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Ameen S, Shafiq SS, Tanvir KM, Saberin A, Banik G, ANM EK, Ashrafee S, Saha PK, Amena B, Alam HMS, Ahmed S, Khan MN, Nahar S, Talha MTUS, Sarkar SS, Hossain AT, Jabeen S, Shaikh MZH, Al-Mahmud M, AFM AU, Ahmed A, Chisti MJ, Islam MS, Sarkar S, Adnan SD, El Arifeen S, Islam MJ, Rahman AE. Introducing a standardised register for strengthening the inpatient management of newborns and sick children: Implementation research in selected health facilities of Bangladesh. J Glob Health 2024; 14:04086. [PMID: 38751318 PMCID: PMC11097124 DOI: 10.7189/jogh.14.04086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Background It is imperative to maintain accurate documentation of clinical interventions aimed at enhancing the quality of care for newborns and sick children. The National Newborn Health and IMCI programme of Bangladesh led the development of a standardised register for managing newborns and sick children under five years of age during inpatient care through stakeholder engagement. We aimed to assess the implementation outcomes of the standardised register in the inpatient department. Methods We conducted implementation research in two district hospitals and two sub-district hospitals of Kushtia and Dinajpur districts from November 2022 to January 2023 to assess the implementation outcomes of the standardised register. We assessed the following World Health Organization implementation outcome variables: usability, acceptability, adoption (actual use), fidelity (completeness and accuracy), and utility (quality of care) of the register against preset benchmarks. We collected data through structured interviews with health care providers; participant enrolment; and data extraction from inpatient registers and case record forms. Results The average usability and acceptability scores among health care providers were 73 (standard deviation (SD) = 14) and 82 (SD = 14) out of 100, respectively. The inpatient register recorded 96% (95% confidence interval (CI) = 95-97) of under-five children who were admitted to the inpatient department (adoption - actual use). The proportions of completed data elements in the inpatient register were above the preset benchmark of 70% for all the assessed data elements except 'investigation done' (24%; 95% CI = 23-26) (fidelity - completeness). The percentage agreements between government-appointed nurses posted and study-appointed nurses were above the preset benchmark of 70% for all the reported variables (fidelity - accuracy). The kappa coefficient for the overall level of agreement between these two groups regarding reported variables indicated moderate to substantial agreement. The proportion of newborns with sepsis receiving injectable antibiotics was 62% (95% CI = 47-75) (utility - quality of care). We observed some variability in the completeness and accuracy of the inpatient register by district and facility type. Conclusions The inpatient register was positively received by health care providers, with evaluations of implementation outcome variables showing encouraging results. Our findings could inform evidence-based decision-making on the implementation and scale-up of the inpatient register in Bangladesh, as well as other low- and middle-income countries.
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Affiliation(s)
- Shafiqul Ameen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabit Saad Shafiq
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K M Tanvir
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashfia Saberin
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | | | - Sabina Ashrafee
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Palash Kumar Saha
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | - Husam Md Shah Alam
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sabbir Ahmed
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | - Salmun Nahar
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | - Sadman Sowmik Sarkar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ziaul Haque Shaikh
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Al-Mahmud
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Azim Uddin AFM
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anisuddin Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Supriya Sarkar
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Sheikh Daud Adnan
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Jahurul Islam
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Yilma M, Taye G, Abebe W. Magnitude of standard precautions practices among healthcare workers in health facilities of Low and Middle Income Countries: A systematic review and meta-analysis. PLoS One 2024; 19:e0302282. [PMID: 38687766 PMCID: PMC11060540 DOI: 10.1371/journal.pone.0302282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Standard precautions are the minimum standard of infection control to prevent transmission of infectious agents, protect healthcare workers, patients, and visitors regardless of infection status. The consistent implementation of standard precautions is highly effective in reducing transmission of pathogens that cause HAIs. Despite their effectiveness, compliance, resources, patient behavior, and time constraints are some of the challenges that can arise when implementing standard precautions. The main objective of this meta-analysis was to show the pooled prevalence of safe standard precaution practices among healthcare workers in Low and Middle Income Countries (LMICs). METHODS A systematic review and meta-analysis was conducted for this study. We systematically searched observational study articles from PubMed Central and Google Scholar. We included articles published any year and involving healthcare workers. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The random effect model was used to estimate the pooled prevalence. The meta-analysis, sensitivity analysis, subgroup analysis, and publication bias (funnel plot, and Egger's tests) were conducted. RESULTS A total of 46 articles were included in this study. The pooled prevalence of standard precautions practices among healthcare workers in LMICs was 53%, with a 95% CI of (47, 59). These studies had a total sample size of 14061 with a minimum sample size of 17 and a maximum sample size of 2086. The majority of the studies (82.6%) were conducted in hospitals only (all kinds), and the remaining 17.4% were conducted in all health facilities, including hospitals. CONCLUSIONS The pooled prevalence of standard precautions practices among healthcare workers in LMICs was suboptimal. The findings of this study can have substantial implication for healthcare practice and policy making by providing robust evidence with synthesized and pooled evidence from multiple studies. TRIAL REGISTRATION Registered on PROSPERO with record ID: CRD42023395129, on the 9th Feb. 2023.
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Affiliation(s)
- Mengistu Yilma
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girma Taye
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Bola R, Ngonzi J, Ujoh F, Kihumuro RB, Lett R. An evaluation of obstetrical data collection at health institutions in Mbarara Region, Uganda and Benue State, Nigeria. Pan Afr Med J 2024; 47:109. [PMID: 38766561 PMCID: PMC11101309 DOI: 10.11604/pamj.2024.47.109.36295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/19/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Rajan Bola
- Canadian Network for International Surgery, Vancouver, Canada
| | - Joseph Ngonzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fanan Ujoh
- Center for Sustainability and Resilient Infrastructure and Communities, London South Bank University, London, United Kingdom
| | | | - Ronald Lett
- Canadian Network for International Surgery, Vancouver, Canada
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Shah NH, Halamka JD, Saria S, Pencina M, Tazbaz T, Tripathi M, Callahan A, Hildahl H, Anderson B. A Nationwide Network of Health AI Assurance Laboratories. JAMA 2024; 331:245-249. [PMID: 38117493 DOI: 10.1001/jama.2023.26930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Importance Given the importance of rigorous development and evaluation standards needed of artificial intelligence (AI) models used in health care, nationwide accepted procedures to provide assurance that the use of AI is fair, appropriate, valid, effective, and safe are urgently needed. Observations While there are several efforts to develop standards and best practices to evaluate AI, there is a gap between having such guidance and the application of such guidance to both existing and new AI models being developed. As of now, there is no publicly available, nationwide mechanism that enables objective evaluation and ongoing assessment of the consequences of using health AI models in clinical care settings. Conclusion and Relevance The need to create a public-private partnership to support a nationwide health AI assurance labs network is outlined here. In this network, community best practices could be applied for testing health AI models to produce reports on their performance that can be widely shared for managing the lifecycle of AI models over time and across populations and sites where these models are deployed.
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Affiliation(s)
- Nigam H Shah
- Stanford Medicine, Palo Alto, California
- Coalition for Health AI, Dover, Delaware
| | - John D Halamka
- Coalition for Health AI, Dover, Delaware
- Mayo Clinic Platform, Mayo Clinic, Rochester, Minnesota
| | - Suchi Saria
- Coalition for Health AI, Dover, Delaware
- Bayesian Health, New York, New York
- Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins Medicine, Baltimore, Maryland
| | - Michael Pencina
- Coalition for Health AI, Dover, Delaware
- Duke AI Health, Duke University School of Medicine, Durham, North Carolina
| | - Troy Tazbaz
- US Food and Drug Administration, Silver Spring, Maryland
| | - Micky Tripathi
- US Office of the National Coordinator for Health IT, Washington, DC
| | | | | | - Brian Anderson
- Coalition for Health AI, Dover, Delaware
- MITRE Corporation, Bedford, Massachusetts
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Skyttberg N, Kottorp A, Alenius LS. Sound psychometric properties of a short new screening tool for patient safety climate: applying a Rasch model analysis. BMC Health Serv Res 2023; 23:742. [PMID: 37424025 PMCID: PMC10331975 DOI: 10.1186/s12913-023-09768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND WHO recommends repeated measurement of patient safety climate in health care and to support monitoring an 11 item questionnaire on sustainable safety engagement (HSE) has been developed by the Swedish Association of Local Authorities and Regions. This study aimed to validate the psychometric properties of the HSE. METHODS Survey responses (n = 761) from a specialist care provider organization in Sweden was used to evaluate psychometric properties of the HSE 11-item questionnaire. A Rasch model analysis was applied in a stepwise process to evaluate evidence of validity and precision/reliability in relation to rating scale functioning, internal structure, response processes, and precision in estimates. RESULTS Rating scales met the criteria for monotonical advancement and fit. Local independence was demonstrated for all HSE items. The first latent variable explained 52.2% of the variance. The first ten items demonstrated good fit to the Rasch model and were included in the further analysis and calculation of an index measure based on the raw scores. Less than 5% of the respondents demonstrated low person goodness-of-fit. Person separation index > 2. The flooring effect was negligible and the ceiling effect 5.7%. No differential item functioning was shown regarding gender, time of employment, role within organization or employee net promotor scores. The correlation coefficient between the HSE mean value index and the Rasch-generated unidimensional measures of the HSE 10-item scale was r = .95 (p < .01). CONCLUSIONS This study shows that an eleven-item questionnaire can be used to measure a common dimension of staff perceptions on patient safety. The responses can be used to calculate an index that enables benchmarking and identification of at least three different levels of patient safety climate. This study explores a single point in time, but further studies may support the use of the instrument to follow development of the patient safety climate over time by repeated measurement.
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Affiliation(s)
- Niclas Skyttberg
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden.
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Lisa Smeds Alenius
- Medical Management Center, Department of Learning, Informatics, Medical Management and Ethics, Karolinska Institutet, Solna, Sweden
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Strilciuc T, Gheorghe A. Collective-Documentary of a National Health Care Tragedy. JAMA 2023; 329:449-450. [PMID: 36662509 DOI: 10.1001/jama.2023.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This Arts and Medicine feature reviews the 2019 movie Collective, which documents corruption underlying poor patient outcomes in the Romanian national health system and provides an update on the people and reform efforts featured in the film.
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Affiliation(s)
- Tefan Strilciuc
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Bellandi D. Global Health Care Facilities Lack Basic Hygiene Services. JAMA 2022; 328:1490-1491. [PMID: 36255419 DOI: 10.1001/jama.2022.18765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Affiliation(s)
- Eric Perakslis
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Husabø G, Hovlid E. What Might Be Required for Inspections to Be Considered Fair? Comment on "What Lies Behind Successful Regulation? A Qualitative Evaluation of Pilot Implementation of Kenya's Health Facility Inspection Reforms". Int J Health Policy Manag 2022; 12:7296. [PMID: 35942956 PMCID: PMC10125043 DOI: 10.34172/ijhpm.2022.7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Abstract
Tama et al offer us an interesting analysis of a piloted regulatory reform that introduced a Joint Health Inspections (JHIs) system in three Kenyan counties. The study highlights key factors facilitating or hindering the implementation of the reform. In this commentary we reflect on the concept of fairness, which is one of the topics that is discussed in the study. We describe four important dimensions of fairness in the context of inspections: expectation clarity, consistency of assessment, consistency of enforcement, and fairness to patients. We argue that all four dimensions are important in the regulatory design, in order for the inspection to be perceived as fair.
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Affiliation(s)
- Gunnar Husabø
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
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Kimbowa IM, Eriksen J, Nakafeero M, Obua C, Lundborg CS, Kalyango J, Ocan M. Antimicrobial stewardship: Attitudes and practices of healthcare providers in selected health facilities in Uganda. PLoS One 2022; 17:e0262993. [PMID: 35113932 PMCID: PMC8812957 DOI: 10.1371/journal.pone.0262993] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 01/10/2022] [Indexed: 12/04/2022] Open
Abstract
Though antimicrobial stewardship (AMS) programmes are the cornerstone of Uganda’s national action plan (NAP) on antimicrobial resistance, there is limited evidence on AMS attitude and practices among healthcare providers in health facilities in Uganda. We determined healthcare providers’ AMS attitudes, practices, and associated factors in selected health facilities in Uganda. We conducted a cross-sectional study among nurses, clinical officers, pharmacy technicians, medical officers, pharmacists, and medical specialists in 32 selected health facilities in Uganda. Data were collected once from each healthcare provider in the period from October 2019 to February 2020. Data were collected using an interview-administered questionnaire. AMS attitude and practice were analysed using descriptive statistics, where scores of AMS attitude and practices for healthcare providers were classified into high, fair, and low using a modified Blooms categorisation. Associations of AMS attitude and practice scores were determined using ordinal logistic regression. This study reported estimates of AMS attitude and practices, and odds ratios with 95% confidence intervals were reported. We adjusted for clustering at the health facility level using clustered robust standard errors. A total of 582 healthcare providers in 32 healthcare facilities were recruited into the study. More than half of the respondents (58%,340/582) had a high AMS attitude. Being a female (aOR: 0.66, 95% CI: 0.47–0.92, P < 0.016), having a bachelor’s degree (aOR: 1.81, 95% CI: 1.24–2.63, P < 0.002) or master’s (aOR: 2.06, 95% CI: 1.13–3.75, P < 0.018) were significant predictors of high AMS attitude. Most (46%, 261/582) healthcare providers had fair AMS practices. Healthcare providers in the western region’s health facilities were less likely to have a high AMS practice (aOR: 0.52, 95% CI 0.34–0.79, P < 0.002). In this study, most healthcare providers in health facilities had a high AMS attitude and fair AMS practice.
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Affiliation(s)
- Isaac Magulu Kimbowa
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Jaran Eriksen
- Unit of Infectious diseases/Venhälsan, Stockholm South Hospital, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mary Nakafeero
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Joan Kalyango
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
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Chowdhury HA, Paromita P, Mayaboti CA, Rakhshanda S, Rahman FN, Abedin M, Rahman AKMF, Mashreky SR. Assessing service availability and readiness of healthcare facilities to manage diabetes mellitus in Bangladesh: Findings from a nationwide survey. PLoS One 2022; 17:e0263259. [PMID: 35171912 PMCID: PMC8849622 DOI: 10.1371/journal.pone.0263259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Diabetes Mellitus (DM) is one of the most prevalent non-communicable diseases (NCDs)as well as a major cause of morbidity and mortality worldwide. Around 80% diabetic patients live in low- and middle-income countries. In Bangladesh, there is a scarcity of data on the quality of DM management within health facilities. This study aims to describe service availability and readiness for DM at all tiers of health facilities using the World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) standard tool.
Methods
This cross-sectional survey was conducted in 266 health facilities all across Bangladesh using the WHO SARA standard tool. Descriptive analyses for the availability of DM services was carried out. Composite scores for facility readiness index (RI) were calculated in four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. Indices were stratified by facility level and a cut off value of 70% was considered as ‘ready’ to manage diabetes at each facility level.
Results
The mean RI score of tertiary and specialized hospitals was above the cutoff value of 70% (RI: 79%), whereas for District Hospitals (DHs), Upazila Health Complexes (UHCs) and NGO and Private hospitals the RI scores were other levels of 65%, 51% and 62% respectively. This indicating that only the tertiary level of health facilities was ready to manage DM. However, it has been observed that the RI scores of the essential medicine domain was low at all levels of health facilities including tertiary-level.
Conclusions
The study revealed only tertiary level facilities were ready to manage DM. However, like other facilities, they require an adequate supply of essential medicines. Alongside the inadequate supply of medicines, shortage of trained staff and unavailability of guidelines on the diagnosis and treatment of DM also contributed to the low RI score for rest of the facilities.
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Affiliation(s)
- Hasina Akhter Chowdhury
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
| | - Progga Paromita
- Kirtipasha Health and Family Welfare Centre, Jhalokathi Sadar Upazila, Barishal, Bangladesh
| | | | - Shagoofa Rakhshanda
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Farah Naz Rahman
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Minhazul Abedin
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
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Islam MS, Tarannum S, Banu S, Chowdhury KIA, Nazneen A, Chughtai AA, Seale H. Preparedness of tertiary care hospitals to implement the national TB infection prevention and control guidelines in Bangladesh: A qualitative exploration. PLoS One 2022; 17:e0263115. [PMID: 35113905 PMCID: PMC8812944 DOI: 10.1371/journal.pone.0263115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/13/2022] [Indexed: 11/19/2022] Open
Abstract
In high tuberculosis (TB) burden countries, health settings, including non-designated TB hospitals, host many patients with pulmonary TB. Bangladesh’s National TB Control Program aims to strengthen TB infection prevention and control (IPC) in health settings. However, there has been no published literature to date that assessed the preparedness of hospitals to comply with the recommendations. To address this gap, our study examined healthcare workers knowledge and attitudes towards TB IPC guidelines and their perceptions regarding the hospitals’ preparedness in Bangladesh. Between January to December 2019, we conducted 16 key-informant interviews and four focus group discussions with healthcare workers from two public tertiary care hospitals. In addition, we undertook a review of 13 documents [i.e., hospital policy, annual report, staff list, published manuscript]. Our findings showed that healthcare workers acknowledged the TB risk and were willing to implement the TB IPC measures but identified key barriers impacting implementation. Gaps were identified in: policy (no TB policy or guidelines in the hospital), health systems (healthcare workers were unaware of the guidelines, lack of TB IPC program, training and education, absence of healthcare-associated TB infection surveillance, low priority of TB IPC, no TB IPC monitoring and feedback, high patient load and bed occupancy, and limited supply of IPC resources) and behavioural factors (risk perception, compliance, and self and social stigma). The additional service-level gap was the lack of electronic medical record systems. These findings highlighted that while there is a demand amongst healthcare workers to implement TB IPC measures, the public tertiary care hospitals have got key issues to address. Therefore, the National TB Control Program may consider these gaps, provide TB IPC guidelines to these hospitals, assist them in developing hospital-level IPC manual, provide training, and coordinate with the ministry of health to allocate separate budget, staffing, and IPC resources to implement the control measures successfully.
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Affiliation(s)
- Md. Saiful Islam
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Sayeeda Tarannum
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - Sayera Banu
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
| | | | - Arifa Nazneen
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - Abrar Ahmad Chughtai
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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Fekadu B, Ali I, Tafesse Z, Segni H. Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia. BMC Pregnancy Childbirth 2022; 22:37. [PMID: 35034632 PMCID: PMC8761277 DOI: 10.1186/s12884-021-04358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Essential newborn care (ENC) is a package of interventions which should be provided for every newborn baby regardless of body size or place of delivery immediately after birth and should be continued for at least the seven days that follows. Even though Ethiopia has endorsed the implementation of ENC, as other many counties, it has been challenged. This study was conducted to measure the level of essential newborn care practice and identify health facility level attributes for consistent delivery of ENC services by health care providers. METHODS This study employed a retrospective cross-sectional study design in 425 facilities. Descriptive statistics were formulated and presented in tables. Binary logistic regression was employed to assess the statistical association between the outcome variable and the independent variables. All variables with p < 0.2 in the bivariate analysis were identified as candidate variables. Then, multiple logistic regression analysis was performed using candidate variables to determine statistically significant predictors of the consistent delivery of ENC by adjusting for possible confounders. RESULTS A total of 273, (64.2%), of facilities demonstrated consistent delivery of ENC. Five factors-availability of essential obstetrics drugs in delivery rooms, high community score card (CSC) performances, availability of maternity waiting homes, consistent partograph use, and availability of women-friendly delivery services were included in the model. The strongest predictor of consistent delivery of essential newborn care (CD-ENC) was consistent partograph use, recording an odds ratio of 2.66 (AOR = 2.66, 95%CI: 1.71, 4.13). Similarly, providing women-friendly services was strongly associated with increased likelihood of exhibiting CD-ENC. Furthermore, facilities with essential obstetric drugs had 1.88 (AOR = 1.88, 95%CI: 1.15, 3.08) times higher odds of exhibiting consistent delivery of ENC. CONCLUSION The delivery of essential newborn care depends on both health provider and facility manager actions and availability of platforms to streamline relationships between the clients and health facility management.
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Affiliation(s)
- Binyam Fekadu
- JSI Research and Training Institute, Inc, USAID Transform: Primary Health Care, Addis Ababa, Ethiopia.
| | - Ismael Ali
- JSI Research and Training Institute, Inc, USAID Transform: Primary Health Care, Addis Ababa, Ethiopia
| | - Zergu Tafesse
- JSI Research and Training Institute, Inc, USAID Transform: Primary Health Care, Addis Ababa, Ethiopia
| | - Hailemariam Segni
- JSI Research and Training Institute, Inc, USAID Transform: Primary Health Care, Addis Ababa, Ethiopia
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Hagaman A, Rodriguez HG, Barrington C, Singh K, Estifanos AS, Keraga DW, Alemayehu AK, Abate M, Bitewulign B, Barker P, Magge H. "Even though they insult us, the delivery they give us is the greatest thing": a qualitative study contextualizing women's experiences with facility-based maternal health care in Ethiopia. BMC Pregnancy Childbirth 2022; 22:31. [PMID: 35031022 PMCID: PMC8759250 DOI: 10.1186/s12884-022-04381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Globally, amidst increased utilization of facility-based maternal care services, there is continued need to better understand women's experience of care in places of birth. Quantitative surveys may not sufficiently characterize satisfaction with maternal healthcare (MHC) in local context, limiting their interpretation and applicability. The purpose of this study is to untangle how contextual and cultural expectations shape women's care experience and what women mean by satisfaction in two Ethiopian regions. METHODS Health center and hospital childbirth care registries were used to identify and interview 41 women who had delivered a live newborn within a six-month period. We used a semi-structured interview guide informed by the Donabedian framework to elicit women's experiences with MHC and delivery, any prior delivery experiences, and recommendations to improve MHC. We used an inductive analytical approach to compare and contrast MHC processes, experiences, and satisfaction. RESULTS Maternal and newborn survival and safety were central to women's descriptions of their MHC experiences. Women nearly exclusively described healthy and safe deliveries with healthy outcomes as 'satisfactory'. The texture behind this 'satisfaction', however, was shaped by what mothers bring to their delivery experiences, creating expectations from events including past births, experiences with antenatal care, and social and community influences. Secondary to the absence of adverse outcomes, health provider's interpersonal behaviors (e.g., supportive communication and behavioral demonstrations of commitment to their births) and the facility's amenities (e.g., bathing, cleaning, water, coffee, etc) enhanced women's experiences. Finally, at the social and community levels, we found that family support and material resources may significantly buffer against negative experiences and facilitate women's overall satisfaction, even in the context of poor-quality facilities and limited resources. CONCLUSION Our findings highlight the importance of understanding contextual factors including past experiences, expectations, and social support that influence perceived quality of MHC and the agency a woman has to negotiate her care experience. Our finding that newborn and maternal survival primarily drove women's satisfaction suggests that quantitative assessments conducted shortly following delivery may be overly influenced by these outcomes and not fully capture the complexity of women's care experience.
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Affiliation(s)
- Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
- Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT, USA.
| | - Humberto Gonzalez Rodriguez
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA
| | - Kavita Singh
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
| | - Dorka Woldesenbet Keraga
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
| | | | - Mehiret Abate
- Institute for Healthcare Improvement, Addis Ababa, Ethiopia
| | | | - Pierre Barker
- Institute for Healthcare Improvement, Boston, MA, USA
| | - Hema Magge
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Zambia Street, Tikur Anbessa Hospital Building, Lideta Sub-city, Addis Ababa, Ethiopia
- Bill & Melinda Gates Foundation, Seattle, USA
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Alem AZ, Yeshaw Y, Liyew AM, Tesema GA, Alamneh TS, Worku MG, Teshale AB, Tessema ZT. Timely initiation of antenatal care and its associated factors among pregnant women in sub-Saharan Africa: A multicountry analysis of Demographic and Health Surveys. PLoS One 2022; 17:e0262411. [PMID: 35007296 PMCID: PMC8746770 DOI: 10.1371/journal.pone.0262411] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Timely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries. METHODS The Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15-49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). RESULTS In this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8-38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25-34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely. CONCLUSION Even though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gabrie Worku
- Department of Human Anatomy, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Shah JN, Murray KM, Lucas FL, Fairfield KM, Cohen MC. Variation in additional testing and patient outcomes after stress echocardiography or myocardial perfusion imaging, according to accreditation status of testing site. J Nucl Cardiol 2021; 28:2952-2961. [PMID: 32676913 DOI: 10.1007/s12350-020-02230-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the present study was to determine whether patients receiving a stress echocardiogram or myocardial perfusion imaging (MPI) test have differences in subsequent testing and outcomes according to accreditation status of the original testing facility. METHODS AND RESULTS An all-payer claims dataset from Maine Health Data Organization from 2012 to 2014 was utilized to define two cohorts defined by an initial stress echocardiogram or MPI test. The accreditation status (Intersocietal Accreditation Commission (IAC), American College of Radiology (ACR) or none) of the facility performing the index test was known. Descriptive statistics and multivariate regression were used to examine differences in subsequent diagnostic testing and cardiac outcomes. We observed 4603 index stress echocardiograms and 8449 MPI tests. Multivariate models showed higher odds of subsequent MPI testing and hospitalization for angina if the index test was performed at a non-accredited facility in both the stress echocardiogram cohort and the MPI cohort. We also observed higher odds of percutaneous coronary interventions (PCI) performed (OR 1.68, 95% CI 1.13-2.50), if the initial MPI test was done in a non-accredited facility. CONCLUSION Cardiac testing completed in non-accredited facilities were associated with higher odds of subsequent MPI testing, hospitalization for angina, and PCI.
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Affiliation(s)
- Jay N Shah
- Maine Medical Center, 22 Bramhall St, Portland, ME, 04103, UK.
| | - Kimberly M Murray
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, UK
| | - F L Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, UK
| | | | - Mylan C Cohen
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, UK
- Maine Medical Partners MaineHealth Cardiology, Portland, UK
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Affiliation(s)
- Mahesh Devnani
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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18
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Swartzlander A. 2021 Hope Babette Tang Humanism in Healthcare Essay Contest: Second Place Nursing Student Essay: Nurses Encounter Diversity. Acad Med 2021; 96:1556-1557. [PMID: 34705753 DOI: 10.1097/acm.0000000000004348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Anna Swartzlander
- A. Swartzlander is a graduate nursing student, University of Nebraska Medical Center, Omaha, Nebraska;
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Yeshitila YG, Bante A, Aschalew Z, Afework B, Gebeyehu S. Utilization of non-pneumatic anti-shock garment and associated factors for postpartum hemorrhage management among obstetric care providers in public health facilities of southern Ethiopia, 2020. PLoS One 2021; 16:e0258784. [PMID: 34710153 PMCID: PMC8553034 DOI: 10.1371/journal.pone.0258784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Delays in care have been recognized as a significant contributor to maternal mortality in low-resource settings. The non-pneumatic antishock garment is a low-cost first-aid device that can help women with obstetric haemorrhage survive these delays without long-term adverse effects. Extending professionals skills and the establishment of new technologies in basic healthcare facilities could harvest the enhancements in maternal outcomes necessary to meet the sustainable development goals. Thus, this study aims to assess utilization of non-pneumatic anti-shock garment to control complications of post-partum hemorrhage and associated factors among obstetric care providers in public health institutions of Southern Ethiopia, 2020. METHODS A facility-based cross-sectional study was conducted among 412 obstetric health care providers from March 15 -June 30, 2020. A simple random sampling method was used to select the study participants. The data were collected through a pre-tested interviewer-administered questionnaire. A binary logistic regression model was used to identify determinants for the utilization of non-pneumatic antishock garment. STATA version 16 was used for data analysis. A P-value of < 0.05 was used to declare statistical significance. RESULTS Overall, 48.5% (95%CI: 43.73, 53.48%) of the obstetric care providers had utilized Non pneumatic antishock garment for management of complications from postpartum hemorrhage. Training on Non pneumatic antishock garment (AOR = 2.92; 95% CI: 1.74, 4.92), working at hospital (AOR = 1.81; 95% CI: 1.04, 3.16), good knowledge about NASG (AOR = 1.997; 95%CI: 1.16, 3.42) and disagreed and neutral attitude on Non pneumatic antishock garment (AOR = 0.41; 95%CI: 0.24, 0.68), and (AOR = 0.39; 95% CI: 0.21, 0.73), respectively were significantly associated with obstetric care provider's utilization of Non-pneumatic antishock garment. CONCLUSIONS In the current study, roughly half of the providers are using Non-pneumatic antishock garment for preventing complications from postpartum hemorrhage. Strategies and program initiatives should focus on strengthening in-service and continuous professional development training, thereby filling the knowledge and attitude gap among obstetric care providers. Health centers should be targeted in future programs for accessibility and utilization of non-pneumatic antishock garment.
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Affiliation(s)
- Yordanos Gizachew Yeshitila
- School of Nursing, College of Medicine and Health Science, Arbaminch University, Arba Minch, Ethiopia
- * E-mail:
| | - Agegnehu Bante
- School of Nursing, College of Medicine and Health Science, Arbaminch University, Arba Minch, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine and Health Science, Arbaminch University, Arba Minch, Ethiopia
| | - Bezawit Afework
- Department of Midwifery, College of Medicine and Health Science, Arbaminch University, Arba Minch, Ethiopia
| | - Selamawit Gebeyehu
- School of Public Health, College of Medicine and Health Science, Arbaminch University, Arba Minch, Ethiopia
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Moonpanane K, Kodyee S, Potjanamart C, Purkey E. Adjusting the family's life: A grounded theory of caring for children with special healthcare needs in rural areas, Thailand. PLoS One 2021; 16:e0258664. [PMID: 34695121 PMCID: PMC8544842 DOI: 10.1371/journal.pone.0258664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
This study aims to understand the experiences of families of children with special healthcare needs in rural areas in Thailand. Grounded theory (GT) was employed to understand families' experiences when caring for children with special healthcare needs (CSHCN) in rural areas. Forty-three family members from thirty-four families with CSHCN participated in in-depth interviews. Interviews were recorded and transcribed. The constant comparative method was used for data analysis and coding analysis. Adjusting family's life was the emergent theory which included experiencing negative effects, managing in home environment, integrating care into a community health system, and maintaining family normalization. This study describes the process that families undergo in trying to care for CSHCN while managing their lives to maintain a sense of normalcy. This theory provides some intervention opportunities for health care professionals when dealing with the complexities in their homes, communities and other ambulatory settings throughout the disease trajectory, and also indicates the importance of taking into consideration the family's cultural background.
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Affiliation(s)
| | - Salisa Kodyee
- School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Eva Purkey
- Department of Family Medicine, Faculty of Health Science, Queen’s University, Kingston, Canada
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Abstract
IMPORTANCE Mortality across US counties varies considerably, from 252 to 1847 deaths per 100 000 people in 2018. Although patient satisfaction with health care is associated with patient- and facility-level health outcomes, the association between health care satisfaction and community-level health outcomes is not known. OBJECTIVE To examine the association between online ratings of health care facilities and mortality across US counties and to identify language specific to 1-star (lowest rating) and 5-star (highest rating) reviews in counties with high vs low mortality. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cross-sectional study examined reviews and ratings of 95 120 essential health care facilities across 1301 US counties. Counties that had at least 1 essential health care facility with reviews available on Yelp, an online review platform, were included. Essential health care was defined according to the 10 essential health benefits covered by Affordable Care Act insurance plans. MAIN OUTCOMES AND MEASURES The mean rating of essential health care facilities was calculated by county from January 1, 2015, to December 31, 2019. Ratings were on a scale of 1 to 5 stars, with 1 being the worst rating and 5 the best. County-level composite measures of health behaviors, clinical care, social and economic factors, and physical environment were obtained from the University of Wisconsin School of Medicine and Public Health County Health Rankings database. The 2018 age-adjusted mortality by county was obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiological Research database. Multiple linear regression analysis was used to estimate the association between mean facility rating and mortality, adjusting for county health ranking variables. Words with frequencies of use that were significantly different across 1-star and 5-star reviews in counties with high vs low mortality were identified. RESULTS The 95 120 facilities meeting inclusion criteria were distributed across 1301 of 3142 US counties (41.4%). At the county level, a 1-point increase in mean rating was associated with a mean (SE) age-adjusted decrease of 18.05 (3.68) deaths per 100 000 people (P < .001). Words specific to 1-star reviews in high-mortality counties included told, rude, and wait, and words specific to 5-star reviews in low-mortality counties included Dr, pain, and professional. CONCLUSIONS AND RELEVANCE This study found that, at the county level, higher online ratings of essential health care facilities were associated with lower mortality. Equivalent online ratings did not necessarily reflect equivalent experiences of care across counties with different mortality levels, as evidenced by variations in the frequency of use of key words in reviews. These findings suggest that online ratings and reviews may provide insight into unequal experiences of essential health care.
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Affiliation(s)
- Daniel C. Stokes
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
- Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia
| | - Arthur P. Pelullo
- Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Zachary F. Meisel
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Eugenia C. South
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - David A. Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raina M. Merchant
- Center for Digital Health, Penn Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Ontiri S, Kabue M, Biesma R, Stekelenburg J, Gichangi P. Assessing quality of family planning counseling and its determinants in Kenya: Analysis of health facility exit interviews. PLoS One 2021; 16:e0256295. [PMID: 34506509 PMCID: PMC8432739 DOI: 10.1371/journal.pone.0256295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background Available evidence suggests that provision of quality of care in family planning services is crucial to increasing uptake and continuation of use of contraception. Kenya achieved a modern contraceptive prevalence rate of 60% in 2018, surpassing its 2020 target of 58%. With the high prevalence, focus is geared towards improved quality of family planning services. The objective of this study is to examine the quality of family planning counseling and its associated factors in health facilities in Kenya. Methods We conducted a secondary analysis of the 2019 Kenya Performance Monitoring and Action, client exit data of women who had received family planning services. Quality of counseling was assessed using the Method Information Index Plus. We conducted a multivariable ordinal logistic regression analysis of data from 3,731 women to establish determinants of receiving quality family planning services. Results The Method Information Index Plus score for higher-quality counseling was 56.7%, lower-quality counseling 32.4%, and no counseling 10.9%. Women aged 15–24 years (aOR = 0.69, 95% CI = 0.56–0.86, p = 0.001) had lower odds of receiving better counseling compared to women aged 35 years and above. Those with no education (aOR = 0.52, 95% CI = 0.33–0.82, p = 0.005), primary (aOR = 0.56, 95% CI = 0.44–0.71, p<0.001) and secondary (aOR = 0.79, 95% CI = 0.65–0.98, p = 0.028) were less likely to receive better counseling compared to those with tertiary education. Women who received long acting and reversible contraception methods (aOR = 1.75, 95% CI = 1.42–2.17, p<0.001), and those who were method switchers (aOR = 1.24, 95% CI = 1.03–1.50, p = 0.027), had a higher likelihood of receiving better quality of counseling as compared to those on short-term methods and those who were continuers, respectively. Conclusion The quality of family planning counseling in Kenya is still sub-optimal considering that some women receive no form of counseling at service delivery point. There is need to review the existing FP guidelines and training packages to increase focus on the quality of counseling services offered by health providers. Social accountability strategies that empower women to demand quality services should be included in community-level family planning interventions.
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Affiliation(s)
- Susan Ontiri
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Mark Kabue
- Department of Monitoring Evaluation and Research, Jhpiego, Johns Hopkins University Affiliate, Nairobi, Kenya
| | - Regien Biesma
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences/Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Peter Gichangi
- Department of Research, Technical University of Mombasa, Mombasa, Kenya
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium
- International Centre for Reproductive Health Kenya (ICRH-K), Mombasa, Kenya
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Ngugi P, Babic A, Were MC. A multivariate statistical evaluation of actual use of electronic health record systems implementations in Kenya. PLoS One 2021; 16:e0256799. [PMID: 34492070 PMCID: PMC8423313 DOI: 10.1371/journal.pone.0256799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Health facilities in developing countries are increasingly adopting Electronic Health Records systems (EHRs) to support healthcare processes. However, only limited studies are available that assess the actual use of the EHRs once adopted in these settings. We assessed the state of the 376 KenyaEMR system (national EHRs) implementations in healthcare facilities offering HIV services in Kenya. Methods The study focused on seven EHRs use indicators. Six of the seven indicators were programmed and packaged into a query script for execution within each KenyaEMR system (KeEMRs) implementation to collect monthly server-log data for each indicator for the period 2012–2019. The indicators included: Staff system use, observations (clinical data volume), data exchange, standardized terminologies, patient identification, and automatic reports. The seventh indicator (EHR variable Completeness) was derived from routine data quality report within the EHRs. Data were analysed using descriptive statistics, and multiple linear regression analysis was used to examine how individual facility characteristics affected the use of the system. Results 213 facilities spanning 19 counties participated in the study. The mean number of authorized users who actively used the KeEMRs was 18.1% (SD = 13.1%, p<0.001) across the facilities. On average, the volume of clinical data (observations) captured in the EHRs was 3363 (SD = 4259). Only a few facilities(14.1%) had health data exchange capability. 97.6% of EHRs concept dictionary terms mapped to standardized terminologies such as CIEL. Within the facility EHRs, only 50.5% (SD = 35.4%, p< 0.001) of patients had the nationally-endorsed patient identifier number recorded. Multiple regression analysis indicated the need for improvement on the mode of EHRs use of implementation. Conclusion The standard EHRs use indicators can effectively measure EHRs use and consequently determine success of the EHRs implementations. The results suggest that most of the EHRs use areas assessed need improvement, especially in relation to active usage of the system and data exchange readiness.
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Affiliation(s)
- Philomena Ngugi
- Department of Information Science and Media studies, University of Bergen, Bergen, Norway
- Institute of Biomedical Informatics, Moi University, Eldoret, Kenya
- * E-mail:
| | - Ankica Babic
- Department of Information Science and Media studies, University of Bergen, Bergen, Norway
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Martin C. Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
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King JJC, Powell-Jackson T, Makungu C, Spieker N, Risha P, Mkopi A, Goodman C. Effect of a multifaceted intervention to improve clinical quality of care through stepwise certification (SafeCare) in health-care facilities in Tanzania: a cluster-randomised controlled trial. Lancet Glob Health 2021; 9:e1262-e1272. [PMID: 34363766 PMCID: PMC8370880 DOI: 10.1016/s2214-109x(21)00228-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Quality of care is consistently shown to be inadequate in health-care settings in many low-income and middle-income countries, including in private facilities, which are rapidly growing in number but often do not have effective quality stewardship mechanisms. The SafeCare programme aims to address this gap in quality of care, using a standards-based approach adapted to low-resource settings, involving assessments, mentoring, training, and access to loans, to improve clinical quality and facility business performance. We assessed the effect of the SafeCare programme on quality of patient care in faith-based and private for-profit facilities in Tanzania. METHODS In this cluster-randomised controlled trial, health facilities were eligible if they were dispensaries, health centres, or hospitals in the faith-based or private for-profit sectors in Tanzania. We randomly assigned facilities (1:1) using computer-generated stratified randomisation to receive the full SafeCare package (intervention) or an assessment only (control). Implementing staff and participants were masked to outcome measurement and the primary outcomes were measured by fieldworkers who had no knowledge of the study group allocation. The primary outcomes were health worker compliance with infection prevention and control (IPC) practices as measured by observation of provider-patient interactions, and correct case management of undercover standardised patients at endline (after a minimum of 18 months). Analyses were by modified intention to treat. The trial is registered with ISRCTN, ISRCTN93644888. FINDINGS Between March 7 and Nov 30, 2016, we enrolled and randomly assigned 237 health facilities to the intervention (n=118) or control (n=119). Nine facilities (seven intervention facilities and two control facilities) closed during the trial and were not included in the analysis. We observed 29 608 IPC indications in 5425 provider-patient interactions between Feb 7 and April 5, 2018. Health facilities received visits from 909 standardised patients between May 3 and June 12, 2018. Intervention facilities had a 4·4 percentage point (95% CI 0·9-7·7; p=0.015) higher mean SafeCare standards assessment score at endline than control facilities. However, there was no evidence of a difference in clinical quality between intervention and control groups at endline. Compliance with IPC practices was observed in 8181 (56·9%) of 14 366 indications in intervention facilities and 8336 (54·7%) of 15 242 indications in control facilities (absolute difference 2·2 percentage points, 95% CI -0·2 to -4·7; p=0·071). Correct management occurred in 120 (27·0%) of 444 standardised patients in the intervention group and in 136 (29·2%) of 465 in the control group (absolute difference -2·8 percentage points, 95% CI -8·6 to -3·1; p=0·36). INTERPRETATION SafeCare did not improve clinical quality as assessed by compliance with IPC practices and correct case management. The absence of effect on clinical quality could reflect a combination of insufficient intervention intensity, insufficient links between structural quality and care processes, scarcity of resources for quality improvement, and inadequate financial and regulatory incentives for improvement. FUNDING UK Health Systems Research Initiative (Medical Research Council, Economic and Social Research Council, UK Department for International Development, Global Challenges Research Fund, and Wellcome Trust).
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Affiliation(s)
| | | | | | | | - Peter Risha
- PharmAccess Tanzania, Dar es Salaam, Tanzania
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Akerele A, Uba B, Aduloju M, Etamesor S, Umar JA, Adeoye OB, Enyojo A, Josiah F, Ayandipo E, Olaoye I, Adegoke OJ, Sidney S, Bagana M, Bassey O, Ghiselli ME, Ndadilnasiya W, Bolu O, Shuaib F. Improving routine immunization data quality using daily short message system reporting platform: An experience from Nasarawa state, Nigeria. PLoS One 2021; 16:e0255563. [PMID: 34411136 PMCID: PMC8376034 DOI: 10.1371/journal.pone.0255563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.
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Affiliation(s)
| | - Belinda Uba
- African Field Epidemiology Network, Abuja, Nigeria
| | | | | | - Jamila A. Umar
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | - Ameh Enyojo
- African Field Epidemiology Network, Abuja, Nigeria
| | | | | | - Itse Olaoye
- African Field Epidemiology Network, Abuja, Nigeria
| | | | - Sampson Sidney
- Sydani Initiative for International Development, Abuja, Nigeria
| | - Murtala Bagana
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Okposen Bassey
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Omotayo Bolu
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Tamene A. What it takes to save lives: An assessment of water, sanitation, and hygiene facilities in temporary COVID-19 isolation and treatment centers of Southern Ethiopia: A mixed-methods evaluation. PLoS One 2021; 16:e0256086. [PMID: 34388184 PMCID: PMC8362949 DOI: 10.1371/journal.pone.0256086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 07/31/2021] [Indexed: 12/13/2022] Open
Abstract
Background Quality water, sanitation, and hygiene facilities act as barricades to the transmission of COVID-19 in health care facilities. These facilities ought to also be available, accessible, and functional in temporary treatment centers. Despite numerous studies on health care facilities, however, there is limited information on the status of WASH facilities in such centers. Methods The assessment of health care facilities for the COVID-19 response checklist and key informant interviews, were used for data collection. 35 treatment centers in Southern Ethiopia were surveyed. Eightkey informants were interviewed to gain an understanding of the WASH conditions in the treatment centers. The Quantitative data was entered using EPI-INFO 7 and exported to SPSS 20 for analysis. Results are presented using descriptive statistics. Open Code 4.02 was used for the thematic analysis of the qualitative data. Results Daily water supply interruptions occurred at 27 (77.1%) of the surveyed sites. Only 30 (85.72%) had bathrooms that were segregated for personnel and patients, and only 3 (3.57%) had toilets that were handicapped accessible. 20(57.2%) of the treatment centers did not have a hand hygiene protocol that satisfied WHO guidelines. In terms of infection prevention and control, 16 (45.71%) of the facilities lacked adequate personal protective equipment stocks. Between urban and rural areas, there was also a significant difference in latrine maintenance, hand hygiene protocol design and implementation, and incineration capacity. Conclusion The results reveal crucial deficiencies in the provision of WASH in the temporary COVID-19 treatment centers. Efforts to improve WASH should offer priority to hygiene service interventions to minimize the risk of healthcare-acquired infections. The sustainable provision of hygiene services, such as hand washing soap, should also be given priority.
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Affiliation(s)
- Aiggan Tamene
- Environmental Health Unit, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossaena, Ethiopia
- * E-mail:
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Shitu S, Adugna G, Abebe H. Occupational exposure to blood/body fluid splash and its predictors among midwives working in public health institutions at Addis Ababa city Ethiopia, 2020. Institution-based cross-sectional study. PLoS One 2021; 16:e0251815. [PMID: 34143794 PMCID: PMC8213160 DOI: 10.1371/journal.pone.0251815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/03/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Blood/body fluid splash are hazards to health care professionals in their working area. Around twenty bloodborne pathogens are known to be transmitted through these occupational injuries. This problem alters the health status of health care professionals in different ways, including physically, mentally, and psychologically. Even though health professionals especially midwives who are working in delivery rooms are highly affected, little is known about the exposure. So, this study was aimed to assess the prevalence of exposure to blood/body fluid splash and its predictors among midwives working in public health institutions of Addis Ababa city. METHODS Institution based cross-sectional study was conducted among 438 study participants in public health institutions in Addis Ababa. Data was collected from March 1-20, 2020 by a self-administered questionnaire. The data were entered into Epi data version 3.1 and then exported to SPSS version 24 for analysis. All variables with P<0.25 in the bivariate analysis were included in a final model and statistical significance was declared at P< 0.05. RESULTS In this study, a total of 424 respondents respond yielding a response rate of 97%. The prevalence of blood and body fluid splashes (BBFs) was 198 (46.7%). Not training on infection prevention, working in two shifts (> 12 hours), not regularly apply universal precautions, job-related stress, an average monthly salary of 5001-8000 were independent predictors of blood and body fluid splashes. CONCLUSION The study revealed that nearly half of midwives were exposed to BBFS. This highlights the need for key stakeholders such as policymakers and service providers to design appropriate policies to avert this magnitude and making the environment enabling to comply with standard precautions. We recommend that this study may be done by including rural setting institutions and by including other health professionals that are susceptible to BBFS at work. Formal training on infection prevention and safety practice to apply universal precautions will be needed from the concerned bodies to prevent exposures to blood/body fluid splash.
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Affiliation(s)
- Solomon Shitu
- Department of Midwifery, Wolkite University College of Health and Medical Sciences, Wolkite University, Wolkite, Ethiopia
| | - Getachew Adugna
- City Health Offices, Addis Ababa City Health Departments, Addis Ababa, Ethiopia
| | - Haimanot Abebe
- Department of Public Health, Wolkite University College of Health and Medical Sciences, Wolkite University, Wolkite, Ethiopia
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Aleanizy FS, Alqahtani FY. Awareness and knowledge of COVID-19 infection control precautions and waste management among healthcare workers: Saudi cross-sectional study. Medicine (Baltimore) 2021; 100:e26102. [PMID: 34032750 PMCID: PMC8154457 DOI: 10.1097/md.0000000000026102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
Healthcare workers (HWs) perform a critical role not only in the clinical management of patients but also in providing adequate infection control and prevention measures and waste management procedures to be implemented in healthcare facilities. The aim of this study was to evaluate the awareness and knowledge of COVID-19 infection control precautions and waste management procedures among HWs in Saudi Arabian hospitals.This was a descriptive, cross-sectional study. Information on knowledge, awareness, and practice of infection control and waste management procedures were obtained from the HWs using a structured questionnaire. A thematic analysis was used to analyze the data.Our findings indicated that most of the study participants were knowledgeable, with a mean score of 78.3%. In total, 92.5%, 90.3%, and 91.7% of the participants were aware of the infection control precautions, COVID-19 waste management procedures, the availability of infection control supplies, respectively. HWs' Knowledge regarding waste management and infection control procedures correlated significantly with sex (P ≤ .001 and <.001), education (P = .024 and .043), and working experience (P = .029 and .009), respectively.Most participants appreciated the importance of their role in infection control, surveillance, and monitoring of the ongoing safety practices in their patients as well as their facilities and communities.
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Graham WJ, Okomo U, Gon G, Aiken AM. Cleaning Neonatal Units in Low-resource Settings: A Hot-topic in Waiting? Pediatr Infect Dis J 2021; 40:S1-S4. [PMID: 34042903 DOI: 10.1097/inf.0000000000002927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Globally, about 3-quarters of births now occur in healthcare facilities, with the proportion being 50% for sub-Saharan Africa, where healthcare-associated infections among newborns are typically 3-20 times higher than in facilities in high-income countries. As this upward trend in institutional deliveries continues, the demand for specialized neonatal care also rises, with dedicated units often only available in tertiary referral hospitals in the case of low- and middle-income countries. Preventing nosocomial infections among vulnerable newborns requires effective and feasible control strategies and interventions. The role of cleaning and cleaners in reducing risks and maintaining a clean safe environment has until very recently been neglected at policy, program, practice, and research levels. There is now an opportunity to reposition cleaning within global and national initiatives related to Water, Sanitation and Hygiene, Infection Prevention and Control, and Antimicrobial Resistance. The evidence base should also be strengthened on cost-effective bundles of cleaning interventions, particularly in the context of low-resource settings. Here increasing overcrowding and shortages of staff and supplies present major threats to neonatal survival and well-being and heighten the case for optimizing the use of low-cost, back-to-basics interventions like cleaning.
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Affiliation(s)
- Wendy J Graham
- From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giorgia Gon
- From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alexander M Aiken
- From the Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Imperial College Healthcare NHS Trust, United Kingdom
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Komolafe AO, Olowokere AE, Irinoye OO. Assessment of integration of emergency obstetric and newborn care in maternal and newborn care in healthcare facilities in Osun State, Nigeria. PLoS One 2021; 16:e0249334. [PMID: 33857184 PMCID: PMC8049269 DOI: 10.1371/journal.pone.0249334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 03/16/2021] [Indexed: 11/18/2022] Open
Abstract
The integration of emergency obstetric and newborn care (EmONC) into maternal and newborn care is essential for its effectiveness to avert preventable maternal and newborn deaths in healthcare facilities. This study used a theory-oriented quantitative approach to document the reported extent of EmONC integration, and its relationship with EmONC training, guidelines availability and level of healthcare facility. A descriptive cross-sectional study was conducted among five hundred and five (505) healthcare providers and facility managers across the three levels of healthcare delivery. An adapted questionnaire from NoMad instrument was used to collect data on the integration of EmONC from the study participants. Ethical approval was obtained and informed consents taken from the participants. Both descriptive (frequency, percentage, mean and median) and inferential analyses (Kruskal Wallis and Mann Whitney tests) were done with statistical significance level of p<0.05 using STATA 14. The mean age of respondents was 38.68±8.27. The results showed that the EmONC integration median score at the three levels of healthcare delivery was high (77 (IQR = 83–71)). The EmONC integration median score were 76 (IQR = 84–70), 76 (IQR = 80–68) and 78 (IQR = 84–74) in the primary, secondary and tertiary healthcare facilities respectively. Integration of EmONC was highest (83 (IQR = 87–78)) among healthcare providers who had EmONC training and also had EmONC guidelines made available to them. There were significant differences in EmONC integration at the three levels of healthcare delivery (p = 0.046), among healthcare providers who had EmONC training and those with EmONC guidelines available in their maternity units (p = 0.001). EmONC integration was reportedly high and significantly associated with EmONC training and availability of guidelines. However, the congruence of reported and actual extent of integration of EmONC at the three levels of healthcare delivery still need validation as such would account for the implementation success and maternal-neonatal outcomes.
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Vlot-van Anrooij K, Naaldenberg J, Hilgenkamp TIM, Vaandrager L, van der Velden K, Leusink GL. Towards healthy settings for people with intellectual disabilities. Health Promot Int 2021; 35:661-670. [PMID: 31243433 PMCID: PMC7414853 DOI: 10.1093/heapro/daz054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
People with intellectual disabilities (ID) depend on their environment for support to live healthily. The characteristics of healthy settings for people with ID are unknown. This study aims to conceptualize healthy settings for people with ID by conducting an international and multidisciplinary concept mapping study. As theoretical framework the settings approach, an ecological model with a whole system focus toward health promotion, was used. The integrative mixed-methods approach of this study involved concept mapping with researchers specialized in healthcare for people with ID and researchers specialized in healthy settings. The 41 participants generated statements that were later sorted and rated. Findings encompass 13 clusters relating to the social environment, the physical environment and societal preconditions. Specific factors of healthy settings for people with ID include: (i) universal design of the physical environment, (ii) the role of care professionals in the social environment to empower people with ID, (iii) possibilities for care providers to contribute to a health-promoting setting and (iv) preconditions that allow people to engage in society. These factors can be used in strategies to apply the approach in practice and give directions to put in place policies on developing enabling environments and decreasing health inequities.
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Affiliation(s)
- Kristel Vlot-van Anrooij
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Corresponding author. E-mail:
| | - J Naaldenberg
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - T I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - L Vaandrager
- Department of Social Sciences, Health and Society, Wageningen University, PO Box 8130, 6706 KN Wageningen, The Netherlands
| | - K van der Velden
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - G L Leusink
- Department of Primary and Community Care, Research group Intellectual Disabilities and Health, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Blasini AW, Waiswa P, Wanduru P, Amutuhaire L, Moyer CA. "Even when people live just across the road…they won't go": Community health worker perspectives on incentivized delays to under-five care-seeking in urban slums of Kampala, Uganda. PLoS One 2021; 16:e0244891. [PMID: 33770087 PMCID: PMC7997045 DOI: 10.1371/journal.pone.0244891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Although under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala’s informal settlements are still dying despite living in close proximity to nearby health facilities. Methods This exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework. Results 20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs’ perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as “incentivized delays” to care-seeking. Discussion This study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support.
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Affiliation(s)
- Amy W. Blasini
- University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda
- * E-mail:
| | - Peter Waiswa
- Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Phillip Wanduru
- Department of Health Policy, Planning, and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Lucky Amutuhaire
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Cheryl A. Moyer
- Departments of Learning Health Sciences and OB/GYN, University of Michigan, Ann Arbor, Michigan, United States of America
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Dewau R, Mekonnen TC, Tadesse SE, Muche A, Bogale GG, Tadesse Amsalu E. Knowledge and practice of clients on preventive measures of COVID-19 pandemic among governmental health facilities in South Wollo, Ethiopia: A facility-based cross-sectional study. PLoS One 2021; 16:e0247639. [PMID: 33647034 PMCID: PMC7920351 DOI: 10.1371/journal.pone.0247639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/10/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Coronavirus-19 is a global health challenge and need an immediate action. Thus, understanding client's knowledge about SARS-COV2 causes, roots of transmissions, and prevention strategies are urgently warranted. Although there were global studies reported knowledge and preventive practices of COVID-19, but the information is not representative and inclusive for Ethiopia. Thus, the current study is done to identify the knowledge and the prevention strategies for COVID-19 among clients in South Wollo, Ethiopia. METHODS An institutional based cross-sectional study was conducted from May 21 to 30, 2020 among clients seeking service in Dessie town health facilities. A total of 81 clients were included from the selected health facilities with simple random sampling technique. We developed measuring tools by adopting from World Health Organization and center for disease prevention recommendation manual for assessing service providers' knowledge and preventive practices. For data entry Epi-data 3.1 version was employed and further data management and analysis was performed using STATA Version 14. Student T-test and one way ANOVA were computed to see the mean difference in knowledge and practice between and among the group. Chi-square test was also done to portray the presence of association between different co-variants with client's knowledge and preventive practices. RESULTS Findings of the study showed that more than half (56.8%) of the participants had good knowledge about its symptoms, way of spread and prevention of the virus. Furthermore, 65.4% of clients demonstrated five or more preventive practice measures of COVID-19. The mean preventive practice score with standard deviation was (4.75±1.28 from 6 components). In the current study, knowledge had no significant difference among sex, education status, and monthly income. However, COVID-19 transmission knowledge was significantly higher among urban residents. Thus, clients who were knowledgeable about way of transmission and symptoms of COVID-19 had significantly higher COVID-19 preventive practice. CONCLUSION Our findings revealed that clients' knowledge and preventive practice of COVID-19 were not optimal. Clients with good knowledge and urban residents had practiced better prevention measures of the pandemic, signifying that packages and programs directed in enhancing knowledge about the virus is useful in combating the pandemic and continuing safe practices.
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Affiliation(s)
- Reta Dewau
- Department of Epidemiology and Biostatistics, school of public health, College of Medicine and Health sciences, Wollo University, Dessie, Ethiopia
| | - Tefera Chane Mekonnen
- Department of nutrition and dietetics, school of public health, College of Medicine and Health sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Eshete Tadesse
- Department of nutrition and dietetics, school of public health, College of Medicine and Health sciences, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- Department of Epidemiology and Biostatistics, school of public health, College of Medicine and Health sciences, Wollo University, Dessie, Ethiopia
| | - Getahun Gebre Bogale
- Department of Health informatics, school of public health, College of Medicine and Health sciences, Wollo University, Dessie, Ethiopia
| | - Erkihun Tadesse Amsalu
- Department of Epidemiology and Biostatistics, school of public health, College of Medicine and Health sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
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Mohammed SA, Workneh BD, kahissay MH. Knowledge, attitude and practice of vaccinators and vaccine handlers on vaccine cold chain management in public health facilities, Ethiopia: Cross-sectional study. PLoS One 2021; 16:e0247459. [PMID: 33630946 PMCID: PMC7906400 DOI: 10.1371/journal.pone.0247459] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Effective management of the vaccine cold chain system at all levels is one of the crucial factors for maintaining vaccine potency. Vaccines require more complex handling and storage requirements due to increased temperature sensitivity and complicated immunization schedules. This urges adequate knowledge, attitude, and practice. This study assessed the knowledge, attitude, and practice of vaccinators and vaccine handlers' in public health facilities. METHODOLOGY An institutional-based cross-sectional study design was used to assess the knowledge, attitude, and practice of 127 vaccinators and vaccine handlers in public health facilities of Oromia Special Zone, from September 1 to 30, 2019. Data were collected using self-administered questionnaires and a structured observation checklist. Descriptive and inferential statistics were made using the statistical package for social sciences version 20. Variables with a p-value <0.05 were taken as statistically significant. RESULT The response rate was (96.94%). Sixty-eight (53.5%; 95% CI: 46.5%, 61.4%), 58 (45.7%; 95% CI: 37.8%, 53.5%) and 62 (48.8%: 95% CI; 41.7%, 56.7%) vaccinators and vaccine handlers had satisfactory knowledge, positive attitude and good practice respectively. Receiving training on cold chain management had a statistically significant association with the level of knowledge on cold chain management (AOR = 3.04, 95% CI: 1.04-8.88). CONCLUSIONS More than half of vaccinators and vaccine handlers had satisfactory knowledge, while below half of vaccinators and vaccine handlers had a positive attitude and good practice. The determinants of knowledge in cold chain management were receiving training on cold chain management. Providing regular technical support and on the job training on vaccine cold chain management will improve the knowledge, attitude, and practice of vaccinators and vaccine handlers.
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Affiliation(s)
- Solomon Ahmed Mohammed
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mesfin Haile kahissay
- Department of Pharmacy, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Ndagire E, Kawakatsu Y, Nalubwama H, Atala J, Sarnacki R, Pulle J, Kyarimpa R, Mwima R, Kansiime R, Okello E, Lwabi P, Beaton A, Sable C, Watkins D. Examining the Ugandan health system's readiness to deliver rheumatic heart disease-related services. PLoS Negl Trop Dis 2021; 15:e0009164. [PMID: 33591974 PMCID: PMC7909659 DOI: 10.1371/journal.pntd.0009164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/26/2021] [Accepted: 01/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In 2018, the World Health Assembly mandated Member States to take action on rheumatic heart disease (RHD), which persists in countries with weak health systems. We conducted an assessment of the current state of RHD-related healthcare in Uganda. METHODOLOGY/PRINCIPAL FINDINGS This was a mixed-methods, deductive simultaneous design study conducted in four districts of Uganda. Using census sampling, we surveyed health facilities in each district using an RHD survey instrument that was modeled after the WHO SARA tool. We interviewed health workers with experience managing RHD, purposively sampling to ensure a range of qualification and geographic variation. Our final sample included 402 facilities and 36 health workers. We found major gaps in knowledge of clinical guidelines and availability of diagnostic tests. Antibiotics used in RHD prevention were widely available, but cardiovascular medications were scarce. Higher levels of service readiness were found among facilities in the western region (Mbarara district) and private facilities. Level III health centers were the most prepared for delivering secondary prevention. Health worker interviews revealed that limited awareness of RHD at the district level, lack of diagnostic tests and case management registries, and absence of clearly articulated RHD policies and budget prioritization were the main barriers to providing RHD-related healthcare. CONCLUSIONS/SIGNIFICANCE Uganda's readiness to implement the World Health Assembly RHD Resolution is low. The forthcoming national RHD strategy must focus on decentralizing RHD diagnosis and prevention to the district level, emphasizing specialized training of the primary healthcare workforce and strengthening supply chains of diagnostics and essential medicines.
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Affiliation(s)
- Emma Ndagire
- Uganda Heart Institute, Kampala, Uganda
- Children’s National Hospital, Division of Cardiology, Washington, District of Columbia, United States of America
| | - Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | | | - Rachel Sarnacki
- Children’s National Hospital, Division of Cardiology, Washington, District of Columbia, United States of America
| | | | | | | | | | | | | | - Andrea Beaton
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Craig Sable
- Children’s National Hospital, Division of Cardiology, Washington, District of Columbia, United States of America
- George Washington University School of Medicine, Washington, District of Columbia, United States of America
| | - David Watkins
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Division of General Internal Medicine, University of Washington, Seattle, Washington, United States of America
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Abstract
Sustainable Development Goal 3.1 calls for a reduction of the maternal mortality ratio to less than 70 per 100,000 live births by 2030. The most important cause of maternal mortality is post-partum haemorrhage (PPH). Oxytocin injections and misoprostol tablets are medicines of first choice for the management of PPH in low- and middle-income countries (LMICs). Unfortunately, both substances are chemically unstable, and previous studies have revealed serious quality problems of these medicines in LMICs. The present study is the first report on their quality in Rwanda. From 40 randomly selected health facilities (hospitals, health centers, retail pharmacies and private clinics) in different parts of Rwanda, as well as from six wholesalers and government stores, oxytocin injections and misoprostol tablets were collected. Oxytocin storage temperatures in the health facilities were monitored for six months using temperature data loggers, and found to correctly follow the storage requirements stated by the manufacturers (2–8°C, or room temperature) with few minor deviations. Oxytocin injections (57 samples, representing seven batches of four brands) were tested for their oxytocin content and pH value according to the United States Pharmacopeia. Twenty-four samples from three European manufacturers passed all tests. However, all nine samples of one batch of a Chinese manufacturer showed an excessive content of oxytocin (range 117.2–121.5% of the declared amount). Another batch of the same manufacturer showed extreme variations of the concentration of the preservative benzyl alcohol. Misoprostol tablets (25 samples, representing ten batches of six brands) were tested for content and dissolution according to the International Pharmacopoeia. Fifteen samples passed, but all 10 samples of two brands from India failed with extreme deviations, containing only 42.5–48.7% of the stated amount of misoprostol. In conclusion, oxytocin quality in Rwanda was better than reported from other African countries. However, two extremely substandard brands of misoprostol tablets were found. The Rwandan authorities reacted quickly and efficiently, and recalled these substandard medicines from the market. For oxytocin and misoprostol, with their well-known problems of quality and stability, procurement should possibly be restricted to medicines which are WHO-prequalified or which have been manufactured in countries with stringent regulatory authorities.
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Affiliation(s)
- Thomas Bizimana
- Department of Pharmacy, School of Medicine and Pharmacy, College of Medicine and Health Sciences (CMHS), University of Rwanda, Kigali, Rwanda
| | - Nhomsai Hagen
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Gesa Gnegel
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Pierre Claver Kayumba
- East African Community Regional Centre of Excellence for Vaccines, Immunizations and Health Supply Chain Management (EAC RCE-VIHSCM), University of Rwanda, Kigali, Rwanda
| | - Lutz Heide
- Pharmaceutical Institute, Eberhard Karls University Tübingen, Tübingen, Germany
- * E-mail:
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Adebisi YA, Ekpenyong A, Ntacyabukura B, Lowe M, Jimoh ND, Abdulkareem TO, Lucero-Prisno DE. COVID-19 Highlights the Need for Inclusive Responses to Public Health Emergencies in Africa. Am J Trop Med Hyg 2020; 104:449-452. [PMID: 33331263 PMCID: PMC7866309 DOI: 10.4269/ajtmh.20-1485] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/04/2020] [Indexed: 12/03/2022] Open
Abstract
COVID-19 is a global public health emergency affecting many countries around the world. Although African governments and other stakeholders are making efforts to contain the pandemic, the outbreak continues to impact human rights and exacerbates inequalities and disparities that are already in existence. The concept of inclusive health focuses on good health and well-being for everyone, and this entails health services that are equitable, affordable, and efficacious. Creating equitable access to mainstream health and healthcare services and ensuring inclusive health responses remain a means of addressing health inequities and disparities. In this article, we argue on the need for inclusive responses to public health emergencies in Africa using COVID-19 as a case example. Africa's response to public health emergencies needs to recognize that for every marginalized/vulnerable group, it is important to strategize to address their particular needs in such a way to surmount any barrier to the right to health. For Africa's public health response to be more inclusive, we therefore need to be more strategic and proactive in reaching out to specific groups and to identify and address their needs. Strengthening the healthcare systems of African countries through increased political will, increased funding to health care, collaboration and cooperation among stakeholders, and effective leadership remains essential in ensuring inclusive responses to health emergencies.
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Affiliation(s)
| | - Aniekan Ekpenyong
- Global Health Policy Unit, University of Edinburgh, Scotland, United Kingdom
| | | | - Mat Lowe
- Society for the Study of Women’s Health (SSWH), Old Yundum, Gambia
| | | | - Toyyib Oladimeji Abdulkareem
- Institute of Health, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Aljabo A, Mueller E, Abdul-Azeez D, Hoare T, Jain A. Gravity steam reprocessing in healthcare facilities for the reuse of N95 respirators. J Hosp Infect 2020; 106:698-708. [PMID: 33017616 PMCID: PMC7530561 DOI: 10.1016/j.jhin.2020.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has significantly impacted the health of millions of people around the world. The shortage of personal protective equipment, including N95 respirators, in hospital facilities has put frontline healthcare professionals at high risk for contracting this virus. AIM To develop a reproducible and safe N95 respirator reprocessing method that satisfies all presented regulatory standards and that can be directly implemented by hospitals using existing available equipment. METHODS A non-toxic gravity steam reprocessing method has been developed for the reuse of N95 respirators consisting of 30 min of steam treatment at 121°C followed by 30 min of heat drying. Samples of model number 1860, 1860s, 1870+, and 9105 N95 respirators were either collected from hospitals (for microbiology testing) or purchased new (for functionality testing), with all functionality tests (i.e. filter efficiency, fit evaluation, and strap integrity) performed at the Centers for Disease Control and Prevention using standard procedures established by the National Institute for Occupational Safety and Health. FINDINGS All tested models passed the minimum filter efficiency of 95% after three cycles of gravity steam reprocessing. The 1870+ N95 respirator model is the most promising model for reprocessing based on its efficient bacterial inactivation coupled with the maintenance of all other key functional respirator properties after multiple reprocessing steps. CONCLUSIONS The gravity steam method can effectively reprocess N95 respirators over at least three reprocessing cycles without negatively impacting the functionality requirements set out by regulators. Enabling the reuse of N95 respirators is a crucial tool for managing both the current pandemic and future healthcare crises.
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Affiliation(s)
- A Aljabo
- SteriPro Canada, Inc., Mississauga, Ontario, Canada.
| | - E Mueller
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - D Abdul-Azeez
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - T Hoare
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - A Jain
- SteriPro Canada, Inc., Mississauga, Ontario, Canada
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Seiglie JA, Serván-Mori E, Begum T, Meigs JB, Wexler DJ, Wirtz VJ. Predictors of health facility readiness for diabetes service delivery in low- and middle-income countries: The case of Bangladesh. Diabetes Res Clin Pract 2020; 169:108417. [PMID: 32891691 PMCID: PMC8092080 DOI: 10.1016/j.diabres.2020.108417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
AIMS We aimed to evaluate the readiness and predictors of diabetes service capability at the level of primary care in Bangladesh as an illustrative instance of readiness for diabetes care in low- and middle-income countries (LMICs). METHODS We used data from the 2014 Bangladesh Health Facility Survey (BHFS), a cross-sectional, nationally representative survey (n = 1596 health facilities). We constructed a diabetes-specific readiness index to assess diabetes service readiness in facilities with outpatient capability and used multivariable regression analysis to evaluate contextual predictors of diabetes service readiness. RESULTS Three-hundred and forty-five facilities with outpatient and diabetes service capability were included. Mean readiness for diabetes service capability on a scale of 0-100 was 24.9 (95%CI: 20.8-28.9) and was lowest in rural settings, districts with high social deprivation, and public facilities, where diabetes diagnostic equipment and medications were largely unavailable. Facility type was the strongest, independent predictor of diabetes service readiness. CONCLUSIONS Diabetes service readiness in outpatient facilities in Bangladesh was low, particularly in public facilities, rural settings, and districts with high social deprivation. .These findings could inform policies aimed at improving diabetes care in areas of high unmet need and may serve as a model to assess diabetes service readiness in other LMICs.
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Affiliation(s)
- Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - James B Meigs
- Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Kanagasabai U, Singh A, Shiraishi RW, Ly V, Hy C, Sanith S, Srun S, Sansam S, SopHeap ST, Liu Y, Jones G, Ijeoma UC, Bock N, Benech I, Selenic D, Drammah B, Gadde R, Mili FD. Improving injection safety practices of Cambodian healthcare workers through training. PLoS One 2020; 15:e0241176. [PMID: 33126238 PMCID: PMC7599083 DOI: 10.1371/journal.pone.0241176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study evaluated the impact of a safe injection safety training on healthcare worker (HCW) practice and knowledge following an HIV outbreak in Roka commune, Cambodia. METHODS Surveys were conducted at baseline (September 2016) and seven months after a training intervention (March 2018) using the World Health Organization standardized injection practices assessment tool. HCWs were sampled at 15 purposively government health facilities in two provinces. HCWs were observed during injection practices and interviewed by trained experts from Becton-Dickinson and the Ministry of Health Cambodia. The Rao-Scott chi square test was used test for differences between baseline and follow-up. RESULTS We completed 115 observations of practice at baseline and 206 at post-training follow-up. The proportion of patients whose identification was confirmed by HCWs prior to procedure being performed increased from 40.4% to 98% (p <0.0001). The proportion of HCWs who practiced correct hand hygiene increased from 22.0% to 80.6% (p = 0.056) [therapeutic observations] and 17.2% to 63.4% (p = 0.0012) [diagnostic observations]. Immediate disposal of sharps by HCWs decreased from 96.5% to 92.5% (p = 0.0030). CONCLUSIONS We found significant improvements in the practice of patient identity confirmation and hand hygiene but not in the immediate disposal of sharps in the post-training intervention. However, findings are not representative of all HCWs in the country. Further pre-service and in-service training and monitoring are necessary to ensure sustained behavior change.
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Affiliation(s)
| | - Adarshpal Singh
- Becton, Dickinson and Company, Franklifn Lakes, NJ, United States of America
| | - Ray W. Shiraishi
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Vanthy Ly
- U.S. Centers for Disease Control and Prevention, Cambodia
| | - Chhaily Hy
- U.S. Centers for Disease Control and Prevention, Cambodia
| | - Sou Sanith
- Ministry of Health, Phnom Pehn, Cambodia
| | - Sok Srun
- Ministry of Health, Phnom Pehn, Cambodia
| | - Sim Sansam
- Ministry of Health, Phnom Pehn, Cambodia
| | | | - Yuliang Liu
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Gerald Jones
- Division of Health Informatics and Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, GA, United States of America
| | - Ugonna C. Ijeoma
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Naomi Bock
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Irene Benech
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Dejana Selenic
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Bakary Drammah
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Renuka Gadde
- Becton, Dickinson and Company, Franklifn Lakes, NJ, United States of America
| | - Fatima D. Mili
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
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Tan C, Kallon II, Colvin CJ, Grant AD. Barriers and facilitators of tuberculosis infection prevention and control in low- and middle-income countries from the perspective of healthcare workers: A systematic review. PLoS One 2020; 15:e0241039. [PMID: 33085717 PMCID: PMC7577501 DOI: 10.1371/journal.pone.0241039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/07/2020] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis remains a leading cause of death worldwide. Transmission is the dominant mechanism sustaining the multidrug-resistant tuberculosis epidemic. Tuberculosis infection prevention and control (TBIPC) guidelines for healthcare facilities are poorly implemented. This systematic review aimed to explore the barriers and facilitators of implementation of TBIPC guidelines in low- and middle-income countries from the perspective of healthcare workers. Two separate reviewers carried out an electronic database search to select qualitative and quantitative studies exploring healthcare workers attitudes towards TBIPC. Eligible studies underwent thematic synthesis. Derived themes were further organised into a macro-, meso- and micro-level framework, which allows us to analyse barriers at different levels of the healthcare system. We found that most studies focused on assessing implementation within facilities in accordance with the hierarchy of TBIPC measures—administrative, environmental and respiratory protection controls. TBIPC implementation was over-estimated by self-report compared with what researchers observed within facilities, indicating a knowledge-action gap. Macro-level barriers included the lack of coordination of integrated HIV/tuberculosis care, in the context of an expanding antiretroviral therapy programme and hence increasing opportunity for nosocomial acquisition of tuberculosis; a lack of funding; and ineffective occupational health policies, such as poor systems for screening for tuberculosis amongst healthcare workers. Meso-level barriers included little staff training to implement programmes, and managers not understanding policy sufficiently to translate it into an IPC programme. Most studies reported micro-level barriers including the impact of stigma, work culture, lack of perception of risk, poor supply and use of respirators and difficulty sensitising patients to the need for IPC. Existing literature on healthcare workers’ attitudes to TBIPC focusses on collecting data about poor implementation at facility level. In order to bridge the knowledge-action gap, we need to understand how best to implement policy, taking account of the context.
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Affiliation(s)
- Charlene Tan
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Idriss I. Kallon
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J. Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Epidemiology, Brown University, Providence, Rhode Island, United States of America
| | - Alison D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Africa Health Research Institute, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Lemma S, Janson A, Persson LÅ, Wickremasinghe D, Källestål C. Improving quality and use of routine health information system data in low- and middle-income countries: A scoping review. PLoS One 2020; 15:e0239683. [PMID: 33031406 PMCID: PMC7544093 DOI: 10.1371/journal.pone.0239683] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A routine health information system is one of the essential components of a health system. Interventions to improve routine health information system data quality and use for decision-making in low- and middle-income countries differ in design, methods, and scope. There have been limited efforts to synthesise the knowledge across the currently available intervention studies. Thus, this scoping review synthesised published results from interventions that aimed at improving data quality and use in routine health information systems in low- and middle-income countries. METHOD We included articles on intervention studies that aimed to improve data quality and use within routine health information systems in low- and middle-income countries, published in English from January 2008 to February 2020. We searched the literature in the databases Medline/PubMed, Web of Science, Embase, and Global Health. After a meticulous screening, we identified 20 articles on data quality and 16 on data use. We prepared and presented the results as a narrative. RESULTS Most of the studies were from Sub-Saharan Africa and designed as case studies. Interventions enhancing the quality of data targeted health facilities and staff within districts, and district health managers for improved data use. Combinations of technology enhancement along with capacity building activities, and data quality assessment and feedback system were found useful in improving data quality. Interventions facilitating data availability combined with technology enhancement increased the use of data for planning. CONCLUSION The studies in this scoping review showed that a combination of interventions, addressing both behavioural and technical factors, improved data quality and use. Interventions addressing organisational factors were non-existent, but these factors were reported to pose challenges to the implementation and performance of reported interventions.
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Affiliation(s)
- Seblewengel Lemma
- Department of Disease control, London School of Hygiene and Tropical Medicine, based at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Annika Janson
- Department of Disease control, London School of Hygiene and Tropical Medicine, based at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lars-Åke Persson
- Department of Disease control, London School of Hygiene and Tropical Medicine, based at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Deepthi Wickremasinghe
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carina Källestål
- Department of Disease control, London School of Hygiene and Tropical Medicine, based at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Kuupiel D. Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review. BMC Health Serv Res 2020; 20:911. [PMID: 33004029 PMCID: PMC7528345 DOI: 10.1186/s12913-020-05755-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA. METHODS We employed the Arskey and O'Malley's framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Out of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system. CONCLUSION This study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- University Clinic, Sunyani Technical University, Sunyani, Ghana
| | - Frederick I. Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- St. John of God College of Health, Duayaw Nkwanta, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Research for Sustainable Development Consult, Sunyani, Ghana
| | - Peter Ansu-Mensah
- Department of Secretaryship and Management Studies, Faculty of Business and Management Studies, Sunyani Technical University, Sunyani, Ghana
| | - Desmond Kuupiel
- Research for Sustainable Development Consult, Sunyani, Ghana
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001 South Africa
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Affiliation(s)
- Dr R B McFee
- Ellis Medical, Department of Emergency and Family Medicine.
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Darafsheh A, Lavvafi H, Taleei R, Khan R. Mitigating disruptions, and scalability of radiation oncology physics work during the COVID-19 pandemic. J Appl Clin Med Phys 2020; 21:187-195. [PMID: 32432389 PMCID: PMC7285927 DOI: 10.1002/acm2.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has led to disorder in work and livelihood of a majority of the modern world. In this work, we review its major impacts on procedures and workflow of clinical physics tasks, and suggest alternate pathways to avoid major disruption or discontinuity of physics tasks in the context of small, medium, and large radiation oncology clinics. We also evaluate scalability of medical physics under the stress of "social distancing". METHODS Three models of facilities characterized by the number of clinical physicists, daily patient throughput, and equipment were identified for this purpose. For identical objectives of continuity of clinical operations, with constraints such as social distancing and unavailability of staff due to system strain, however with the possibility of remote operations, the performance of these models was investigated. General clinical tasks requiring on-site personnel presence or otherwise were evaluated to determine the scalability of the three models at this point in the course of disease spread within their surroundings. RESULTS The clinical physics tasks within three models could be divided into two categories. The former, which requires individual presence, include safety-sensitive radiation delivery, high dose per fraction treatments, brachytherapy procedures, fulfilling state and nuclear regulatory commission's requirements, etc. The latter, which can be handled through remote means, include dose planning, physics plan review and supervision of quality assurance, general troubleshooting, etc. CONCLUSION: At the current level of disease in the United States, all three models have sustained major system stress in continuing reduced operation. However, the small clinic model may not perform if either the current level of infections is maintained for long or staff becomes unavailable due to health issues. With abundance, and diversity of innovative resources, medium and large clinic models can sustain further for physics-related radiotherapy services.
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Affiliation(s)
- Arash Darafsheh
- Department of Radiation OncologyWashington University School of MedicineSt. LouisMO63110USA
| | - Hossein Lavvafi
- William E. Kahlert Regional Cancer CenterWestminsterMD21157USA
| | - Reza Taleei
- Department of Radiation OncologySidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPA19107USA
| | - Rao Khan
- Department of Radiation OncologyWashington University School of MedicineSt. LouisMO63110USA
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Defar A, Getachew T, Taye G, Tadele T, Getnet M, Shumet T, Molla G, Gonfa G, Teklie H, Tadesse A, Bekele A. Quality antenatal care services delivery at health facilities of Ethiopia, assessment of the structure/input of care setting. BMC Health Serv Res 2020; 20:485. [PMID: 32487097 PMCID: PMC7268345 DOI: 10.1186/s12913-020-05372-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/27/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND According to the Donabedian model, the assessment for the quality of care includes three dimensions. These are structure, process, and outcome. Therefore, the present study aimed at assessing the structural quality of Antenatal care (ANC) service provision in Ethiopian health facilities. METHODS Data were obtained from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. The SARA was a cross-sectional facility-based assessment conducted to capture health facility service availability and readiness in Ethiopia. A total of 764 health facilities were sampled in the 9 regions and 2 city administrations of the country. The availability of equipment, supplies, medicine, health worker's training and availability of guidelines were assessed. Data were collected from October-December 2017. We run a multiple linear regression model to identify predictors of health facility readiness for Antenatal care service. The level of significance was determined at a p-value < 0.05. RESULT Among the selected health facilities, 80.5% of them offered Antenatal care service. However, the availability of specific services was very low. The availability of tetanus toxoid vaccination, folic acid, iron supplementation, and monitoring of hypertension disorder was, 67.7, 65.6, 68.6, and 75.1%, respectively. The overall mean availability among the ten tracer items that are necessary to provide quality Antenatal care services was 50%. In the multiple linear regression model, health centers, health posts and clinics scored lower Antenatal care service readiness compared to hospitals. The overall readiness index score was lower for private health facilities (β = - 0.047, 95% CI: (- 0.1, - 0.004). The readiness score had no association with the facility settings (Urban/Rural) (p-value > 0.05). Facilities in six regions except Dire Dawa had (β = 0.067, 95% CI: (0.004, 0.129) lower readiness score than facilities in Tigray region (p-value < 0.015). CONCLUSION This analysis provides evidence of the gaps in structural readiness of health facilities to provide quality Antenatal care services. Key and essential supplies for quality Antenatal care service provision were missed in many of the health facilities. Guaranteeing properly equipped and staffed facilities shall be a target to improve the quality of Antenatal care services provision.
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Affiliation(s)
- Atkure Defar
- Reproductive Health Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, University of Gondar, College of Medicine and Health Science, Institute of Public health, Gondar, Ethiopia
| | - Theodros Getachew
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Science, Institute of Public health, University of Gondar, Gondar, Ethiopia
| | - Girum Taye
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tefera Tadele
- Reproductive Health Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Misrak Getnet
- Reproductive Health Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tigist Shumet
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Gebeyaw Molla
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Geremew Gonfa
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Habtamu Teklie
- Reproductive Health Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ambaye Tadesse
- Health System Research Team, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Vanni C, Maurizi G, Rocco M, Rendina EA. A Dedicated Path to Emergent Thoracic Surgery in COVID-19 Patients: An Italian Institution Protocol. Ann Thorac Surg 2020; 110:e333-e334. [PMID: 32425203 PMCID: PMC7230136 DOI: 10.1016/j.athoracsur.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2020] [Indexed: 11/28/2022]
Abstract
The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic pointed out that the need to ensure emergent surgery in patients positive for infection is no longer hypothetical. Among emergency procedures, thoracic surgical operations are frequent. A standardized surgical pathway is mandatory to achieve effective and safe management of this subset of patients. We briefly present the protocol adopted by our thoracic surgery division.
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Affiliation(s)
- Camilla Vanni
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Monica Rocco
- Division of Anesthesiology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Liu Y, Kong Q, Wang S, Zhong L, van de Klundert J. The impact of hospital attributes on patient choice for first visit: evidence from a discrete choice experiment in Shanghai, China. Health Policy Plan 2020; 35:267-278. [PMID: 31830248 PMCID: PMC7152730 DOI: 10.1093/heapol/czz159] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 01/09/2023] Open
Abstract
The underutilization of primary care in urban China threatens the efficiency and effectiveness of the Chinese health system. To guide patient flow to primary care, the Chinese government has rolled out a sequence of health care reforms which improve the affordability, the infrastructure and workforce of the primary care system. However, these measures have not yielded the desired effect on the utilization of primary care, which is lowest in urban areas. It is unclear how the factors identified to influence facility choice in urban China are actually impacting choice behaviour. We conducted a discrete choice experiment to elicit the quantitative impact of facility attributes when choosing a health care facility for first visit and analysed how the stated choice varies with these attributes. We found that the respondents placed different weights on the identified attributes, depending on whether they perceived their condition to be minor or severe. For conditions perceived as minor, the respondents valued visit time, equipment and medical skill most. For conditions perceived as severe, they placed most importance on equipment, travel time and facility size. We found that for conditions perceived as minor, only 14% preferred visiting a facility over opting out, a percentage which would more than double to 37% if community health centres were maximally improved. For conditions perceived as severe, improvements in community health centres may almost double first visits to primary care, mostly from patients who would otherwise choose higher-level facilities. Our findings suggest that for both severity conditions, improvements to medical equipment and medical skill at community health centres in urban China can effectively direct patient flow to primary care and promote the efficiency and effectiveness of the urban health system.
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Affiliation(s)
- Yun Liu
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Qingxia Kong
- Rotterdam School of Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Shan Wang
- Lingnan College, Sun Yat-sen University, 135 Xingang Xi Road, J.T. Wu Hall 320, Guangzhou 510275, China
| | - Liwei Zhong
- School of Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, 650 Songjiang Road, Shanghai 201620, China
| | - Joris van de Klundert
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, the Netherlands
- Prince Mohammad Bin Salman College, 7682 Hejaz Boulevard, Unit No. 1, BayLaSun, King Abdullah Economic City 23965-2609, Kingdom of Saudi Arabia
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Afulani PA, Buback L, McNally B, Mbuyita S, Mwanyika-Sando M, Peca E. A Rapid Review of Available Evidence to Inform Indicators for Routine Monitoring and Evaluation of Respectful Maternity Care. Glob Health Sci Pract 2020; 8:125-135. [PMID: 32234844 PMCID: PMC7108935 DOI: 10.9745/ghsp-d-19-00323] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Some opportunities to routinely capture and improve respectful maternity care (RMC) during facility-based childbirth include quality improvement (QI) initiatives, community-based monitoring efforts through community score cards (CSC), and performance-based financing (PBF) initiatives. But there is limited guidance on which types of RMC indicators are best suited for inclusion in these initiatives. We sought to provide practical evidence-based recommendations on indicators that may be used for routine measurement of RMC in programs. METHODS We used a rapid review approach, which included (1) reviewing existing documents and publications to extract RMC indicators and identify which have or can be used in facility-based QI, CSCs, and PBF schemes; (2) surveying RMC and maternal health experts to rank indicators, and (3) analyzing survey data to select the most recommended indicators. RESULTS We identified 49 indicators spanning several domains of RMC and mistreatment including dignified/nondignified care, verbal and physical abuse, privacy/confidentiality, autonomy/loss of autonomy, supportive care/lack thereof, communication, stigma, discrimination, trust, facility environment/culture, responsiveness, and nonevidence-based care. Based on the analysis of the survey data, we recommend 33 indicators (between 2 and 6 indicators for each RMC domain) that may be suited for incorporation in both facility-based QI and CSC-related monitoring efforts. CONCLUSION Integrating RMC indicators into QI and CSC initiatives, as well as in other maternal and neonatal health programs, could help improve RMC at the facility and community level. More research is needed into whether RMC can be integrated into PBF initiatives. Integration of RMC indicators into programs to improve quality of care and other health system outcomes will facilitate routine monitoring and accountability around experience of care. Measurement and improvement of women's experiences will increase maternal health service utilization and improve quality of care as a means of reducing maternal and neonatal morbidity and mortality.
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Affiliation(s)
- Patience A Afulani
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Laura Buback
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Brienne McNally
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Emily Peca
- University Research Co., LLC, Chevy Chase, MD, USA
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Randell R, Alvarado N, McVey L, Ruddle RA, Doherty P, Gale C, Mamas M, Dowding D. Requirements for a quality dashboard: Lessons from National Clinical Audits. AMIA Annu Symp Proc 2020; 2019:735-744. [PMID: 32308869 PMCID: PMC7153077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Healthcare organizations worldwide use quality dashboards to provide feedback to clinical teams and managers, in order to monitor care quality and stimulate quality improvement. However, there is limited evidence regarding the impact of quality dashboards and audit and feedback research focuses on feedback to individual clinicians, rather than to clinical and managerial teams. Consequently, we know little about what features a quality dashboard needs in order to provide benefit. We conducted 54 interviews across five healthcare organizations in the National Health Service in England, interviewing personnel at different levels of the organization, to understand how national (UK) clinical audit data are used for quality improvement and factors that support or constrain use of these data. The findings, organized around the themes of choosing performance indicators, assessing performance, identifying causes, communicating from ward to board, and data quality, have implications for the design of quality dashboards, which we have translated into a series of requirements.
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