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Rahman M, Islam MJ, Adam IF, Duc NHC, Sarkar P, Haque MN, Mostofa MG. Assessing the readiness of health facilities to provide family planning services in low-resource settings: Insights from nationally representative service provision assessment surveys in 10 Countries. PLoS One 2023; 18:e0290094. [PMID: 37972005 PMCID: PMC10653533 DOI: 10.1371/journal.pone.0290094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/01/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Many low-income countries continue to have high fertility levels and unmet need for family planning (FP) despite progress in increasing access to modern contraceptive methods and in reducing the total fertility rate (TFR). Health facilities in sub-Saharan Africa (SSA) and South Asia (SA) are thought to be unable to adequately deal with the burden of high unmet FP demands due to their weaker health systems. As a result, determining the readiness of health facilities that offer FP services is critical for identifying weaknesses and opportunities for continued development of FP health systems in those regions. Service Provision Assessment (SPA) tools-which break down health systems into measurable, trackable components-are one useful way to assess service readiness and the ability of health institutions to deliver FP services. METHODS Using data from nationally representative SPA surveys, we conducted a study that aimed to: (1) evaluate healthcare facilities' readiness to provide FP services; and (2) identify the factors that affect FP service readiness. Using a cross-sectional survey design, we used data from SPA surveys conducted in 10 low-resource SA and SSA countries: Afghanistan, Bangladesh, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and the Democratic Republic of the Congo (DRC). We analyzed data from public and private health facilities in Afghanistan (84), Bangladesh (1,303), Kenya (567), Malawi (810), Namibia (357), Nepal (899), Rwanda (382), Senegal (334), Tanzania (933), and the DRC (1,061) for a total of 6,730 facilities. We used 17 items/indicators recommended by the Service Availability and Readiness Assessment to measure a health facility's readiness to provide FP services across four domains. RESULTS Only 3.6% to 34.1% of the health facilities were reporting at least 75% (12-13 of 17) of the relevant items for FP service provision. Most of the health facilities in the countries under investigation suffered from lack of readiness, meaning that they did not fulfill at least 75% of the standards (12-13 items of 17 items on the availability of trained staff and guidelines, equipment, and commodities components). The factors associated with higher readiness scores varied among the 10 countries analyzed. Regression models showed that increases in the number of FP healthcare providers available at a health facility and infection control measures for FP exams were factors linked to increased readiness scores in all 10 countries. The low readiness of health facilities to provide FP services in the countries studied showed that the health systems in these low-resource settings faced significant problems with providing FP services. Differences in country-specific variability in the characteristics linked with better preparedness ratings could be attributed to data collected across different years in different nations or to country-specific healthcare financing policies. CONCLUSIONS To increase a health facility's readiness to offer FP services, country-specific factors must be addressed, in addition to common factors found in all 10 countries. Further research is required to determine the causes of country-level differences in FP tracer item availability to develop targeted and effective country-specific strategies to improve the quality of FP services in the SA and SSA regions and address unmet need for FP.
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Affiliation(s)
- Mosiur Rahman
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Jahirul Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, Queensland, Australia
| | | | | | - Prosannajid Sarkar
- Dr. Wazed Research and Training Institute, Begum Rokeya University, Rangpur, Bangladesh
| | - Md. Nuruzzaman Haque
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Golam Mostofa
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi, Bangladesh
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Saptarini I, Suparmi, Dhewantara PW, Kristina, Suryatma A, Sumiarsih M, Hendarwan H. The Availability and Readiness of Primary Health Care Facilities to Provide HIV Testing and Counseling Services in Indonesia. Asia Pac J Public Health 2023; 35:546-548. [PMID: 37846043 DOI: 10.1177/10105395231206450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Ika Saptarini
- Research Center for Pre-clinical and Clinical Medicine, National Research and Innovation Agency, Jakarta, Indonesia
| | - Suparmi
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Pandji Wibawa Dhewantara
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Kristina
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Jakarta, Indonesia
| | - Anton Suryatma
- Research Center for Pre-clinical and Clinical Medicine, National Research and Innovation Agency, Jakarta, Indonesia
| | - Mimi Sumiarsih
- Center for Health Resilience and Resource Policy, Health Development Policy Agency, Ministry of Health of the Republic of Indonesia, Jakarta, Indonesia
| | - Harimat Hendarwan
- Research Center for Pre-clinical and Clinical Medicine, National Research and Innovation Agency, Jakarta, Indonesia
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Cockburn N, Flood D, Seiglie JA, Manne-Goehler J, Aryal K, Karki K, Damasceno A, Atun R, Vollmer S, Bärnighausen T, Geldsetzer P, Mayige M, Hirschhorn L, Davies J. Health service readiness to provide care for HIV and cardiovascular disease risk factors in low- and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002373. [PMID: 37738224 PMCID: PMC10516419 DOI: 10.1371/journal.pgph.0002373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/18/2023] [Indexed: 09/24/2023]
Abstract
Cardiovascular disease risk factors (CVDRF), in particular diabetes and hypertension, are chronic conditions which carry a substantial disease burden in Low- and Middle-Income Countries. Unlike HIV, they were neglected in the Millenium Development Goals along with the health services required to manage them. To inform the level of health service readiness that could be achieved with increased attention, we compared readiness for CVDRF with that for HIV. Using data from national Service Provision Assessments, we describe facility-reported readiness to provide services for CVDRF and HIV, and derive a facility readiness score of observed essential components to manage them. We compared HIV vs CVDRF coverage scores by country, rural or urban location, and facility type, and by whether or not facilities reported readiness to provide care. We assessed the factors associated with coverage scores for CVDRF and HIV in a multivariable analysis. In our results, we include 7522 facilities in 8 countries; 86% of all facilities reported readiness to provide services for CVDRF, ranging from 77-98% in individual countries. For HIV, 30% reported of facilities readiness to provide services, ranging from 3-63%. Median derived facility readiness score for CVDRF was 0.28 (IQR 0.16-0.50), and for HIV was 0.43 (0.32-0.60). Among facilities which reported readiness, this rose to 0.34 (IQR 0.18-0.52) for CVD and 0.68 (0.56-0.76) for HIV. Derived readiness scores were generally significantly lower for CVDRF than for HIV, except in private facilities. In multivariable analysis, odds of a higher readiness score in both CVDRF or HIV care were higher in urban vs rural and secondary vs primary care; facilities with higher CVDRF scores were significantly associated with higher HIV scores. Derived readiness scores for HIV are higher than for CVDRF, and coverage for CVDRF is significantly higher in facilities with higher HIV readiness scores. This suggests possible benefits from leveraging HIV services to provide care for CVDRF, but poor coverage in rural and primary care facilities threatens Sustainable Development Goal 3.8 to provide high quality universal healthcare for all.
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Affiliation(s)
- Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - David Flood
- Department of Medicine, Division of Hospital Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Jacqueline A. Seiglie
- Department of Medicine, Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Krishna Aryal
- Public Health Development Organization, Kathmandu, Nepal
| | - Khem Karki
- Department of Community Medicine, Maharajganj Medical College, Institute of Medicine, Kathmandu, Nepal
| | | | - Rifat Atun
- Department of Global Health & Population, Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sebastian Vollmer
- Center for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Pascal Geldsetzer
- Department of Medicine, Division of Primary Care and Population Health, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, California, United States of America
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Lisa Hirschhorn
- Ryan Family Center on Global Primary Care, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois, United States of America
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Chen T, Wan B, Wang M, Lin S, Wu Y, Huang J. Evaluating the global, regional, and national impact of syphilis: results from the global burden of disease study 2019. Sci Rep 2023; 13:11386. [PMID: 37452074 PMCID: PMC10349077 DOI: 10.1038/s41598-023-38294-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
Syphilis is a global public health concern. This study aimed to assess the global and regional burden of syphilis from 1990 to 2019. Disease burden was evaluated using disability-adjusted life-years (DALYs) and prevalence. Data were extracted from the 2019 global burden of disease Study, an open database available for download. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were calculated to evaluate the syphilis burden over time. In 2019, the total number of prevalent cases of syphilis was 49.71 million worldwide. The ASR of prevalence was stable from 1990 to 2019 with an EAPC of 0.00 (95% CI - 0.10-0.11). The number of DALYs caused by syphilis was 7.36 million in 2019, reflecting a reduction of 16.38% compared with that in 1990 (8.80 million). The ASR of DALYs exhibited a decreasing trend from 1990 to 2019 (EAPC = - 1.01; 95% CI - 1.19 to - 0.84), with the highest rates observed in the younger age group (< 14 years old). In 2019, the highest ASR of DALYs was found in low sociodemographic index (SDI) regions (239.21/100,000), and the lowest in high SDI regions (3.14/100,000). Generally, the ASR of DALYs decreased as the SDI increased. The top three countries with the highest ASR of DALYs for syphilis were the Solomon Islands, Equatorial Guinea, and Liberia. While the global prevalence of syphilis remained persistently high from 1990 to 2019, there has been a recent decrease in the ASR of DALYs. Increased attention should be dedicated to younger populations and regions characterized by low SDIs.
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Affiliation(s)
- Tao Chen
- The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Bo Wan
- The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mingfang Wang
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China
- Fujian Clinical Research Center for Liver and Intestinal Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Su Lin
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China
- Fujian Clinical Research Center for Liver and Intestinal Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Yinlian Wu
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China
- Fujian Clinical Research Center for Liver and Intestinal Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
- Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Jiaofeng Huang
- Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, No. 20, Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China.
- Fujian Clinical Research Center for Liver and Intestinal Diseases, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
- Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
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Fassinou LC, Hien H, Yombi JC, Nagot N, Kirakoya-Samadoulougou F. Availability and readiness of the health facilities to provide HIV counseling and testing and prevention of mother-to-child transmission services in Burkina Faso: a trend analysis from 2012 to 2018. BMC Health Serv Res 2023; 23:757. [PMID: 37452422 PMCID: PMC10347843 DOI: 10.1186/s12913-023-09757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Provider-Initiated HIV Testing and Counseling (PITC) and Prevention of Mother-To-Child Transmission (PMTCT) are key services for achieving the goal of complete elimination of HIV. However, there is limited evidence on the ability of health facilities to provide these services in Burkina Faso. Therefore, we aimed to assess the trends and disparities in the availability and readiness of health facilities to provide PITC and PMTCT services in Burkina Faso between 2012 and 2018. METHODS We performed a secondary analysis of facility-level data from the World Health Organization's Service Availability and Readiness Assessment (SARA) surveys conducted in 2012, 2014, 2016, and 2018 in Burkina Faso. The availability and readiness of health facilities were assessed using SARA's manual, and linear regressions were used to examine trends. RESULTS Between 2012 and 2018, the mean proportion of health facilities providing PITC services increased, but not significantly, from 82.9% to 83.4% (p = 0.11), with the mean readiness index significantly decreasing from 71.5% to 65.4% (p < 0.001). This decrease concerned the staff and guidelines (73.8% to 50.5%; p < 0.001), equipment (79.0% to 77.4%; p < 0.001), and medicines and commodities (54.2% to 45.2%; p < 0.001) domains. Regarding the PMTCT services, the mean proportion of health facilities globally providing the service significantly decreased from 83.7% in 2012 to 67.7% (p = 0.030) in 2018, and the mean readiness significantly decreased from 53.2% in 2012 to 50.9% in 2018 (p = 0.004). This decreasing trend was related to the staff and training (80.3% to 57.6%; p < 0.001) and medicines and commodities (9.2% to 6.5%; p < 0.001) domains. The global significant negative trend of readiness was mainly observed at the primary level of healthcare (52.7% to 49.4%; p = 0.030). Four regions experienced a significant decrease in the readiness index of health facilities to provide PMTCT services: Cascades, Centre, Centre-Sud, and Sud-Ouest, while Haut-Bassins and Nord regions showed increasing trends. CONCLUSION Availability and readiness of health facilities to provide PITC and PMTCT remain suboptimal in Burkina Faso. Actions to strengthen the skills of professionals and enhance the availability of medicines and commodities while focusing more on health regions with significant decreasing trends are urgently needed to improve the quality of services for HIV.
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Affiliation(s)
- Lucresse Corine Fassinou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Hervé Hien
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Department of Internal Medicine, Infectious and Tropical Diseases, AIDS Reference Centre, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Nagot
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, University of Antilles, Etablissement Français du Sang, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
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Thapa DK, Acharya K, Karki A, Cleary M. Health facility readiness to provide antenatal care (ANC) and non-communicable disease (NCD) services in Nepal and Bangladesh: Analysis of facility-based surveys. PLoS One 2023; 18:e0281357. [PMID: 36913361 PMCID: PMC10010536 DOI: 10.1371/journal.pone.0281357] [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: 08/12/2021] [Accepted: 01/20/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Antenatal care (ANC) visits provide an important opportunity for diagnostic, preventive, and curative services for non-communicable diseases (NCDs) during pregnancy. There is an identified need for an integrated, system-wide approach to provide both ANC and NCD services to improve maternal and child health outcomes in the short and long term. OBJECTIVE This study assessed the readiness of health facilities to provide ANC and NCD services in Nepal and Bangladesh, identified as low-and middle-income countries. METHOD The study used data from national health facility surveys in Nepal (n = 1565) and Bangladesh (n = 512) assessing recent service provision under the Demographic and Health Survey programs. Using the WHO's service availability and readiness assessment framework, the service readiness index was calculated across four domains: staff and guidelines, equipment, diagnostic, and medicines and commodities. Availability and readiness are presented as frequency and percentages, while factors associated with readiness were examined using binary logistic regression. RESULTS Of the facilities, 71% in Nepal, and 34% in Bangladesh reported offering both ANC and NCD services. The proportion of facilities which showed readiness for providing ANC and NCD services was 24% in Nepal and 16% in Bangladesh. Gaps in readiness were observed in the availability of trained staff, guidelines, basic equipment, diagnostics, and medicines. Facilities managed by the private sector or a Non-Governmental Organization, located in an urban area, with management systems to support the delivery of quality services were positively associated with readiness to provide both ANC and NCD services. CONCLUSION There is a need to strengthen the health workforce by ensuring skilled personnel, having policy, guidelines and standards, and that diagnostics, medicines, and commodities are available/provided in health facilities. Management and administrative systems are also required, including supervision and staff training, to enable health services to provide integrated care at an acceptable level of quality.
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Affiliation(s)
- Deependra K. Thapa
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
- * E-mail:
| | | | - Anjalina Karki
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, Australia
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Khatri RB, Durham J, Assefa Y. Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal. Arch Public Health 2022; 80:162. [PMID: 35787734 PMCID: PMC9252055 DOI: 10.1186/s13690-022-00917-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Access to routine antenatal and perinatal services is improved in the last two decades in Nepal. However, gaps remain in coverage and quality of care delivered from the health facilities. This study investigated the delivery of technical quality antenatal and perinatal services from health facilities and their associated determinants in Nepal.
Methods
Data for this study were derived from the Nepal Health Facility Survey 2015. The World Health Organization's Service Availability and Readiness Assessment framework was adopted to assess the technical quality of antenatal and perinatal services of health facilities. Outcome variables included technical quality scores of i) 269 facilities providing antenatal services and ii) 109 facilities providing childbirth and postnatal care services (perinatal care). Technical quality scores of health facilities were estimated adapting recommended antenatal and perinatal interventions. Independent variables included locations and types of health facilities and their management functions (e.g., supervision). We conducted a linear regression analysis to identify the determinants of better technical quality of health services in health facilities. Beta coefficients were exponentiated into odds ratios (ORs) and reported with 95% confidence intervals (CIs). The significance level was set at p-value < 0.05.
Results
The mean score of the technical quality of health facilities for each outcome variable (antenatal and perinatal services) was 0.55 (out of 1.00). Compared to province one, facilities of Madhesh province had 4% lower odds (adjusted OR = 0.96; 95%CI: 0.92, 0.99) of providing better quality antenatal services, while health facilities of Gandaki province had higher odds of providing better quality antenatal services (aOR = 1.05; 95% CI: 1.01, 1.10). Private facilities had higher odds (aOR = 1.13; 95% CI: 1.03, 1.23) of providing better quality perinatal services compared to public facilities.
Conclusions
Private facilities provide better quality antenatal and perinatal health services than public facilities, while health facilities of Madhesh province provide poor quality perinatal services. Health system needs to implement tailored strategies, including recruiting health workers, supervision and onsite coaching and access to necessary equipment and medicine in the facilities of Madhesh province. Health system inputs (trained human resources, equipment and supplies) are needed in the public facilities. Extending the safe delivery incentive programme to the privately managed facilities could also improve access to better quality health services in Nepal.
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Saweri OP, Batura N, Pulford J, Khan MM, Hou X, Pomat WS, Vallely AJ, Wiseman V. Investigating health service availability and readiness for antenatal testing and treatment for HIV and syphilis in Papua New Guinea. BMC Pregnancy Childbirth 2022; 22:780. [PMID: 36261790 PMCID: PMC9580192 DOI: 10.1186/s12884-022-05097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papua New Guinea (PNG) has one of the highest burdens of HIV and syphilis in pregnancy in the Asia-Pacific region. Timely and effective diagnosis can alleviate the burden of HIV and syphilis and improve maternal and newborn health. Supply-side factors related to implementation and scale up remain problematic, yet few studies have considered their impact on antenatal testing and treatment for HIV and syphilis. This study explores health service availability and readiness for antenatal HIV and/or syphilis testing and treatment in PNG. METHODS Using data from two sources, we demonstrate health service availability and readiness. Service availability is measured at a province level as the average of three indicators: infrastructure, workforce, and antenatal clinic utilization. The readiness score comprises 28 equally weighted indicators across four domains; and is estimated for 73 health facilities. Bivariate and multivariate robust linear regressions explore associations between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis. RESULTS Most provinces had fewer than one health facility per 10 000 population. On average, health worker density was 11 health workers per 10 000 population per province, and approximately 22% of pregnant women attended four or more antenatal clinics. Most health facilities had a composite readiness score between 51% and 75%, with urban health facilities faring better than rural ones. The multivariate regression analysis, when controlling for managing authority, catchment population, the number of clinicians employed, health facility type and residence (urban/rural) indicated a weak positive relationship between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis. CONCLUSION This study adds to the limited evidence base for the Asia-Pacific region. There is a need to improve antenatal testing and treatment coverage for HIV and syphilis and reduce healthcare inequalities faced by rural and urban communities. Shortages of skilled health workers, tests, and medicines impede the provision of quality antenatal care. Improving service availability and health facility readiness are key to ensuring the effective provision of antenatal care interventions.
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Affiliation(s)
- Olga Pm Saweri
- The Kirby Institute, University of New South Wales, Sydney, Australia. .,The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Neha Batura
- Institute for Global Health, University College London, London, UK
| | | | | | | | - William S Pomat
- The Kirby Institute, University of New South Wales, Sydney, Australia.,The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew J Vallely
- The Kirby Institute, University of New South Wales, Sydney, Australia.,The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Almeida MCD, Cordeiro AMR, Cunha-Oliveira A, Barros DMS, Santos DGSM, Lima TS, Valentim RAM. Syphilis response policies and their assessments: A scoping review. Front Public Health 2022; 10:1002245. [PMID: 36187663 PMCID: PMC9523564 DOI: 10.3389/fpubh.2022.1002245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/30/2022] [Indexed: 01/27/2023] Open
Abstract
Syphilis is one of the most common sexually transmitted infections (STIs) worldwide and has shown a rising trend in recent years, according to a report published by the World Health Organization (WHO) in 2021. Given this problem, the present study aims to develop a scoping review of what has been done in the world after the publication of the global strategy for the elimination of STIs, with a specific focus on syphilis. Thus, we searched for papers on health policies in response to syphilis in Pubmed, Scopus, ScienceDirect, and EBSCO by CINAHL, as well as in official documents from international health organizations. The period from January 1, 2016, to August 14, 2022 was considered. Our search returned 880 papers addressing "Syphilis," "Health Policy," and "Health Policies" combined. Twenty-three papers fulfilled the inclusion and exclusion criteria according to two research questions set out for this scoping review. Our findings suggest that Brazil and Peru presented the greatest adequacy of the strategies provided by WHO in 2016 and the Pan American Health Organization (PAHO) in 2017, aiming tothe goals set out in the UN's 2030 Agenda for sustainable development. Among the studies found, six countries (Cuba, Thailand, Belarus, Armenia, Moldova, and Puerto Rico) reported the elimination of mother-to-child transmission (MTCT) of syphilis, but the most recent data are from 2016. Furthermore, it is essential to mention that no country has been found that has presented a comprehensive response to syphilis, noting the control or elimination of the disease in all key populations. Thus, it is necessary to constantly monitor national policies based on in-depth studies on the quality of the response, the challenges, and the national, regional, and global perspectives for the control of the disease until 2030, the year in which the SDGs will be reviewed. Systematic review registration https://osf.io/x9er5/?view_only=0cc0062222ec45dcb2f4d41484d285b6, identifier: 10.17605/OSF.IO/X9ER5.
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Affiliation(s)
- Milena C. D. Almeida
- Centre for Interdisciplinary Studies, University of Coimbra, Coimbra, Portugal
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | - Aliete Cunha-Oliveira
- Centre for Interdisciplinary Studies, University of Coimbra, Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), School of Nursing of Coimbra (ESEnfC), Coimbra, Portugal
| | - Daniele M. S. Barros
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | - Diana G. S. M. Santos
- Health Sciences Research Unit: Nursing (UICISA:E), School of Nursing of Coimbra (ESEnfC), Coimbra, Portugal
- Coimbra Hospital, University Center, Coimbra, Portugal
| | - Thaísa S. Lima
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Brazilian Ministry of Health, Brasília, Brazil
| | - Ricardo A. M. Valentim
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
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Batura N, Kasteng F, Condoane J, Bagorogosa B, Castel-Branco AC, Kertho E, Källander K, Soremekun S, Lingam R, Vassall A, Tibenderana J, Meek S, Hill Z, Strachan D, Ayebale G, Nakirunda M, Counihan H, Ndima S, Muiambo A, Salomao N, Kirkwood B. Costs of treating childhood malaria, diarrhoea and pneumonia in rural Mozambique and Uganda. Malar J 2022; 21:239. [PMID: 35987625 PMCID: PMC9392282 DOI: 10.1186/s12936-022-04254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Globally, nearly half of all deaths among children under the age of 5 years can be attributed to malaria, diarrhoea, and pneumonia. A significant proportion of these deaths occur in sub-Saharan Africa. Despite several programmes implemented in sub-Saharan Africa, the burden of these illnesses remains persistently high. To mobilise resources for such programmes it is necessary to evaluate their costs, costs-effectiveness, and affordability. This study aimed to estimate the provider costs of treating malaria, diarrhoea, and pneumonia among children under the age of 5 years in routine settings at the health facility level in rural Uganda and Mozambique. Methods Service and cost data was collected from health facilities in midwestern Uganda and Inhambane province, Mozambique from private and public health facilities. Financial and economic costs of providing care for childhood illnesses were investigated from the provider perspective by combining a top-down and bottom-up approach to estimate unit costs and annual total costs for different types of visits for these illnesses. All costs were collected in Ugandan shillings and Mozambican meticais. Costs are presented in 2021 US dollars. Results In Uganda, the highest number of outpatient visits were for children with uncomplicated malaria and of inpatient admissions were for respiratory infections, including pneumonia. The highest unit cost for outpatient visits was for pneumonia (and other respiratory infections) and ranged from $0.5 to 2.3, while the highest unit cost for inpatient admissions was for malaria ($19.6). In Mozambique, the highest numbers of outpatient and inpatient admissions visits were for malaria. The highest unit costs were for malaria too, ranging from $2.5 to 4.2 for outpatient visits and $3.8 for inpatient admissions. The greatest contributors to costs in both countries were drugs and diagnostics, followed by staff. Conclusions The findings highlighted the intensive resource use in the treatment of malaria and pneumonia for outpatient and inpatient cases, particularly at higher level health facilities. Timely treatment to prevent severe complications associated with these illnesses can also avoid high costs to health providers, and households. Trial registration: ClinicalTrials.gov, identifier: NCT01972321. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04254-y.
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Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data. Healthcare (Basel) 2022; 10:healthcare10071200. [PMID: 35885727 PMCID: PMC9319856 DOI: 10.3390/healthcare10071200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open
Abstract
The World Health Organization’s systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates in Mozambique. The aim of the analysis was to determine the readiness score of nutrition and diarrhea services for children under five and the influence of malaria and HIV (Human Immunodeficiency Virus) service readiness on the readiness of these two services. A total of 1644 public health facilities in Mozambique were included from the 2018 Service Availability and Readiness Assessment. Additionally, a cross-sectional study was conducted to determine the availability and readiness scores of nutrition services in 2021 in five referral health facilities. The availability of nutrition and diarrhea services for children is low in Mozambique, with both scoring below 75%. Major unavailability was observed for human resources, guidelines, and training dimensions. Diarrhea (median (IQ): 72.2% (66.7 to 83.3)) and nutrition service readiness (median (IQ): 57.1% (52.4 to 57.1)) scores were significantly different (p < 0.001), while it is desirable for both services to be comprehensively ready. Nutrition services are positively associated with diarrhea service readiness and both services are associated with malaria and HIV service readiness (p < 0.05). None of the health facilities had all tracer items available and none of the facilities were considered ready (100%). There is a persisting need to invest comprehensively in readiness dimensions, within and across child health services.
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Acharya K, Subedi D, Acharya P. Health facility readiness to provide integrated Family Planning, Maternal and Child Health (FPMCH) services in Nepal: Evidence from the comprehensive health facility survey. PLoS One 2022; 17:e0264417. [PMID: 35213614 PMCID: PMC8880709 DOI: 10.1371/journal.pone.0264417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction This study aimed to build the emergent body of evidence of family planning and maternal and child health (FPMCH) service integration benefits that can be useful in reaching the target of sustainable development goals (SDGs). Methods We utilized data from the 2015 Nepal Health Facility Survey and used the World Health Organization service readiness manual for defining the service readiness indicator score of all services related to FPMCH integration. Composite readiness index for all services including family planning, antenatal care service, delivery and newborn service readiness index, and curative child care service readiness index was considered for the integration of all services (i.e. readiness for FPMCH). Multivariable linear regression models were fitted to examine the association between covariates and readiness score to provide integrated services. Results The mean readiness score of integrated services in health facilities in Nepal was 52.1%. The services in private hospitals and peripheral health facilities had significantly lower readiness scores of integrated services compared to government hospitals. Compared to Province 3(Province 3 holds the national capital), Province 2 had significantly lower and Province 7 had significantly higher readiness scores. There is a marginally significantly higher readiness score of integrated services in the facilities where management meetings are held compared to where management meetings are never conducted. Interestingly, health facilities where external supervision occurred in the last 4 months had better service readiness of integrated services compared with those facilities with no external supervision. Similarly, the facilities that performed the routine quality assurance activities and facilities having a system for collecting opinion and being reviewed had a higher integrated services readiness score than their counterparts. Conclusion This study found a scope of improvement in management practices in the health sector of Nepal especially for supportive supervision, quality assurance (QA) activities, monthly management meetings, and a system of collecting and reviewing opinions from the clients. Strengthening management practices especially, promoting supportive supervision and adhering to QA protocols may improve HF readiness to implement integrated FPMCH in Nepal. Being low readiness, there is an urgent need for policy reform to improve the integrated service readiness, particularly in Province 2.
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Affiliation(s)
- Kiran Acharya
- New ERA, Rudramati Marga, Kalopul, Kathmandu, Nepal
- * E-mail:
| | - Dipak Subedi
- Ministry of Health and Population, Kathmandu, Nepal
| | - Pawan Acharya
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
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Bhattarai N, Bam K, Acharya K, Thapa R, Shrestha B. Factors associated with HIV testing and counselling services among women and men in Nepal: a cross-sectional study using data from a nationally representative survey. BMJ Open 2021; 11:e049415. [PMID: 34862281 PMCID: PMC8647541 DOI: 10.1136/bmjopen-2021-049415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This study is set up to explore the factors associated with Human Immunodeficiency Virus (HIV) testing among women and men in Nepal. STUDY DESIGN Nepal Demographic and Health Survey, 2016 adopts a cross-sectional design. SETTING Nepal. PARTICIPANTS Women and men of age 15-49 years. PRIMARY OUTCOME MEASURES Our primary outcome was ever tested for HIV. We used multivariable analysis at a 95% level of significance to measure the effect in outcome variables. RESULTS About one in 10 women (10.8%) and one in five men (20.5%) ever tested for HIV. Women who had media exposure at least once a week ((adjusted odds ratio (aOR)=2.8; 95% CI: 1.4 to 5.3) were more likely to get tested for HIV compared with those who had no media exposure at all. Similarly, those who had their recent delivery in the health facility (aOR=3.9; 95% CI: 2.4 to 6.3) were more likely to get tests for HIV compared with those delivered elsewhere. Likewise, among men, compared with adolescents (15-19 years), those from older age groups were more likely to get tested for HIV. Compared with no education, secondary (aOR=2.3; 95% CI: 1.4 to 3.6) and higher education (aOR=1.7; 95% CI: 1.0 to 2.8) had higher odds of getting tested for HIV. Similarly, wealth quintiles in richer and richest groups were more likely to get tested for HIV compared with the poorest quintile. Other characteristics like media exposure, paid sex and 2+ sexual partners were positively associated with being tested for HIV. CONCLUSIONS HIV testing is not widespread and more men than women are accessing HIV services. More than two-thirds of women who delivered at health facilities never tested for HIV. It is imperative to reach out to people engaging in risky sexual behaviour, people with lower educational attainment, and those in the lower wealth quintile for achieving 95-95-95 targets by 2030.
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Affiliation(s)
- Navaraj Bhattarai
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Kiran Bam
- Public Health Professional, Kathmandhu, Nepal
| | | | - Rajshree Thapa
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Readiness of health facilities and determinants to manage diabetes mellitus: evidence from the nationwide Service Provision Assessment survey of Afghanistan, Bangladesh and Nepal. BMJ Open 2021. [PMCID: PMC8719183 DOI: 10.1136/bmjopen-2021-054031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Using nationally representative surveys, the study’s aims were to: (1) evaluate healthcare facilities’ readiness to provide diabetes mellitus (DM) services and (2) identify the factors that affect DM service readiness. Data source Data from Service Provision Assessment surveys conducted in three low-resource South Asian (SA) countries: Afghanistan, Bangladesh and Nepal, were used in this study. Design Cross-sectional nationally representative survey Participants A total of 117, 317 and 397 public and private health facilities in Afghanistan, Bangladesh and Nepal, respectively were analysed. Primary outcome A total of 12 items/indicators were used to measure a health facility’s readiness to provide DM services across four domains. Results For DM management, about 39.3%, 58.4% and 58.2% of health facilities in Afghanistan, Bangladesh and Nepal centred around 7–8, 3–6 and 4–6 items. Only 12.8%, 5.0% and 4.8% of healthcare facilities in Afghanistan, Bangladesh and Nepal reported having at least % (9/12) of the necessary items for DM management, and no one reported having all 12 important items for DM management. According to the negative binomial regression models, the factors associated with higher readiness scores vary among the three countries analysed. Regression models also showed that increases in the number of DM care providers and facility types are similar factors linked to increased readiness scores in all three countries. Conclusions In order to increase a health facility’s readiness to offer DM care, country-specific factors must be addressed in addition to common factors found in all three countries. Further research is required to determine the cause of country-level differences in tracer item availability in order to develop targeted and effective country-specific strategies to improve care quality in the SA region.
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Acharya K, Subedi RK, Dahal S, Karkee R. Basic emergency obstetric and newborn care service availability and readiness in Nepal: Analysis of the 2015 Nepal Health Facility Survey. PLoS One 2021; 16:e0254561. [PMID: 34288943 PMCID: PMC8294533 DOI: 10.1371/journal.pone.0254561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/29/2021] [Indexed: 01/01/2023] Open
Abstract
Background Achieving maternal and newborn related Sustainable Development Goals targets is challenging for Nepal, mainly due to poor quality of maternity services. In this context, we aim to assess the Basic Emergency Obstetric and Newborn Care (BEmONC) service availability and readiness in health facilities in Nepal by analyzing data from Nepal Health Facility Survey (NHFS), 2015. Methods We utilized cross-sectional data from the nationally representative NHFS, 2015. Service availability was measured by seven signal functions of BEmONC, and service readiness by the availability and functioning of supportive items categorized into three domains: staff and guidelines, diagnostic equipment, and basic medicine and commodities. We used the World Health Organization’s service availability and readiness indicators to estimate the readiness scores. We performed a multiple linear regression to identify important factors in the readiness of the health facilities to provide BEmONC services. Results The BEmONC service readiness score was significantly higher in public hospitals compared with private hospitals and peripheral public health facilities. Significant factors associated with service readiness score were the facility type (14.69 points higher in public hospitals, P<0.001), number of service delivery staff (2.49 points increase per each additional delivery staff, P<0.001), the service hours (4.89 points higher in facilities offering 24-hour services, P = 0.01) and status of periodic review of maternal and newborn deaths (4.88 points higher in facilities that conducted periodic review, P = 0.043). Conclusions These findings suggest that BEmONC services in Nepal could be improved by increasing the number of service delivery staff, expanding service hours to 24-hours a day, and conducting periodic review of maternal and newborn deaths at health facilities, mainly in the peripheral public health facilities. The private hospitals need to be encouraged for BEmONC service readiness.
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Affiliation(s)
| | | | - Sushma Dahal
- School of Public Health, Georgia State University, Atlanta, GA, United States of America
| | - Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
- * E-mail:
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