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Mootz JJ, de Vos L, Stockton M, Sweetland AC, Kann B, Seijo C, Bezuidenhout C, Suleman A, Feliciano P, Dos Santos PF, Shelton R, Palinkas LA, Wainberg ML. Providers' perspectives of barriers and facilitators to scale-up of mental health care in the public health delivery system of Mozambique: a qualitative inquiry. BMC Health Serv Res 2024; 24:1138. [PMID: 39334160 PMCID: PMC11428441 DOI: 10.1186/s12913-024-11594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND A central challenge to closing the mental health treatment gap in low- and middle-income countries (LMICs) is determining the most effective pathway for delivering evidence-based mental health services. We are conducting a cluster-randomized, Type 2 hybrid implementation-effectiveness trial across 20 districts of Mozambique called the Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs (PRIDE) program. Following training of nonspecialized providers in facilitation of evidence-based treatments for mental health and informed by the Consolidated Framework for Implementation Research (CFIR), we identified how PRIDE compares to care as usual and the perceived barriers and facilitators of implementation and modifications needed for widescale service delivery and scale-up. METHODS We conducted rapid ethnographic assessment using freelisting among 34 providers, followed by four focus group discussions (n = 29 participants) with a subsample of psychiatric technicians and primary care providers from 14 districts in Nampula Province. We used Thematic Analysis to inductively apply open codes to transcripts and then deductively applied the CFIR domains and constructs to organize open codes. RESULTS The main Outer Setting constructs relevant to implementation were recognition that patient mental health needs were significant. Additionally, numerous community-level characteristics were identified as barriers, including distance between clinics; shortage of providers; and low awareness of mental health problems, stigma, and discrimination among community members towards those with mental health struggles. The PRIDE program was perceived to offer a relative advantage over usual care because of its use of task-sharing and treating mental illness in the community. PRIDE addressed Inner Setting barriers of having available resources and training and provider low self-efficacy and limited knowledge of mental illness. Providers recommended leadership engagement to give support for supervision of other task-shared professionals delivering mental healthcare. CONCLUSIONS Primary care providers and psychiatric technicians in Mozambique perceived the relative advantage of the PRIDE program to address mental health treatment access barriers and offered recommendations for successful sustainment and scale up of integrated mental health care.
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Affiliation(s)
- Jennifer J Mootz
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 117, New York, NY, 10032, USA.
| | - Lindsey de Vos
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Melissa Stockton
- Gillings School of Global Public Health, Epidemiology Department, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Annika C Sweetland
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 117, New York, NY, 10032, USA
| | - Bianca Kann
- London School of Hygiene and tropical Medicine, Global Mental Health Department, London, UK
| | - Chariz Seijo
- College of Humanities and Sciences, Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Antonio Suleman
- Mental Health Department, Mozambique Ministry of Health, Maputo, Mozambique
| | - Paulino Feliciano
- Mental Health Department, Mozambique Ministry of Health, Maputo, Mozambique
| | | | - Rachel Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, Kolb 117, New York, NY, 10032, USA
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Li Q, Kanduma E, Ramiro I, Xu DR, Cuco RMM, Chaquisse E, Yang Y, Wang X, Pan J. Spatial Access to Continuous Maternal and Perinatal Health Care Services in Low-Resource Settings: Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e49367. [PMID: 39024564 PMCID: PMC11294765 DOI: 10.2196/49367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/26/2023] [Accepted: 05/07/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Maternal and perinatal health are fundamental to human development. However, in low-resource settings such as sub-Saharan Africa (SSA), significant challenges persist in reducing maternal, newborn, and child mortality. To achieve the targets of the sustainable development goal 3 (SDG3) and universal health coverage (UHC), improving access to continuous maternal and perinatal health care services (CMPHS) has been addressed as a critical strategy. OBJECTIVE This study aims to provide a widely applicable procedure to illuminate the current challenges in ensuring access to CMPHS for women of reproductive age. The findings are intended to inform targeted recommendations for prioritizing resource allocation and policy making in low-resource settings. METHODS In accordance with the World Health Organization guidelines and existing literature, and taking into account the local context of CMPHS delivery to women of reproductive age in Mozambique, we first proposed the identification of CMPHS as the continuum of 3 independent service packages, namely antenatal care (ANC), institutional delivery (ID), and postnatal care (PNC). Then, we used the nearest-neighbor method (NNM) to assess spatial access to each of the 3 service packages. Lastly, we carried out an overlap analysis to identify 8 types of resource-shortage zones. RESULTS The median shortest travel times for women of reproductive age to access ANC, ID, and PNC were 2.38 (IQR 1.38-3.89) hours, 3.69 (IQR 1.87-5.82) hours, and 4.16 (IQR 2.48-6.67) hours, respectively. Spatial barriers for women of reproductive age accessing ANC, ID, and PNC demonstrated large variations both among and within regions. Maputo City showed the shortest travel time and the best equity within the regions (0.46, IQR 0.26-0.69 hours; 0.74, IQR 0.47-1.04 hours; and 1.34, IQR 0.83-1.85 hours, respectively), while the provinces of Niassa (4.07, IQR 2.41-6.63 hours; 18.20, IQR 11.67-24.65 hours; and 7.69, IQR 4.74-13.05 hours, respectively) and Inhambane (2.69, IQR 1.49-3.91 hours; 4.43, IQR 2.37-7.16 hours; and 10.76, IQR 7.73-13.66 hours, respectively) lagged behind significantly in both aspects. In general, more than 51% of the women of reproductive age, residing in 83.25% of Mozambique's land area, were unable to access any service package of CMPHS in time (within 2 hours), while only about 21%, living in 2.69% of Mozambique's land area, including Maputo, could access timely CMPHS. CONCLUSIONS The spatial accessibility and equity of CMPHS in Mozambique present significant challenges in achieving SDG3 and UHC, especially in the Inhambane and Niassa regions. For Inhambane, policy makers should prioritize the implementation of a decentralization allocation strategy to increase coverage and equity through upgrading existing health care facilities. For Niassa, the cultivation of well-trained midwives who can provide door-to-door ANC and PNC at home should be prioritized, with an emphasis on strengthening communities' engagement. The proposed 2-step procedure should be implemented in other low-resource settings to promote the achievement of SDG3.
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Affiliation(s)
- Qin Li
- HEOA Group, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities, West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Elsa Kanduma
- Comité para a Saúde de Moçambique, Maputo City, Mozambique
| | - Isaías Ramiro
- Comité para a Saúde de Moçambique, Maputo City, Mozambique
| | - Dong Roman Xu
- Acacia Lab for Implementation Science, Center for World Health Organization Studies, School of Health Management, Southern Medical University, Guangzhou, China
- SMU Institute for Global Health, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Rosa Marlene Manjate Cuco
- Mozambique Ministry of Health and Faculty of Medicine, Eduardo Mondlane University, Maputo City, Mozambique
| | - Eusebio Chaquisse
- Mozambique Ministry of Health and Faculty of Medicine, Eduardo Mondlane University, Maputo City, Mozambique
| | - Yili Yang
- HEOA Group, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities, West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Xiuli Wang
- HEOA Group, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities, West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Jay Pan
- HEOA Group, West China School of Public Health, West China Fourth Hospital, Sichuan University, Chengdu, China
- China Center for South Asian Studies, Sichuan University, Chengdu, China
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Sartorello A, Benoni R, Ramirez L, Mundjane A, Kalombola F, Ramos A, Meque E, Massaro P, Jessen N, Putoto G, Damasceno A. Effectiveness of the Hypertension Screening Corner in Enhancing the Cascade of Care at Primary Healthcare Center Level: Evidence from Zambezia, Mozambique. Glob Heart 2024; 19:58. [PMID: 39006864 PMCID: PMC11243761 DOI: 10.5334/gh.1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Background Hypertension is the leading cause of cardiovascular disease, whose death burden is dramatically increasing in sub-Saharan Africa. To curb its effects, early diagnosis and effective follow-up are essential. Therefore, this study aims to evaluate the impact of a hypertension screening corner on the hypertension care cascade at the primary healthcare level. Methods A prospective cohort study was conducted between October 2022 and March 2023 in two PHCCs in Zambezia (Mozambique). The study involved a demographic and socioeconomic status (SES) questionnaire for those screened. Patients with blood pressure (BP) > 140/90 mmHg were given a follow-up questionnaire regarding the care cascade. The four cascade steps were: medical visit, diagnosis confirmation, follow-up visit, and recalling the follow-up appointment. The odds ratio (OR) of reaching each step of the cascade was assessed by binomial logistic regression. Results Patients with BP > 140/90 mmHg were 454, and 370 (86.0%) completed both study phases. Individuals attending the medical visit were 225 (60.8%). Those with low SES had a higher probability of visit attendance than those with middle (OR = 0.46, 0.95CI[0.23-0.88] p = 0.020) and high (OR = 0.21 0.95CI[0.10-0.42], p < 0.001). Hypertension diagnosis was confirmed in 181 (80.4%), with higher probability in the low SES group compared to the middle (OR = 0.24 IC95[0.08-0.66], p = 0.007) and high (OR = 0.23, IC95[0.07-0.74], p = 0.016) groups. The OR to complete step 1 and step 2 were higher for older age groups. A follow-up appointment was received and recalled by 166 (91.7%) and 162 (97.6%) patients, respectively. Conclusions The hypertension corner proved to be a useful tool for effective screening of hypertension with satisfactory retention in care, especially for people with lower socio-economic status.
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Affiliation(s)
- Anna Sartorello
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- Doctors with Africa CUAMM, Maputo, Mozambique
| | - Roberto Benoni
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- Doctors with Africa CUAMM, Maputo, Mozambique
| | | | | | | | - Alfredo Ramos
- Department of research, training and health surveys, National Institute of Health, Maputo, Mozambique
| | - Edgar Meque
- Sofala Provincial Health Service, Ministry of Health, Beira, Mozambique
| | - Paolo Massaro
- Operational Research Unit, Doctors with Africa CUAMM, Padova, Italy
| | - Neusa Jessen
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, Padova, Italy
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Towongo MF, Kelepile M. Prevalence, distribution and factors associated with modern contraceptive use among women of reproductive age in Uganda: evidence from UDHS 2016. Contracept Reprod Med 2024; 9:32. [PMID: 38937845 PMCID: PMC11212173 DOI: 10.1186/s40834-024-00288-6] [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: 03/23/2024] [Accepted: 05/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Unintended pregnancies pose significant health risks, particularly in sub-Saharan Africa, where millions of cases are recorded annually, disproportionately affecting adolescent women. Utilization of modern contraceptives is crucial in managing fertility and reducing unintended pregnancies, abortions, and associated health complications. This study aimed to assess the prevalence, distribution and factors associated with modern contraceptives utilization among women aged 15-49 in Uganda. METHODS The study used secondary data from the 2016 Uganda Demographic and Health Survey (UDHS). The study sample comprise of 9,235 women aged 15-49 who used any method to prevent pregnancy in the five years preceding 2016 UDHS survey. The outcome variable for this study is utilization of modern contraceptives. Univariate, bivariate, and multilevel binary logistic regression was used to examine the relationship between individual and contextual factors on the modern contraceptive use among women aged 15-49 in Uganda. Choropleth mapping and network analysis in ArcGIS 10.8.2 was used to visualize spatial distribution of modern contraceptive use and measure community access to health facilities respectively. RESULTS The prevalence of modern contraceptive use was 53.19% (n = 4,919) in Uganda, with significant spatial variation by district. Higher prevalence (23.18%) was observed among women aged 20-29 compared to adolescents (4.1%). Only 21.9% of married women reported using modern contraceptives. At the individual-level, the factors that positively influenced use of modern contraceptives included: women's marital status, wealth index and level of education while sex of the household head, ever terminated a pregnancy and religion negatively affected the use of modern contraceptives. At community-level, community access to health facilities was found to have negative influence on the use of modern contraceptives among women. In communities where women frequently visited health facilities in the 12 months preceding the survey, the use of modern contraceptives reduced by 3.9%. Accessibility analysis revealed challenges, with women in northeastern districts (rural districts) facing travel times exceeding four hours to reach health facilities. CONCLUSION Utilization of modern contraceptives are essential for promoting women's health and well-being, particularly concerning maternal healthcare. This study highlights disparities in modern contraceptive use across age groups and the districts, emphasizing the need for targeted interventions. Policymakers and stakeholders must prioritize strategies that promote utilization of modern contraceptives and maternal healthcare services to address these disparities effectively. Such efforts are crucial for improving reproductive health outcomes and reducing the burden of unintended pregnancies and related complications in Uganda.
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Affiliation(s)
- Moses Festo Towongo
- Department of Population Studies, University of Botswana, Gaborone, Botswana.
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Shubayr MA, Kruger E, Majeed MM, Hattan AH, Jearan SA, Tennant M. Distribution of dental practices in Jazan of Saudi Arabia: a GIS-based approach. BMC Health Serv Res 2023; 23:356. [PMID: 37041635 PMCID: PMC10091529 DOI: 10.1186/s12913-023-09337-3] [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: 10/02/2022] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Jazan region in the Kingdom of Saudi Arabia (KSA) has been extensively studied regarding access to dental care services, but there is currently no specific study on the distribution of public (primary healthcare centres (PHCs) and hospitals) and private dental healthcare facilities in the area. This study aimed to evaluate the spatial distribution of public and private dental care facilities in the Jazan region in relation to the population distribution in each governorate of the region. METHODS The most up-to-date, easily accessible, and anonymous data and information were used for this investigation. The Ministry of Health's (MOH) Statistical Yearbook 2020 and interactive map were used to identify the locations of healthcare facilities. These locations were plotted on a map using Google Maps, and the data was converted to longitude and latitude with 90% level building accuracy. QGIS's integrated database was used to develop buffer zones and perform attribute analysis. The data was then exported for analysis in Microsoft Excel, where healthcare facility-to-population ratios were determined. RESULTS In Jazan region, consisting of 17 governorates and a population of 1,726,739, there were 275 public and private dental clinics, with a ratio of one dental clinic per 6,279 people in terms of general health services. Only 12.4% of these clinics were located beyond 20 km of the city centre, serving approximately 70% of the region's population. CONCLUSION The uneven distribution of dental clinics in the Jazan region has hampered access to dental treatments and has led to a significant burden on dental health facilities, reducing the quality of care available in the region. Mapping the distribution of MOH, private, and other health facilities, as well as the burden of oral disease in the Jazan region, is necessary for further research.
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Affiliation(s)
- Mosa Ali Shubayr
- International Research Collaborative, Oral Health and Equity, School of Human Sciences, The University of Western Australia, Nedlands, Australia.
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Estie Kruger
- International Research Collaborative, Oral Health and Equity, School of Human Sciences, The University of Western Australia, Nedlands, Australia
| | | | - Afrah H Hattan
- International Research Collaborative, Oral Health and Equity, School of Human Sciences, The University of Western Australia, Nedlands, Australia
| | | | - Marc Tennant
- International Research Collaborative, Oral Health and Equity, School of Human Sciences, The University of Western Australia, Nedlands, Australia
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Leosari Y, Uelmen JA, Carney RM. Spatial evaluation of healthcare accessibility across archipelagic communities of Maluku Province, Indonesia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001600. [PMID: 36963056 PMCID: PMC10021735 DOI: 10.1371/journal.pgph.0001600] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
The Maluku Province is an underdeveloped region in Indonesia with over 1,340 scattered islands. Due to the limited health facilities and transportation infrastructure, access to healthcare is very challenging. Here, we combined data from various sources to locate the population clusters, health facilities, roads, and ports/docks, and then utilize geographic information systems (GIS) to estimate distances from residents to health facilities. Health workforce distribution data was then integrated to elucidate overall healthcare equity among districts in the province. The average distances to puskesmas (primary health clinics) were 8.89 km (by land) and 18.43 km (by land and water) respectively, and the average distances to hospitals were 56.19 km (by land) and 73.09 km (by land and water), with large disparities within and among districts. Analysis of health workforce data shows that 65% of 207 puskesmas lack physicians, while 49% lack midwives. Ambon, Tual, and Southeast Maluku have the highest health equity, while East Ceram, Buru, and South Buru have the lowest. In general, this study demonstrates the utility of GIS and spatial analyses, which can help identify problem areas in healthcare accessibility and equity in archipelago settings, and provide recommendations to stakeholders such as public health officials and district administrators.
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Affiliation(s)
- Yanti Leosari
- College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Johnny Albert Uelmen
- Department of Integrative Biology, University of South Florida, Tampa, Florida, United States of America
| | - Ryan Marc Carney
- Department of Integrative Biology, University of South Florida, Tampa, Florida, United States of America
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Blatnik P, Bojnec Š. Optimal Network of General Hospitals in Slovenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4235. [PMID: 36901246 PMCID: PMC10001727 DOI: 10.3390/ijerph20054235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/12/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
This article explores how the minimum number of general hospital locations can be determined with optimal population coverage. Due to the increasing financial problems of hospitals and the poor organization of general hospital healthcare, Slovenia is currently working to reform the healthcare system. Defining the optimal network of hospital providers is one of the key elements in reforming the healthcare system. To define the optimal network of general hospitals, the allocation-location model was used, and the maximize attendance model was used as the central method. The chief purpose of maximize attendance model is to optimize the demand attendance with respect to distance and time spent getting to the point of demand. In the analysis of optimal locations and the number of Slovenian general hospitals, we used data on the locations of settlements with their number of inhabitants and data on the Slovenian road network, based on which we defined average travel speeds on the categorized road network. The hypothetical locations of general hospitals and the number of optimally located general hospitals that provide access to the nearest provider were determined in three different time intervals. We found that the same accessibility to hospital services as provided by the existing network of general hospitals can be achieved with only ten optimally located general hospitals within a 30-min time interval. This means that two general hospitals could be rationalized or reorganized, which would bring significant savings in the field of hospital activity, which creates a large loss in the health system in Slovenia.
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Das M, Dutta B, Roy U, Das S, Rath S. Spatial accessibility modeling to healthcare facilities in the case of health shocks of Midnapore municipality, India. GEOJOURNAL 2023:1-24. [PMID: 38625266 PMCID: PMC9919752 DOI: 10.1007/s10708-023-10838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 04/17/2024]
Abstract
This research aims to identify the accessibility of the entire population, especially the slum population to existing healthcare facilities (HCF) as well as the slum neighborhoods having low geographic accessibility, and finally, to provide an analytical model for the people living in areas that are outside the coverage range of existing healthcare facilities (HCF) across the study area. Spatial data has been collected and used based on the road network, elevation, location of HCF, municipal boundary, slum point, and satellite images from various sources. Also, non-spatial data such as socioeconomic variables are collected from questionnaires survey within a particular period. The spatial analysis tool like as near, network analysis, and predictive analysis in the ArcGIS platform was used to examine geographic accessibility. The results of the spatial analysis show that the distribution of public healthcare facility centers in the study area has not been uniformly distributed. Across 84% of areas in the study area have sound spatial accessibility with traveling time coverage is about 12 min. However, 16% of areas have a traveling time of 12 to 30 min under low accessibility with existing slum neighborhoods. Therefore, the low spatial accessibility areas are demanding new healthcare facilities in the study area. The Analytical Hierarchy Process (AHP) is employed to find the most optimal and efficient locational suitability for building new healthcare facility centers. The finding of AHP analysis for site suitability of healthcare facilities revealed five major classes as most suitable (2%), suitable (5%), moderate (35%), poor (54%), and very poor (4%) in the study area. Moreover, the realistic framework of this study helps to measure geographic accessibility and suitability in any geographical area.
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Affiliation(s)
- Manas Das
- Dept. of Remote Sensing and GIS, Vidyasagar University, Midnapore, West Bengal 721102 India
| | - Bikash Dutta
- Assistant Professor, Dept. of Geography, Nistarini College, Purulia, West Bengal 723101 India
| | - Utpal Roy
- Associate Professor, Dept. of Geography, University of Calcutta, Kolkata, West Bengal 700073 India
| | - Sutapa Das
- Dept. of Economics, Vidyasagar University, Midnapore, West Bengal 721102 India
| | - Sutapa Rath
- Dept. of Geography, Vidyasagar University, Midnapore, West Bengal 721102 India
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Daca CSL, Schumann B, Arnaldo C, San Sebastian M. Wealth inequalities in reproductive and child health preventive care in Mozambique: a decomposition analysis. Glob Health Action 2022; 15:2040150. [PMID: 35290171 PMCID: PMC8928807 DOI: 10.1080/16549716.2022.2040150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Assessing the gap between rich and poor is important to monitor inequalities in health. Identifying the contribution to that gap can help policymakers to develop interventions towards decreasing that difference. Objective To quantify the wealth inequalities in health preventive measures (bed net use, vaccination, and contraceptive use) to determine the demographic and socioeconomic contribution factors to that inequality using a decomposition analysis. Methods Data from the 2015 Immunisation, Malaria and AIDs Indicators Survey were used. The total sample included 6946 women aged 15–49 years. Outcomes were use of insecticide-treated nets (ITN), child vaccination, and modern contraception use. Wealth Index was the exposure variable and age, marital status, place of residence, region, education, occupation, and household wealth index were the explanatory variables. Wealth inequalities were assessed using concentration indexes (Cindex). Wagstaff-decomposition analysis was conducted to assess the determinants of the wealth inequality. Results The Cindex was −0.081 for non-ITN, −0.189 for lack of vaccination coverage and −0.284 for non-contraceptive use, indicating a pro-poor inequality. The results revealed that 88.41% of wealth gap for ITN was explained by socioeconomic factors, with education and wealth playing the largest roles. Lack of full vaccination, socioeconomic factors made the largest contribution, through the wealth variable, whereas geographic factors came next. Finally, the lack of contraceptive use, socioeconomic factors were the main explanatory factors, but to a lesser degree than the other two outcomes, with wealth and education contributing most to explaining the gap. Conclusion There was a pro-poor inequality in reproductive and child preventive measures in Mozambique. The greater part of this inequality could be attributed to wealth, education, and residence in rural areas. Resources should be channeled into poor and non-educated rural communities to tackle these persistent inequities in preventive care.
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Affiliation(s)
- Chanvo S L Daca
- Department of Cooperation, Ministry of Health, Directorate of Planning and Cooperation, Maputo, Mozambique.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Barbara Schumann
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Macharia PM, Joseph NK, Nalwadda GK, Mwilike B, Banke-Thomas A, Benova L, Johnson O. Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens. BMC Pregnancy Childbirth 2022; 22:908. [PMID: 36474193 PMCID: PMC9724345 DOI: 10.1186/s12884-022-05238-1] [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: 06/07/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. METHODS We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning. RESULTS About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had 20,000 women having CONCLUSIONS These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths.
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Affiliation(s)
- Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Beatrice Mwilike
- Community Health Nursing Department, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olatunji Johnson
- Department of Mathematics, The University of Manchester, Manchester, UK
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Lokotola CL, Uyttersprot T, Felimone P, Scheerens C. How did primary health care in Beira experience Cyclone Idai? Afr J Prim Health Care Fam Med 2022; 14:e1-e3. [PMID: 36331201 PMCID: PMC9724033 DOI: 10.4102/phcfm.v14i1.3626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 06/16/2023] Open
Abstract
Beira, the biggest city of Mozambique's Sofala province, was struck by Cyclone Idai on 14 March 2019, with devastating impacts. The floods along with the cyclone destroyed road infrastructure and health facilities and disrupted primary health care (PHC) service delivery. In addition, destruction of farmland and food stocks resulted in malnutrition; the abundance of water fostered the reproduction of mosquitos, exacerbating the burden of malaria; and problems with water and sanitation led to epidemics of cholera. The exact role and contribution of human-induced climate change is very difficult to quantify, but there is little doubt that climate change is driving more frequent and severe cyclones, such as Idai. Considering the current climatic changes, it is expected that climate hotspots such as Beira will only experience more frequent extreme weather events. In these settings, with high risks but low adaptive capacity, dedicated efforts are required to strengthen PHC with a focus on preparedness for disasters. This should entail community awareness and education, strengthening infrastructure and service provision, as well as collaboration with important stakeholders across other sectors.Contribution: Using a case study approach, this article contributes climate resilient PHC for better preparedness to service continuity.
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Charle-Cuéllar P, Espí-Verdú L, Goyanes J, Bunkembo M, Samake S, Traore M, Coulibaly AB, Landouré A, Diawara F, Dougnon AO, Vargas A, López-Ejeda N. Scaling severe acute malnutrition treatment with community health workers: a geospatial coverage analysis in rural Mali. HUMAN RESOURCES FOR HEALTH 2022; 20:74. [PMID: 36271427 PMCID: PMC9587545 DOI: 10.1186/s12960-022-00771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In 2015, the Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated Community Case Management (iCCM). This paper aims to analyze the impact of including community health workers (CHWs) as treatment providers outside the Health Facilities (HFs) on the coverage of SAM treatment when scaling up the intervention in the three largest districts of the Kayes Region in Mali. METHODS A baseline coverage assessment was conducted in August 2017 in the three districts before the CHWs started treating SAM. The end-line assessment was conducted one year later, in August 2018. Coverage was assessed by the standardized methodology called Semi-Quantitative Evaluation of Access and Coverage (SQUEAC). The primary outcome was treatment coverage and other variables evaluated were the geographical distribution of the HFs, CHW's sites and overlapping between both health providers, the estimation of children with geographical access to health care and the estimation of children screened for acute malnutrition in their communities. RESULTS Treatment coverage increased in Kayes (28.7-57.1%) and Bafoulabé (20.4-61.1%) but did not in Kita (28.4-28.5%). The decentralization of treatment has not had the same impact on coverage in all districts, with significant differences. The geospatial analyses showed that Kita had a high proportion of overlap between HFs and/or CHWs 48.7% (39.2-58.2), a high proportion of children without geographical access to health care 70.4% (70.1-70.6), and a high proportion of children not screened for SAM in their communities 52.2% (51.9-52.5). CONCLUSIONS Working with CHWs in SAM increases treatment coverage, but other critical aspects need to be considered by policymakers if this intervention model is intended to be scaled up at the country level. To improve families' access to nutritional health care, before establishing decentralized treatment in a whole region it must be considered the geographical location of CHWs. This previous assessment will avoid overlap among health providers and ensure the coverage of all unserved areas according to their population densities need. TRIAL REGISTRATION ISRCTN registry with ID 1990746. https://doi.org/10.1186/ISRCTN14990746.
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Affiliation(s)
| | - Lidia Espí-Verdú
- Action Against Hunger Spain, C/ Duque de Sevilla No. 3. 28002, Madrid, Spain
| | - Juan Goyanes
- Action Against Hunger Spain, C/ Duque de Sevilla No. 3. 28002, Madrid, Spain
| | | | | | - Mamadou Traore
- Nutrition Direction of the Ministry of Hygiene and Public Health, BP 232, Bamako, Mali
| | - Adama Balla Coulibaly
- Nutrition Direction of the Ministry of Hygiene and Public Health, BP 232, Bamako, Mali
| | - Aly Landouré
- Institut National de Recherche en Santé Publique, BP 235, Bamako, Mali
| | - Fatou Diawara
- Institut National de Recherche en Santé Publique, BP 235, Bamako, Mali
| | | | - Antonio Vargas
- Action Against Hunger Spain, C/ Duque de Sevilla No. 3. 28002, Madrid, Spain
| | - Noemí López-Ejeda
- EPINUT Research Group (Ref. 920325), Faculty of Biological Sciences, Department of Biodiversity, Ecology and Evolution, Unit of Physical Anthropology, Complutense University of Madrid, Jose Antonio Novais, 12, 8th Floor, 28040 Madrid, Spain
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Hierink F, Boo G, Macharia PM, Ouma PO, Timoner P, Levy M, Tschirhart K, Leyk S, Oliphant N, Tatem AJ, Ray N. Differences between gridded population data impact measures of geographic access to healthcare in sub-Saharan Africa. COMMUNICATIONS MEDICINE 2022; 2:117. [PMID: 36124060 PMCID: PMC9481590 DOI: 10.1038/s43856-022-00179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022] Open
Abstract
Background Access to healthcare is imperative to health equity and well-being. Geographic access to healthcare can be modeled using spatial datasets on local context, together with the distribution of existing health facilities and populations. Several population datasets are currently available, but their impact on accessibility analyses is unknown. In this study, we model the geographic accessibility of public health facilities at 100-meter resolution in sub-Saharan Africa and evaluate six of the most popular gridded population datasets for their impact on coverage statistics at different administrative levels. Methods Travel time to nearest health facilities was calculated by overlaying health facility coordinates on top of a friction raster accounting for roads, landcover, and physical barriers. We then intersected six different gridded population datasets with our travel time estimates to determine accessibility coverages within various travel time thresholds (i.e., 30, 60, 90, 120, 150, and 180-min). Results Here we show that differences in accessibility coverage can exceed 70% at the sub-national level, based on a one-hour travel time threshold. The differences are most notable in large and sparsely populated administrative units and dramatically shape patterns of healthcare accessibility at national and sub-national levels. Conclusions The results of this study show how valuable and critical a comparative analysis between population datasets is for the derivation of coverage statistics that inform local policies and monitor global targets. Large differences exist between the datasets and the results underscore an essential source of uncertainty in accessibility analyses that should be systematically assessed.
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Affiliation(s)
- Fleur Hierink
- GeoHealth group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Gianluca Boo
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
- Small Arms Survey, The Graduate Institute, Geneva, Switzerland
| | - Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Paul O. Ouma
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Pablo Timoner
- GeoHealth group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Marc Levy
- CIESIN, The Center for International Earth Science Information Network, Columbia University, Palisades, NY USA
| | - Kevin Tschirhart
- CIESIN, The Center for International Earth Science Information Network, Columbia University, Palisades, NY USA
| | - Stefan Leyk
- Department of Geography, University of Colorado in Boulder, Boulder, CO USA
| | - Nicholas Oliphant
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Andrew J. Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Nicolas Ray
- GeoHealth group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
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A training and implementation model for head and neck oncology service delivery in Mozambique. Curr Opin Otolaryngol Head Neck Surg 2022; 30:201-206. [PMID: 35635116 DOI: 10.1097/moo.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is an extreme shortage of head and neck surgeons in Africa. In Mozambique prior to 2000, there were no surgeons with specific training in head and neck surgical oncology. Here, we introduce a training model and report our experience with implementation following the training of the first two head and neck surgeons from Mozambique. RECENT FINDINGS This training program, undertaken in Brazil, facilitated the formation of the first two head and neck surgeons from Mozambique. These surgeons received comprehensive training in head and neck surgical oncology and multidisciplinary care, allowing them to then treat their patients under continuous online mentorship collaboration. This model is expected to help in the local formation of new specialists and in the establishment of this specialty in Mozambique. SUMMARY The program started with remote training and support provided by the MD Anderson Cancer Center, in Texas, USA, as part of the Extension for Community Healthcare Outcomes program. Further training was then undertaken at an established fellowship program in Brazil as a focal point for 2 years, and the knowledge gained was replicated and disseminated locally.
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Rural Transportation Infrastructure in Low- and Middle-Income Countries: A Review of Impacts, Implications, and Interventions. SUSTAINABILITY 2022. [DOI: 10.3390/su14042149] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The rural transport infrastructure sector is a critical force for sustainable development that is interwoven with many other sectors. Rural transportation is an underlying driver of many of the Sustainable Development Goals (SDGs) and a crucial contributor to many socioeconomic benefits for rural people around the world. This review paper expands upon, enhances, and cross-references the perspectives outlined in previous rural infrastructure-focused review papers. Firstly, this work gives a thorough look into the progress of the rural transportation sector in recent years by focusing on the thematic relationships between infrastructure and other components of sustainable development, namely, economics and agriculture, policy and governance, health, gender, education, and climate change and the environment. Secondly, several strategies, approaches, and tools employed by governments and practitioners within the rural transport sector are analyzed and discussed for their contributions to the wellbeing of rural dwellers in low- and middle-income countries (LMICs). These include rural roads, bridges, maintenance, and non-infrastructural approaches that include concepts such as advanced technological innovations, intermediate modes of transport (IMTs), and transport services. This paper concludes that enhancement, improvement, and extension of rural transportation infrastructure brings significant benefits to rural dwellers. However, this paper also calls for additional integration of the sector and increased usage of systems approaches that view rural transport as an active part of many other sectors and a key leverage point within rural development as a whole. Further, this paper notes areas for future research and investigation, including increased investigation of the relationship between rural transportation infrastructure and education, improved data collection and management in support of improved policymaking, improved prioritization of interventions and institutionalization of maintenance, and expansion of pro-poor transportation strategies and interventions.
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16
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Khan S, Scorza P, Lovero KL, dos Santos P, Fumo W, Camara B, Oquendo MA, Wainberg ML, Fejo M, Duarte CS. Women's mental health in Mozambique: is maternity a protective factor? Glob Ment Health (Camb) 2022; 9:38-44. [PMID: 36618727 PMCID: PMC9806954 DOI: 10.1017/gmh.2022.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/16/2021] [Accepted: 01/02/2022] [Indexed: 01/11/2023] Open
Abstract
Backgroud Globally, women have been shown to have high rates of common mental disorders (CMDs). In low and middle-income countries (LMICs), women face significant challenges related to maternity. However, no study has compared mental health problems among pregnant/post-partum women, childless women of childbearing age, and women with children in a low-income country. We sought to compare the frequency of CMD and suicide risk in a sample of women presenting or accompanying patients in primary care in two Mozambican semi-urban settings. Methods We administered the MINI International Neuropsychiatric Interview to 853 women, of whom 220 (25.8%) were pregnant/post-partum, 177 (20.8%) were non-pregnant and childless, and 456 (53.5%) were non-pregnant and with children more than 1-year-old. Logistic regression models compared the likelihood of a psychiatric disorder across groups, adjusting for sociodemographic and chronic-illness covariates. Results We found a high frequency of CMD and suicide risk among all women in this low-income context sample. In adjusted models, no differences in rates of depression, anxiety, or panic disorder were observed among groups. However, suicide risk was higher in women without children than pregnant/post-partum women. Conclusion The frequency of CMD among women of childbearing age in our study was higher than documented rates in high-income countries and other LMIC. Additionally, we found that motherhood was not protective and that pregnancy and the postpartum period were not stages of increased risk for most disorders. This highlights the need to expand mental health services not only for perinatal women but all women of childbearing age in this and possibly similar settings.
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Affiliation(s)
- Saida Khan
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Pamela Scorza
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Kathryn L. Lovero
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Palmira dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Barbara Camara
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 200, Philadelphia, Pennsylvania, USA
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Marcelo Fejo
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Cristiane S. Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
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Asabere NY, Lawson G, Badu-Marfo G, Kwofie L, Mensah DO, Lartey R. Classification of Public Health Centres in Accra through a Web-Based Portal Integrated with Geographical Information System (GIS). JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4178161. [PMID: 34900186 PMCID: PMC8664506 DOI: 10.1155/2021/4178161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/18/2021] [Indexed: 11/18/2022]
Abstract
A health system is described as a logically organized collection of resources, agents, and institutions that offer healthcare to a specific population based on the finance, regulation, and delivery of health services. Many health centres have been established in Accra, the capital city of Ghana, due to the importance of good health. People in other developed nations can seek adequate healthcare, since information about relevant health centres is readily available. However, there is a paucity of information about the services provided by existing health institutions in Ghana, particularly in Accra. The majority of patients commute to either Korle-Bu Teaching Hospital or Greater Accra Regional Hospital, putting a considerable medical strain on these facilities. In this study, we use a Geographic Information System (GIS) to establish a database for all of Accra's health centres and categorize them according to the services they provide. This research tackled the previously mentioned problem by proposing and developing a web-based map called Geohealth for the classification of public health centres in Accra using GIS to assist users in accessing information and locating health centres. We utilized a mixed-method approach consisting of quantitative as well as Build Computer Science Research Methods. Results of our study show that the majority of the participants and stakeholders in our research are eager to embrace Geohealth. Furthermore, in comparison with existing techniques such as Google Maps, our proposed approach, Geohealth, takes less time to obtain information and locate public health centres in Accra, Ghana.
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Affiliation(s)
- Nana Yaw Asabere
- Department of Computer Science, Faculty of Applied Sciences, Accra Technical University (ATU), Accra, Ghana
| | - Gare Lawson
- Department of Computer Science, Faculty of Applied Sciences, Accra Technical University (ATU), Accra, Ghana
- DexAfrica Limited, Accra, Ghana
| | - Godwin Badu-Marfo
- DexAfrica Limited, Accra, Ghana
- Department of Geography Urban Planning and Environmental Studies, Concordia University, Montreal, Canada
| | - Lydia Kwofie
- Department of Computer Science, Faculty of Applied Sciences, Accra Technical University (ATU), Accra, Ghana
| | | | - Reginald Lartey
- Department of Computer Science, Faculty of Applied Sciences, Accra Technical University (ATU), Accra, Ghana
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Sundararajan R, Langa PV, Morshed T, Manuel S. Traditional healers as client advocates in the HIV-endemic region of Maputo, Mozambique: results from a qualitative study. SAHARA J 2021; 18:77-85. [PMID: 33902401 PMCID: PMC8081305 DOI: 10.1080/17290376.2021.1909492] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Traditional healers are commonly utilised throughout sub-Saharan Africa instead of - and in concert with - biomedical facilities. Traditional healers are trusted providers and prominent community members and could be important partners in improving engagement with HIV services in endemic contexts. Our study sought to understand the roles of healers in the urban setting of Maputo, Mozambique, where HIV prevalence is high and testing rates are low. Qualitative data were gathered through minimally structured interviews with 36 healers. Analysis followed an inductive, grounded theory approach. Data reveal three themes relevant to improving engagement with HIV services in this endemic region: (1) healers have positive attitudes towards biomedicine; (2) healers advocate for their sick clients and (3) clients are reticent to present to biomedical facilities. Healers describe their roles as 'cooperative' with biomedical providers to provide healthcare for their clients. Results suggest that healers could be considered critical enablers to effective HIV programmes in communities. They have social and symbolic capital that positions them to beneficially influence clients and are natural partners for interventions to improve uptake of HIV services.
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Affiliation(s)
| | - Patricio V. Langa
- Faculty of Arts and Social Sciences, Universidade Eduardo Mondlane, Maputo City, Mozambique
| | - Trisha Morshed
- Emergency Medicine, Banner Medical Center, Vituity Physician Group, Sun City, AZ, USA
| | - Sandra Manuel
- Faculty of Education, Universidade Eduardo Mondlane, Maputo City, Mozambique
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Kim C, Erim D, Natiq K, Salehi AS, Zeng W. Combination of Interventions Needed to Improve Maternal Healthcare Utilization: A Multinomial Analysis of the Inequity in Place of Childbirth in Afghanistan. Front Glob Womens Health 2021; 1:571055. [PMID: 34816155 PMCID: PMC8594015 DOI: 10.3389/fgwh.2020.571055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022] Open
Abstract
Giving birth with a skilled birth attendant at a facility that provides emergency obstetric care services has better outcomes, but many women do not have access to these services in low- and middle-income countries. Individual, household, and societal factors influence women's decisions about place of birth. Factors influencing birthplace preference by type of provider and level of public facility are not well understood. Applying the Andersen Behavioral Model of healthcare services use, we explored the association between characteristics of women and their choice of childbirth location using a multinomial logistic regression, and conducted a scenario analysis to predict changes in the childbirth location by imposing various interventions. Most women gave birth at home (68.1%), while 15.1% gave birth at a public clinic, 12.1% at a public hospital, and 4.7% at a private facility. Women with higher levels of education, from households in the upper two wealth quintiles, and who had any antenatal care were more likely to give birth in public or private facilities than at home. A combination of multisector interventions had the strongest signals from the model for increasing the predicted probability of in-facility childbirths. This study enhances our understanding of factors associated with the use of public facilities and the private sector for childbirth in Afghanistan. Policymakers and healthcare providers should seek to improve equity in the delivery of health services. This study highlights the need for decisionmakers to consider a combination of multisector efforts (e.g., health, education, and social protection), to increase equitable use of maternal healthcare services.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Erim
- Health Economics and Outcomes Research (HEOR) Modeling and Advanced Analytics, Parexel International, Durham, NC, United States
| | - Kayhan Natiq
- Silk Route Training and Research Organization, Kabul, Afghanistan
| | - Ahmad Shah Salehi
- Department of Global Health Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wu Zeng
- Department of International Health, School of Nursing & Health Studies, Georgetown University, Washington, DC, United States
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Sritart H, Tuntiwong K, Miyazaki H, Taertulakarn S. Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10782. [PMID: 34682527 PMCID: PMC8535297 DOI: 10.3390/ijerph182010782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 01/21/2023]
Abstract
Reducing the disparities in healthcare access is one of the important goals in healthcare services and is significant for national health. However, measuring the complexity of access in truly underserved areas is the critical step in designing and implementing healthcare policy to improve those services and to provide additional support. Even though there are methods and tools for modeling healthcare accessibility, the context of data is challenging to interpret at the local level for targeted program implementation due to its complexity. Therefore, the purpose of this study is to develop a concise and context-specific methodology for assessing disparities for a remote province in Thailand to assist in the development and expansion of the efficient use of additional mobile health clinics. We applied the geographic information system (GIS) methodology with the travel time-based approach to visualize and analyze the concealed information of spatial data in the finer analysis resolution of the study area, which was located in the border region of the country, Ubon Ratchathani, to identify the regional differences in healthcare allocation. Our results highlight the significantly inadequate level of accessibility to healthcare services in the regions. We found that over 253,000 of the population lived more than half an hour away from a hospital. Moreover, the relationships of the vulnerable residents and underserved regions across the province are underlined in the study and substantially discussed in terms of expansion of mobile health delivery to embrace the barrier of travel duration to reach healthcare facilities. Accordingly, this research study addresses regional disparities and provides valuable references for governmental authorities and health planners in healthcare strategy design and intervention to minimize the inequalities in healthcare services.
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Affiliation(s)
- Hiranya Sritart
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
| | - Kuson Tuntiwong
- School of Dentistry, King Mongkut’s Institute of Technology Ladkrabang, Bangkok 10520, Thailand;
| | - Hiroyuki Miyazaki
- Center for Spatial Information Science, Tokyo University, Chiba 277-8568, Japan;
| | - Somchat Taertulakarn
- Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand;
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Obi IR, Obi KM, Seer-Uke EN, Onuorah SI, Okafor NP. Preventive health care services utilization and its associated factors among older adults in rural communities in Anambra State, Nigeria. Pan Afr Med J 2021; 39:83. [PMID: 34466185 PMCID: PMC8379407 DOI: 10.11604/pamj.2021.39.83.26997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction quality of life and life expectancy of people are improved when preventive health care services are utilized because these identify treatable health problems and puts life-threatening diseases in check. Morbidity and mortality associated with age-related chronic disease among the older adults is on the increase, therefore, this study aims at determining preventive health care services utilization among older adults in rural communities in Anambra State. Methods a cross sectional design adopted for this study was carried out on older adults from the ages of 65 years and above in rural communities in Anambra State from October 2019 to January 2020. Data were collected through researcher-administered structured questionnaire. Data were analysed using univariable and multivariable regression analysis. Results a total of 1944 older adults participated with an overall cluster percentage of 40.6% older adults utilizing investigated preventive health care services. The results of the multivariable analysis indicates that the following factors were associated with utilization of preventive healthcare services: male gender (aOR: 0.443, 95%CI: 0.281 - 5.472, p=0.47), level of education; primary (aOR: 1.536, 95%CI: 1.201 - 5.261, p=0.00), secondary (aOR: 4.516, 95%CI: 3.192 - 6.242, p=0.00), and tertiary (aOR: 3.407, 95%CI: 3.199 - 5.666, p=0.00)], income of N50,000-N100,000 (aOR: 2.754, 95%CI: 1.066 - 10.766, p=0.01), and N100,000 and above (aOR: 4.233, 95%CI: 1.846 - 12.811, p=0.00)], and health insurance [aOR: 0.691, 95%CI: 0.422 - 1.945, p=0.03]. Conclusion preventive health care services were under-utilized. Creating awareness on the importance of utilizing preventive health care services is highly recommended since most age-related chronic diseases once established may last a lifetime and affect quality of life and wellbeing.
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Affiliation(s)
- Ifunanya Rosemary Obi
- Department of Physical and Health Education, Federal College of Education (Technical), Umunze, Nigeria
| | | | | | | | - Nonye Peculiar Okafor
- Department of Human Kinetics and Sports Studies, Alvan Ikoku College of Education, Owerri, Nigeria
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22
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Using Prospective Methods to Identify Fieldwork Locations Favourable to Understanding Divergences in Health Care Accessibility. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2021. [DOI: 10.3390/ijgi10080506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Central to this article is the issue of choosing sites for where a fieldwork could provide a better understanding of divergences in health care accessibility. Access to health care is critical to good health, but inhabitants may experience barriers to health care limiting their ability to obtain the care they need. Most inhabitants of low-income countries need to walk long distances along meandering paths to get to health care services. Individuals in Malawi responded to a survey with a battery of questions on perceived difficulties in accessing health care services. Using both vertical and horizontal impedance, we modelled walking time between household locations for the individuals in our sample and the health care centres they were using. The digital elevation model and Tobler’s hiking function were used to represent vertical impedance, while OpenStreetMap integrated with land cover map were used to represent horizontal impedance. Combining measures of walking time and perceived accessibility in Malawi, we used spatial statistics and found spatial clusters with substantial discrepancies in health care accessibility, which represented fieldwork locations favourable for providing a better understanding of barriers to health access.
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Tan PP, Chang CT, Abdul Rahman J, Mohd Noor S. Development and Validation of a Malaysian Blood Donor's Satisfaction Questionnaire. Malays J Med Sci 2021; 28:86-96. [PMID: 34285647 PMCID: PMC8260069 DOI: 10.21315/mjms2021.28.3.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/03/2021] [Indexed: 11/08/2022] Open
Abstract
Objective To develop and validate a questionnaire which evaluates the blood donors’ satisfaction. Background In Malaysia, blood procurement relies mainly on voluntary non-remunerated donors. Hence, it is important to ensure the satisfaction of the blood donors in order to increase retention. Methods This study was conducted among blood donors who attended blood donation and understood the Malay language. Non-Malaysian and illiterate donors were excluded. The questionnaire was developed by the transfusion medicine team. Content validity was established by content reviewers, while face validity was examined in the cognitive debriefing stage. For the 18-item questionnaire, 90 respondents were required based on the 1:5 ratio. A retest was performed in two weeks’ time. Results One hundred and thirty-seven participants responded in the first phase, while 103 responded after two weeks. The five domains were: technical, interpersonal, accessibility/ convenience, physical experience and overall satisfaction. The Kaiser-Meyer-Olkin (KMO) value was 0.896, with significant Bartlett’s Test of Sphericity (P < 0.001). The factor loadings ranged from 0.729 to 0.953. The Cronbach alpha values of the five domains ranged from 0.814 to 0.955 and the intraclass correlation coefficient ranged from 0.663 to 0.847. Conclusion The Malaysian blood donor’s satisfaction (M-BDS) questionnaire is a reliable and valid tool suitable for the assessment of blood donor’s satisfaction in blood donation centres.
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Affiliation(s)
- Pei Pei Tan
- Transfusion Medicine Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.,Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Jernih Abdul Rahman
- Transfusion Medicine Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.,Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Sabariah Mohd Noor
- Transfusion Medicine Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
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Oladeji O, Oladeji B, Diaaeldin Omer M, Elmi Farah A, Ameda IM, Gera R, Ismail AS, Ayanle M, Nixon O, Diriye HM. Exploring opportunities to enhance effectiveness of mobile health and nutrition strategy for providing health and nutrition services amongst pastoralists in Somali region, Ethiopia. Afr J Prim Health Care Fam Med 2021; 13:e1-e7. [PMID: 33881333 PMCID: PMC8063561 DOI: 10.4102/phcfm.v13i1.2723] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The health system in Ethiopia's Somali Region is weak with limited number of health facilities with more than 60% of the population living more than 5 km to the nearest health facilities. The deployment of mobile health and nutrition teams has played critical role in providing essential health and nutrition services. AIM This study aimed to assess the effectiveness of the mobile health and nutrition strategy in providing health and nutrition services in the targeted woredas (districts). SETTING Somali Region of Ethiopia. METHODS The study was a retrospective chart review of the monthly mobile health and nutrition team and the static health facilities in the 29 woredas between April 2019 and March 2020 and the AccessMod analyses for geographical accessibility to health facilities in the region. RESULTS 40 (40.4%) out of the 99 woredas in Somali regions have at least 80% of the population living more than 5 km from the nearest health facility out of which 18 (45%) woredas are currently being supported by the mobile health team. The mobile team contributed to increasing access to health services in the targeted woredas with 30.8% of the total children vaccinated for measles and 39% of the total children treated for severe acute malnutrition in the targeted 29 woredas. CONCLUSION With mobile health and nutrition strategy being recognised as a useful strategy to deliver health and nutrition services in the region, there is a need to explore opportunities and innovation to enhance the effectiveness of the implementation.
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Denhard L, Kaviany P, Chicumbe S, Muianga C, Laisse G, Aune K, Sheffel A. How prepared is Mozambique to treat COVID-19 patients? A new approach for estimating oxygen service availability, oxygen treatment capacity, and population access to oxygen-ready treatment facilities. Int J Equity Health 2021; 20:90. [PMID: 33823863 PMCID: PMC8022128 DOI: 10.1186/s12939-021-01403-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/07/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study aims to assess the COVID-19 response preparedness of the Mozambican health system by 1) determining the location of oxygen-ready public health facilities, 2) estimating the oxygen treatment capacity, and 3) determining the population coverage of oxygen-ready health facilities in Mozambique. METHODS This analysis utilizes information on the availability of oxygen sources and delivery apparatuses to determine if a health facility is ready to deliver oxygen therapy to patients in need, and estimates how many patients can be treated with continuous oxygen flow for a 7-day period based on the available oxygen equipment at health facilities. Using GIS mapping software, the study team modeled varying travel times to oxygen-ready facilities to estimate the proportion of the population with access to care. RESULTS 0.4% of all health facilities in Mozambique are prepared to deliver oxygen therapy to patients, for a cumulative total of 283.9 to 406.0 patients-weeks given the existing national capacity, under varying assumptions including ability to divert oxygen from a single source to multiple patients. 35% of the population in Mozambique has adequate access within one-hour driving time of an oxygen-ready health facility. This varies widely by region; 89.1% of the population of Maputo City was captured by the one-hour driving time network, as compared ot 4.4% of the population of Niassa province. CONCLUSIONS The Mozambican health system faces the dual challenges of under-resourced health facilities and low geographic accessibility to healthcare as it prepares to confront the COVID-19 pandemic. This analysis also illustrates the disparity between provinces in preparedness to deliver oxygen therapy to patient, with Cabo Delgado and Nampula being particularly under-resourced.
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Affiliation(s)
- Langan Denhard
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Parisa Kaviany
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sérgio Chicumbe
- Programa de Sistemas de Saúde, Instituto Nacional de Saúde, Maputo, Mozambique
| | | | | | - Kyle Aune
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ashley Sheffel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Daca C, Sebastian MS, Arnaldo C, Schumann B. Socio-economic and demographic factors associated with reproductive and child health preventive care in Mozambique: a cross-sectional study. Int J Equity Health 2020; 19:200. [PMID: 33168017 PMCID: PMC7653841 DOI: 10.1186/s12939-020-01303-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Reproductive and child health interventions are essential to improving population health in Africa. In Mozambique, although some progress on reproductive and child health has been made, knowledge of social inequalities in health and health care is lacking. Objective To investigate socio-economic and demographic inequalities in reproductive and child preventive health care as a way to monitor progress towards universal health coverage. Methods A cross-sectional study was conducted, using data collected from the 2015 Immunization, AIDS and Malaria Indicators Survey (IMASIDA) in Mozambique. The sample included 6946 women aged 15 to 49 years. Outcomes variables were the use of insecticide treated nets (ITN) for children under 5 years, full child immunization and modern contraception use, while independent variables included age, marital status, place of residence, region, education, occupation, and household wealth index. Prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship between the socio-economic and demographic characteristics and the three outcomes of interest. Results The percentage of mothers with at least one child under 5 years that did not use ITN was 51.01, 46.25% of women had children aged 1 to 4 years who were not fully immunized, and 74.28% of women were not using modern contraceptives. Non-educated mothers (PR = 1.33; 95% CI: 1.16–1.51) and those living in the Southern region (PR = 1.36; 95% CI: 1.17–1.59) had higher risk of not using ITN, while the poorest quintile (PR = 1.34; 95% CI: 1.04–1.71) was more likely to have children who were not fully immunized. Similarly, non-educated women (PR = 1.17; 95% CI: 1.10–1.25), non-working women (PR = 1.09; 95% CI: 1.04–1.16), and those in the poorest quintile (PR = 1.13; 95% CI: 1.04–1.24) had a higher risk of not using modern contraceptives. Conclusion Our study showed a low rate of ITN utilization, immunization coverage of children, and modern contraceptive use among women of reproductive age. Several socio-economic and demographics factors (region, education, occupation, and wealth) were associated with these preventive measures. We recommend an equity-oriented resource allocation across regions, knowledge dissemination on the importance of ITN and contraceptives use, and an expansion of immunization services to reach socio-economically disadvantaged families in order to achieve universal health coverage in Mozambique.
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Affiliation(s)
- Chanvo Daca
- Ministry of Health, Directorate of Planning and Cooperation, Maputo, Mozambique. .,Department of Epidemiology and Global Health, Umea University, Umea, Sweden.
| | | | | | - Barbara Schumann
- Department of Epidemiology and Global Health, Umea University, Umea, Sweden
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Hierink F, Rodrigues N, Muñiz M, Panciera R, Ray N. Modelling geographical accessibility to support disaster response and rehabilitation of a healthcare system: an impact analysis of Cyclones Idai and Kenneth in Mozambique. BMJ Open 2020; 10:e039138. [PMID: 33148747 PMCID: PMC7640533 DOI: 10.1136/bmjopen-2020-039138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Modelling and assessing the loss of geographical accessibility is key to support disaster response and rehabilitation of the healthcare system. The aim of this study was therefore to estimate postdisaster travel times to functional health facilities and analyse losses in accessibility coverage after Cyclones Idai and Kenneth in Mozambique in 2019. SETTING We modelled travel time of vulnerable population to the nearest functional health facility in two cyclone-affected regions in Mozambique. Modelling was done using AccessMod V.5.6.30, where roads, rivers, lakes, flood extent, topography and land cover datasets were overlaid with health facility coordinates and high-resolution population data to obtain accessibility coverage estimates under different travel scenarios. OUTCOME MEASURES Travel time to functional health facilities and accessibility coverage estimates were used to identify spatial differences between predisaster and postdisaster geographical accessibility. RESULTS We found that accessibility coverage decreased in the cyclone-affected districts, as a result of reduced travel speeds, barriers to movement, road constraints and non-functional health facilities. In Idai-affected districts, accessibility coverage decreased from 78.8% to 52.5%, implying that 136 941 children under 5 years of age were no longer able to reach the nearest facility within 2 hours travel time. In Kenneth-affected districts, accessibility coverage decreased from 82.2% to 71.5%, corresponding to 14 330 children under 5 years of age having to travel >2 hours to reach the nearest facility. Damage to transport networks and reduced travel speeds resulted in the most substantial accessibility coverage losses in both Idai-affected and Kenneth-affected districts. CONCLUSIONS Postdisaster accessibility modelling can increase our understanding of spatial differences in geographical access to care in the direct aftermath of a disaster and can inform targeting and prioritisation of limited resources. Our results reflect opportunities for integrating accessibility modelling in early disaster response, and to inform discussions on health system recovery, mitigation and preparedness.
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Affiliation(s)
- Fleur Hierink
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | | | - Maria Muñiz
- Eastern and Southern Africa Regional Office, United Nations Children's Fund, Nairobi, Kenya
| | - Rocco Panciera
- Health Section, United Nations Children's Fund, New York, New York, USA
| | - Nicolas Ray
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
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Shakeri M, Sadeghi-Niaraki A, Choi SM, Islam SMR. Performance Analysis of IoT-Based Health and Environment WSN Deployment. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5923. [PMID: 33092224 PMCID: PMC7590066 DOI: 10.3390/s20205923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022]
Abstract
With the development of Internet of Things (IoT) applications, applying the potential and benefits of IoT technology in the health and environment services is increasing to improve the service quality using sensors and devices. This paper aims to apply GIS-based optimization algorithms for optimizing IoT-based network deployment through the use of wireless sensor networks (WSNs) and smart connected sensors for environmental and health applications. First, the WSN deployment research studies in health and environment applications are reviewed including fire monitoring, precise agriculture, telemonitoring, smart home, and hospital. Second, the WSN deployment process is modeled to optimize two conflict objectives, coverage and lifetime, by applying Minimum Spanning Tree (MST) routing protocol with minimum total network lengths. Third, the performance of the Bees Algorithm (BA) and Particle Swarm Optimization (PSO) algorithms are compared for the evaluation of GIS-based WSN deployment in health and environment applications. The algorithms were compared using convergence rate, constancy repeatability, and modeling complexity criteria. The results showed that the PSO algorithm converged to higher values of objective functions gradually while BA found better fitness values and was faster in the first iterations. The levels of stability and repeatability were high with 0.0150 of standard deviation for PSO and 0.0375 for BA. The PSO also had lower complexity than BA. Therefore, the PSO algorithm obtained better performance for IoT-based sensor network deployment.
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Affiliation(s)
- Maryam Shakeri
- Geoinformation Technology Center of Excellence, Faculty of Geodesy & Geomatics Engineering, K.N. Toosi University of Technology, Tehran 19697, Iran;
| | - Abolghasem Sadeghi-Niaraki
- Geoinformation Technology Center of Excellence, Faculty of Geodesy & Geomatics Engineering, K.N. Toosi University of Technology, Tehran 19697, Iran;
- Department of Computer Science and Engineering, Sejong University, Seoul 05006, Korea; (S.-M.C.); (S.M.R.I.)
| | - Soo-Mi Choi
- Department of Computer Science and Engineering, Sejong University, Seoul 05006, Korea; (S.-M.C.); (S.M.R.I.)
| | - S. M. Riazul Islam
- Department of Computer Science and Engineering, Sejong University, Seoul 05006, Korea; (S.-M.C.); (S.M.R.I.)
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Stone B, Sambo J, Sawadogo-Lewis T, Roberton T. When it rains, it pours: detecting seasonal patterns in utilization of maternal healthcare in Mozambique using routine data. BMC Health Serv Res 2020; 20:950. [PMID: 33059682 PMCID: PMC7559485 DOI: 10.1186/s12913-020-05807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Climatic conditions and seasonal trends can affect population health, but typically, we consider the effect of climate on the epidemiology of communicable diseases. However, climate can also have an effect on access to care, particularly in remote rural areas of low- and middle-income countries. In this study, we investigate associations between the rainy season and the utilization of maternal health services in Mozambique. METHODS We examined patterns in the number of women receiving antenatal care (ANC) and delivering at a health facility for 2012-2019, using data from Mozambique's Health Management Information Systems. We investigated the association between seasonality (rainfall) and maternal health service utilization (ANC and institutional delivery) at national and provincial level. We fit a negative binomial regression model for institutional delivery and used it to estimate the yearly reduction in institutional deliveries due to the rainy season, with other factors held constant. We used the Lives Saved Tool (LiST) to model increases in mortality due to this estimated decrease in institutional delivery associated with the rainy season. RESULTS In our national analysis, the rate of ANC visits was 1% lower during the rainy season, adjusting for year and province (IRR = 0.99, 95% CI: 0.96-1.03). The rate of institutional deliveries was 6% lower during the rainy season than the dry season, after adjusting for time and province (IRR = 0.94, 95% CI: 0.92-0.96). In provincial analyses, all provinces except for Maputo-Cidade, Maputo-Province, Nampula, and Niassa showed a statistically significantly lower rate of institutional deliveries in the rainy season. None were statistically significantly lower for ANC. We estimate that, due to reductions in institutional delivery attributable only to the rainy season, there were 74 additional maternal deaths and 726 additional deaths of children under the age of 1 month in 2021, that would not have died if the mothers had instead delivered at a facility. CONCLUSION Fewer women deliver at a health facility during the rainy season in Mozambique than during the dry season. Barriers to receiving care during pregnancy and childbirth must be addressed using a multisectoral approach, considering the impact of geographical inequities.
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Affiliation(s)
- Briana Stone
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Júlia Sambo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Kim C, Tappis H, McDaniel P, Soroush MS, Fried B, Weinberger M, Trogdon JG, Kristen Hassmiller Lich, Delamater PL. National and subnational estimates of coverage and travel time to emergency obstetric care in Afghanistan: Modeling of spatial accessibility. Health Place 2020; 66:102452. [PMID: 33011490 DOI: 10.1016/j.healthplace.2020.102452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/30/2022]
Abstract
In Afghanistan, the risk of maternal death is among the highest in the world, with wide variation across the country. One explanation may be wide geographic disparities in access and use of maternal health care services. This study describes the spatial distribution of public facilities providing maternal health care in Afghanistan, specifically emergency obstetric care (EmOC), and the differences in travel time estimates using different transportation modes from 2010 to 2015 at the national and subnational levels. We conducted mapping and spatial analyses to measure the proportion of pregnant women able to access any EmOC health facility within 2 h by foot, animal, motor vehicle and a combination of transport modes. In 2015, adequate coverage of active public health facilities within 2 h of travel time was 36.6% by foot and 71.2% by a combination of transport modes. We found an 8.3% and 63.2% increase in access to EmOC facilities within 2 h of travel time by a combination of transport modes and by foot only, respectively, by 2015. Access to a combination of transportation options such as motor vehicles and animals may benefit pregnant women in reaching health facilities efficiently. Afghanistan made impressive gains in maternal healthcare access; despite these improvements, large disparities remain in geographic access by province and overall access to facilities is still poor.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hannah Tappis
- Technical Leadership and Innovations Department, Jhpiego, Baltimore, MD, USA.
| | - Philip McDaniel
- Davis Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Paul L Delamater
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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A cross-sectional study of the role of men and the knowledge of danger signs during pregnancy in southern Mozambique. BMC Pregnancy Childbirth 2020; 20:572. [PMID: 32993554 PMCID: PMC7526108 DOI: 10.1186/s12884-020-03265-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background The role of the male partner and wider family in maternal health, especially in case of emergencies, has been receiving increasing attention over the last decade. Qualitative research has highlighted that women depend on others to access high quality maternity care. Currently little is known about these factors in relation to maternal health in Mozambique. Methods A cross sectional household survey was conducted with men and women in southern Mozambique about decision making, financial support and knowledge of danger signs. A multivariable logistic model was used to identify factors associated with knowledge of danger signs and Cohen’s kappa for agreement among couples. Results A total of 775 men and women from Marracuene and Manhica districts were interviewed. Maternal health care decisions were frequently made jointly by the couple (32–49%) and financial support was mainly provided by the man (46–80%). Parental and parent-in-law involvement in decision making and financial support was minimal (0–3%). The average number of danger signs respondents knew was 2.05 and no significant difference (p = 0.294) was found between men and women. Communication with the partner was a significant predictor for higher knowledge of danger signs for both men (p = 0.01) and women (p = 0.03). There was very low agreement within couples regarding decision making (p = 0.04), financial support (p = 0.01) and presence at antenatal care consultations (p = 0.001). Results suggest women and men have a high willingness for more male participation in antenatal care, although their understanding of what constitutes this participation is not clear. Conclusion The study findings highlight the important role men play in decision making and financial support for maternal health care issues. Strengthening male involvement in antenatal care services, by investing in counselling and receiving couples, could help accelerate gains in maternal health in Mozambique. Maternal health care studies should collect more data from men directly as men and women often report different views and behavior regarding maternal health care issues and male involvement.
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Joseph NK, Macharia PM, Ouma PO, Mumo J, Jalang'o R, Wagacha PW, Achieng VO, Ndung'u E, Okoth P, Muñiz M, Guigoz Y, Panciera R, Ray N, Okiro EA. Spatial access inequities and childhood immunisation uptake in Kenya. BMC Public Health 2020; 20:1407. [PMID: 32933501 PMCID: PMC7493983 DOI: 10.1186/s12889-020-09486-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders. METHODS Spatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models. RESULTS Nationally, the mean travel time to immunising health facilities was 63 and 40 min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with < 90% of the population within one-hour from an immunising health facility using scenarios 1 and 2 respectively. Travel times > 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33-0.94) and receive DPT3 [AOR:0.51(0.21-0.92) after controlling for household wealth, mother's highest education level, parity and urban/rural residence. CONCLUSION Travel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (> 2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.
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Affiliation(s)
- Noel K Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paul O Ouma
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jeremiah Mumo
- Health Information System Unit, Ministry of Health, Nairobi, Kenya
| | - Rose Jalang'o
- National Vaccines and Immunization Programme, Ministry of Health, Nairobi, Kenya
| | - Peter W Wagacha
- School of Computing and Informatics, University of Nairobi, Nairobi, Kenya
| | - Victor O Achieng
- Kenya Country Office, The United Nations Children's Fund, Nairobi, Kenya
| | - Eunice Ndung'u
- Kenya Country Office, The United Nations Children's Fund, Nairobi, Kenya
| | - Peter Okoth
- Kenya Country Office, The United Nations Children's Fund, Nairobi, Kenya
| | - Maria Muñiz
- Regional Office for Eastern and Southern Africa, The United Nations Children's Fund, Nairobi, Kenya
| | - Yaniss Guigoz
- GeoHealth group, Institute of Global Health & Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Rocco Panciera
- Health section, The United Nations Children's Fund, New York, USA
| | - Nicolas Ray
- GeoHealth group, Institute of Global Health & Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK
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Agbadi P, Nutor JJ, Darkwah E, Duah HO, Duodu PA, Alhassan RK, Baltzell K. Covariates and Spatial Interpolation of HIV Screening in Mozambique: Insight from the 2015 AIDS Indicator Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165630. [PMID: 32764221 PMCID: PMC7460053 DOI: 10.3390/ijerph17165630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 01/20/2023]
Abstract
We examined the factors associated with human immunodeficiency virus (HIV) screening and developed a HIV screening prevalence surface map using spatial interpolation techniques to identify the geographical areas with the highest and lowest rates of HIV screening in Mozambique. We analyzed the cross-sectional 2015 Mozambique AIDS Indicator Surveys with an analytic sample of 12,995 participants. Analyses were conducted on SPSS-21, STATA-14, and R freeware 3.5.3. We adjusted for the sample design and population weights. Results indicated that 52.5% of Mozambicans had undergone HIV screening. Mozambicans with these characteristics have a higher probability of undergoing HIV screening: females, those with a primary education or higher, urban dwellers, residents of wealthy households, having at least one lifetime sexual partner, and dwelling in these provinces—Niassa, Tete, Manica, Sofala, Inhambane, Gaza, Maputo Provincia, and Maputo Cidade. The spatial map revealed that the national and regional estimates mask sub-regional level estimates. Generally, zones with the highest HIV screening prevalence are found in southern provinces while the lowest prevalence was found in the northern provinces. The map further revealed intraregional differences in HIV screening estimates. We recommend that HIV screening be expanded, with equitable screening resource allocations that target more nuanced areas within provinces which have a low HIV screening prevalence.
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Affiliation(s)
- Pascal Agbadi
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA 94143, USA;
- Correspondence:
| | - Ernest Darkwah
- Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Ghana;
| | | | | | - Robert Kaba Alhassan
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana;
| | - Kimberly Baltzell
- Department of Family Health Care Nursing, School of Nursing, University of California, 2 Koret Way, Suite N431G, San Francisco, CA 94143, USA;
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Llop-Girones A, Jones S. Beyond access to basic services: perspectives on social health determinants of Mozambique. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1769838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alba Llop-Girones
- Health Inequalities Research Group, University Pompeu Fabra, Barcelona, Spain
| | - Sam Jones
- Department of Economics, Kobenhavns Universitet, Kobenhavn, Denmark
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Chan J, Friborg J, Zubizarreta E, van Eck JW, Hanna TP, Bourque JM, Gaudet M, Dennis K, Olson R, Coleman CN, Petersen AJ, Grau C, Abdel-Wahab M, Brundage M, Slotman B, Polo A. Examining geographic accessibility to radiotherapy in Canada and Greenland for indigenous populations: Measuring inequities to inform solutions. Radiother Oncol 2020; 146:1-8. [DOI: 10.1016/j.radonc.2020.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
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Asemahagn MA, Alene GD, Yimer SA. Geographic Accessibility, Readiness, and Barriers of Health Facilities to Offer Tuberculosis Services in East Gojjam Zone, Ethiopia: A Convergent Parallel Design. Res Rep Trop Med 2020; 11:3-16. [PMID: 32099509 PMCID: PMC7007782 DOI: 10.2147/rrtm.s233052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Tuberculosis (TB) remains a foremost global public health threat. Active TB control needs geographically accessible health facilities that have quality diagnostics, equipment, supplies, medicines, and staff. Objective This study aimed at assessing the geographic distribution, physical accessibility, readiness and barriers of health facilities for TB services in East Gojjam zone, Ethiopia. Methods A convergent parallel design was applied using health facility and geographic data. Data on facility attributes, service availability and readiness were collected by inteviewing TB officers, laboratory heads and onsite facility visits. Coordinates of health facilities and kebele centroids were collected by GPS. We used ArcGIS 10.6 to measure Euclidean distance from each kebele centroids to the nearest health facility. Descriptive statistics were computed by using SPSS version 25. Barriers to TB service readiness were explored by in-depth interviews. NVivo12 was used to thematically analyze the qualitative data. Results The overall TB health service coverage (THSC) was 23% (ranging: 10–85%). The mean distance from the nearest health facility was 8km (ranging: 0.5–16km). About 132 (32%) kebeles had poor geographic accessibility to TB services (over 10km distance from the nearest health facility) and had poor facility readiness. Although 114 (95%) health facilities offered at least one TB service, 44 (38.6%) of them had no sputum smear microscopy. The overall TB readiness index was 63.5%: first-line anti-TB drugs (97%), diagnostics (63%), trained staffs, diagnostic and treatment guidelines (53%) and laboratory supplies (41%). Lack of health workers (laboratory personnel), inadequate budget, poor management practice and TB program support, inadequate TB commodity suppliers, and less accessible geographic locations of health facilities were identified as barriers to TB service readiness distribution. Conclusion Considerable proportion of the population in the study area have poor access to quality TB diagnostic services due to low THSC and poor facility readiness. Barriers to TB service availability and readiness were health system related. Regular refresher training of health workers on TB, creating mechanisms to attract laboratory personnel to work in the study area and scaling up of sputum smear microscopy services, establishing an efficient mechanism for procurement, distribution, utilization and reporting of TB commodity supplies, and good management practices are crucial to enhance TB service readiness in the study zone.
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Affiliation(s)
- Mulusew Andualem Asemahagn
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Solomon Abebe Yimer
- Department of Microbiology, Unit for Genome Dynamics, Faculty of Medicine, University of Oslo, Oslo, Norway.,Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
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Prin M, Pan S, Kadyaudzu C, Li G, Charles A. ICU Risk Stratification Models Feasible for Use in Sub-Saharan Africa Show Poor Discrimination in Malawi: A Prospective Cohort Study. World J Surg 2019; 43:2357-2364. [PMID: 31312950 DOI: 10.1007/s00268-019-05078-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Critical illness disproportionately affects people in low-income countries (LICs). Efforts to improve critical care in LICs must account for differences in demographics and infrastructure compared to high-income settings. Part of this effort includes the development and validation of intensive care unit (ICU) risk stratification models feasible for use in LICs. The purpose of this study was to validate and compare the performance of ICU mortality models developed for use in sub-Saharan Africa. MATERIALS AND METHODS This was a prospective, observational cohort study of ICU patients in a referral hospital in Malawi. Models were selected for comparison based on a Medline search for studies which developed ICU mortality models based on cohorts in sub-Saharan Africa. Model discrimination was evaluated using the area under the curve with 95% confidence intervals (CI). RESULTS During the study, 499 patients were admitted to the study ICU, and after exclusions, there were 319 patients. The cohort was 62% female, with the mean age 31 years (IQR: 23-41), and 74% had surgery preceding ICU admission. Discrimination for hospital mortality ranged from 0.54 (95% CI 0.48, 0.60) for the Universal Vital Assessment (UVA) to 0.72 (95% CI 0.66, 0.78) for the Malawi Intensive care Mortality Evaluation (MIME). After tenfold cross-validation, these results were unchanged. CONCLUSIONS The MIME outperformed other models in this prospective study. Most ICU models developed for LICs had poor to modest discrimination for hospital mortality. Future research may contribute to a better risk stratification model for LICs by refining and enhancing the MIME.
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Affiliation(s)
- Meghan Prin
- Department of Anesthesiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - Stephanie Pan
- Icahn School of Medicine At Mt. Sinai, New York, NY, USA
| | - Clement Kadyaudzu
- Department of Anesthesiology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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Gong E, Dula J, Alberto C, de Albuquerque A, Steenland M, Fernandes Q, Cuco RM, Sequeira S, Chicumbe S, Gudo ES, McConnell M. Client experiences with antenatal care waiting times in southern Mozambique. BMC Health Serv Res 2019; 19:538. [PMID: 31370854 PMCID: PMC6670125 DOI: 10.1186/s12913-019-4369-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling. METHODS This study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software. RESULTS Clients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts. CONCLUSIONS Findings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times.
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Affiliation(s)
- Estelle Gong
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Janeth Dula
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Carla Alberto
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Maria Steenland
- Population Studies and Training Center, Brown University, Providence, RI USA
| | - Quinhas Fernandes
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Rosa Marlene Cuco
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Sandra Sequeira
- Department of International Development, London School of Economics, London, UK
| | - Sérgio Chicumbe
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Eduardo Samo Gudo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA USA
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Maina J, Ouma PO, Macharia PM, Alegana VA, Mitto B, Fall IS, Noor AM, Snow RW, Okiro EA. A spatial database of health facilities managed by the public health sector in sub Saharan Africa. Sci Data 2019; 6:134. [PMID: 31346183 PMCID: PMC6658526 DOI: 10.1038/s41597-019-0142-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Health facilities form a central component of health systems, providing curative and preventative services and structured to allow referral through a pyramid of increasingly complex service provision. Access to health care is a complex and multidimensional concept, however, in its most narrow sense, it refers to geographic availability. Linking health facilities to populations has been a traditional per capita index of heath care coverage, however, with locations of health facilities and higher resolution population data, Geographic Information Systems allow for a more refined metric of health access, define geographic inequalities in service provision and inform planning. Maximizing the value of spatial heath access requires a complete census of providers and their locations. To-date there has not been a single, geo-referenced and comprehensive public health facility database for sub-Saharan Africa. We have assembled national master health facility lists from a variety of government and non-government sources from 50 countries and islands in sub Saharan Africa and used multiple geocoding methods to provide a comprehensive spatial inventory of 98,745 public health facilities.
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Affiliation(s)
- Joseph Maina
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Paul O Ouma
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Victor A Alegana
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
- Geography and Environmental Science, University of Southampton, Southampton, UK
- Faculty of Science and Technology, Lancaster University, LA1 4YR, UK
| | - Benard Mitto
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Abdisalan M Noor
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.
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Amuquandoh A, Escamilla V, Mofolo I, Rosenberg NE. Exploring the spatial relationship between primary road distance to antenatal clinics and HIV prevalence in pregnant females of Lilongwe, Malawi. Int J STD AIDS 2019; 30:639-646. [PMID: 30890119 DOI: 10.1177/0956462419830232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While urbanization in a sub-Saharan African (SSA) context can lead to greater independence in women, various sociological, biological, and geographical factors in urban areas may keep women at a higher risk for HIV than men. Access to major roads during Malawi's transition into rapid urbanization may leave women disproportionately vulnerable to HIV infection. It is not well established whether women who report to health clinics closer to major roads have higher or lower levels of HIV. In this study we explored the spatial heterogeneity of HIV prevalence among pregnant females in Lilongwe District, Malawi. Using Geographic Information Systems, we visually represented patterns of HIV prevalence in relation to primary roads. HIV prevalence data for 2015 were obtained from 44 antenatal clinics (ANC) in Lilongwe District. ANC prevalence data were aggregated to the administrative area and mapped. Euclidean distance between clinics and two primary roads that run through Lilongwe District were measured. A correlation was run to assess the relationship between area-level ANC HIV prevalence and clinic distance to the nearest primary road. ANC HIV prevalence ranged from 0% to 10.3%. Clinic to major road distance ranged from 0.1 to 35 km. Correlation results ( r= -0.622, p = 0.002) revealed a significant negative relationship between clinic distance to primary road and HIV prevalence, indicating that the farther the clinics stood from primary roads, the lower the reported antenatal HIV prevalence. Overall, the clinic catchments through which the major roads run reported higher ANC HIV prevalence. Antenatal HIV prevalence decreases as ANC distance from primary roads increases in Lilongwe, Malawi. As urbanization continues to grow in this region, road distance may serve as a good indicator of HIV burden and help to guide targeted prevention and treatment efforts.
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Affiliation(s)
- Amy Amuquandoh
- 1 UNC Project, University of North Carolina at Chapel Hill, Lilongwe, Malawi.,2 School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Veronica Escamilla
- 3 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Innocent Mofolo
- 1 UNC Project, University of North Carolina at Chapel Hill, Lilongwe, Malawi
| | - Nora E Rosenberg
- 1 UNC Project, University of North Carolina at Chapel Hill, Lilongwe, Malawi.,4 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Punchak M, Hall K, Seni A, Chris Buck W, DeUgarte DA, Hartford E, Kelly RB, Muando VI. Epidemiology of Disease and Mortality From a PICU in Mozambique. Pediatr Crit Care Med 2018; 19:e603-e610. [PMID: 30063654 PMCID: PMC6218274 DOI: 10.1097/pcc.0000000000001705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Delivery of pediatric critical care in low-income countries is limited by a lack of infrastructure, resources, and providers. Few studies have analyzed the epidemiology of disease associated with a PICU in a low-income country. The aim of this study was to document the primary diagnoses and the associated mortality rates of patients presenting to a tertiary PICU in Mozambique in order to formulate quality improvement projects through an international academic partnership. We hypothesized that the PICU mortality rate would be high and that sepsis would be a common cause of death. DESIGN Retrospective, observational study. SETTING Tertiary academic PICU. PATIENTS All admitted PICU patients. INTERVENTIONS All available data collection forms containing demographic and clinical data of patients admitted to the PICU at Hospital Central de Maputo, Mozambique from January 2013 to December 2013 were analyzed retrospectively. MEASUREMENTS AND MAIN RESULTS The patient median age was 2 years (57% male). The most common primary diagnoses were malaria (22%), sepsis (18%), respiratory tract infections (12%), and trauma (6%). The mortality rate was 25%. Mortality rates were highest among patients with sepsis (59%), encephalopathy (56%), noninfectious CNS pathologies (33%), neoplastic diseases (33%), meningitis/encephalitis (29%), burns (26%), and cardiovascular pathologies (26%). The median length of PICU stay was 2 days. HIV exposure/infection had a nonstatistically significant association with mortality. Patients admitted for burns had the highest median length of PICU stay (4 d). Most trauma admissions were male (75%), and approximately half of all trauma admissions had an associated head injury (55%). CONCLUSIONS Infectious disease and trauma were highly represented in this Mozambican PICU, and overall mortality was high compared with high-income countries. With this knowledge, targeted collaborative projects in Mozambique can now be created and modified. Further research is needed to monitor the potential benefits of such interventions.
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Affiliation(s)
- Maria Punchak
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kaitlin Hall
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir Seni
- Hospital Central de Maputo, Maputo, Mozambique
| | - W. Chris Buck
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Emily Hartford
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert B. Kelly
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Valéria I. Muando
- Hospital Central de Maputo, Maputo, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
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Amimo F, Moon TD, Magit A, Sacarlal J. Impact of Per Capita Income on the Effectiveness of School-Based Health Education Programs to Promote Cervical Cancer Screening Uptake in Southern Mozambique. J Glob Infect Dis 2018; 10:152-158. [PMID: 30166815 PMCID: PMC6100336 DOI: 10.4103/jgid.jgid_165_17] [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] [Indexed: 11/04/2022] Open
Abstract
Context In the face of rising mortality rates from cervical cancer (CC) among women of reproductive age, a nationwide screening program based on visual inspection with acetic acid was introduced in Mozambique in 2009. Objective The objective of the study is to examine the impact of per capita income on the effectiveness of school-based health education programs to promote the utilization of CC screening services. Materials and Methods We conducted a cross-sectional study in 2013 involving 105 women randomly selected from households of different economic backgrounds. Marginal effect estimates derived from a logit model were used to explore the patterns in the effectiveness of school-based health education to promote CC screening uptake according to household per capita income, based on purchasing power parity. Results We found a CC screening uptake of 16.1% (95% confidence interval [CI], 9.7%-24.6%) even though 64.6% (95% CI, 54.2%-74.1%) of women had heard of it. There are important economic differentials in the effectiveness of school-based health education to influence women's decision to receive CC screening. Among women with primary school or less, the probability of accessing CC screening services increases with increasing income (P < 0.05). However, income significantly reduces the effect that school-based health education has on the probability of screening uptake among those women with more than 7 years of educational attainment (P = 0.02). Conclusion These results show that CC screening programs in resource-constrained settings need approaches tailored to different segments of women with respect to education and income to achieve equitable improvement in the levels of screening uptake.
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Affiliation(s)
- Floriano Amimo
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.,Faculty of Medicine, Eduardo Mondlane University, PO Box 257, Maputo, Mozambique
| | - Troy D Moon
- Division of Infectious Diseases, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony Magit
- Human Research Protection Program, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Jahit Sacarlal
- Faculty of Medicine, Eduardo Mondlane University, PO Box 257, Maputo, Mozambique
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Health Expenditure Modelling in Southeast of Iran: A Population-Based Setting Using Quantile Regression Perspective. HEALTH SCOPE 2017. [DOI: 10.5812/jhealthscope.64185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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