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Arsenault C, Wright K, Taddele T, Tadele A, Derseh Mebratie A, Tiruneh Tiyare F, Kosgei RJ, Nzinga J, Holt B, Mugenya I, Clarke-Deelder E, Nega A, Prabhakaran D, Mohan S, Mfeka-Nkabinde NG, Mthethwa L, Haile Mariam D, Molla G, Getachew T, Jarhyan P, Chaudhry M, Kassa M, Kruk ME. The maternal and newborn health eCohort to track longitudinal care quality: study protocol and survey development. Glob Health Action 2024; 17:2392352. [PMID: 39163134 PMCID: PMC11338195 DOI: 10.1080/16549716.2024.2392352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024] Open
Abstract
The MNH eCohort was developed to fill gaps in maternal and newborn health (MNH) care quality measurement. In this paper, we describe the survey development process, recruitment strategy, data collection procedures, survey content and plans for analysis of the data generated by the study. We also compare the survey content to that of existing multi-country tools on MNH care quality. The eCohort is a longitudinal mixed-mode (in-person and phone) survey that will recruit women in health facilities at their first antenatal care (ANC) visit. Women will be followed via phone survey until 10-12 weeks postpartum. User-reported information will be complemented with data from physical health assessments at baseline and endline, extraction from MNH cards, and a brief facility survey. The final MNH eCohort instrument is centered around six key domains of high-quality health systems including competent care (content of ANC, delivery, and postnatal care for the mother and newborn), competent systems (prevention and detection, timely care, continuity, integration), user experience, health outcomes, confidence in the health system, and economic outcomes. The eCohort combines the maternal and newborn experience and, due to its longitudinal nature, will allow for quality assessment according to specific risks that evolve throughout the pregnancy and postpartum period. Detailed information on medical and obstetric history and current health status of respondents and newborns will allow us to determine whether women and newborns at risk are receiving needed care. The MNH eCohort will answer novel questions to guide health system improvements and to fill data gaps in implementing countries.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katherine Wright
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tefera Taddele
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ashenif Tadele
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Anagaw Derseh Mebratie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Firew Tiruneh Tiyare
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Rose J. Kosgei
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI Wellcome Trust Research Program, Nairobi, Kenya
| | - Bethany Holt
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Irene Mugenya
- Health Economics Research Unit, KEMRI Wellcome Trust Research Program, Nairobi, Kenya
| | - Emma Clarke-Deelder
- Department of Epidemiology and Public Health, Swiss Tropical & Public Health Institute, Allschwil, Switzerland
| | - Adiam Nega
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, India
- Centre for Chronic Disease Control, New Delhi, India
| | | | | | - Londiwe Mthethwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Damen Haile Mariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gebeyaw Molla
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Theodros Getachew
- Health System Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | - Munir Kassa
- Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Yeboah E, Lohmann J, Koulidiati JL, Kuunibe N, Kyei NNA, Hamadou S, Ridde V, Danquah I, Brenner S, De Allegri M. Quality of nutritional status assessment and its relationship with the effect of rainfall on childhood stunting: a cross-sectional study in rural Burkina Faso. Public Health 2024; 234:91-97. [PMID: 38970856 DOI: 10.1016/j.puhe.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVES In Burkina Faso, one in every four children under 5 years is stunted. Climate change will exacerbate childhood stunting. Strengthening the health system, particularly the quality of nutrition care at primary health facilities, can minimise the adverse climate effect on stunting. Thus, we examined the quality of nutritional status assessment (QoNA) during curative childcare services in primary health facilities in rural Burkina Faso and its relationship with rainfall-induced childhood stunting. STUDY DESIGN We conducted a cross-sectional analysis using anthropometric, rainfall, and clinical observation data. METHODS Our dependent variable was the height-for-age z-score (HAZ) of children under 2 years. Our focal climatic measure was mean rainfall deviation (MRD), calculated as the mean of the difference between 30-year monthly household-level rainfall means and the corresponding months for each child from conception to data collection. QoNA was based on the weight, height, general paleness and oedema assessment. We used a mixed-effect multilevel model and analysed heterogeneity by sex and socio-economic status. RESULTS Among 5027 young (3-23 months) children (mean age 12 ± 6 months), 21% were stunted (HAZ ≤ -2). The mean MRD was 11 ± 4 mm, and the mean QoNA was 2.86 ± 0.99. The proportion of children in low, medium, and high QoNA areas was 10%, 54%, and 36%, respectively. HAZ showed a negative correlation with MRD. Higher QoNA lowered the negative effect of MRD on HAZ (β = 0.017, P = 0.003, confidence interval = [0.006, 0.029]). Males and children from poor households benefited less from the moderating effect of QoNA. CONCLUSION Improving the quality of nutrition assessments can supplement existing efforts to reduce the adverse effects of climate change on children's nutritional well-being.
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Affiliation(s)
- Edmund Yeboah
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Julia Lohmann
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany; Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - J-L Koulidiati
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, 01 BP 1091, Bobo Dioulasso, Burkina Faso
| | - Naasegnibe Kuunibe
- Department of Economics, Faculty of Social Science and Arts, Simon Diedong Dombo University of Business and Integrated Development Studies, P O Box WA64, Wa, Ghana
| | - N N A Kyei
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Unversität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany; Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, P. O. Box 60 12 03, 14412, Potsdam, Germany
| | - S Hamadou
- The World Bank, 1818 H Street, NW Washington, DC, 20433, USA
| | - V Ridde
- Université Paris Cité, IRD, Inserm, Ceped Paris, France
| | - I Danquah
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - S Brenner
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - M De Allegri
- Heidelberg Institute of Global Health, University Hospital and Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Maher L, Leece B, Sheaves F, Wilson A, Brown J, O'Connell L, Carnegie-Brown M, Stanbury L, Turalic U, Mooney D, Hoyling L, Cama E, Treloar C. Moving from 'stigma reduction' to 'inclusion': development of the inclusion collaborative at Nepean Blue Mountains Local Health District, New South Wales. Harm Reduct J 2024; 21:158. [PMID: 39192243 DOI: 10.1186/s12954-024-01080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
This commentary outlines the development of an Inclusion Collaborative in a large health district in Sydney, New South Wales Australia. The Collaborative grew out of ongoing efforts to reduce stigma associated with blood borne viruses while recognising that there are many health conditions and situations where people feel judged when attending services for health care. The formation of the Collaborative drew in health workers in other sectors to create a critical mass of voices calling for stigma reduction, move beyond siloed responses to stigma and to reframe conversations about stigma to a more positive description of "inclusion". The involvement of consumer representatives (paid for their time) was a key principle of the Collaborative. The members of the Collaborative identified the common experience of their clients being 'othered' by the mainstream services and that services can be unwelcoming or not supportive of difference, and therefore create a significant barrier to accessing healthcare. The group considered ways to highlight these issues among colleagues from mainstream services and community members who were not 'othered'. The Collaborative designed and carried out a range of activities including a Festival of Inclusion, a series of seeding grants for staff and consumer-focused initiatives, promotion of diversity days and an audit of compliance with strategic priorities. The Inclusion Collaborative is an example of a structured approach for efforts to reducing stigma that draws on the ambitions of many parts of a large, complex public health service to deliver better outcomes for its staff and consumers.
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Affiliation(s)
- Louise Maher
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Bronwyn Leece
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | | | - Andrew Wilson
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - James Brown
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | | | | | - Linda Stanbury
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Una Turalic
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Deanna Mooney
- Nepean Blue Mountains Local Health District, Sydney, Australia
| | - Larissa Hoyling
- Nepean Blue Mountains Local Health District, Sydney, Australia
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Baticulon RE, Dewan MC, Karekezi C, Shlobin NA, Garcia RM, Ghotme KA, Thango N, Rosseau G, Hutchinson PJ. Achieving Equity Through Global Neurosurgery Research. Neurosurgery 2024:00006123-990000000-01319. [PMID: 39185879 DOI: 10.1227/neu.0000000000003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/13/2024] [Indexed: 08/27/2024] Open
Abstract
Since the release of the Lancet Commission on Global Surgery report in 2015, there has been an increase in the number of published papers on global neurosurgery, gaining widespread support from major neurosurgery journals. However, there remains no consensus on what may be considered part of global neurosurgery literature. Here, we propose that global neurosurgery research encompasses all scholarly work that measure, explore, or address inequity in the care of neurosurgical disease. We describe the growth of global neurosurgery research, cite landmark papers, and discuss barriers to participation, particularly among neurosurgeons in low- and middle-income countries. We introduce the 3Rs framework, advocating for global neurosurgery research that is rigorous, responsive, and responsible. This narrative review aims to guide young neurosurgeons and other researchers interested in the field, and to provide a framework through which global neurosurgery practitioners and advocates can evaluate previously accomplished work, paving the way toward neurosurgery that is timely, safe, and affordable to all.
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Affiliation(s)
- Ronnie E Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Department of Anatomy, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, University of Rwanda, Kigali, Rwanda
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
- Neurosurgery Department, Fundacion Santa Fe De Bogota, Bogota, Colombia
| | - Nqobile Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Peter J Hutchinson
- NIHR Global Health Research Group on Neurotrauma, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Mcizana T, Adams S, Khan S, Ntatamala I. Sociodemographic and work-related factors associated with psychological resilience in South African healthcare workers: a cross-sectional study. BMC Health Serv Res 2024; 24:979. [PMID: 39182095 DOI: 10.1186/s12913-024-11430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Psychological resilience facilitates adaptation in stressful environments and is an important personal characteristic that enables workers to navigate occupational challenges. Few studies have evaluated the factors associated with psychological resilience in healthcare workers. OBJECTIVES To determine the prevalence and factors associated with psychological resilience in a group of South African medical doctors and ambulance personnel. MATERIALS AND METHODS This analytical cross-sectional study used secondary data obtained from two studies conducted among healthcare workers in 2019 and 2022. Self-reported factors associated with resilience, as measured by the Connor-Davidson Resilience Scale-10 (CD-RISC-10), were evaluated. R statistical software was used for analysing the data and performing statistical tests. RESULTS A total of 647 healthcare workers were included in the study, of which 259 were doctors and 388 were ambulance personnel. Resilience scores were low overall (27.6 ± 6.6) but higher for ambulance personnel (28.0 ± 6.9) than for doctors (27.1 ± 6.0) (p = 0.006). Female gender (OR 1.94, 95%CI 1.03-3.72, p = 0.043), job category (OR 6.94 95%CI 1.22-60.50, p = 0.044) and overtime work (OR 13.88, 95%CI 1.61-368.00, p = 0.044) significantly increased the odds of low resilience for doctors. Conversely, salary (OR 0.13, 95%CI 0.02-0.64, p = 0.024) and current smoking status (OR 0.16, 95%CI 0.02-0.66, p = 0.027) significantly reduced the odds of low resilience amongst doctors. In addition, only previous alcohol use significantly reduced the odds of low resilience for ambulance personnel (OR 0.44, 95%CI 0.20-0.94, p = 0.038) and overall sample (OR 0.52, 95%CI 0.29-0.91, p = 0.024). CONCLUSIONS Resilience was relatively low in this group of South African healthcare workers. The strong association between low resilience and individual and workplace factors provides avenues for early intervention and building resilience among healthcare workers.
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Affiliation(s)
- Thandokazi Mcizana
- Division of Actuarial Science, School of Management Studies, University of Cape Town, Cape Town, South Africa.
| | - Shahieda Adams
- Division of Occupational Medicine and Centre for Environmental and Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Saajida Khan
- Division of Occupational Medicine and Centre for Environmental and Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
- Livingstone Tertiary Hospital, Department of Health, Gqeberha, South Africa
- Faculty of Health Science, Nelson Mandela University, Gqeberha, South Africa
| | - Itumeleng Ntatamala
- Division of Occupational Medicine and Centre for Environmental and Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
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Philip J, Chang YK, Collins A, Smallwood N, Sullivan DR, Yawn BP, Mularski R, Ekström M, Yang IA, McDonald CF, Mori M, Perez-Cruz P, Halpin DMG, Cheng SY, Hui D. Consensus palliative care referral criteria for people with chronic obstructive pulmonary disease. Thorax 2024:thorax-2024-221721. [PMID: 39174326 DOI: 10.1136/thorax-2024-221721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/08/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVE People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral.We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care for people with COPD. METHODS Clinicians in the fields of respiratory medicine, palliative and primary care from five continents with expertise in respiratory medicine and palliative care rated 81 criteria over three Delphi rounds. Consensus was defined a priori as ≥70% agreement. A criterion was considered 'major' if experts endorsed meeting that criterion alone justified palliative care referral. RESULTS Response rates from the 57 panellists were 86% (49), 84% (48) and 91% (52) over first, second and third rounds, respectively. Panellists reached consensus on 17 major criteria for specialist outpatient palliative care referral, categorised under: (1) 'Health service use and need for advanced respiratory therapies' (six criteria, eg, need for home non-invasive ventilation); (2) 'Presence of symptoms, psychosocial and decision-making needs' (eight criteria, eg, severe (7-10 on a 10 point scale) chronic breathlessness); and (3) 'Prognostic estimate and performance status' (three criteria, eg, physician-estimated life expectancy of 6 months or less). CONCLUSIONS International experts evaluated 81 potential referral criteria, reaching consensus on 17 major criteria for referral to specialist outpatient palliative care for people with COPD. Evaluation of the feasibility of these criteria in practice is required to improve standardised palliative care delivery for people with COPD.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
- Palliative Care, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anna Collins
- Department of Medicine, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Monash University, Clayton, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Donald Richard Sullivan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Barbara P Yawn
- Department of Family and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Richard Mularski
- Kaiser Permanente Bernard J Tyson School of Medicine, Portland, Oregon, USA
| | - Magnus Ekström
- Department of Clinical Sciences Lund Respiratory Medicine, Lund University, Lund, Sweden
| | - Ian A Yang
- The University of Queensland, Brisbane, Queensland, Australia
- The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Christine F McDonald
- Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Masanori Mori
- Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | | | - David M G Halpin
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Choonara YM. Enhancing diabetic foot management: Advocating for independent prescribing rights for podiatrists in South Africa. Foot (Edinb) 2024; 60:102126. [PMID: 39178497 DOI: 10.1016/j.foot.2024.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/24/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024]
Abstract
Diabetic foot complications are serious issues resulting from uncontrolled diabetes, primarily affecting the feet. Common complications include diabetic neuropathy, ulcers, PAD, Charcot foot, and gangrene. Preventive measures include controlling blood glucose levels, regular foot inspections, proper foot care, wearing appropriate footwear, and seeking prompt medical attention. A holistic approach to diabetic foot management is crucial due to the complex interplay of physiological, psychological, and environmental factors. Glycaemic control is essential for mitigating neuropathy and vasculopathy, while cardiovascular risk factors like hypertension and dyslipidemia are crucial for preventing complications. In South Africa, podiatrists play a crucial role in diabetic foot care, offering specialized expertise in the assessment, management, and prevention of foot complications associated with diabetes mellitus. They collaborate closely with other healthcare professionals to ensure comprehensive and coordinated care.Pharmacological management is a crucial aspect of podiatric care in the UK, where podiatrists use various medications to treat foot conditions effectively. In South Africa, podiatrists lack prescribing authority, leading to limited treatment options, dependency on referrals, and disparities in access to care. This fragmented approach can compromise patient outcomes, especially in chronic conditions like diabetes. To improve patient outcomes and promote optimal foot condition management, policy reforms, interdisciplinary collaboration, and professional advocacy efforts are needed.Policy recommendations for expanding podiatrist prescribing privileges include legislative reforms, regulatory framework updates, and professional accreditation. Legislative reforms could involve amending existing healthcare laws or introducing new regulations that recognize podiatrists as authorized prescribers. Regulatory framework updates should involve working with regulatory bodies to establish prescribing standards, prescribing limitations, and mechanisms for ongoing oversight and accountability. Professional accreditation should ensure educational programs for podiatrists incorporate training in pharmacology, pharmacotherapy, and prescribing practices to prepare graduates for the expanded scope of practice.Stakeholders in South Africa can improve diabetes management by advocating for policy reforms, professional recognition, and patient empowerment initiatives. By aligning policy, practice, education, research, and advocacy efforts, stakeholders can create a supportive ecosystem that fosters innovation, collaboration, and continuous improvement in diabetic foot care.
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Muttalib F, Memon ZA, Muhammad S, Soomro A, Khan S, Bano S, Jawwad M, Soofi S, Hansen B, Adhikari NKJ, Bhutta Z. The spectrum of acute illness and mortality of children and adolescents presenting to emergency services in Sanghar district hospital, Pakistan: a prospective cohort study. BMJ Open 2024; 14:e082255. [PMID: 39179281 PMCID: PMC11344522 DOI: 10.1136/bmjopen-2023-082255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVE To describe presenting diagnoses and rates and causes of death by age category and sex among children with acute illness brought to a district headquarter hospital in Pakistan. DESIGN Prospective cohort study. SETTING Sanghar district headquarter hospital, Sindh, Pakistan between December 2019 and April 2020 and August 2020 and December 2020. PARTICIPANTS 3850 children 0-14 years presenting with acute illness to the emergency and outpatient departments and 1286 children admitted to the inpatient department. OUTCOME MEASURES The primary outcome was Global Burden of Disease diagnosis category. Secondary outcomes were 28-day mortality rate, cause of death and healthcare delays, defined as delay in care-seeking, delay in reaching the healthcare facility and delay in appropriate treatment. RESULTS Communicable diseases were the most common presenting diagnoses among outpatients and among inpatients aged 1 month to 9 years. Non-communicable diseases and nutritional disorders were more common with increasing age. Few children presented with injuries. Newborn period (age <28 days) was associated with increased odds of death (OR 4.34 [95% CI 2.38 to 8.18], p<0.001, reference age 28 days-14 years) and there was no significant difference in odds of death between female vs male children (OR 1.12, 95% CI 0.6 to 2.04, p=0.72). 47 children died in the hospital (3.6%) and three (0.2%) died within 28 days of admission. Most children who died were <28 days old (n=32/50, 64%); leading diagnoses included neonatal sepsis/meningitis (n=13/50, 26%), neonatal encephalopathy (n=7/50, 14%) and lower respiratory tract infections (n=6/50, 12%). Delays in care-seeking (n=15) and in receiving appropriate treatment (n=12) were common. CONCLUSION This study adds to sparse literature surrounding the epidemiology of disease and hospital outcomes for children with acute illness seeking healthcare in rural Pakistan and, in particular, among children aged 5-14 years. Further studies should include public and private hospitals within a single region to comprehensively describe patterns of care-seeking and interfacility transfer in district health systems.
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Affiliation(s)
- Fiona Muttalib
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Zahid Ali Memon
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shah Muhammad
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Asif Soomro
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Samia Khan
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Shazia Bano
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Jawwad
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sajid Soofi
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Pediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Neill KJ Adhikari
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Managament, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zulfiqar Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Centre for Global Child Health, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Rao KD, Bairwa M, Mehta A, Hyat S, Ahmed R, Rajapaksa L, Adams AM. Improving urban health through primary health care in south Asia. Lancet Glob Health 2024:S2214-109X(24)00121-9. [PMID: 39178875 DOI: 10.1016/s2214-109x(24)00121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 02/19/2024] [Accepted: 03/06/2024] [Indexed: 08/26/2024]
Abstract
South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities. Health and its social determinants vary considerably across south Asian cities and substantial socioeconomic inequities are present. Although cities offer easy geographical access to PHC services, financial hardship associated with health care use and low quality of care are a concern, particularly for low-income residents. Providing better PHC in south Asia requires a multi-sectoral response, with effective and resourced urban local bodies; increased public financing for health care; and new service delivery models aimed at low-income urban communities that involve strengthening public sector services, strengthening government engagement with private providers where necessary, and engaging with low-income communities and the PHC providers that serve them.
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Affiliation(s)
- Krishna D Rao
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Mohan Bairwa
- All India Institute of Medical Sciences, New Delhi, India
| | - Akriti Mehta
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sana Hyat
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rushdia Ahmed
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lalini Rajapaksa
- Department of Community Medicine, University of Colombo, Colombo, Sri Lanka
| | - Alayne M Adams
- Factor-Inwentash Faculty of Social Work, McGill University, Montreal, QC, Canada
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Dany A, Aujoulat P, Colin F, Le Reste JY, Le Goff D. Assessment of multi-professional primary healthcare center quality by patients with multimorbidity. BMC Health Serv Res 2024; 24:954. [PMID: 39164682 PMCID: PMC11337593 DOI: 10.1186/s12913-024-11315-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/15/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND The main aim of this study was to build an item bank for assessing the care quality of multi-professional healthcare centers (MPHCC) from the perspective of patients with multimorbidity. This study was part of the QUALSOPRIM (QUALité des SOins PRIMaires; primary healthcare quality) research project to create a psychometrically robust self-administered questionnaire to assess healthcare quality. METHODS First, twelve experts built an item bank using data from a previous qualitative work and a systematic literature review. Second, the validity of each item was assessed in a sample of patients. Adult patients with multimorbidity were recruited from six French MPHCC. Items were assessed based on ceiling effects, the level of missing or neutral responses and patient feedback. Patient feedback was recorded after the item bank completion. Based on results, items were validated, improved, or removed during expert meetings. In case of disagreement the Delphi method was used to reach consensus. RESULTS The study sample included 209 outpatients. The most frequent medical conditions were cardiovascular risk factors, cardiovascular diseases and rheumatological conditions. In total, a bank of 109 items classified in nine domains was built. The validity assessment led to the removal of 34 items. Retained items explored a variety of topics related to care quality: availability, accessibility, premises' layout and building, technical care, expertise, organization, relationships with caregivers and communication, involvement and personal relationships. CONCLUSIONS This study allowed cross-validation of a bank of 75 items, leading to a complete picture of the patient perception of care quality items. Overall, patients were generally satisfied with their care at the MPHCC. Nonetheless, there were still numerous items on subjects for which patients' satisfaction could be improved.
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Affiliation(s)
- Antoine Dany
- ER 7479 SPURBO, University of Western Brittany, Brest, France.
- Department of Human Sciences, University of Western Brittany, Brest, France.
| | - Paul Aujoulat
- ER 7479 SPURBO, University of Western Brittany, Brest, France
- Department of General Practice, University of Western Brittany, Brest, France
| | - Floriane Colin
- ER 7479 SPURBO, University of Western Brittany, Brest, France
- Department of General Practice, University of Western Brittany, Brest, France
| | - Jean-Yves Le Reste
- ER 7479 SPURBO, University of Western Brittany, Brest, France
- Department of General Practice, University of Western Brittany, Brest, France
| | - Delphine Le Goff
- ER 7479 SPURBO, University of Western Brittany, Brest, France
- Department of General Practice, University of Western Brittany, Brest, France
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11
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Vera M, Aketch H, Omom C, Otieno F, Owiti G, Sila J, Kinuthia J, Beima-Sofie K, Pintye J, Kemunto V, Akim E, John-Stewart G, Kohler P. "I was given PrEP, but had no privacy": Mystery shopper perspectives of PrEP counseling for adolescent girls and young women in Kisumu County, Kenya. PLoS One 2024; 19:e0309075. [PMID: 39159171 PMCID: PMC11332929 DOI: 10.1371/journal.pone.0309075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 08/05/2024] [Indexed: 08/21/2024] Open
Abstract
Pre-exposure prophylaxis (PrEP) is being scaled up to prevent HIV acquisition among adolescent girls and young women (AGYW) in Eastern and Southern Africa. In a prior study more than one-third of AGYW 'mystery shoppers' stated they would not return to care based on interactions with health providers. We examined the experiences of AGYW in this study to identify main barriers to effective PrEP services. Unannounced patient actors (USP/'mystery shoppers') posed as AGYWs seeking PrEP using standardized scenarios 8 months after providers had received training to improve PrEP services. We conducted targeted debriefings using open-ended questions to assess PrEP service provision and counseling quality with USPs immediately following their visit. Debriefings were audio-recorded and transcribed. Transcripts were analyzed using thematic analysis to explore why USPs reported either positive or negative encounters. We conducted 91 USP debriefings at 24 facilities and identified three primary influences on PrEP service experiences: 1) Privacy improved likelihood of continuing care, 2) respectful attitudes created a safe environment for USPs, and 3) patient-centered communication improved the experience and increased confidence for PrEP initiation among USPs. Privacy and provider attitudes were primary drivers that influenced decision-making around PrEP in USP debriefs. Access to privacy and improving provider attitudes is important for scale-up of PrEP to AGYW.
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Affiliation(s)
- Melissa Vera
- School of Nursing/Global Health, University of Washington, Seattle, WA, United States of America
| | - Helen Aketch
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caroline Omom
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Felix Otieno
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - George Owiti
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Joseph Sila
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - John Kinuthia
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kristin Beima-Sofie
- School of Nursing/Global Health, University of Washington, Seattle, WA, United States of America
| | - Jillian Pintye
- School of Nursing/Global Health, University of Washington, Seattle, WA, United States of America
| | - Valarie Kemunto
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eunita Akim
- Centre for Clinical Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Grace John-Stewart
- School of Nursing/Global Health, University of Washington, Seattle, WA, United States of America
| | - Pamela Kohler
- School of Nursing/Global Health, University of Washington, Seattle, WA, United States of America
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12
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Wang W, Zhao R, Zhang J, Xu T, Lu J, Nicholas S, Wei X, Liu X, Yang H, Matiland E. Public expectations of good primary health care in China: a national qualitative study. Fam Pract 2024; 41:564-570. [PMID: 36573339 DOI: 10.1093/fampra/cmac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND China is currently making efforts to transform the current hospital-centric service delivery system to people-centred primary health care (PHC)-based delivery system, with service delivery organized around the health needs and expectations of people. To help direct China's PHC reform efforts, a profile of high-quality PHC from the public's perspective is required. OBJECTIVES To profile high-quality PHC from the perspective of the Chinese public. METHODS Semistructured interviews were conducted in 6 provinces (Henan, Shandong, Zhejiang, Shaanxi, Shanxi, and Heilongjiang) in China. In total, 58 interviewees completed the recorded interview. For transcription, trained research assistant listened to the recording of the interviews, summarizing each 30-s segment in English. Next, thematic analysis was performed on the narrative summaries to identify thematic families. RESULTS Seven themes and 16 subthemes were generated from the analysis of our interview data. In order of their frequency, the interviewees expressed a high expectation for interpersonal communication and technical quality; followed by access, comprehensive care, cost, continuity, and coordination. CONCLUSIONS Using qualitative data from 6 provinces in China, knowledge was generated to reveal the public's views and expectations for high-quality PHC. Our results confirm the urgent need for quality improvement efforts to improve patient experience and technical quality. The government also needs to further improve the delivery system and medical training programme to better meet public expectation in these areas, especially in establishing an innovative integrated primary care model, and strengthening interpersonal and clinical competency training for family doctors.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Ruixue Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Tiange Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, Australia
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, PR China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, PR China
- Newcastle Business School, University of Newcastle, Newcastle, Australia
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, PR China
| | - Huiyun Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Elizabeth Matiland
- School of Management, University of Liverpool, Liverpool, United Kingdom
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13
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Bellizzi S, Panu Napodano CM, Murgia P. Family-centered care for newborns: a global perspective and review. J Trop Pediatr 2024; 70:fmae026. [PMID: 39142805 DOI: 10.1093/tropej/fmae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Person-centered models of care built on newborn and family needs and rights, such as nonseparation immediately after birth and during the care process, can address the complex needs of the newborn, family, and health system. This is particularly important in low- and middle-income countries, where cost-effective modalities are highly needed to accelerate the survival of newborn babies. We conducted a systematic review to explore country experiences on implementation and challenges to implement and scale-up family-centered newborn care models of care. MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched to identify studies on patient-centered care and newborns between 1990 and 2023. Studies meeting our predefined inclusion criteria were quality assessed and relevant data extracted. We utilized the World Health Organization framework on integrated people-centered health services to summarize and analyze findings while highlighting patterns. Forty-one studies were included for review (including approximately 60% from low- and middle-income countries). Different research conducted over time highlighted how immediate and uninterrupted skin-to-skin care facilitates a series of critical processes for newborns, parents, and health system, including breastfeeding initiation and exclusivity rates, reduced incidence of post-partum depression, and prevention of infection and hospitalization. Thanks to the close contact of the kangaroo position or skin-to-skin contact, parents recount becoming more and more attached to and familiar with their baby, easily establishing a relationship. Overall, countries could transform the newborn care service in terms of family center care by adopting three simple rules: (i) minimizing mother-child separation; (ii) involving fathers; (iii) empowering parents from the time of birth. A paradigm shift is required to change the conventional model of provider-centric care to one of person-centered neonatal health care. Such an approach is feasible in diverse country settings and should be facilitated through political commitment and policies enabling early focus on the maternal-infant relationship. This could, in turn, help achieve improved dignity of care and help create a more efficient and responsive health system and society.
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Affiliation(s)
- Saverio Bellizzi
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Catello M Panu Napodano
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Paola Murgia
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
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Sheffel A, Andrews KG, Conner R, Di Giorgio L, Evans DK, Gatti R, Lindelow M, Sharma J, Svensson J, Wane W, Welander Tärneberg A. Human resource challenges in health systems: evidence from 10 African countries. Health Policy Plan 2024; 39:693-709. [PMID: 38722023 PMCID: PMC11308604 DOI: 10.1093/heapol/czae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/02/2024] [Accepted: 05/02/2024] [Indexed: 08/09/2024] Open
Abstract
Sub-Saharan Africa has fewer medical workers per capita than any region of the world, and that shortage has been highlighted consistently as a critical constraint to improving health outcomes in the region. This paper draws on newly available, systematic, comparable data from 10 countries in the region to explore the dimensions of this shortage. We find wide variation in human resources performance metrics, both within and across countries. Many facilities are barely staffed, and effective staffing levels fall further when adjusted for health worker absences. However, caseloads-while also varying widely within and across countries-are also low in many settings, suggesting that even within countries, deployment rather than shortages, together with barriers to demand, may be the principal challenges. Beyond raw numbers, we observe significant proportions of health workers with very low levels of clinical knowledge on standard maternal and child health conditions. This study highlights that countries may need to invest broadly in health workforce deployment, improvements in capacity and performance of the health workforce, and on addressing demand constraints, rather than focusing narrowly on increases in staffing numbers.
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Affiliation(s)
- Ashley Sheffel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, United States
| | | | - Ruben Conner
- World Bank, 1818 H Street, NW Washington, DC 20433, United States
| | - Laura Di Giorgio
- World Bank, 1818 H Street, NW Washington, DC 20433, United States
| | - David K Evans
- Inter-American Development Bank, 1300 New York Avenue NW, Washington, DC 20577, United States
| | - Roberta Gatti
- World Bank, 1818 H Street, NW Washington, DC 20433, United States
| | - Magnus Lindelow
- World Bank, 1818 H Street, NW Washington, DC 20433, United States
| | - Jigyasa Sharma
- World Bank, 1818 H Street, NW Washington, DC 20433, United States
| | - Jakob Svensson
- Stockholm University, Institute for International Economic Studies, Universitetsvägen 10A, Stockholm 114 18, Sweden
| | - Waly Wane
- World Bank, Rue Washington, Abidjan, Côte d’Ivoire
| | - Anna Welander Tärneberg
- Centre for Economic Demography and Department of Economic History, Lund University School of Economics and Management, Scheelevägen 15B, Lund 223 63, Sweden
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Benedetto V, De Vita E, Nuti S. Setting priorities in outpatient cardiovascular care to guarantee equitable access: the case of Tuscany region. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:11. [PMID: 39177938 DOI: 10.1007/s43999-024-00047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 07/15/2024] [Indexed: 08/24/2024]
Abstract
Universal healthcare systems orient their actions towards promoting, restoring, and improving public health with a particular focus on the need to guarantee equitable access to care. Unwarranted variation in healthcare delivery poses significant challenges to health systems globally, impacting quality of care, financial sustainability, and equity of access. It is therefore important to assist healthcare management in measuring unwarranted variation in order to prioritise intervention strategies to ensure continuity of care and equity. Through an investigation of geographical variation in visit rates and waiting times, the study identifies vulnerable health districts which need priority interventions for patients with cardiovascular disease in the Tuscany region (Italy). Furthermore, a benchmarking-based method for identifying a quantitative estimate of the supply gap to be reduced is proposed. Results illustrate variation in visit rates and waiting times across local health districts in 2021, with some districts experiencing substantially lower rates and longer waiting times compared to the regional median. To address this gap, two targeted interventions aimed at increasing visit volumes and reduced waiting times through advanced training activities, technology integration, and multidisciplinary collaborations are presented. This study contributes to the topic of unwarranted variation by highlighting the necessity of tailored interventions to address diverse healthcare challenges across heterogeneous geographical areas. As healthcare systems globally navigate evolving complexities, the findings and tools presented here offer valuable guidance for policymakers and managers, aiming towards more equitable, efficient, and responsive healthcare services.
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Affiliation(s)
- Vera Benedetto
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy.
| | - Erica De Vita
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy
| | - Sabina Nuti
- Interdisciplinary Research Center "Health Science", Scuola Superiore Sant'Anna, Via Cardinale Maffi 27, Pisa, Italy
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16
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Kohler P, Larsen A, Abuna F, Owiti G, Sila J, Owens T, Kemunto V, Lagat H, Vera M, Richardson BA, Wilson K, Pintye J, John-Stewart G, Kinuthia J. Patient actor training improves preexposure prophylaxis delivery for adolescent girls and young women in Kenya: a cluster randomized trial. AIDS 2024; 38:1505-1512. [PMID: 38857513 PMCID: PMC11288181 DOI: 10.1097/qad.0000000000003943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of preexposure prophylaxis (PrEP) services for adolescent girls and young women (AGYW) in Kenya. DESIGN Cluster randomized trial and mystery shopper evaluation. METHODS Twelve of 24 maternal child health and family planning facilities were randomized to SP training. Providers at intervention facilities participated in 2-day training in adolescent health, PrEP guidelines, values clarification, and communication skills, followed by role-playing and de-briefing with trained actors. Control facilities received standard national training. The primary outcome was quality of care, assessed by unannounced SPs (USPs) or "mystery shoppers" blinded to intervention arm. Quality was measured in two domains: guideline adherence and communication skills. Intent to treat analysis compared postintervention quality scores by randomization arm, clustering on facility, and adjusting for baseline scores and USP. RESULTS Overall, 232 providers consented to USP visits, and 94 providers completed the training. Following training, USPs posed as AGYW seeking PrEP in 142 encounters (5-6 encounters per site). The mean quality score was 73.6% at intervention sites and 58.4% at control sites [adjusted mean difference = 15.3, 95% confidence interval (CI): 9.4-21.1, P < 0.001]. Mean guideline adherence scores were 57.2% at intervention sites and 36.2% at control sites (adjusted mean difference = 21.0, 95% CI: 12.5-29.4, P < 0.001). Mean communication scores were 90.0% at intervention sites and 80.5% at control sites (adjusted mean difference = 9.5, 95% CI: 5.5-13.6, P < 0.001). CONCLUSIONS SP training significantly improved quality of PrEP care for AGYW in Kenya. Incorporating SP training and unannounced SP evaluation could improve PrEP uptake among AGYW.
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Affiliation(s)
- Pamela Kohler
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
- Department of Global Health, University of Washington, Seattle USA
| | - Anna Larsen
- Department of Global Health, University of Washington, Seattle USA
- Department of Epidemiology, University of Washington, Seattle USA
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - George Owiti
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Tamara Owens
- Clinical Skills and Simulation Center, Howard University, Washington DC USA
| | - Valerie Kemunto
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Harrison Lagat
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
| | - Melissa Vera
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle USA
- Department of Biostatistics University of Washington, Seattle USA
| | - Kate Wilson
- Department of Global Health, University of Washington, Seattle USA
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, Seattle USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle USA
- Department of Pediatrics, University of Washington, Seattle USA
- Department of Allergy and Infectious Diseases, University of Washington, Seattle USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi KENYA
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17
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Arsenault C, Mfeka-Nkabinde NG, Chaudhry M, Jarhyan P, Taddele T, Mugenya I, Sabwa S, Wright K, Amboko B, Baensch L, Molla Wondim G, Mthethwa L, Clarke-Deelder E, Yang WC, Kosgei RJ, Purohit P, Mzolo NC, Derseh Mebratie A, Shaw S, Nega A, Tlou B, Fink G, Moshabela M, Prabhakaran D, Mohan S, Haile Mariam D, Nzinga J, Getachew T, Kruk ME. Antenatal care quality and detection of risk among pregnant women: An observational study in Ethiopia, India, Kenya, and South Africa. PLoS Med 2024; 21:e1004446. [PMID: 39190623 DOI: 10.1371/journal.pmed.1004446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/22/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is an essential platform to improve maternal and newborn health (MNH). While several articles have described the content of ANC in low- and middle-income countries (LMICs), few have investigated the quality of detection and management of pregnancy risk factors during ANC. It remains unclear whether women with pregnancy risk factors receive targeted management and additional ANC. METHODS AND FINDINGS This observational study uses baseline data from the MNH eCohort study conducted in 8 sites in Ethiopia, India, Kenya, and South Africa from April 2023 to January 2024. A total of 4,068 pregnant women seeking ANC for the first time in their pregnancy were surveyed. We built country-specific ANC completeness indices that measured provision of 16 to 22 recommended clinical actions in 5 domains: physical examinations, diagnostic tests, history taking and screening, counselling, and treatment and prevention. We investigated whether women with pregnancy risks tended to receive higher quality care and we assessed the quality of detection and management of 7 concurrent illnesses and pregnancy risk factors (anemia, undernutrition, obesity, chronic illnesses, depression, prior obstetric complications, and danger signs). ANC completeness ranged from 43% in Ethiopia, 66% in Kenya, 73% in India, and 76% in South Africa, with large gaps in history taking, screening, and counselling. Most women in Ethiopia, Kenya, and South Africa initiated ANC in second or third trimesters. We used country-specific multivariable mixed-effects linear regression models to investigate factors associated with ANC completeness. Models included individual demographics, health status, presence of risk factors, health facility characteristics, and fixed effects for the study site. We found that some facility characteristics (staffing, patient volume, structural readiness) were associated with variation in ANC completeness. In contrast, pregnancy risk factors were only associated with a 1.7 percentage points increase in ANC completeness (95% confidence interval 0.3, 3.0, p-value 0.014) in Kenya only. Poor self-reported health was associated with higher ANC completeness in India and South Africa and with lower ANC completeness in Ethiopia. Some concurrent illnesses and risk factors were overlooked during the ANC visit. Between 0% and 6% of undernourished women were prescribed food supplementation and only 1% to 3% of women with depression were referred to a mental health provider or prescribed antidepressants. Only 36% to 73% of women who had previously experienced an obstetric complication (a miscarriage, preterm birth, stillbirth, or newborn death) discussed their obstetric history with the provider during the first ANC visit. Although we aimed to validate self-reported information on health status and content of care with data from health cards, our findings may be affected by recall or other information biases. CONCLUSIONS In this study, we observed gaps in adherence to ANC standards, particularly for women in need of specialized management. Strategies to maximize the potential health benefits of ANC should target women at risk of poor pregnancy outcomes and improve early initiation of ANC in the first trimester.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | | | | | | | - Tefera Taddele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Irene Mugenya
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Shalom Sabwa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Katherine Wright
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Beatrice Amboko
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Londiwe Mthethwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Emma Clarke-Deelder
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Wen-Chien Yang
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Rose J Kosgei
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | | | | | - Anagaw Derseh Mebratie
- Department of Health Systems Management and Health Policy, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Adiam Nega
- Department of Health Systems Management and Health Policy, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Boikhutso Tlou
- Department of Public Health Medicine, Howard College campus, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Günther Fink
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Damen Haile Mariam
- Department of Health Systems Management and Health Policy, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Salluh JIF, Amado F, Pilcher D, Hashmi M. The relevance and sustainability of registry-embedded research for critical care. J Crit Care 2024; 82:154765. [PMID: 38492521 DOI: 10.1016/j.jcrc.2024.154765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Jorge I F Salluh
- D'OR Institute for Research and Education, Rio de Janeiro, Brazil; Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipe Amado
- D'OR Institute for Research and Education, Rio de Janeiro, Brazil.
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road, Prahran, VIC 3004, Australia; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, High Street, Prahran, VIC 3004, Australia
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Obayashi K, Kodate N, Ishii Y, Masuyama S. Assistive technologies and aging in place for people with dementia and disabilities: a proof-of-concept study with in-home passive remote monitoring with interactive communication functions. Disabil Rehabil Assist Technol 2024; 19:2341-2354. [PMID: 38143315 DOI: 10.1080/17483107.2023.2287148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/12/2023] [Accepted: 11/19/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Can assistive technologies (ATs) support aging in place for people with dementia and disability? In seeking to go beyond the persistent institutional care delivery paradigm, this proof-of-concept study tested the feasibility of home care delivery using sensors and remote communication devices. This article reports the collaborative efforts among care professionals, care recipients and family caregivers in their private home environment and the impact of in-home passive remote monitoring (PRM) system on the users. The purpose of this study was to investigate the usability and impact of a PRM system combining in-house passive remote monitoring and an interactive communication function. METHODS In order to realize AT-supported, person-centered aging in place, a new care delivery model was designed, developed and tested for the duration of 12 weeks. The study was conducted with 5 older people (1 with severe disability and 4 with dementia), their primary family carers with 15 care professionals as users. RESULTS The findings indicate that there were some technical issues. However, the overall assessment of the system performance was positive, and the users expressed favorable views regarding its preventive and interactive nature. The importance of team-based care delivery, adjusted to fit the PRM equipment, was also highlighted. Faced with the challenge of meeting the increasing demand for person-centered care with limited resources, there will be a greater need for better integration of improved ATs. The study indicates ATs' potential for enhancing the quality of life for those involved in caregiving, while stressing the significance of stakeholders' engagement, skills and teamwork.
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Affiliation(s)
- Kazuko Obayashi
- Faculty of Healthcare Management, Nihon Fukushi University, Mihama, Aichi, Japan
- Social Welfare Corporation Tokyo Seishin-kai, Nishitokyo, Tokyo, Japan
- Universal Accessibility & Ageing Research Centre, Nishitokyo, Tokyo, Japan
| | - Naonori Kodate
- Universal Accessibility & Ageing Research Centre, Nishitokyo, Tokyo, Japan
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
- Public Policy Research Center, Hokkaido University, Sapporo, Hokkaido, Japan
- Fondation France Japon, L'École des hautes études en sciences sociales, Paris, France
- Institute for Future Initiatives, University of Tokyo, Bunkyo, Tokyo, Japan
| | - Yoko Ishii
- Universal Accessibility & Ageing Research Centre, Nishitokyo, Tokyo, Japan
| | - Shigeru Masuyama
- Universal Accessibility & Ageing Research Centre, Nishitokyo, Tokyo, Japan
- Traveler's Medical Center, Tokyo Medical University, Shinjuku, Tokyo, Japan
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20
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Zhong L, Lopez D, Pei S, Gao J. Healthcare system resilience and adaptability to pandemic disruptions in the United States. Nat Med 2024; 30:2311-2319. [PMID: 38956198 DOI: 10.1038/s41591-024-03103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/31/2024] [Indexed: 07/04/2024]
Abstract
Understanding healthcare system resilience has become paramount, particularly in the wake of the COVID-19 pandemic, which imposed unprecedented burdens on healthcare services and severely impacted public health. Resilience is defined as the system's ability to absorb, recover from and adapt to disruptions; however, despite extensive studies on this subject, we still lack empirical evidence and mathematical tools to quantify its adaptability (the ability of the system to adjust to and learn from disruptions). By analyzing millions of patients' electronic medical records across US states, we find that the COVID-19 pandemic caused two successive waves of disruptions within the healthcare systems, enabling natural experiment analysis of the adaptive capacity of each system to adapt to past disruptions. We generalized the quantification framework and found that the US healthcare systems exhibit substantial adaptability (ρ = 0.58) but only a moderate level of resilience (r = 0.70). When considering system responses across racial groups, Black and Hispanic groups were more severely impacted by pandemic disruptions than white and Asian groups. Physician abundance was the key characteristic for determining healthcare system resilience. Our results offer vital guidance in designing resilient and sustainable healthcare systems to prepare for future waves of disruptions akin to COVID-19 pandemics.
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Affiliation(s)
- Lu Zhong
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA
- Network Science and Technology Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Dimitri Lopez
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Sen Pei
- Department of Environmental Health Sciences, Columbia University, New York City, NY, USA
| | - Jianxi Gao
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA.
- Network Science and Technology Center, Rensselaer Polytechnic Institute, Troy, NY, USA.
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21
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Di Martino M, Podda M, Raptis D, Machairas N, Ielpo B, Pata F, Pellino G, Di Saverio S, Catena F, Pisanu A, Donadon M, Pawlik TM. The influence of socioeconomic inequity and guidelines compliance on clinical outcomes of patients with acute biliary pancreatitis. An international multicentric cohort study. HPB (Oxford) 2024; 26:1022-1032. [PMID: 38796347 DOI: 10.1016/j.hpb.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND There is lack of data on the association between socioeconomic factors, guidelines compliance and clinical outcomes among patients with acute biliary pancreatitis (ABP). METHODS Post-hoc analysis of the international MANCTRA-1 registry evaluating the impact of regional disparities as indicated by the Human Development Index (HDI), and guideline compliance on ABP clinical outcomes. Multivariable logistic regression models were employed to identify prognostic factors associated with mortality and readmission. RESULTS Among 5313 individuals from 151 centres across 42 countries marked disparities in comorbid conditions, ABP severity, and medical procedure usage were observed. Patients from lower HDI countries had higher guideline non-compliance (p < 0.001) and mortality (5.0% vs. 3.2%, p = 0.019) in comparison with very high HDI countries. On adjusted analysis, ASA score (OR 1.810, p = 0.037), severe ABP (OR 2.735, p < 0.001), infected necrosis (OR 2.225, p = 0.006), organ failure (OR 4.511, p = 0.001) and guideline non-compliance (OR 2.554, p = 0.002 and OR 2.178, p = 0.015) were associated with increased mortality. HDI was a critical socio-economic factor affecting both mortality (OR 2.452, p = 0.007) and readmission (OR 1.542, p = 0.046). CONCLUSION These data highlight the importance of collaborative research to characterise challenges and disparities in global ABP management. Less developed regions with lower HDI scores showed lower adherence to clinical guidelines and higher rates of mortality and recurrence.
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Affiliation(s)
- Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy.
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy.
| | - Dimitri Raptis
- Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, 7790, 2602, Al Maather, Riyadh 12713, Saudi Arabia.
| | - Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | | | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria 87036, Rende, Italy.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso, Hospital, San Benedetto del Tronto, Italy.
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
| | - Adolfo Pisanu
- Department of Surgical Science, University of Cagliari, Cagliari, Italy.
| | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy.
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, OH, USA.
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22
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Surendran S, Nampoothiri V, Dhar P, Holmes A, Singh S, Charani E. Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India. JAC Antimicrob Resist 2024; 6:dlae105. [PMID: 39005590 PMCID: PMC11245696 DOI: 10.1093/jacamr/dlae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
Background and objectives Antibiotic use in paediatric surgical specialties is understudied. We investigated the antibiotic prescribing practices of paediatric general and cardiovascular surgical teams in a tertiary hospital in South India. Methods Mixed-methods study including observations from ward rounds, semi-structured interviews, and review of antibiotic prescribing. Field notes from observations and interview transcripts were coded using NVivo and thematically analysed. Data collection and analysis were iterative and continued until thematic saturation. Quantitative data were analysed using descriptive statistics. Results Data included 62 h of observation, 24 interviews, one case study and 200 patient chart reviews (100/specialty). Senior surgeons make key decisions, referring to their own experience when prescribing antibiotics. Being outcome-driven, the doctors often prescribe antibiotics at the earliest indication of infection with a reluctance to de-escalate, even when an infection is not diagnosed. This practice is more acute among surgeons who consider themselves responsible for their patients' health and attribute the consistently low surgical site infection rates to this practice.In general surgery, 83.3% (80/96; 4 lost to follow-up) of patients were prescribed antibiotics for the duration of their stay with oral antibiotics prescribed at discharge. The surgeons use antibiotics prophylactically for patients who may be vulnerable to infection. The antimicrobial stewardship team was considered to have limited influence in the decision-making process. Conclusions Outcome-driven decision-making in surgery leads to overprescription of antibiotics and prolonged surgical prophylaxis. The rationale for suboptimal practices is complicated by the surgeons' beliefs about the contextual determinants of health in India.
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Affiliation(s)
- Surya Surendran
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
- Health System and Equity, The George Institute for Global Health, New Delhi, India
| | - Vrinda Nampoothiri
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India
| | - Puneet Dhar
- Surgical Gastroenterology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Faridabad, India
| | - Alison Holmes
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Sanjeev Singh
- Department of Medical Admin, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Faridabad, India
| | - Esmita Charani
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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23
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Bamodu OA, Chung CC. Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries. JCO Glob Oncol 2024; 10:e2300439. [PMID: 39173080 DOI: 10.1200/go.23.00439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/25/2024] [Accepted: 07/18/2024] [Indexed: 08/24/2024] Open
Abstract
The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.
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Affiliation(s)
- Oluwaseun Adebayo Bamodu
- Directorate of Postgraduate Studies, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Ilala District, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Ilala District, Dar es Salaam, Tanzania
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington DC
| | - Chen-Chih Chung
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
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24
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Juma D, Stordal K, Kamala B, Bishanga DR, Kalolo A, Moshiro R, Kvaløy JT, Manongi R. Readiness to provide comprehensive emergency obstetric and neonatal care: a cross-sectional study in 30 health facilities in Tanzania. BMC Health Serv Res 2024; 24:870. [PMID: 39085821 PMCID: PMC11290101 DOI: 10.1186/s12913-024-11317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Despite the global progress in bringing health services closer to the population, mothers and their newborns still receive substandard care leading to morbidity and mortality. Health facilities' capacity to deliver the service is a prerequisite for quality health care. This study aimed to assess health facilities' readiness to provide comprehensive emergency obstetric and newborn care (CEmONC), comprising of blood transfusion, caesarean section and basic services, and hence to inform improvement in the quality of care interventions in Tanzania. METHODS A cross-sectional assessment of 30 CEmONC health facilities implementing the Safer Births Bundle of Care package in five regions of Tanzania was carried out between December 2020 and January 2021. We adapted the World Health Organization's Service Availability and Readiness Assessment tool to assess amenities, equipment, trained staff, guidelines, medicines, and diagnostic facilities. Composite readiness scores were calculated for each category and results were compared at the health facility level. For categorical variables, we tested for differences by Fisher's exact test; for readiness scores, differences were tested by a linear mixed model analysis, taking into account dependencies within the regions. We used p < 0.05 as our level of significance. RESULTS The overall readiness to provide CEmONC was 69.0% and significantly higher for regional hospitals followed by district hospitals. Average readiness was 78.9% for basic amenities, 76.7% for medical equipment, 76.0% for diagnosis and treatment commodities, 63.6% for staffing and 50.0% for guidelines. There was a variation in the availability of items at the individual health facility level and across levels of facilities. We found a significant difference in the availability of basic amenities, equipment, staffing, and guidelines between regional, and district hospitals and health centres (p = 0.05). Regional hospitals had significantly higher scores of medical equipment than district hospitals and health centers (p = 0.02). There was no significant difference in the availability of commodities for diagnosis and treatment between different facility levels. CONCLUSION Facilities' readiness was inadequate and varied across different levels of the facility. There is room to improve the facilities' readiness to deliver quality maternal and newborn care. The responsible authorities should take immediate actions to address the observed deficiencies while carefully choosing the most effective and feasible interventions and monitoring progress in readiness.
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Affiliation(s)
- Damas Juma
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania.
- Manyara Regional Secretariat, Manyara, Tanzania.
| | - Ketil Stordal
- Department of Pediatric Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Benjamin Kamala
- Department of Research, Haydom Lutheran Hospital, Manyara, Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Dunstan R Bishanga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Albino Kalolo
- Department of Public Health, St. Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Robert Moshiro
- Department of Research, Haydom Lutheran Hospital, Manyara, Tanzania
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Rachel Manongi
- Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
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25
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Altobelli LC. Good Management Practice Is Correlated With Good Performance of Community-Engaged Primary Health Care Facilities in Peru. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024:GHSP-D-23-00402. [PMID: 39084878 DOI: 10.9745/ghsp-d-23-00402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/18/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Increasing prioritization of quality primary health care (PHC) includes community engagement as a key element to improve PHC performance. We assessed the correlation of good regional management practices with PHC performance in Peru in community-comanaged PHC that is designed with multiple accountability mechanisms. METHODS We conducted a secondary analysis of a survey of Dirección Regional de Salud (regional health directorates, DIRESAs) regarding their management of public PHC services with collaborative community involvement by a Comunidad Local de Administración de Salud (Local Community for Health Administration, CLAS). CLAS-run facilities have previously shown evidence of superior performance over standard PHC services. We classified survey questions on 5 management functions of the Primary Health Care Performance Initiative: leadership, information system, financial control, transfer of management and leadership skills to health facilities, and supervision. An expert panel designated management practices as "good" or "less effective." The outcome, PHC service performance, was the percentage of CLAS comanaged facilities in each DIRESA achieving coverage and utilization goals. We correlated frequency of good management practices with PHC service performance. DIRESAs were divided into Group 1, "higher performance," and Group 2, "lower performance," to identify specific practices linked to better performance. RESULTS We identified 32 good management practices among 52 response options to 17 questions. Correlation between good management practice and good service performance was significant (r=.7266; 12 df; P<.01). An average of 91.1% and 37.6% of CLAS facilities achieved service goals in Groups 1 and 2, respectively. Of all good management practices identified, an average of 40.6% and 24.0% were used by Groups 1 and 2, respectively. Group 1 used 11 specific good practices more frequently than Group 2. CONCLUSIONS Regional management and community-comanaged PHC services designed with accountability mechanisms should be intentionally aligned, incorporating these into policies, budgets, processes, and capacities to strengthen PHC services.
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Affiliation(s)
- Laura C Altobelli
- Future Generations University, Franklin, WV, USA.
- School of Public Health and Administration, Cayetano Heredia University, Lima, Peru
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26
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Appelbäck M, Carlbom A, Eriksson L, Essén B. The dynamics of intercultural clinical encounters in times of pandemic crisis. Swedish healthcare providers' reflections on social norms in relation to sexual and reproductive healthcare. Midwifery 2024; 138:104129. [PMID: 39126859 DOI: 10.1016/j.midw.2024.104129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/17/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Experiences from the COVID-19 pandemic may help to better understand resilience, competences and skills for healthcare providers and the healthcare system. Within sexual and reproductive health inequalities for migrants exist and it is an area where promoting both cultural competency and healthcare equity in the clinical encounter is expected of healthcare providers yet can create tension. The aim is to explore healthcare providers experiences of encounters with migrants in the context of the pandemic and the subsequent changes in routines and norms. METHODS A qualitative study based on semi-structured interviews with 31 healthcare providers working in sexual and reproductive healthcare in southern Sweden. Interviews were conducted during the COVID-19 pandemic influencing how healthcare providers reflected on their experiences. Analysis was done using reflexive thematic data analysis. FINDINGS Healthcare providers reflected on how changes in routines increased the understanding of challenges and enablers in the intercultural encounter including the impact on communication and role of relatives and male partners. They emphasized the dynamics of culture in the clinical encounter and healthcare system through highlighting the importance of structural awareness, self-reflection and the flexibility of conducts and norms, often given a cultural connotation. CONCLUSION The COVID-19 pandemic resulted in changes of previously established routines directly affecting clinical encounters, which provided a unique opportunity for healthcare providers to reflect, with communication and self-reflection being discussed as central in complex encounters. It highlighted the dynamics of presumed deeply rooted cultural norms and the interplay with social factors affecting healthcare providers and patients alike.
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Affiliation(s)
- Mia Appelbäck
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Aje Carlbom
- Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden
| | - Lise Eriksson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Birgitta Essén
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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27
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Adhikari B, Tiwari I, Karki S, Pandey AR, K. C. SP, Lamichhane B, Sharma S, Sapkota S, Dulal BP, Gautam G, Joshi D, Castro-Sánchez E, Budhathoki SS, Baral SC. Health facilities readiness for standard precautions to infection prevention and control in Nepal: A secondary analysis of Nepal Health Facility Survey 2021. PLoS One 2024; 19:e0307589. [PMID: 39052585 PMCID: PMC11271867 DOI: 10.1371/journal.pone.0307589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Improvements in standard precaution related to infection prevention and control (IPC) at the national and local-level health facilities (HFs) are critical to ensuring patient's safety, preventing healthcare-associated infections (HAIs), mitigating Antimicrobial Resistance (AMR), protecting health workers, and improving trust in HFs. This study aimed to assess HF's readiness to implement standard precautions for IPC in Nepal. METHODS This study conducted a secondary analysis of the nationally-representative Nepal Health Facility Survey (NHFS) 2021 data and used the Service Availability and Readiness Assessment (SARA) Manual from the World Health Organization (WHO) to examine the HF's readiness to implement standard precautions for IPC. The readiness score for IPC was calculated for eight service delivery domains based on the availability of eight tracer items: guidelines for standard precautions, latex gloves, soap and running water or alcohol-based hand rub, single use of standard disposal or auto-disable syringes, disinfectant, safe final disposal of sharps, safe final disposal of infectious wastes, and appropriate storage of infectious waste. We used simple and multiple linear regression and quantile regression models to examine the association of HF's readiness with their characteristics. Results were presented as beta (β) coefficients and 95% confidence interval (95% CI). RESULTS The overall readiness scores of all HFs, federal/provincial hospitals, local HFs, and private hospitals were 59.9±15.6, 67.1±14.4, 59.6±15.6, and 62.6±15.5, respectively. Across all eight health service delivery domains, the HFs' readiness for tuberculosis services was the lowest (57.8±20.0) and highest for delivery and newborn care services (67.1±15.6). The HFs performing quality assurance activities (β = 3.68; 95%CI: 1.84, 5.51), reviewing clients' opinions (β = 6.66; 95%CI: 2.54, 10.77), and HFs with a monthly meeting (β = 3.28; 95%CI: 1.08, 5.49) had higher readiness scores. The HFs from Bagmati, Gandaki, Lumbini, Karnali and Sudurpaschim had readiness scores higher by 7.80 (95%CI: 5.24, 10.36), 7.73 (95%CI: 4.83, 10.62), 4.76 (95%CI: 2.00, 7.52), 9.40 (95%CI: 6.11, 12.68), and 3.77 (95%CI: 0.81, 6.74) compared to Koshi. CONCLUSION The readiness of HFs to implement standard precautions was higher in HFs with quality assurance activities, monthly HF meetings, and mechanisms for reviewing clients' opinions. Emphasizing quality assurance activities, implementing client feedback mechanisms, and promoting effective management practices in HFs with poor readiness can help to enhance IPC efforts.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Enrique Castro-Sánchez
- Imperial College London, Health Protection Research Unit in Healthcare-Associated Infection and Antimicrobial Resistance, London, United Kingdom
- University of the Balearic Islands, Global Health Research Group, Palma, Spain
- Brunel University London, College of Business, Arts, and Social Sciences, Uxbridge, United Kingdom
- Universidad Internacional de Valencia, Valencia, Spain
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health School of Public Health Imperial College London, London, United Kingdom
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Harris E, Ali S, Mungurere-Baker J, Mompe A, Maru C, Korgaonkar B, Srihari S, Molla Y. Indicators and Implementation Guidance to Advance Value-Based HIV Care Through People-Centered Metrics. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024:GHSP-D-23-00220. [PMID: 39054062 DOI: 10.9745/ghsp-d-23-00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 06/26/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Emily Harris
- U.S. Agency for International Development, Washington, DC, USA.
| | | | | | - Atlang Mompe
- U.S. Agency for International Development, Washington, DC, USA
| | | | | | - Shipra Srihari
- Local Health System Sustainability Project, Rockville, MD, USA
| | - Yordanos Molla
- Local Health System Sustainability Project, Rockville, MD, USA
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29
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Brant LCC, Miranda JJ, Carrillo-Larco RM, Flood D, Irazola V, Ribeiro ALP. Epidemiology of cardiometabolic health in Latin America and strategies to address disparities. Nat Rev Cardiol 2024:10.1038/s41569-024-01058-2. [PMID: 39054376 DOI: 10.1038/s41569-024-01058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/27/2024]
Abstract
In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.
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Affiliation(s)
- Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vilma Irazola
- Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Antonio Luiz P Ribeiro
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Li M, Zhang X, Tang H, Zheng H, Long R, Cheng X, Cheng H, Dong J, Wang X, Zhang X, Geldsetzer P, Liu X. Quality of primary health care for chronic diseases in low-resource settings: Evidence from a comprehensive study in rural China. PLoS One 2024; 19:e0304294. [PMID: 39052549 PMCID: PMC11271947 DOI: 10.1371/journal.pone.0304294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND There is a paucity of evidence regarding the definition of the quality of primary health care (PHC) in China. This study aims to evaluate the PHC quality for chronic diseases in rural areas based on a modified conceptual framework tailored to the context of rural China. METHODS This comprehensive study, involving a patient survey, a provider survey and chart abstraction, and second-hand registered data, was set in three low-resource counties in rural China from 2021 to 2022. Rural patients with hypertension or type 2 diabetes, and health care workers providing care on hypertension or diabetes were involved. The modified PHC quality framework encompasses three core domains: a competent PHC system (comprehensiveness, accessibility, continuity, and coordination), effective clinical care (assessment, diagnosis, treatment, disease management, and provider competence), and positive user experience (information sharing, shared decision-making, respect for patient's preferences, and family-centeredness). Standardized PHC quality score was generated by arithmetic means or Rasch models of Item Response Theory. RESULTS This study included 1355 patients, 333 health care providers and 2203 medical records. Ranging from 0 (the worst) to 1 (the best), the average quality score for the PHC system was 0.718, with 0.887 for comprehensiveness, 0.781 for accessibility, 0.489 for continuity, and 0.714 for coordination. For clinical care, average quality was 0.773 for disease assessment, 0.768 for diagnosis, 0.677 for treatment, 0.777 for disease management, and 0.314 for provider competence. The average quality for user experience was 0.727, with 0.933 for information sharing, 0.657 for shared decision-making, 0.936 for respect for patients' preferences, and 0.382 for family-centeredness. The differences in quality among population subgroups, although statistically significant, were small. CONCLUSION The PHC quality in rural China has shown strengths and limitations. We identified large gaps in continuity of care, treatment, provider competence, family-centeredness, and shared decision-making. Policymakers should invest more effort in addressing these gaps to improve PHC quality.
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Affiliation(s)
- Mingyue Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Xiaotian Zhang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Haoqing Tang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Huixian Zheng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ren Long
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaoran Cheng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haozhe Cheng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jiajia Dong
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xiaohui Wang
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xiaoyan Zhang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, New York, United States of America
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, San Francisco, California, United States of America
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
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Basile FW, Sweeney S, Singh MP, Bijker EM, Cohen T, Menzies NA, Vassall A, Indravudh P. Uncertainty in tuberculosis clinical decision-making: An umbrella review with systematic methods and thematic analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003429. [PMID: 39042611 PMCID: PMC11265660 DOI: 10.1371/journal.pgph.0003429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/12/2024] [Indexed: 07/25/2024]
Abstract
Tuberculosis is a major infectious disease worldwide, but currently available diagnostics have suboptimal accuracy, particularly in patients unable to expectorate, and are often unavailable at the point-of-care in resource-limited settings. Test/treatment decision are, therefore, often made on clinical grounds. We hypothesized that contextual factors beyond disease probability may influence clinical decisions about when to test and when to treat for tuberculosis. This umbrella review aimed to identify such factors, and to develop a framework for uncertainty in tuberculosis clinical decision-making. Systematic reviews were searched in seven databases (MEDLINE, CINAHL Complete, Embase, Scopus, Cochrane, PROSPERO, Epistemonikos) using predetermined search criteria. Findings were classified as barriers and facilitators for testing or treatment decisions, and thematically analysed based on a multi-level model of uncertainty in health care. We included 27 reviews. Study designs and primary aims were heterogeneous, with seven meta-analyses and three qualitative evidence syntheses. Facilitators for decisions to test included providers' advanced professional qualification and confidence in tests results, availability of automated diagnostics with quick turnaround times. Common barriers for requesting a diagnostic test included: poor provider tuberculosis knowledge, fear of acquiring tuberculosis through respiratory sampling, scarcity of healthcare resources, and complexity of specimen collection. Facilitators for empiric treatment included patients' young age, severe sickness, and test inaccessibility. Main barriers to treatment included communication obstacles, providers' high confidence in negative test results (irrespective of negative predictive value). Multiple sources of uncertainty were identified at the patient, provider, diagnostic test, and healthcare system levels. Complex determinants of uncertainty influenced decision-making. This could result in delayed or missed diagnosis and treatment opportunities. It is important to understand the variability associated with patient-provider clinical encounters and healthcare settings, clinicians' attitudes, and experiences, as well as diagnostic test characteristics, to improve clinical practices, and allow an impactful introduction of novel diagnostics.
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Affiliation(s)
- Francesca Wanda Basile
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maninder Pal Singh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Else Margreet Bijker
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Department of Paediatrics, Maastricht University Medical Centre, MosaKids Children’s Hospital, Maastricht, the Netherlands
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Nicolas A. Menzies
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
- Center for Health Decision Science, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pitchaya Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Acharya K, Bhattarai N, Dahal R, Bhattarai A, Paudel YR, Dharel D, Aryal K, Adhikari K. Examining the availability and readiness of health facilities to provide cervical cancer screening services in Nepal: a cross-sectional study using data from the Nepal Health Facility Survey. BMJ Open 2024; 14:e077537. [PMID: 39038865 PMCID: PMC11288140 DOI: 10.1136/bmjopen-2023-077537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE We assessed the availability and readiness of health facilities to provide cervical cancer screening services in Nepal. DESIGN Cross-sectional study. SETTING We used secondary data from a nationally representative 2021 Nepal Health Facility Survey, specifically focusing on the facilities offering cervical cancer screening services. OUTCOME MEASURES We defined the readiness of health facilities to provide cervical cancer screening services using the standard WHO service availability and readiness assessment manual. RESULTS The overall readiness score was 59.1% (95% CI 55.4% to 62.8%), with more equipment and diagnostic tests available than staff and guidelines. Public hospitals (67.4%, 95% CI 63.0% to 71.7%) had the highest readiness levels. Compared with urban areas, health facilities in rural areas had lower readiness. The Sudurpashchim, Bagmati and Gandaki provinces had higher readiness levels (69.1%, 95% CI 57.7% to 80.5%; 60.1%, 95% CI 53.4% to 66.8%; and 62.5%, 95% CI 56.5% to 68.5%, respectively). Around 17% of facilities had trained providers and specific guidelines to follow while providing cervical cancer screening services. The basic healthcare centres (BHCCs) had lower readiness than private hospitals. Facility types, province and staff management meetings had heterogeneous associations with three conditional quantile scores. CONCLUSION The availability of cervical cancer screening services is limited in Nepal, necessitating urgent action to expand coverage. Our findings suggest that efforts should focus on improving the readiness of existing facilities by providing training to healthcare workers and increasing access to guidelines. BHCCs and healthcare facilities in rural areas and Karnali province should be given priority to enhance their readiness.
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Affiliation(s)
| | | | - Rudra Dahal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Asmita Bhattarai
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Provincial Primary Health Care, Alberta Health Services, Edmonton, Alberta, Canada
| | - Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dinesh Dharel
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kabita Aryal
- Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | - Kamala Adhikari
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Provincial Population and Public Health, Alberta Health Services, Edmonton, Alberta, Canada
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Spanos S, Dammery G, Pagano L, Ellis LA, Fisher G, Smith CL, Foo D, Braithwaite J. Learning health systems on the front lines to strengthen care against future pandemics and climate change: a rapid review. BMC Health Serv Res 2024; 24:829. [PMID: 39039551 PMCID: PMC11265124 DOI: 10.1186/s12913-024-11295-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/09/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND An essential component of future-proofing health systems against future pandemics and climate change is strengthening the front lines of care: principally, emergency departments and primary care settings. To achieve this, these settings can adopt learning health system (LHS) principles, integrating data, evidence, and experience to continuously improve care delivery. This rapid review aimed to understand the ways in which LHS principles have been applied to primary care and emergency departments, the extent to which LHS approaches have been adopted in these key settings, and the factors that affect their adoption. METHODS Three academic databases (Embase, Scopus, and PubMed) were searched for full text articles reporting on LHSs in primary care and/or emergency departments published in the last five years. Articles were included if they had a primary focus on LHSs in primary care settings (general practice, allied health, multidisciplinary primary care, and community-based care) and/or emergency care settings. Data from included articles were catalogued and synthesised according to the modified Institute of Medicine's five-component framework for LHSs (science and informatics, patient-clinician partnerships, incentives, continuous learning culture, and structure and governance). RESULTS Thirty-seven articles were included, 32 of which reported LHSs in primary care settings and seven of which reported LHSs in emergency departments. Science and informatics was the most commonly reported LHS component, followed closely by continuous learning culture and structure and governance. Most articles (n = 30) reported on LHSs that had been adopted, and many of the included articles (n = 17) were descriptive reports of LHS approaches. CONCLUSIONS Developing LHSs at the front lines of care is essential for future-proofing against current and new threats to health system sustainability, such as pandemic- and climate change-induced events. Limited research has examined the application of LHS concepts to emergency care settings. Implementation science should be utilised to better understand the factors influencing adoption of LHS approaches on the front lines of care, so that all five LHS components can be progressed in these settings.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia.
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Lisa Pagano
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
| | - Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
| | - Darran Foo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- Faculty of Medicine, Health and Human Sciences, MQ Health General Practice, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, North Ryde, NSW, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Macquarie University, Sydney, Australia
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Dlangalala T, Musekiwa A, Mashamba-Thompson T. Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa. PLoS One 2024; 19:e0307149. [PMID: 39024321 PMCID: PMC11257344 DOI: 10.1371/journal.pone.0307149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024] Open
Abstract
Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson's pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.
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Affiliation(s)
- Thobeka Dlangalala
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Gauteng, South Africa
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Franzoi IG, Sauta MD, De Luca A, Barbagli F, Granieri A. PSYCHOLOGICAL INTERVENTIONS FOR MESOTELIOMA PATIENTS AND THEIR CAREGIVERS: A SYSTEMATIC LITERATURE REVIEW. J Pain Symptom Manage 2024:S0885-3924(24)00855-8. [PMID: 39029809 DOI: 10.1016/j.jpainsymman.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/06/2024] [Accepted: 07/05/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE Malignant Mesothelioma (MM) has a striking impact on the somatopsychic balance of patients and their families, including physical, psychological, and interpersonal problems. The aim of this systematic literature review was to investigate what psychological interventions are offered to patients with MM and their caregivers worldwide. METHODS The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification of 12 articles. Results were categorized into five categories. 1. Individual psychological support, 2. Group psychological support, 3. Cognitive-behavioral group psychotherapy, 4. Brief psychoanalytic groups, 5. Multifamily group. RESULTS The interventions differed in terms of form, duration and resources used. Most of them were group-based and psychoanalytically oriented, although individual and cognitive-behavioral interventions were also described. Despite the differences, the interventions appeared to be fundamental in facilitating the processing of mental pain and anger related to the diagnosis. CONCLUSION Our study has shown that there are still few psychological interventions available for MM patients and their caregivers. The somatopsychic consequences of MM in patients and caregivers should encourage institutions and healthcare professionals to develop assessment and intervention models that address the different dimensions of their suffering and promote their residual vitality.
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Viña J, Borrás C. Unlocking the biochemical secrets of longevity: balancing healthspan and lifespan. FEBS Lett 2024. [PMID: 38956807 DOI: 10.1002/1873-3468.14963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
In an era of rising global life expectancies, research focuses on enhancing the quality of extended years. This review examines the link between mitochondrial function and aging, highlighting the importance of healthspan alongside lifespan. This involves significant human and economic challenges, with longer lifespans often accompanied by reduced well-being. Addressing mitochondrial decline, exploring targeted interventions, and understanding the complexities of research models are vital for advancing our knowledge in this field. Additionally, promoting physical exercise and adopting personalized supplementation strategies based on individual needs can contribute to healthy aging. The insights from this Perspective article offer a hopeful outlook for future advances in extending both lifespan and healthspan, aiming to improve the overall quality of life in aging populations.
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Affiliation(s)
- Jose Viña
- Freshage Research Group, Department of Physiology, Faculty of Medicine, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable-Instituto de Salud Carlos III (CIBERFES-ISCIII), Institute of Health Research-INCLIVA, University of Valencia, Spain
| | - Consuelo Borrás
- Freshage Research Group, Department of Physiology, Faculty of Medicine, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable-Instituto de Salud Carlos III (CIBERFES-ISCIII), Institute of Health Research-INCLIVA, University of Valencia, Spain
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Dhawale KK, Tidake P. Cataract Surgery and Mental Health: A Comprehensive Review on Outcomes in the Elderly. Cureus 2024; 16:e65469. [PMID: 39188457 PMCID: PMC11346754 DOI: 10.7759/cureus.65469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Cataract surgery is a widely performed and highly effective procedure that significantly improves vision in elderly patients. This narrative review examines the impact of cataract surgery on mental health outcomes in the elderly, focusing on conditions such as depression, anxiety, and cognitive decline. The review highlights the prevalence of cataracts in older adults and the importance of mental health in this demographic, emphasizing the interconnectedness of visual and mental health. Improved vision following cataract surgery has been associated with enhanced quality of life, increased independence, and better psychological well-being. Mechanisms linking visual improvement to mental health benefits include biological pathways, psychosocial factors, and overall health improvements. However, socioeconomic factors, access to healthcare, and patient education play crucial roles in achieving positive outcomes. This review also compares cataract surgery with other interventions, providing a cost-benefit analysis and discussing the long-term sustainability of mental health benefits. Practice recommendations include pre-surgical mental health screening, integrative care approaches, and guidelines for postoperative care focusing on mental health. The review concludes with suggestions for future research to further explore the relationship between cataract surgery and mental health in the elderly, aiming to enhance clinical practice and public health strategies.
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Affiliation(s)
- Kasturi K Dhawale
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pravin Tidake
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kanabar B, Piparva KG, Pandya D, Kanabar RB. The Impact and Challenges of the Implementation of 5S Methodology in Healthcare Settings: A Systematic Review. Cureus 2024; 16:e64634. [PMID: 39149689 PMCID: PMC11326763 DOI: 10.7759/cureus.64634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/17/2024] Open
Abstract
The 5S methodology, rooted in lean manufacturing principles, has been adopted in healthcare settings to improve organization, efficiency, and quality. This systematic review aimed to synthesize the literature on the implementation of the 5S methodology in healthcare, its impact, and factors influencing successful implementation. A comprehensive literature search was conducted in PubMed, Google Scholar, and Cochrane databases for original studies on the implementation of the 5S methodology in healthcare settings. Studies were screened based on inclusion and exclusion criteria, and data were extracted on study characteristics, implementation details, outcomes, and key findings. Six studies met the inclusion criteria, spanning various healthcare settings, including hospitals, clinics, and laboratories. The studies reported positive outcomes associated with implementing the 5S methodology, such as improved workplace organization and cleanliness, increased utilization of healthcare services, enhanced staff satisfaction and motivation, and reduced waste and non-conformities. Critical success factors included commitment from top management, staff involvement, continuous monitoring, and adequate training. However, challenges were noted, including limited resources, small sample sizes, and difficulty assessing long-term sustainability. The implementation of the 5S methodology in healthcare settings can lead to improved organization, efficiency, and quality. However, successful implementation requires addressing critical factors such as leadership commitment, staff engagement, continuous monitoring, and training. Future research should focus on larger-scale implementation studies, long-term assessments, quantitative and qualitative evaluations, and cost-effectiveness analyses to strengthen the evidence base and inform best practices.
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Affiliation(s)
- Bhavesh Kanabar
- Preventive and Social Medicine, Pandit Deendayal Upadhyay (PDU) Government Medical College, Rajkot, IND
| | - Kiran G Piparva
- Pharamacology, All India Institutes of Medical Sciences (AIIMS), Rajkot, IND
| | - Dhruvin Pandya
- Medicine, Pandit Deendayal Upadhyay (PDU) Government Medical College, Rajkot, IND
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Bartosch P, Jaye C, Crampton P. Moral economy and moral capital: A new approach to understanding health systems. Soc Sci Med 2024; 352:117016. [PMID: 38796950 DOI: 10.1016/j.socscimed.2024.117016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
Healthcare systems can be considered moral economies in which moral capital in the form of expectations toward norms, values, and virtues are exchanged and traded. Moral capital, as a concept, is an extension of Bourdieu's forms of symbolic, and in particular, cultural capital. This research set out to identify forms of moral capital evident in the accounts of health professionals and patients within the distinctive healthcare systems of Germany, New Zealand, and the Unites States. Here, we provide an overview of 15 forms of moral capital that were identified. An important form of moral capital is equality. The global coronavirus pandemic has illuminated inequalities in healthcare systems across the world. We suggest considering moral capital as a useful tool to reform healthcare systems and make the provision of healthcare a more equitable enterprise.
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Nashwan AJ, Abou Hashish EA, Mohamed AS, Alrimawi I, Aqtam I, Al Obeisat S, Alhalaiqa F, Alzaatreh M, Al Hadidi M, Al-Fayyadh S, Faleh JN, Shaban M, Shaban M, Mirzaei A, Vakilabad R, Arabloo J, Siddique S, Shdefat A, Atout M, Alharbi HF. Exploring the National Nursing Research Priorities in the Eastern Mediterranean Region and Overcoming the Associated Challenges: An Expert Opinion. Cureus 2024; 16:e64540. [PMID: 39144876 PMCID: PMC11322553 DOI: 10.7759/cureus.64540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Nurses play a significant role in contributing to various health priorities globally, including research. Identifying the status of national nursing research priorities in the Eastern Mediterranean Region is crucial to cultivating these priorities. This expert opinion paper highlights the existing status of national nursing research priorities in Eastern Mediterranean Region countries concerning their existence and publicity. METHODS Experts from nine Eastern Mediterranean Region countries, including Egypt, Iran, Iraq, Jordan, Pakistan, Palestine, Qatar, Oman, and Saudi Arabia, contributed to this report. They participated by completing a cross-sectional survey and providing a narrative description of their opinions. RESULTS The findings revealed that 58% of the participating countries have existing national nursing research priorities, while 25.8% do not, and 16% are under development. Governmental organizations developed the largest portion of the priorities (38%). Midwives were not considered in half of the published priorities. The vast majority of national nursing research priorities (65%) were developed by experts' opinions and consensus, and 33% only have an associated strategy, outcome measures, and/or funding opportunities. Generally, most published research priorities were not updated regularly. CONCLUSION Eastern Mediterranean Region countries face a challenge with the need for more nurses, which may hinder their involvement in research projects or continued education. Despite this, all countries involved in this report emphasized the importance of developing nursing education and research as priorities for improving their current nursing workforce. Health policymakers, nurse practitioners, academic researchers, educators, and nursing leaders should collaborate to develop operational plans to foster national nursing education and research.
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Affiliation(s)
- Abdulqadir J Nashwan
- Department of Nursing & Midwifery Research, Hamad Medical Corporation, Doha, QAT
| | - Ebtsam A Abou Hashish
- Faculty of Nursing, Alexandria University, Alexandria, EGY
- College of Nursing, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Intima Alrimawi
- School of Nursing, Georgetown University, Washington, DC, USA
| | - Ibrahim Aqtam
- Ibn Sina College for Health Professions, Nablus University for Vocational and Technical Education, Nablus, PSE
| | - Salwa Al Obeisat
- Faculty of Nursing, Jordan University of Science and Technology, Irbid, JOR
| | | | - Mohammad Alzaatreh
- Department of Applied Medical Sciences, Al-Balqa Applied University, Amman, JOR
| | | | - Sadeq Al-Fayyadh
- Department of Adult Nursing, University of Baghdad, Baghdad, IRQ
| | - Jadeel N Faleh
- Al-Muthanah Health Directorate, Al-Muthanah Governorate, Al-Muthanah, IRQ
| | - Marwa Shaban
- Department of Community Health Nursing, Cairo University, Cairo, EGY
| | - Mostafa Shaban
- Department of Gerontological Nursing, Faculty of Nursing, Cairo University, Cairo, EGY
| | - Alireza Mirzaei
- School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, IRN
| | - Reza Vakilabad
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, IRN
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, IRN
| | - Sulman Siddique
- Department of Healthcare Education, Shifa International Hospitals, Islamabad, PAK
| | - Aisha Shdefat
- Department of Nursing, Sultan Qaboos University (SQU), Muscat, OMN
| | - Maha Atout
- Faculty of Nursing, Philadelphia University, Amman, JOR
| | - Hanan F Alharbi
- Department of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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García PJ, Leslie H, Medina-Ranilla J, Espinoza-Pajuelo L, Guglielmino M, Roberti J, Mazzoni A, García-Elorrio E. The QuEST LAC network uses data to promote evidence-based policies for health in Latin America. Nat Med 2024; 30:1811-1812. [PMID: 38862715 DOI: 10.1038/s41591-024-03029-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Affiliation(s)
- Patricia J García
- Faculty of Public Health and Administration, Epidemiology Department, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Hannah Leslie
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jesús Medina-Ranilla
- Faculty of Public Health and Administration, Epidemiology Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Laura Espinoza-Pajuelo
- Faculty of Public Health and Administration, Epidemiology Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marina Guglielmino
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Javier Roberti
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET) - Centre for Research in Epidemiology and Public Health (CIESP), Buenos Aires, Argentina
| | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ezequiel García-Elorrio
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET) - Centre for Research in Epidemiology and Public Health (CIESP), Buenos Aires, Argentina
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Kruk ME, Sabwa S, Lewis TP, Aniebo I, Arsenault C, Carai S, Garcia PJ, Garcia-Elorrio E, Fink G, Kassa M, Mohan S, Moshabela M, Oh J, Pate MA, Nzinga J. Population assessment of health system performance in 16 countries. Bull World Health Organ 2024; 102:486-497B. [PMID: 38933481 PMCID: PMC11197641 DOI: 10.2471/blt.23.291184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. Methods We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. Findings In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Conclusion Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments.
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Affiliation(s)
- Margaret E Kruk
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Shalom Sabwa
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Todd P Lewis
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Ifeyinwa Aniebo
- Ministry of Health and Social Welfare of Nigeria, Abuja, Nigeria
| | - Catherine Arsenault
- Milken Institute School of Public Health, George Washington University, WashingtonDC, USA
| | - Susanne Carai
- WHO Office on Quality of Care and Patient Safety, Athens, Greece
| | | | | | - Günther Fink
- University of Basel and Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | - Mosa Moshabela
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, Republic of Korea
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Duong DB, Holt B, Munoz C, Pollack TM. For and with people: announcing the Lancet Global Health Commission on people-centred care for universal health coverage and a call for commissioner nominations. Lancet Glob Health 2024; 12:e1089-e1090. [PMID: 38823407 DOI: 10.1016/s2214-109x(24)00216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024]
Affiliation(s)
- David B Duong
- Program in Global Primary Care & Social Change, Department of Global Health and Social Medicine, Boston, MA 02115, USA; Center for Primary Care, Harvard Medical School, Boston, MA 02115, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
| | - Bethany Holt
- Program in Global Primary Care & Social Change, Department of Global Health and Social Medicine, Boston, MA 02115, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Chris Munoz
- Yellow Warriors Society, Manila, Philippines
| | - Todd M Pollack
- Program in Global Primary Care & Social Change, Department of Global Health and Social Medicine, Boston, MA 02115, USA; Center for Primary Care, Harvard Medical School, Boston, MA 02115, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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44
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Anwar NA, Aizuddin AN, Ahmad N, Aziz A. Attributes Influencing Willingness to Pay for Overweight and Obesity Interventions in Adults: A Systematic Literature Review. Cureus 2024; 16:e65468. [PMID: 39071073 PMCID: PMC11281942 DOI: 10.7759/cureus.65468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 07/30/2024] Open
Abstract
This review aims to identify the associated attributes of willingness to pay (WTP) for overweight and obesity interventions. A narrative review was conducted by partially adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A non-exhaustive search using a pre-defined strategy and keywords was done on three selected literature databases: Pubmed, Scopus, and Web of Science. The inclusion criteria for the review were original studies written in English, published between 2000 and 2022, and focused on WTP for overweight and obesity interventions in adults. The extracted studies were manually screened for their eligibility through three cascading tiers: the title, the abstract, and the full article. Only nine original studies were eligible for review based on the screening procedure of 40 screened articles. There was heterogeneity in the study designs, methods, target populations, study duration, and perspectives across the studies. The majority of the studies showed that higher WTP was associated with younger age, having higher income, being female, having higher body mass index (BMI), having the perception of being overweight, habits, and attitudes. WTP is also attributed to the associated percentage of weight loss, long-term health risk reduction, time to noticeable weight loss, delivery mode, side effects, lifestyle modification, and costs of interventions. The identification of common attributes of the WTP for overweight and obesity intervention can assist in the formulation and implementation of effective evidence-based policies. Specific sub-groups with low WTP could be targeted via unique initiatives to improve their participation in weight-loss interventions.
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Affiliation(s)
- Nurul A Anwar
- Epidemiology and Public Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Azimatun Noor Aizuddin
- Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Norfazilah Ahmad
- Public Health Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Abdul Aziz
- Public Health, Ministry of Health Malaysia, Putrajaya, MYS
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Villa Nogueyra S, Trujillo Rodríguez MF, Garcia Oliva ML, Vidal-Gallardo A, Ramírez Leal A, Beltran Hernandez J, Vargas Beltran AM, Guillen Sandoval JD, Arriaga Escamilla D, Martinez Ramirez M. The Genetic Diagnostics of Hemochromatosis: Disparities in Low- Versus High-Income Countries. Cureus 2024; 16:e64074. [PMID: 39114232 PMCID: PMC11305073 DOI: 10.7759/cureus.64074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
This study provides a comprehensive overview of hereditary hemochromatosis (HH), a genetic condition characterized by iron overload due to excessive iron absorption. It elucidates diverse inheritance patterns and clinical manifestations by exploring mutations in critical genes such as HFE (hemochromatosis), HJV (hemojuvelin), HAMP (hepcidin antimicrobial peptide), TfR2 (transferrin receptor 2), and FP (ferroportin). The significance of early screening, diagnosis, and personalized management strategies based on genetic classification is emphasized, particularly in terms of high-income vs. low-income countries. Addressing challenges in diagnosis, genetic testing accessibility, and healthcare disparities, the study highlights the importance of early detection, cost-effective screening strategies, and enhancing healthcare outcomes globally. Advanced genetic testing in high-income countries facilitates early diagnosis and management, reducing complications such as liver disease and cardiomyopathy. In contrast, low-income populations face several barriers, including limited access to genetic testing, high costs, and inadequate healthcare infrastructure. Cost-effective serum ferritin (SF) and transferrin saturation (TS) tests and emerging point-of-care (POC) tests offer affordable diagnostic options for low-resource settings. Additionally, the ongoing development of hepcidin measurement methods holds promise for enhancing diagnostic capabilities. Implementing these strategies can aid healthcare providers in improving global HH management and reducing the burden of iron overload complications. Furthermore, the study underscores the need for public health initiatives to raise awareness about HH, promote routine screenings, and advocate for equitable healthcare policies. Collaborative efforts between governments, healthcare organizations, and research institutions are crucial in addressing the global burden of HH. By fostering international cooperation and resource-sharing, it is possible to bridge the gap between high-income and low-income countries, ensuring all individuals have access to the necessary diagnostic and treatment options. This holistic approach can ultimately lead to better health outcomes and improved quality of life for individuals affected by HH worldwide. This comprehensive examination of HH not only illuminates the genetic and clinical aspects of the condition but also provides a roadmap for addressing the multifaceted challenges associated with its diagnosis and management.
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Affiliation(s)
| | | | | | | | - Amanda Ramírez Leal
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, MEX
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Brazo-Sayavera J, Silva DR, Lang JJ, Tomkinson GR, Agostinis-Sobrinho C, Andersen LB, García-Hermoso A, Gaya AR, Jurak G, Lee EY, Liu Y, Lubans DR, Okely AD, Ortega FB, Ruiz JR, Tremblay MS, Dos Santos L. Physical Fitness Surveillance and Monitoring Systems Inventory for Children and Adolescents: A Scoping Review with a Global Perspective. Sports Med 2024; 54:1755-1769. [PMID: 38710913 PMCID: PMC11258155 DOI: 10.1007/s40279-024-02038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
Surveillance of health-related physical fitness can improve decision-making and intervention strategies promoting health for children and adolescents. However, no study has comprehensively analyzed surveillance/monitoring systems for physical fitness globally. This review sought to address this gap by identifying: (1) national-level surveillance/monitoring systems for physical fitness among children and adolescents globally, (2) the main barriers and challenges to implementing surveillance/monitoring systems, and (3) governmental actions related to existing surveillance/monitoring systems. We used a scoping review to search, obtain, group, summarize, and analyze available evidence. Our review involved three stages: (1) identification of surveillance systems through a systematic literature review, with complementary search of the grey literature (e.g., reference lists, Google Scholar, webpages, recommendations), (2) systematic consultation with relevant experts using a Delphi method to confirm/add systems and to gather and analyze information on the barriers and challenges to implementing systems, and (3) Web searches for public documents on government sites and surveillance/monitoring system pages, and direct internet searches to identify relevant governmental actions related to surveillance systems. A total of 15 fitness surveillance/monitoring systems met our inclusion criteria. Experts identified a lack of government support and funding, and the low priority of fitness on the public health agenda as the main barriers/challenges to implementation. Several governmental actions related to surveillance systems were identified, including policies, strategies, programs, and guidelines. We propose a Global Observatory of Physical Fitness to help address these issues.
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Affiliation(s)
- Javier Brazo-Sayavera
- Department of Sports and Computer Science, Universidad Pablo de Olavide, Seville, Spain.
| | - Danilo R Silva
- Department of Sports and Computer Science, Universidad Pablo de Olavide, Seville, Spain
- Department of Physical Education, Federal University of Sergipe, UFS, São Cristóvão, Brazil
| | - Justin J Lang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Cesar Agostinis-Sobrinho
- Health Research and Innovation Science Centre, Klaipeda University, Klaipeda, Lithuania
- Sport Physical Activity and Health Research & Innovation Center (SPRINT), Polytechnic Institute of Guarda, Guarda, Portugal
| | - Lars Bo Andersen
- Faculty of Teacher Education, Art and Sport, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Antonio García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Anelise R Gaya
- Projeto Esporte Brasil, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gregor Jurak
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Eun-Young Lee
- School of Kinesiology & Health Studies, Queen's University, Kingston, ON, Canada
| | - Yang Liu
- School of Physical Education, Shanghai University of Sport, Shanghai, China
- Shanghai Research Center for Physical Fitness and Health of Children and Adolescents, Shanghai, China
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anthony D Okely
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health, University Research Institute (iMUDS), University of Granada, Granada, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
| | - Jonatan R Ruiz
- Department of Physical Education and Sports, Faculty of Sports Science, Sport and Health, University Research Institute (iMUDS), University of Granada, Granada, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.Granada, Granada, Spain
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Leandro Dos Santos
- Department of Sports and Computer Science, Universidad Pablo de Olavide, Seville, Spain
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Duda-Sikuła M, Kurpas D. Enhancing Chronic Disease Management: Personalized Medicine Insights from Rural and Urban General Practitioner Practices. J Pers Med 2024; 14:706. [PMID: 39063960 PMCID: PMC11277769 DOI: 10.3390/jpm14070706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Health policies worldwide emphasize managing chronic conditions like diabetes and hypertension through medication and lifestyle modifications. However, translating guidelines into practical application remains challenging, leading to suboptimal care and poor health outcomes, particularly in low-resource settings. This study aims to reveal significant differences between rural and urban patients requiring personalized approaches to chronic disease management based on geographical location and demographic data, considering the impact of emergencies such as the COVID-19 pandemic. Data were collected from rural and urban general practitioner (GP) practices in Poland, covering four years from 2018 to the first quarter of 2021, focusing on diabetes and hypertension epidemiology, risk factors, comorbidities, resource consumption, and disease burden. The findings revealed significant differences between rural and urban patients regarding age, number of patient visits, gender distribution, and types of diagnoses and visit modalities. Rural patients tended to be older, had a higher median number of visits, and exhibited different patterns of diagnoses and visit types compared to urban patients. The study also investigated the impact of the COVID-19 pandemic on chronic disease treatment, finding that while age at visits increased during the pandemic, there were no significant changes in gender distribution, but a noticeable shift in diagnoses and visit modalities with an increase in remote visits and changes in the prevalence of specific diagnoses. These disparities highlight the need for tailored approaches to chronic disease management based on geographic location and patient demographics. The study underscores the importance of understanding the unique challenges and opportunities in managing chronic diseases across different settings and during public health crises like the COVID-19 pandemic, aiding healthcare providers and policymakers in developing targeted interventions to improve chronic disease prevention and management, ultimately leading to better health outcomes for individuals and communities. Further research is needed to explore the long-term effects of the pandemic on chronic disease treatment and assess the effectiveness of interventions to mitigate its impact.
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Affiliation(s)
- Marta Duda-Sikuła
- Clinical Trial Support Centre, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Donata Kurpas
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wroclaw Medical University, 50-996 Wrocław, Poland;
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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024; 12:556-574. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Arsenault C, Mebratie AD, Gelaw SK, Shamebo D. Routine data in a primary care performance dashboard, Ethiopia. Bull World Health Organ 2024; 102:465-475A. [PMID: 38933476 PMCID: PMC11197649 DOI: 10.2471/blt.23.291122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To explore the feasibility of building a primary care performance dashboard using DHIS2 data from Ethiopia's largest urban (Addis Ababa), agrarian (Oromia) and pastoral (Somali) regions. Methods We extracted 26 data elements reported by 12 062 health facilities to DHIS2 for the period 1 July 2022 to 30 June 2023. Focusing on indicators of effectiveness, safety and user experience, we built 14 indicators of primary care performance covering reproductive, maternal and child health, human immunodeficiency virus, tuberculosis, noncommunicable disease care and antibiotic prescription. We assessed data completeness by calculating the proportion of facilities reporting each month, and examined the presence of extreme outliers and assessed external validity. Findings At the regional level, average completeness across all data elements was highest in Addis Ababa (82.9%), followed by Oromia (66.2%) and Somali (52.6%). Private clinics across regions had low completeness, ranging from 38.6% in Somali to 58.7% in Addis Ababa. We found only a few outliers (334 of 816 578 observations) and noted that external validity was high for 11 of 14 indicators of primary care performance. However, the 12-month antiretroviral treatment retention rate and proportions of patients with controlled diabetes or hypertension exhibited poor external validity. Conclusion The Ethiopian DHIS2 contains information for measuring primary care performance, using simple analytical methods, at national and regional levels and by facility type. Despite remaining data quality issues, the health management information system is an important data source for generating health system performance assessment measures on a national scale.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW Washington, DC20052, United States of America
| | - Anagaw Derseh Mebratie
- Department of Health Systems Management and Health Policy, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | | | - Dessalegn Shamebo
- Department of Development Economics, Ethiopian Civil Service University, Addis Ababa, Ethiopia
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50
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Woskie L, Kalita A, Bose B, Chakraborty A, Gupta K, Yip W. Patient satisfaction and value based purchasing in hospitals, Odisha, India. Bull World Health Organ 2024; 102:509-520. [PMID: 38933484 PMCID: PMC11197647 DOI: 10.2471/blt.24.290519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/17/2024] [Accepted: 05/02/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To examine how a general inpatient satisfaction survey functions as a hospital performance measure. Methods We conducted a mixed-methods pilot study of the Hospital Consumer Assessment of Health Providers and Systems survey in Odisha, India. We divided the study into three steps: cognitive testing of the survey, item testing with exploratory factor analysis and content validity indexing. Cognitive testing involved 50 participants discussing their interpretation of survey items. The survey was then administered to 507 inpatients across five public hospitals in Odisha, followed by exploratory factor analysis. Finally, we interviewed 15 individuals to evaluate the content validity of the survey items. Findings Cognitive testing revealed that six out of 18 survey questions were not consistently understood within the Odisha inpatient setting, highlighting issues around responsibilities for care. Exploratory factor analysis identified a six-factor structure explaining 66.7% of the variance. Regression models showed that interpersonal care from doctors and nurses had the strongest association with overall satisfaction. An assessment of differential item functioning revealed that patients with a socially marginalized caste reported higher disrespectful care, though this did not translate into differences in reported satisfaction. Content validity indexing suggested that discordance between experiences of disrespectful care and satisfaction ratings might be due to low patient expectations. Conclusion Using satisfaction ratings without nuanced approaches in value-based purchasing programmes may mask poor-quality interpersonal services, particularly for historically marginalized patients. Surveys should be designed to accurately capture true levels of dissatisfaction, ensuring that patient concerns are not hidden.
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Affiliation(s)
- Liana Woskie
- Department of Community Health, Tufts University, 574 Boston Ave, Suite 208, MedfordMA02155, United States of America (USA)
| | - Anuska Kalita
- Department of Global Health and Population, Harvard University, Boston, USA
| | - Bijetri Bose
- Department of Global Health and Population, Harvard University, Boston, USA
| | | | - Kirti Gupta
- Oxford Policy Management India Pvt Ltd, New Delhi, India
| | - Winnie Yip
- Department of Global Health and Population, Harvard University, Boston, USA
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