Ibadan, Oyo 00285, Nigeria
- Department of Global Public Health, Karolinska Institutet, Norrbackagatan 4, Stockholm 171 76, Sweden
| | - Carina King
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
- Department of Global Public Health, Karolinska Institutet, Norrbackagatan 4, Stockholm 171 76, Sweden
| | - Ayobami Adebayo Bakare
- Department of Global Public Health, Karolinska Institutet, Norrbackagatan 4, Stockholm 171 76, Sweden
- Department of Community Medicine, University of Ibadan, CW22+H4W, Queen Elizabeth I I Road, Agodi, Ibadan, Oyo 200285, Nigeria
| | - Paula Valentine
- Save the Children, 1 St John’s Ln, London EC1M 4AR, United Kingdom
| | - Ibrahim Haruna
- Save the Children International, Plot 773 Cadastral Zone B03, Wuye District, Ankuru 902101, Nigeria
| | - Tim Colbourn
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| |
Collapse
|
29
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WW, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Kidney Int Rep 2024; 9:1541-1552. [PMID: 38899169 PMCID: PMC11184315 DOI: 10.1016/j.ekir.2024.04.019] [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: 10/25/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 06/21/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
Collapse
Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W.S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | | | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | |
Collapse
|
30
|
Himel GMS, Hasan MS, Salsabil US, Islam MM. MedLingua: A conceptual framework for a multilingual medical conversational agent. MethodsX 2024; 12:102614. [PMID: 38439929 PMCID: PMC10909737 DOI: 10.1016/j.mex.2024.102614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/10/2024] [Indexed: 03/06/2024] Open
Abstract
This study introduces a hybrid model for an advanced medical chatbot addressing crucial healthcare communication challenges. Leveraging a hybrid ML model, the chatbot aims to provide accurate and prompt responses to users' health-related queries. The proposed model will overcome limitations observed in previous medical chatbots by integrating a dual-stemming approach, P-Stemmer and NLTK-Stemmer, accommodating both semitic and non-semitic languages. The system prioritizes the analysis of cognates, identification of symptoms, doctor recommendations, and prescription generation. It integrates an automatic translation module to facilitate a smooth multilingual diagnostic experience. Following the Scrum methodology for agile development, the framework ensures adaptability to evolving research needs and stays current with recent medical discoveries. This groundbreaking idea aims to improve the effectiveness and availability of healthcare services by introducing an intelligent, multilingual chatbot. This technology enables patients to communicate with doctors from diverse linguistic backgrounds through an automated language translation model, eliminating language barriers and extending healthcare access to rural regions worldwide.•A simple but efficient hybrid conceptual model for advancement in smart medical assistance.•This conceptual model can be applied to implement a medical chatbot that can understand multiple languages.•This method can be utilized to address medical chatbot limitations and enhance accuracy in response generation.
Collapse
Affiliation(s)
- Galib Muhammad Shahriar Himel
- Department of Computer Science, American International University-Bangladesh, Dhaka, Bangladesh
- School of Computer Sciences, Universiti Sains Malaysia, 11800 USM Penang, Malaysia
| | - Md. Shourov Hasan
- Department of Computer Science, American International University-Bangladesh, Dhaka, Bangladesh
| | - Umme Sadia Salsabil
- Department of Computer Science, American International University-Bangladesh, Dhaka, Bangladesh
| | - Md. Masudul Islam
- Department of Computer Science and Engineering, Bangladesh University of Business and Technology, Dhaka, Bangladesh
| |
Collapse
|
31
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: Translating what we know into what we do. J Ren Care 2024; 50:79-91. [PMID: 38770802 DOI: 10.1111/jorc.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024]
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
Collapse
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Medicine, Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Department of Medicine, Nephrology Division, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Department of Medicine, Brigham and Women's Hospital, Renal Division, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianella Sierra
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, ISN, Brussel, New Jersey, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | |
Collapse
|
32
|
Fabiani MA, Banuet-Martínez M, Gonzalez-Urquijo M, Cassagne GM. Where does Hispanic Latin America stand in biomedical and life sciences literature production compared with other countries? PUBLIC HEALTH IN PRACTICE 2024; 7:100474. [PMID: 38379754 PMCID: PMC10878784 DOI: 10.1016/j.puhip.2024.100474] [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: 07/28/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
Objectives to provide objective quantitative data about medical-related scientific production in Hispanic Latin America compared to different regions and identify demographic and political variables that could improve research. Study design This is an analytical, observational, cross-section bibliometric study about all fields of medical-related scientific production over five years in different regions and its relationship with demographic and political variables that could impact research and the health system quality. Methods Data on the total scientific production of all Hispanic Latin American countries and other countries representing almost 90% of mundial publications between 2017 and 2021 were retrieved from the PubMed database. Demographic and political data were obtained from open online databases. Counts of publications were rationed to population and analyzed with all other demographic, region, and language variables, using univariate Poisson regression and negative binomial regression (for over-disperse variables) analysis. Multivariate negative binomial regression was used to analyze the combined effect of variables related to the healthcare and research Sectors. Results Hispanic Latin America increased yearly from 29,445 publications in 2017 to 47,053 in 2021. This cumulative growth of almost 60% exceeded the 36% increment in all countries' publications and was only below that of Russia and China, which grew 92% and 87%, respectively. Negative binomial regression showed that the percentage of gross income dedicated to research (IRR 2.036, 95% CI: 1.624, 2.553, p< .001), life expectancy at birth (IRR 1.444, 95% CI: 1.338, 1.558, p< .001), and the number of medical doctors per inhabitant (IRR 1.581, 95% CI: 1.17, 2.13, p = .003) positively impacted scientific production. A higher mortality associated with chronic diseases between ages 30 and 70 (IRR 0.782, 95% CI: 0.743 0.822, p< .001) and a lower population with access to medicine (IRR 0.960, 95% CI: 0.933, 0.967, p< .001) were found to impact scientific production negatively. Hispanic Latin American countries published less than 20% of those with English as their native language (p< .001). Conclusion Hispanic Latin America has increased the gross number of publications by almost 60 % from 2017 to 2021. However, the number of publications per 100,000 inhabitants is still low compared to other countries. Our analysis highlights that this may be related to lower GDP, research investment, and less healthcare system quality.
Collapse
Affiliation(s)
- Mario Alejandro Fabiani
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| | | | | | - Gabriela Marta Cassagne
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico
| |
Collapse
|
33
|
Khalid Mohamed S, Khalid Mohamed D, Ahmed K, Saad F, Zurovac D. Health workers' adherence to malaria case management protocols in Northern Sudan: a qualitative study. Malar J 2024; 23:170. [PMID: 38816778 PMCID: PMC11137897 DOI: 10.1186/s12936-024-04998-9] [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: 03/17/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Nonadherence to national standards for malaria diagnosis and treatment has been reported in Sudan. In this study, qualitative research examined the clinical domains of nonadherence, factors influencing nonadherent practices and health workers' views on how to improve adherence. METHODS In September 2023, five Focus Group Discussions (FGDs) were undertaken with 104 health workers from 42 health facilities in Sudan's Northern State. The participants included medical assistants, doctors, nurses, laboratory personnel, pharmacists and public health officers. The FGDs followed a semi-structured guide reflecting the national malaria case management protocol. Qualitative thematic analysis was performed. RESULTS Nonadherent practices included disregarding parasitological test results, suboptimal paediatric artemether-lumefantrine (AL) dosing, lack of counselling, use of prohibited artemether injections for uncomplicated and severe malaria, artesunate dose approximations and suboptimal preparations, lack of AL follow on treatment for severe malaria; and rare use of primaquine for radical Plasmodium vivax treatment and dihydroartemisinin-piperaquine as the second-line treatment for uncomplicated malaria. Factors influencing nonadherence included stock-outs of anti-malarials and RDTs; staff shortages; lack of training, job aids and supervision; malpractice by specialists; distrust of malaria microscopy and RDTs; and patient pressure for diagnosis and treatment. Health workers recommended strengthening the supply chain; hiring personnel; providing in-service protocol training including specialists; establishing external quality assurance for malaria diagnosis; and providing onsite supportive supervision and public health campaigns. CONCLUSIONS This study revealed a broad spectrum of behavioural and systemic challenges in malaria management among frontline health workers in Northern Sudan, including nonadherence to protocols due to resource shortages, training gaps, a lack of supportive supervision and patient pressure. These insights, including health workers' views about improvements, will inform evidence-based interventions by Sudan's National Malaria Control Programme to improve health systems readiness and the quality of malaria case management.
Collapse
Affiliation(s)
- Sahar Khalid Mohamed
- National Malaria Control Programme, Federal Ministry of Health, Khartoum, Sudan.
- Department of Community Medicine, Faculty of Medicine, Al-Neelain University, Khartoum, Sudan.
| | - Duha Khalid Mohamed
- National Malaria Control Programme, Federal Ministry of Health, Khartoum, Sudan
| | - Khansaa Ahmed
- National Malaria Control Programme, Federal Ministry of Health, Khartoum, Sudan
| | - Fadwa Saad
- National Malaria Control Programme, Federal Ministry of Health, Khartoum, Sudan
| | | |
Collapse
|
34
|
Shrestha R, Shakya A, Khanal P, Khanal VK, Jha N, Nepal Gurung G, Subedi L. User satisfaction with the National Health Insurance Program: A community-based survey from the Ilam district of Nepal. PLoS One 2024; 19:e0303045. [PMID: 38787905 PMCID: PMC11125507 DOI: 10.1371/journal.pone.0303045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The Government of Nepal initiated a family-based National Health Insurance Program (NHIP) in April 2016, aiming to ensure universal health coverage (UHC) by enhancing access to and utilization of quality health services. However, NHIP, in its initial years of implementation, encountered challenges such as low population coverage, a high dropout rate, and concerns among the insured regarding the quality of healthcare services. There is a dearth of information regarding user satisfaction with the NHIP in Nepal. This study aimed to assess user satisfaction with NHIP at the household level in Nepal. METHODS We conducted a cross-sectional study among 347 households in the Ilam district using a multi-stage random sampling method. Face-to-face interviews were conducted with household heads enrolled in NHIP. A semi-structured questionnaire was used to collect the data. The multivariable logistic regression analysis was done to identify the predictors of satisfaction level. RESULTS Overall, 53.6% of the insured were satisfied with the NHIP, while 31.1% had comprehensive knowledge about the NHIP. Factors such as gender (AOR: 1.80, 95% CI: 1.08-3.00), distance to the first point of contact (AOR: 2.15, 95% CI: 1.24-3.74), waiting time (AOR: 2.02, 95% CI: 1.20-3.42), availability of diagnostic services (AOR: 1.90, 95% CI: 1.05-3.45), availability of prescribed medicine (AOR: 3.90, 95% CI: 1.97-7.69), perceived service quality (AOR: 2.20, 95% CI: 1.15-4.20), and the behavior of service providers (AOR: 3.48, 95% CI: 1.04-11.63) were significantly associated with user satisfaction. CONCLUSION The satisfaction level among NHIP users was deemed moderate. This study highlighted several factors, such as gender, distance to the first point of contact, waiting time, availability of diagnostic services and prescribed medicine, perceived service quality, and the behavior of service providers, as key determinants impacting user satisfaction. Recognizing the pivotal role of user satisfaction, health insurance stakeholders must prioritize it to ensure higher retention rates and coverage within NHIP.
Collapse
Affiliation(s)
- Rasmita Shrestha
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Aditya Shakya
- Health Office Ilam, Ministry of Health, Koshi Province, Nepal
| | - Pratik Khanal
- Nepal Public Health Association, Lalitpur, Nepal
- Bergen Center for Ethics and Priority Setting in Health (BCEPS), Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Vijay Kumar Khanal
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nilambar Jha
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Gyanu Nepal Gurung
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Laxmi Subedi
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
35
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know Into What We do. Can J Kidney Health Dis 2024; 11:20543581241252506. [PMID: 38764602 PMCID: PMC11102772 DOI: 10.1177/20543581241252506] [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: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 05/21/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary-care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
Collapse
Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, USA
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Winston W. S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | | | - Fiona Loud
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Vasundhara Raghavan
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, American Hellenic Educational Progressive Association University Hospital Medical School, Aristotle University of Thessaloniki, Greece
| | - Marianella Sierra
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Nigeria
| | - Bill Wang
- Patient Liaison Advisory Group, International Society of Nephrology, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, American Hellenic Educational Progressive Association University Hospital Medical School, Aristotle University of Thessaloniki, Greece
| | | |
Collapse
|
36
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the Gap in Kidney Care: Translating What We Know into What We Do. Blood Purif 2024; 53:691-703. [PMID: 38754386 PMCID: PMC11397411 DOI: 10.1159/000539071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W S Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | | | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, Brussels, Belgium
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | |
Collapse
|
37
|
Tagoola A, Hildenwall H. Paediatric Emergency Care in Low-Income Countries-Can Guidelines be Generalized? Glob Pediatr Health 2024; 11:2333794X241251787. [PMID: 38737871 PMCID: PMC11088294 DOI: 10.1177/2333794x241251787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/08/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Affiliation(s)
| | - Helena Hildenwall
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
38
|
Hussien M. The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study. BMC Health Serv Res 2024; 24:614. [PMID: 38730420 PMCID: PMC11084123 DOI: 10.1186/s12913-024-11091-z] [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: 12/26/2023] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Patients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users' perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers. METHODS A community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval. RESULTS A typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0-10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091). CONCLUSIONS Service users' perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users' perceptions, with a special emphasis on improving health care providers' communication skills and removing facility-level access barriers.
Collapse
Affiliation(s)
- Mohammed Hussien
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| |
Collapse
|
39
|
Chi H, Jung S, Subramanian SV, Kim R. Socioeconomic and geographic inequalities in antenatal and postnatal care components in India, 2016-2021. Sci Rep 2024; 14:10221. [PMID: 38702357 PMCID: PMC11068794 DOI: 10.1038/s41598-024-59981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/17/2024] [Indexed: 05/06/2024] Open
Abstract
Despite the well-known importance of high-quality care before and after delivery, not every mother and newborn in India receive appropriate antenatal and postnatal care (ANC/PNC). Using India's National Family Health Surveys (2015-2016 and 2019-2021), we quantified the socioeconomic and geographic inequalities in the utilization of ANC/PNC among women aged 15-49 years and their newborns (N = 161,225 in 2016; N = 150,611 in 2021). For each of the eighteen ANC/PNC components, we assessed absolute and relative inequalities by household wealth (poorest vs. richest), maternal education (no education vs. higher than secondary), and type of place of residence (rural vs. urban) and evaluated state-level heterogeneity. In 2021, the national prevalence of ANC/PNC components ranged from 19.8% for 8 + ANC visits to 91.6% for maternal weight measurement. Absolute inequalities were greatest for ultrasound test (33.3%-points by wealth, 30.3%-points by education) and 8 + ANC visits (13.2%-points by residence). Relative inequalities were greatest for 8 + ANC visits (1.8 ~ 4.4 times). All inequalities declined over time. State-specific estimates were overall consistent with national results. Socioeconomic and geographic inequalities in ANC/PNC varied significantly across components and by states. To optimize maternal and newborn health in India, future interventions should aim to achieve universal coverage of all ANC/PNC components.
Collapse
Affiliation(s)
- Hyejun Chi
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - Sohee Jung
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea
| | - S V Subramanian
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, 145 Anam-Ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
- Division of Health Policy and Management, College of Health Sciences, Korea University, 145 Anam-ro, Seongbuk-Gu, Seoul, 02841, Republic of Korea.
| |
Collapse
|
40
|
Luyckx VA, Tuttle KR, Abdellatif D, Correa-Rotter R, Fung WWS, Haris A, Hsiao LL, Khalife M, Kumaraswami LA, Loud F, Raghavan V, Roumeliotis S, Sierra M, Ulasi I, Wang B, Lui SF, Liakopoulos V, Balducci A. Mind the gap in kidney care: Translating what we know into what we do. J Family Med Prim Care 2024; 13:1594-1611. [PMID: 38948565 PMCID: PMC11213387 DOI: 10.4103/jfmpc.jfmpc_518_24] [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: 03/29/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024] Open
Abstract
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
Collapse
Affiliation(s)
- Valerie A. Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R. Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, USA
- Nephrology Division, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dina Abdellatif
- Department of Nephrology, Cairo University Hospital, Cairo, Egypt
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Winston W. S. Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Agnès Haris
- Nephrology Department, Péterfy Hospital, Budapest, Hungary
| | - Li-Li Hsiao
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Makram Khalife
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | | | - Fiona Loud
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Vasundhara Raghavan
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Stefanos Roumeliotis
- 2 Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marianella Sierra
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Ifeoma Ulasi
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Bill Wang
- ISN Patient Liaison Advisory Group, ISN, Brussels, Belgium
- Patient Representatives of the Patient Liaison Advisory Group of the International Society of Nephrology
| | - Siu-Fai Lui
- Division of Health System, Policy and Management, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Vassilios Liakopoulos
- 2 Department of Nephrology, AHEPA University Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | |
Collapse
|
41
|
Bomfim RA, Della Bona A, Cury JA, Celeste RK. Brazilian primary dental care in a universal health system: Challenges for training and practice. J Dent 2024; 144:104932. [PMID: 38499281 DOI: 10.1016/j.jdent.2024.104932] [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: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES To report the challenges for training and practice for the Brazilian primary dental care in a universal health system. METHODS Health, education and protection rights against poverty are guaranteed by the 1988 Brazilian Constitution and public health in Brazil is provided by the Unified Health System (SUS), one of the largest public health systems in the world. According to SUS, every Brazilian citizen has the right to free primary oral health care as secondary and tertiary care, offering a unique opportunity to integrate oral care within general health care. RESULTS The Brazilian undergraduate Dental curriculum was updated in 2021 aiming to graduate general practitioners with a major in comprehensive health care in primary health care, integrated with public and general health. This curriculum update requires at least 20% of the academic hours to be exercised outside the university walls (extramural or community work), preferably within the SUS. CONCLUSIONS Considering the World Health Organization (WHO) agenda, Brazil needs to advance the innovative oral health workforce, the integration of oral health into primary care, the population access to essential dental medicines and optimal fluorides for caries control. CLINICAL SIGNIFICANCE It is necessary political action and the engagement of multiple stakeholders, mainly from the health and education sectors, to improve primary health care.
Collapse
Affiliation(s)
- Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Alvaro Della Bona
- Postgraduate Program in Dentistry, School of Dentistry, University of Passo Fundo, Passo Fundo, RS, Brazil.
| | | | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
42
|
Zhang Y, Yang Y, Feng Y, Gao X, Pei L, Li X, Gao B, Liu L, Wang C, Gao S. Sonodynamic therapy for the treatment of atherosclerosis. J Pharm Anal 2024; 14:100909. [PMID: 38799235 PMCID: PMC11127226 DOI: 10.1016/j.jpha.2023.11.016] [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: 08/11/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 05/29/2024] Open
Abstract
Atherosclerosis (AS) is a chronic inflammatory disease of large and medium-sized arteries that leads to ischemic heart disease, stroke, and peripheral vascular disease. Despite the current treatments, mortality and disability still remain high. Sonodynamic therapy (SDT), a non-invasive and localized methodology, has been developed as a promising new treatment for inhibiting atherosclerotic progression and stabilizing plaques. Promising progress has been made through cell and animal assays, as well as clinical trials. For example, the effect of SDT on apoptosis and autophagy of cells in AS, especially macrophages, and the concept of non-lethal SDT has also been proposed. In this review, we summarize the ultrasonic parameters and known sonosensitizers utilized in SDT for AS; we elaborate on SDT's therapeutic effects and mechanisms in terms of macrophages, T lymphocytes, neovascularization, smooth muscle cells, lipid, extracellular matrix and efferocytosis within plaques; additionally, we discuss the safety of SDT. A comprehensive summary of the confirmed effects of SDT on AS is conducted to establish a framework for future researchers.
Collapse
Affiliation(s)
- Yan Zhang
- The Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Ying Yang
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yudi Feng
- The Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xueyan Gao
- The Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Liping Pei
- The Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaopan Li
- The Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Bingxin Gao
- The Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lin Liu
- The Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chengzeng Wang
- The Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Shuochen Gao
- The Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| |
Collapse
|
43
|
Hone T, Gonçalves J, Seferidi P, Moreno-Serra R, Rocha R, Gupta I, Bhardwaj V, Hidayat T, Cai C, Suhrcke M, Millett C. Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019. Lancet Glob Health 2024; 12:e744-e755. [PMID: 38614628 DOI: 10.1016/s2214-109x(24)00040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). METHODS We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. FINDINGS A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981-0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973-0·993) than poorer quintiles (quintile 1 0·991, 0·985-0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). INTERPRETATION Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. FUNDING UK National Institute for Health and Care Research.
Collapse
Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil.
| | - Judite Gonçalves
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Paraskevi Seferidi
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | | | - Rudi Rocha
- Instituto de Estudos para Políticas de Saúde, São Paulo, Brazil; São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Indrani Gupta
- Institute of Economic Growth, University of Delhi, Delhi, India
| | - Vinayak Bhardwaj
- South African Medical Research Council and Wits Centre for Health Economics and Decision Science, PRICELESS South Africa, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Taufik Hidayat
- Center for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia; Department of Economics, University of Sussex, Brighton, UK
| | - Chang Cai
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, Heslington, York, UK; Luxembourg Institute of Socio-economic Research, Esch-sur-Alzette, Luxembourg
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| |
Collapse
|
44
|
AbouNader K, Abou Mourad G, Chalouhi G, Rady A, Von Schreeb J, Halmin M. Assessing quality of critical care during an ongoing health emergency-a novel approach to evaluate quality of care at Lebanese public ICUs during COVID-19. Int J Qual Health Care 2024; 36:mzae028. [PMID: 38581654 PMCID: PMC11060481 DOI: 10.1093/intqhc/mzae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Quality of care has been systematically monitored in hospitals in high-income countries to ensure adequate care. However, in low- and middle-income countries, quality indicators are not readily measured. The primary aim of this study was to assess to what extent it was feasible to monitor the quality of intensive care in an ongoing health emergency, and the secondary aim was to assess a quality of care intervention (twinning project) focused on Intensive Care Unit (ICU) quality of care in public hospitals in Lebanon. METHODS We conducted a retrospective cohort study nested within an intervention implemented by the World Health Organization (WHO) together with partners. To assess the quality of care throughout the project, a monitoring system framed in the Donabedian model and included structure, process, and outcome indicators was developed and implemented. Data collection consisted of a checklist performed by external healthcare workers (HCWs) as well as collection of data from all admitted patients performed by each unit. The association between the number of activities within the interventional project and ICU mortality was evaluated. RESULTS A total of 1679 patients were admitted to five COVID-19 ICUs during the study period. The project was conducted fully across four out of five hospitals. In these hospitals, a significant reduction in ICU mortality was found (OR: 0.83, P < 0.05, CI: 0.72-0.96). CONCLUSION We present a feasible way to assess quality of care in ICUs and how it can be used in assessing a quality improvement project during ongoing crises in resource-limited settings. By implementing a quality of care intervention in Lebanon's public hospitals, we have shown that such initiatives might contribute to improvement of ICU care. The observed association between increased numbers of project activities and reduced ICU mortality underscores the potential of quality assurance interventions to improve outcomes for critically ill patients in resource-limited settings. Future research is needed to expand this model to be applicable in similar settings.
Collapse
Affiliation(s)
- Karim AbouNader
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Ghada Abou Mourad
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Georges Chalouhi
- Middle East Academy for Learning Health Systems, Beirut, Lebanon
| | - Alissar Rady
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Johan Von Schreeb
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Märit Halmin
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| |
Collapse
|
45
|
Dableh S, Frazer K, Stokes D, Kroll T. Access of older people to primary health care in low and middle-income countries: A systematic scoping review. PLoS One 2024; 19:e0298973. [PMID: 38640096 PMCID: PMC11029620 DOI: 10.1371/journal.pone.0298973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/01/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Ensuring access for older people to Primary Health Care (PHC) is vital to achieve universal health coverage, improve health outcomes, and health-system performance. However, older people living in Low-and Middle-Income Countries (LMICs) face barriers constraining their timely access to appropriate care. This review aims to summarize the nature and breadth of literature examining older people's experiences with access to PHC in LMICs, and access barriers and enablers. METHODS Guided by Arksey and O'Malley's framework, four databases [CINAHL, Cochrane, PubMed, and Embase] were systematically searched for all types of peer-reviewed articles published between 2002 and 2023, in any language but with English or French abstract. Gray literature presenting empirical data was also included by searching the United Nations, World Health Organization, and HelpAge websites. Data were independently screened and extracted. RESULTS Of 1165 identified records, 30 are included. Data were generated mostly in Brazil (50%) and through studies adopting quantitative designs (80%). Older people's experiences varied across countries and were shaped by several access barriers and enablers classified according to the Patient-Centered Access to Healthcare framework, featuring the characteristics of the care delivery system at the supply side and older people's attributes from the demand side. The review identifies that most access barriers and enablers pertain to the availability and accommodation dimension, followed by the appropriateness, affordability, acceptability, and approachability of services. Socio-economic level and need perception were the most reported characteristics that affected older people's access to PHC. CONCLUSIONS Older people's experiences with PHC access varied according to local contexts, socioeconomic variables, and the provision of public or private health services. Results inform policymakers and PHC practitioners to generate policies and services that are evidence-based and responsive to older people's needs. Identified knowledge gaps highlight the need for research to further understand older people's access to PHC in different LMICs.
Collapse
Affiliation(s)
- Saydeh Dableh
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - Kate Frazer
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Thilo Kroll
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| |
Collapse
|
46
|
Song WP, Bo XW, Dou HX, Fan Q, Wang H. Association between periodontal disease and coronary heart disease: A bibliometric analysis. Heliyon 2024; 10:e28325. [PMID: 38571655 PMCID: PMC10988017 DOI: 10.1016/j.heliyon.2024.e28325] [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: 07/24/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Background Periodontal disease and coronary heart disease are both prevalent diseases worldwide and cause patients physical and mental suffering and a global burden. Recent studies have suggested a link between periodontal disease and coronary heart disease, but there is less research in this field from the perspective of bibliometrics. Objective This study aimed to quantitatively analyze the literature on periodontal disease and coronary heart disease to summarize intellectual bases, research hotspots, and emerging trends and pave the way for future research. Methods The Science Citation Index Expanded database was used to retrieve study records on periodontal disease and coronary heart disease from 1993 to 2022. After manual screening, the data were used for cooperative network analysis (including countries/regions, institutions and authors), keyword analysis, and reference co-citation analysis by CiteSpace software. Microsoft Excel 2019 was applied for curve fitting of annual trend in publications and citations. Results A total of 580 studies were included in the analysis. The number of publications and citations in this field has shown an upward trend over the past 30 years. There was less direct collaboration among authors and institutions in this field but closer collaboration between countries. The United States was the country with the most published articles in this field (169/580, 29.14%). Based on the results of keyword analysis and literature co-citation analysis, C-reactive protein, oral flora, atherosclerosis, infection, and inflammation were previous research hotspots, while global burden and cardiovascular outcomes were considered emerging trends in this field. Conclusion Studies on periodontal disease and coronary heart disease, which have attracted the attention of an increasing number of researchers, have been successfully analyzed using bibliometrics and visualization techniques. This paper will help scholars better understand the dynamic evolution of periodontal disease and coronary heart disease and point out the direction for future research. Clinical significance This paper presents an overview between periodontal disease and coronary heart disease. Further exploration of the two diseases themselves and the potential causal relationship between the two is necessary and relevant, which may impact basic research, diagnosis, and treatment related to both diseases. This will aid the work of researchers and specialist doctors, and ultimately benefit patients with both diseases.
Collapse
Affiliation(s)
- Wen-peng Song
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Xiao-wen Bo
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hui-xin Dou
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| | - Qian Fan
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Hao Wang
- Department of Stomatology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100029, China
| |
Collapse
|
47
|
Lozada-Tequeanes AL, Théodore FL, Kim-Herrera E, García-Guerra A, Quezada-Sánchez AD, Alvarado-Casas R, Bonvecchio A. Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e55509. [PMID: 38592753 PMCID: PMC11005909 DOI: 10.2196/55509] [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: 12/18/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. OBJECTIVE This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. METHODS NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children's age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants' experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. RESULTS Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was "good," "useful," and "helpful" for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. CONCLUSIONS While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. TRIAL REGISTRATION ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896.
Collapse
Affiliation(s)
| | - Florence L Théodore
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Edith Kim-Herrera
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Armando García-Guerra
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Amado D Quezada-Sánchez
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Rocio Alvarado-Casas
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Anabelle Bonvecchio
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| |
Collapse
|
48
|
Abebaw WA, Wolde HF, Tilahun WM, Gebreegziabher ZA, Teshome DF. Quality of childbirth care and its determinants along the continuum of care among pregnant women who gave birth vaginally in Gondar town public health facility, Northwest Ethiopia, 2022: generalised structural equation modelling. BMJ Open 2024; 14:e073199. [PMID: 38580371 PMCID: PMC11002431 DOI: 10.1136/bmjopen-2023-073199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the quality of childbirth care and its determinants along the continuum of care in Gondar town public health facility in Ethiopia. DESIGN An institution-based, cross-sectional study was employed. Completed data were imported to Stata V.16 for cleaning and analysis. A generalised structural equation model was employed to examine the relationships along the continuum of childbirth care and to determine the factors affecting the quality of childbirth care. SETTING AND PARTICIPANTS This study was conducted among a total of 865 women who delivered in the public health facility of Gondar, Ethiopia, from 19 May to 30 June 2022. RESULTS The study revealed the proportion of good-quality childbirth care during admission, intrapartum and immediate postpartum period was 59% (95% CI 55.7, 62.4), 76.8% (95% CI 73.8, 79.5) and 45% (95% CI 41.7, 48.5), respectively. Postsecondary educational status of mothers (β=0.60, 95% CI 0.16, 1.04) and maternal age of 25-35 (β=0.68, 95% CI 0.33, 1.02) were predictors of quality of care at admission. Referral hospital (β=0.43, 95% CI 0.10, 0.76), presence of guidelines (β=1.36, 95% CI 0.72, 1.99) and provider age of 25-35 (β=0.61, 95% CI 0.12, 1.10) affected the quality of care during the intrapartum period. Urban residence (β=0.52, 95% CI 0.12, 0.93), skilled birth attendant experience (β=0.19, 95% CI 0.11, 0.28) and number of delivery couches (β=-0.29, 95% CI -0.44, -0.13) had significant associations with the quality of childbirth care during the immediate postpartum period. CONCLUSIONS Although our study found improvements in the quality of childbirth care along the continuum compared with previous studies, more workers are needed to alleviate the problem of poor-quality service. Different maternal, provider and facility factors were found to be predictors of the quality of childbirth care.
Collapse
Affiliation(s)
| | - Haileab Fekadu Wolde
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | | | - Destaw Fetene Teshome
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| |
Collapse
|
49
|
McBenedict B, Ahmed YA, Reda Elmahdi R, Yusuf WH, Netto JGM, Valentim G, Abrahão A, Lima Pessôa B, Mesquita ET. Pericardial Diseases Mortality Trends in Brazil From 2000 to 2022. Cureus 2024; 16:e57949. [PMID: 38738132 PMCID: PMC11084855 DOI: 10.7759/cureus.57949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Background Pericardial diseases manifest in various clinical forms, including acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade, with acute pericarditis being the most prevalent. These conditions significantly contribute to mortality rates. Therefore, this article aimed to analyze mortality trends in the Brazilian population based on age and sex, shedding light on the impact of pericardial diseases on public health outcomes. Methods This is a retrospective time-series analysis of pericardial disease mortality rates in Brazil (2000-2022). Data was obtained from the Department of Informatics of the Unified Health System (DATASUS), and the 10th edition of the International Classification of Diseases (ICD-10) codes: I30, I31, and I32 were included for analysis. We gathered population and demographic data categorized by age range and sex from the Brazilian Institute of Geography and Statistics (IBGE). Subsequently, we computed the age-standardized mortality rate per 100,000 individuals and assessed the annual percentage changes (APCs) and average annual percentage changes (AAPCs) using joinpoint regression, along with their corresponding 95% confidence intervals (CIs). Results In terms of mortality trends based on sex, overall mortality rates remained stable for males and combined sexes over the study period. However, there was a notable increase in mortality rates among females (AAPC=1.18), particularly between 2020 and 2022, with a significant APC of 27.55. Analyzing pericardial diseases across different age groups (20 to 80 years and above), it wasobserved that mortality rates significantly increased in the 70-79 and 80 years and above age groups throughout the study period (AAPC=1.0339 and AAPC=3.4587, respectively). These two age groups experienced the highest significant rise in mortality between 2020 and 2022. Other age groups did not exhibit a significant change in AAPC. Conclusions This comprehensive analysis spanning two decades (2000-2022), examined the mortality trends of pericardial diseases in Brazil and revealed relative stability overall. Males exhibited an overall higher mortality number due to pericardial diseases; however, females showed the most significant increase in mortality trend throughout the whole period. In the first segment (2000-2015), mortality rose across all cohorts, which was attributed to substandard healthcare facilities and infectious diseases like tuberculosis. The second segment (2016-2020) saw a decline in mortality, likely due to improved healthcare, particularly the increased availability of echocardiograms. However, the third segment (2020-2022) witnessed a sharp rise in mortality, coinciding with the COVID-19 pandemic, with post-COVID-19 symptoms, particularly pericarditis. Pericarditis-related death rates declined compared to pericardial effusion, and mortality rates correlated directly with age, with older cohorts experiencing higher mortality due to increased comorbidities, and decline in health and immunocompetency.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ana Abrahão
- Public Health, Fluminense Federal University, Niterói, BRA
| | | | | |
Collapse
|
50
|
de Moura Pedro RA, Besen BAMP, Mendes PV, Gomes ACM, de Carvalho MT, Malbouisson LMS, Park M, Taniguchi LU. Adverse events leading to intensive care unit admission in a low-and-middle-income-country: A prospective cohort study and a systematic review. J Crit Care 2024; 80:154510. [PMID: 38150833 DOI: 10.1016/j.jcrc.2023.154510] [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: 10/03/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Adverse events (AE) are frequent in critical care and could be even more prevalent in LMIC due to a shortage of ICU beds and Human resources. There is limited data on how relevant AE are among the reasons for ICU admission, being all of which published by High-Income-Countries services. Our main goal is to describe the rate of adverse events-related ICU admissions and their preventability in a LMIC scenario, comparing our results with previous data. METHODS This was a prospective cohort study, during a one-year period, in two general ICUs from a tertiary public academic hospital. Our exposure of interest was ICU admission related to an AE in adult patients, we further characterized their preventability and clinical outcomes. We also performed a systematic review to identify and compare previous published data on ICU admissions due to AE. RESULTS Among all ICU admissions, 12.1% were related to an AE (9.8% caused by an AE, 2.3% related but not directly caused by an AE). These ICU admissions were not associated with a higher risk of death, but most of them were potentially preventable (70.9% of preventability rate, representing 8.6% of all ICU admissions). The meta-analysis resulted in a proportion of ICU admissions due to AE of 11% (95% CI 6%-16%), with a preventability rate of 54% (95% CI 42%-66%). CONCLUSIONS In this prospective cohort, adverse events were a relevant reason for ICU admission. This result is consistent with data retrieved from non-LMIC as shown in our meta-analysis. The high preventability rate described reinforces that quality and safety programs could work as a tool to optimize scarce resources.
Collapse
Affiliation(s)
| | | | - Pedro Vitale Mendes
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Marcelo Park
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro Utino Taniguchi
- Intensive Care Unit, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Hospital Sírio-Libanês, São Paulo, SP, Brazil
| |
Collapse
|