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Lathlean TJH, Inacio MC, Westbrook J, Gray L, Braithwaite J, Hibbert P, Comans T, Crotty M, Wesselingh S, Sluggett JK, Ward S, Wabe N, Caughey GE. Quality indicators to monitor the quality and safety of care for older people: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00314. [PMID: 38832459 DOI: 10.11124/jbies-23-00212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE The objective of this review is to identify quality indicators used to monitor the quality and safety of care provided to older people (≥ 65 years old) in 8 care settings: primary care; hospital/acute care; aged care (including residential aged care and home or community care); palliative care; rehabilitation care; care transitions; dementia care; and care in rural areas. INTRODUCTION There is a need for high-quality, holistic, person-centered aged and health care for older people. Older people receive care across multiple care settings, and population-level monitoring of quality and safety of care across settings represents a significant challenge. INCLUSION CRITERIA National and international quality indicators used to monitor and evaluate quality and safety of care at the population level for older individuals in the 8 key care settings will be considered for inclusion. English-language quantitative and mixed method studies published from 2012 will be considered. METHODS Academic (MEDLINE, Embase) and gray (government websites, clinical guidelines, Google) literature searches will be conducted. A standardized data extraction tool will be used to describe the identified quality indicators and associated tools. Quality indicators will be categorized by key domains (ie, pain, function, consumer experience, service delivery), quality indicator type (structure, process, outcome) and the Institute of Medicine's 6 dimensions of care quality (eg, efficiency, effectiveness, appropriateness, accessibility, acceptability/person-centered, safety). The scoping review will be conducted in accordance with the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). REVIEW REGISTRATION Open Science Framework osf.io/8czun.
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Affiliation(s)
- Timothy J H Lathlean
- Registry of Senior Australians (ROSA) South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians (ROSA) South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Len Gray
- Centre for Health Services Research, the University of Queensland, St Lucia, QLD, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Peter Hibbert
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Tracy Comans
- Centre for Health Services Research, the University of Queensland, St Lucia, QLD, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Janet K Sluggett
- Registry of Senior Australians (ROSA) South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Stephanie Ward
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW, Australia
| | - Nasir Wabe
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Gillian E Caughey
- Registry of Senior Australians (ROSA) South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Hussien M. The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study. BMC Health Serv Res 2024; 24:614. [PMID: 38730420 PMCID: PMC11084123 DOI: 10.1186/s12913-024-11091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 05/08/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Patients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users' perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers. METHODS A community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval. RESULTS A typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0-10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091). CONCLUSIONS Service users' perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users' perceptions, with a special emphasis on improving health care providers' communication skills and removing facility-level access barriers.
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Affiliation(s)
- Mohammed Hussien
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Oyugi B, Audi-Poquillon Z, Kendall S, Peckham S. Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study. BMJ Open 2024; 14:e082011. [PMID: 38697765 PMCID: PMC11086406 DOI: 10.1136/bmjopen-2023-082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address this challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya. METHODS We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews with national stakeholders (n=15), in-depth interviews with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (n=9) with mothers who returned for postnatal visits (at 6, 10 and 14 weeks). Quantitative data were analysed descriptively, while qualitative data were analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for maternal and newborns. RESULTS The results showed that the expanded FMP enhanced maternal care access: geographical, financial and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care package of the LMP. The availability and standards of equipment, supplies and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal and emotional abuse and a lack of attention/care. CONCLUSIONS Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the Universal Health Coverage goals through better quality service for every woman.
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Affiliation(s)
- Boniface Oyugi
- Western Heights, The Mint Nairobi, M and E Advisory Group, Nairobi, Kenya
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Zilper Audi-Poquillon
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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Patry J, Bourgault A, Blanchette V. Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach: Exploratory Cross-Sectional Study of Patients' Views on Quality of Care. J Wound Ostomy Continence Nurs 2024; 51:236-241. [PMID: 38820221 DOI: 10.1097/won.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
PURPOSE The purpose of this study was to evaluate patients' perception and quality of diabetic foot ulcer (DFU) care delivered by an interdisciplinary team approach (ITA). DESIGN Exploratory cross-sectional study. SUBJECTS AND SETTING Twenty patients with a healed plantar DFU were recruited from an interdisciplinary Wound Care clinic of a Canadian University affiliated hospital. Their mean age was 64 years (75% were males [n = 15]), 18 (90%) were living with type 2 diabetes, and 45% (n = 9) had osteomyelitis in the previous year of their enrollment in the study. METHODS The validated short form of the Quality From the Patient's Perspective questionnaire was used to evaluate quality of care dimensions (medical-technical competence of the caregivers; physical-technical conditions of the care organization; degree of identity-orientation in the attitudes and actions of the caregivers; and sociocultural atmosphere of the care organization). RESULTS Respondents reported experiencing a high level of quality care with an ITA. All indicators of patient-perceived reality of care delivered were superior or equal related to their subjective importance in all dimensions of quality care (with scores ranging from 3.85 to 4.00 on a 4-Point Likert scale). Patients' satisfaction regarding the ITA was high. CONCLUSIONS Study findings suggest that an ITA model provided high quality of care for treating DFUs for all quality dimensions judged important for patients.
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Affiliation(s)
- Jérôme Patry
- Jérôme Patry, DPM, MD, MSc, Emergency and Family Medicine Department, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Annabel Bourgault, DPM Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, (Québec) Canada G9A 5H7
- Virginie Blanchette, PhD, DPM Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, (Québec) Canada G9A 5H7
| | - Annabel Bourgault
- Jérôme Patry, DPM, MD, MSc, Emergency and Family Medicine Department, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Annabel Bourgault, DPM Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, (Québec) Canada G9A 5H7
- Virginie Blanchette, PhD, DPM Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, (Québec) Canada G9A 5H7
| | - Virginie Blanchette
- Jérôme Patry, DPM, MD, MSc, Emergency and Family Medicine Department, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Annabel Bourgault, DPM Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, (Québec) Canada G9A 5H7
- Virginie Blanchette, PhD, DPM Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, (Québec) Canada G9A 5H7
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Zhang L, Liang H, Luo H, He W, Cai Y, Liu S, Fan Y, Huang W, Zhao Q, Zhong D, Li J, Lv S, Li C, Xie Y, Zhang N, Xu D(R. Quality in screening and measuring blood pressure in China's primary health care: a national cross-sectional study using unannounced standardized patients. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100973. [PMID: 38076324 PMCID: PMC10701131 DOI: 10.1016/j.lanwpc.2023.100973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/15/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024]
Abstract
Background This study aims to evaluate primary care providers' adherence to the standard of measuring blood pressure for people aged 35 or above during their initial visit, as per Chinese guidelines, and to identify factors affecting their practices. Methods We developed 11 standardized patients (SP) cases as tracer conditions to evaluate primary care, and deployed trained SPs for unannounced visits to randomly selected providers in seven provinces of China. The SPs used a checklist based on guidelines to record whether and how blood pressure was measured. Data were analyzed descriptively and regression analysis was performed to examine the association between outcomes and factors such as provider, patient, facility, and clinical case characteristics. Findings The SPs conducted 1201 visits and found that less than one-third of USPs ≥35 had their blood pressure measured. Only 26.9% of migraine and 15.4% of diabetes cases received blood pressure measurements. Additionally, these measurements did not follow the proper guidelines and recommended steps. On average, 55.6% of the steps were followed with few providers considering influencing factors before measurement and only 6.0% of patients received both-arm measurements. The use of wrist sphygmomanometers was associated with poor blood pressure measurement. Interpretation In China, primary care hypertension screening practices fall short of guidelines, with infrequent initiation of blood pressure measurements and inadequate adherence to proper measurement steps. To address this, priority should be placed on adopting, implementing, and upholding guidelines for hypertension screening and measurement. Funding National Natural Science Foundation of China, Swiss Agency for Development and Cooperation, Doctoral Fund Project of Inner Mongolia Medical University, China Postdoctoral Science Foundation.
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Affiliation(s)
- Lanping Zhang
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- The Third Department of Lung Disease, Shenzhen Third People's Hospital, Shenzhen, Guangdong Province 518112, China
| | - Huijuan Liang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Huanyuan Luo
- Acacia Lab for Implementation Science, Institute for Global Health, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Wenjun He
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yiyuan Cai
- Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guizhou Province, China
| | - Siyuan Liu
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Yancun Fan
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Wenxiu Huang
- Erfenzi Township Health Center of Wuchuan County, Inner Mongolia, China
| | - Qing Zhao
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
| | - Dongmei Zhong
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Jiaqi Li
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Sensen Lv
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Chunping Li
- Acacia Lab for Implementation Science, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yunyun Xie
- Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China
| | - Nan Zhang
- School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Dong (Roman) Xu
- Acacia Lab for Implementation Science, School of Health Management and Dermatology Hospital, Southern Medical University, Guangzhou, China
- Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China
- Southern Medical University Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
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Pearson EE, Chakraborty NM, Baum SE, Menzel JL, Dijkerman S, Chowdhury R, Chekol BM, Adojutelegan YA, Bercu C, Powell B, Montagu D, Sprockett A, Gerdts C. Developing and validating an abortion care quality metric for facility and out-of-facility settings: an observational cohort study in Bangladesh, Ethiopia, and Nigeria. EClinicalMedicine 2023; 66:102347. [PMID: 38125934 PMCID: PMC10730338 DOI: 10.1016/j.eclinm.2023.102347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Background Despite progress in assuring provision of safe abortion, substantial disparities remain in quality of abortion care around the world. However, no consistent, valid, reliable method exists to routinely measure quality in abortion care across facility and out-of-facility settings, impeding learning and improvement. To address this need, the Abortion Service Quality Initiative developed the first global standard for measuring quality of abortion care in low-income and middle-income countries. Methods This prospective cohort study was conducted in Bangladesh, Ethiopia, and Nigeria in 2020-2022. Participants included sites and providers offering abortion care, including health facilities, pharmacies, proprietary and patent medicine vendors (PPMVs), and hotlines, and clients aged 15-49 receiving abortion care from a selected site. 111 structure and process indicators were tested, which originated from a review of existing abortion quality indicators and from qualitative research to develop additional client-centred quality indicators. The indicators were tested against 12 clinical and client experience outcomes at the site-level (such as abortion-related deaths) and client-level (such as whether the client would recommend the service to a friend) that were expected to result from the abortion quality indicators. Indicators were selected for the final metric based on predictive validity assessed using Bayesian models to test associations between indicators and outcomes, content validity, and performance. Findings We included 1915 abortion clients recruited from 131 sites offering abortion care across the three countries. Among the 111 indicators tested, 44 were associated with outcomes in Bayesian analyses and an additional 8 were recommended for inclusion by the study's Resource Group for face validity. These 52 indicators were evaluated on content validity, predictive validity, and performance, and 29 validated indicators were included in the final abortion care quality metric. The 29 validated indicators were feasibility tested among 53 clients and 24 providers from 9 facility sites in Ethiopia and 57 clients and 6 PPMVs from 9 PPMV sites in Nigeria. The median time required to complete each survey instrument indicated feasibility: 10 min to complete the client exit survey, 16 min to complete the provider survey, and 11 min to complete the site checklist. Overall, the indicators performed well. However, all providers in the feasibility test failed two indicators of provider knowledge to competently complete the abortion procedure, and these indicators were subsequently revised to improve performance. Interpretation This study provides 29 validated abortion care quality indicators to assess quality in facility, pharmacy, and hotline settings in low-income and middle-income countries. Future research should validate the Abortion Care Quality (ACQ) Tool in additional abortion care settings, such as telemedicine, online medication abortion (MA) sellers, and traditional abortion providers, and in other geographical and legal settings. Funding The David and Lucile Packard Foundation and the Children's Investment Fund Foundation.
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Affiliation(s)
| | | | - Sarah E. Baum
- Ibis Reproductive Health, Oakland, CA, United States
| | | | | | | | | | | | - Chiara Bercu
- Ibis Reproductive Health, Oakland, CA, United States
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Abdelmola A. Antenatal Care Services in Sudan Before and During the 2023 War: A Review Article. Cureus 2023; 15:e51005. [PMID: 38259390 PMCID: PMC10803029 DOI: 10.7759/cureus.51005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
Antenatal care (ANC) is provided by skilled healthcare professionals to pregnant women to ensure the best health conditions for both mother and baby during pregnancy. It includes risk identification, prevention, management of pregnancy-related diseases, health education, and health promotion. Antenatal care has a great effect on vital health indicators such as maternal and neonatal mortality by identifying and treating pregnancy-related complications. Political instability and armed conflict have seriously affected the health system, which has catastrophic implications for pregnant women's health. This review aimed to summarize the literature on ANC in Sudan before and during political instability and war by highlighting its effect on maternal mortality, coverage, care providers, quality of care, accessibility, and utilization. Other aspects of this review are the ANC components and service provision during the war. In addition, the author tried to identify the gaps and point out the future research needs in Sudan. A total of 58 articles about ANC in Sudan have been reviewed through PubMed, Google Scholar, ResearchGate databases, and other search tools. The keywords used were "antenatal care", "coverage", "service providers", "service quality", "accessibility and utilization", "components", and "ANC during the war". All the keywords were followed by "Sudan" to confine the search. According to the reviewed data, ANC services in Sudan, even during normal political situations, were not sufficient and of poor quality in most of the reviewed regions. The political instability and armed conflicts worsened the situation, and it became catastrophic. To improve the accessibility and quality of ANC services, we will need the collaboration of all stakeholders to address the health needs of vulnerable groups, people in remote rural areas, and nomadic communities towards providing the required health services in general and ANC in particular. On the other hand, an important aspect of this development is the availability of skilled healthcare providers and the adoption, revision, and updating of working procedure guidelines to match the needs of the local communities. The main shareholders are the local communities; they must be empowered and involved by raising their awareness. Then, effective, punctual, and applicable contingency plans should be ready for any unfortunate crises.
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Hagey JM, Kirya J, Kaggwa J, Headley J, Egger JR, Baumgartner JN. Timeliness of Delivery Care and Maternal and Neonatal Health Outcomes in Private Facilities in Masaka Area, Uganda: A Quasi-Experimental Study. Matern Child Health J 2023; 27:2048-2057. [PMID: 37440101 DOI: 10.1007/s10995-023-03754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES While access to basic emergency obstetric and newborn care is necessary to reduce maternal and neonatal morbidity in low- and middle-income countries, data on the timeliness and quality of care at lower-level facilities is limited. This study examines timeliness of labor and delivery interventions and maternal and neonatal health status following deliveries in Uganda. METHODS Women were recruited from 6 rural, private facilities in the greater Masaka area, Uganda on admission to the labor ward. Research assistants directly observed timeliness and quality of care from admission through discharge. Research assistants also abstracted medical chart information. All 6 facilities received training from LifeNet International on quality-of-care interventions for maternal and newborn health. RESULTS 321 participants were directly observed during delivery, and 304 participants were followed at 28 days postpartum. Labor and delivery processes were overall timely and reflect international guidance on labor interventions. Maternal and neonatal health was good at discharge (90.6% and 88.8%) and 28 days postpartum (93.1% and 87.5%). However, there was no association between health at discharge and at 28 days for mothers or neonates (p = 0.67, p = 1.0, respectively). Demographic characteristics associated with maternal and neonatal health on discharge were different than those associated with maternal and neonatal health at 28 days. CONCLUSIONS FOR PRACTICE Evidence on timeliness and quality of care can help inform strategies to further decrease maternal and neonatal morbidity. Additional focus is needed to retain patients in care to identify those developing poor health after delivery.
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Affiliation(s)
- Jill M Hagey
- Department of Obstetrics and Gynecology, University of North Carolina, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
| | - Julius Kirya
- LifeNet International, Princes Anne Drive, Plot 56, Bugolobi, Kampala, Uganda
| | - James Kaggwa
- LifeNet International, Princes Anne Drive, Plot 56, Bugolobi, Kampala, Uganda
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
| | - Joseph R Egger
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
| | - Joy Noel Baumgartner
- School of Social Work, University of North Carolina, 325 Pittsboro Street, Chapel Hill, NC, 27516, USA
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Reyes-Morales H, Flores-Hernández S, Díaz-Portillo SP, Serván-Mori E, Escalante-Castañón A, Hegewisch-Taylor J, Dreser-Mansilla A. Design and validation of indicators for the comprehensive measurement of quality of care for type 2 diabetes and acute respiratory infections in ambulatory health services. Int J Qual Health Care 2023; 35:mzad087. [PMID: 37930778 DOI: 10.1093/intqhc/mzad087] [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: 05/18/2023] [Revised: 09/12/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Developing ambulatory health services (AHS) of optimal quality is a pending issue for many health systems at a global level, especially in middle- and low-income countries. An effective health response requires indicators to measure the quality of care that are context-specific and feasible for routine monitoring. This paper aimed to design and validate indicators for assessing the technical and interpersonal quality dimensions for type 2 diabetes (T2D) and acute respiratory infections (ARI) care in AHS. The study was conducted in two stages. First, technical and user-centered-based indicators of quality of care for T2D and ARI care were designed following international recommendations, mainly from the American Diabetes Association standards and the National Institute for Health and Care Excellence guidelines. We then assessed the validity, reliability, relevance, and feasibility of the proposed indicators implementing the modified Delphi technique. A panel of 17 medical experts from five countries scored the indicators using two electronic questionnaires, one for each reason for consultation selected, sent by email in two sequential rounds of rating. We defined the levels of consensus according to the overall median for each performance category, which was established as the threshold. Selected indicators included those with scores equal to or higher than the threshold. We designed 36 T2D indicators, of which 16 were validated for measuring the detection of risks and complications, glycemic control, pharmacological treatment, and patient-centered care. Out of the 22 indicators designed for ARI, we validated 10 for diagnosis, appropriate prescription of antimicrobials, and patient-centered care. The validated indicators showed consistency for the dimensions analyzed. Hence, they proved to be a potentially reliable and valuable tool for monitoring the performance of the various T2D and ARI care processes in AHS. Further research will be needed to verify the applicability of the validated indicators in routine clinical practice.
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Affiliation(s)
- Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Sergio Flores-Hernández
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Sandra Patricia Díaz-Portillo
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - André Escalante-Castañón
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Jennifer Hegewisch-Taylor
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
| | - Anahí Dreser-Mansilla
- Center for Health Systems Research, National Institute of Public Health, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos, CP 062100, Mexico
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Gebremedhin AF, Dawson A, Hayen A. Effective coverage of newborn postnatal care in Ethiopia: Measuring inequality and spatial distribution of quality-adjusted coverage. PLoS One 2023; 18:e0293520. [PMID: 37883459 PMCID: PMC10602323 DOI: 10.1371/journal.pone.0293520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Neonatal health is a significant global public health concern, and the first two days of life are crucial for newborn survival. Most studies on newborn postnatal care have focused on crude coverage measures, which limit the evaluation of care quality. However, evidence suggests a shift towards emphasising effective coverage, which incorporates the quality of care when measuring intervention coverage. This research aimed to assess the effective coverage of newborn postnatal care in Ethiopia while also examining its inequalities and spatial distribution. The study used secondary data from the 2016 Ethiopian Demographic and Health Survey, which was a cross-sectional community-based study. A total weighted sample of 4169 women was used for analyses. We calculated crude coverage, which is the proportion who received a postnatal check within 48 hours of birth and quality-adjusted coverage (effective coverage), which is the proportion who received a postnatal check within 48 hours of birth and reported receipt of 6 or more contents of care provided by health care providers. Concentration index and concentration curves were used to estimate the socioeconomic-related inequalities in quality-adjusted newborn postnatal care. The spatial statistic was analysed by using Arc-GIS. The crude coverage of newborn postnatal care was found to be 13.2%, while the effective coverage was 9%. High-quality postnatal care was disproportionately concentrated among the rich. A spatial variation was found in quality-adjusted coverage of newborn postnatal care across regions. The findings suggest that there is a significant gap in the coverage and quality of postnatal care for newborns across regions in Ethiopia. The low rates of coverage and effective coverage, combined with the concentration of high-quality care among the rich and the spatial variation across regions, highlight the need for targeted interventions and policies to address the inequalities in access to high-quality postnatal care for newborns.
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Affiliation(s)
- Aster Ferede Gebremedhin
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
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Sheffel A, Carter E, Zeger S, Munos MK. Association between antenatal care facility readiness and provision of care at the client level and facility level in five low- and middle-income countries. BMC Health Serv Res 2023; 23:1109. [PMID: 37848885 PMCID: PMC10583346 DOI: 10.1186/s12913-023-10106-5] [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: 01/17/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Despite growing interest in monitoring improvements in quality of care, data on service quality in low-income and middle-income countries (LMICs) is limited. While health systems researchers have hypothesized the relationship between facility readiness and provision of care, there have been few attempts to quantify this relationship in LMICs. This study assesses the association between facility readiness and provision of care for antenatal care at the client level and facility level. METHODS To assess the association between provision of care and various facility readiness indices for antenatal care, we used multilevel, multivariable random-effects linear regression models. We tested an inflection point on readiness scores by fitting linear spline models. To compare the coefficients between models, we used a bootstrapping approach and calculated the mean difference between all pairwise comparisons. Analyses were conducted at client and facility levels. RESULTS Our results showed a small, but significant association between facility readiness and provision of care across countries and most index constructions. The association was most evident in the client-level analyses that had a larger sample size and were adjusted for factors at the facility, health worker, and individual levels. In addition, spline models at a facility readiness score of 50 better fit the data, indicating a plausible threshold effect. CONCLUSIONS The results of this study suggest that facility readiness is not a proxy for provision of care, but that there is an important association between facility readiness and provision of care. Data on facility readiness is necessary for understanding the foundations of health systems particularly in countries with the lowest levels of service quality. However, a comprehensive view of quality of care should include both facility readiness and provision of care measures.
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Affiliation(s)
- Ashley Sheffel
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205-2103 USA
| | - Emily Carter
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205-2103 USA
| | - Scott Zeger
- Departments of Biostatistics and International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205-2103 USA
| | - Melinda K. Munos
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205-2103 USA
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12
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Schuler C, Agbozo F, Ntow GE, Waldboth V. Health-system drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana. BMC Pediatr 2023; 23:501. [PMID: 37798632 PMCID: PMC10552361 DOI: 10.1186/s12887-023-04330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care. METHODS A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined. RESULTS Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers. CONCLUSION A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.
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Affiliation(s)
- Christina Schuler
- School of Health Sciences, Institute of Nursing, Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
| | - Faith Agbozo
- FN Binka School of Public Health, Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | | | - Veronika Waldboth
- School of Health Sciences, Institute of Nursing, Zurich University of Applied Sciences (ZHAW), Winterthur, Switzerland
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Baum SE, Jacobson L, Ramirez AM, Katz A, Grosso B, Bercu C, Pearson E, Gebrehanna E, Chakraborty NM, Dirisu O, Chowdhury R, Zurbriggen R, Filippa S, Tabassum T, Gerdts C. Quality of care from the perspective of people obtaining abortion: a qualitative study in four countries. BMJ Open 2023; 13:e067513. [PMID: 37730400 PMCID: PMC10510917 DOI: 10.1136/bmjopen-2022-067513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/23/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion. METHODS We conducted interviews with people seeking abortion aged 15-41 who obtained care in Argentina, Bangladesh, Ethiopia or Nigeria. Participants were recruited from hospitals, clinics, pharmacies, call centres and accompaniment models. We conducted thematic analysis and quantified key domains of quality identified by the participants. RESULTS We identified six themes that contributed to high-quality abortion care from the clients' perspective, with particular focus on interpersonal dynamics. These themes emerged as participants described their abortion experience, reflected on their interactions with providers and defined good and bad care. The six themes included (1) kindness and respect, (2) information exchange, (3) emotional support, (4) attentive care throughout the process, (5) privacy and confidentiality and (6) prepared for and able to cope with pain. CONCLUSIONS People seeking abortion across multiple country contexts and among various care models have confirmed the importance of interpersonal care in quality. These findings provide guidance on six priority areas which could be used to sharpen the definition of abortion quality, improve measurement, and design interventions to improve quality.
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Affiliation(s)
- Sarah E Baum
- Ibis Reproductive Health, Oakland, California, USA
| | - Laura Jacobson
- Ibis Reproductive Health, Oakland, California, USA
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | | | - Anna Katz
- Ibis Reproductive Health, Oakland, California, USA
- University of California Berkeley School of Law, Berkeley, California, USA
| | - Belen Grosso
- Colectiva Feminista La Revuelta, Neuquen, Argentina
| | - Chiara Bercu
- Ibis Reproductive Health, Oakland, California, USA
| | | | - Ewenat Gebrehanna
- School of Public Health, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Adetunji O, Bishai D, Pham CV, Taylor J, Thi NT, Khan Z, Bachani AM. Patient-centered care and geriatric knowledge translation among healthcare providers in Vietnam: translation and validation of the patient-centered care measure. BMC Health Serv Res 2023; 23:379. [PMID: 37076905 PMCID: PMC10116792 DOI: 10.1186/s12913-023-09311-z] [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: 03/20/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND People are living longer, and the majority of aging people reside in low- and middle-income countries (LMICs). However, inappropriate healthcare contributes to health disparities between populations of aging people and leads to care dependency and social isolation. Tools to assess and evaluate the effectiveness of quality improvement interventions for geriatric care in LMICs are limited. The aim of this study was to provide a validated and culturally relevant instrument to assess patient-centered care in Vietnam, where the population of aging people is growing rapidly. METHODS The Patient-Centered Care (PCC) measure was translated from English to Vietnamese using forward-backward method. The PCC measure grouped activities into sub-domains of holistic, collaborative, and responsive care. A bilingual expert panel rated the cross-cultural relevance and translation equivalence of the instrument. We calculated Content Validity Indexing (CVI) scores at both the item (I-CVI) and scale (S-CVI/Ave) levels to evaluate the relevance of the Vietnamese PCC (VPCC) measure to geriatric care in the Vietnamese context. We piloted the translated instrument VPCC measure with 112 healthcare providers in Hanoi, Vietnam. Multiple logistic regression models were specified to test the a priori null hypothesis that geriatric knowledge is not different among healthcare providers with perception of high implementation compared with low implementation of PCC measures. RESULTS On the item level, all 20 questions had excellent validity ratings. The VPCC had excellent content validity (S-CVI/Ave of 0.96) and translation equivalence (TS- CVI/Ave of 0.94). In the pilot study, the highest-rated PCC elements were the holistic provision of information and collaborative care, while the lowest-rated elements were the holistic attendance to patients' needs and responsive care. Attention to the psychosocial needs of aging people and poor coordination of care within and beyond the health system were the lowest-rated PCC activities. After controlling for healthcare provider characteristics, the odds of the perception of high implementation of collaborative care were increased by 21% for each increase in geriatric knowledge score. We fail to reject the null hypotheses for holistic care, responsive care and PCC. CONCLUSION The VPCC is a validated instrument that may be utilized to systemically evaluate the practice of patient-centered geriatric care in Vietnam.
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Affiliation(s)
- Oluwarantimi Adetunji
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - David Bishai
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cuong Viet Pham
- Center for Injury Policy and Prevention Research (CIPPR), Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Ngan Tran Thi
- Center for Injury Policy and Prevention Research (CIPPR), Hanoi University of Public Health, Hanoi, Vietnam
| | - Zainab Khan
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rasheed MA, Hussain A, Hashwani A, Kedzierski JT, Hasan BS. Implementation evaluation of a leadership development intervention for improved family experience in a private paediatric care hospital, Pakistan. BMC Health Serv Res 2022; 22:944. [PMID: 35870912 PMCID: PMC9308933 DOI: 10.1186/s12913-022-08342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.
Methods
A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the employees using Facebook group and subsequently inviting them to lead quality improvement (QI) projects; and iv) demonstrating integrity by streamlining actions taken based on routine patient experience data. Implementation outcomes included acceptability, adoption, fidelity across degree & quality of execution and facilitators & barriers to the implementation. Data analyzed included project documentation records and posts on the Facebook group.
Analysis indicated acceptability and adoption of the intervention by the employees as178 applications for different QI projects were received. Leadership sessions were delivered to 455 (75%) of the employees and social media communication was effective to engage employees. However, mentorship package was not rolled out nor the streamlined processes for action on patient experience data achieved the desired fidelity. Only 6 QI projects were sustained for at least a year out of the 18 approved by the working group. Facilitators included leadership involvement, real-time recognition and feedback and value-creation through participation by national and international celebrities. Challenges identified were the short length of the intervention and incentives not being institutionalized.
The authors conclude that leadership development through short training sessions and on-going communications facilitated by social media were the key processes that helped achieve the outcomes. However, a long-term strategy is needed for individual managerial behaviours to sustain.
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Haemmerli M, Asante A, Susilo D, Satrya A, Fattah RA, Cheng Q, Kosen S, Novitasari D, Puteri GC, Adawiyah E, Hayen A, Gilson L, Mills A, Tangcharoensathien V, Jan S, Thabrany H, Wiseman V. Using measures of quality of care to assess equity in health care funding for primary care: analysis of Indonesian household data. BMC Health Serv Res 2022; 22:1349. [PMID: 36376946 PMCID: PMC9664775 DOI: 10.1186/s12913-022-08739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many countries implementing pro-poor reforms to expand subsidized health care, especially for the poor, recognize that high-quality healthcare, and not just access alone, is necessary to meet the Sustainable Development Goals. As the poor are more likely to use low quality health services, measures to improve access to health care need to emphasise quality as the cornerstone to achieving equity goals. Current methods to evaluate health systems financing equity fail to take into account measures of quality. This paper aims to provide a worked example of how to adapt a popular quantitative approach, Benefit Incidence Analysis (BIA), to incorporate a quality weighting into the computation of public subsidies for health care. METHODS We used a dataset consisting of a sample of households surveyed in 10 provinces of Indonesia in early-2018. In parallel, a survey of public health facilities was conducted in the same geographical areas, and information about health facility infrastructure and basic equipment was collected. In each facility, an index of service readiness was computed as a measure of quality. Individuals who reported visiting a primary health care facility in the month before the interview were matched to their chosen facility. Standard BIA and an extended BIA that adjusts for service quality were conducted. RESULTS Quality scores were relatively high across all facilities, with an average of 82%. Scores for basic equipment were highest, with an average score of 99% compared to essential medicines with an average score of 60%. Our findings from the quality-weighted BIA show that the distribution of subsidies for public primary health care facilities became less 'pro-poor' while private clinics became more 'pro-rich' after accounting for quality of care. Overall the distribution of subsidies became significantly pro-rich (CI = 0.037). CONCLUSIONS Routine collection of quality indicators that can be linked to individuals is needed to enable a comprehensive understanding of individuals' pathways of care. From a policy perspective, accounting for quality of care in health financing assessment is crucial in a context where quality of care is a nationwide issue. In such a context, any health financing performance assessment is likely to be biased if quality is not accounted for.
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Affiliation(s)
- Manon Haemmerli
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Dwidjo Susilo
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Aryana Satrya
- Department of Management, Faculty of Economics, University of Indonesia, Depok, Indonesia
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Rifqi Abdul Fattah
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Danty Novitasari
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Gemala Chairunnisa Puteri
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
- Centre for Health Economics and Policy Studies, University of Indonesia, Jakarta, Indonesia
| | - Eviati Adawiyah
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Health Policy and Systems Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Anne Mills
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Kirby Institute, University of New South Wales, Sydney, Australia
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Ayawine A, Atinga RA. User and community coping responses to service delivery gaps in emergency obstetric care provision in a rural community in Ghana. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4513-e4521. [PMID: 35611655 DOI: 10.1111/hsc.13855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/04/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
The study sought to explore user and community responses to service delivery gaps in emergency obstetric care provision in rural Ghana. A qualitative design was employed to draw evidence from observations, interviews and focus group discussion among healthcare providers, clients and community members. Data processing and analysis followed a thematic approach. Findings reveal community interference in obstetric care delivery processes, reliance on unskilled providers, recourse to local oxytocin use, non-compliance to prescribed treatment and mistrust in healthcare providers as user and community coping mechanisms to perceived poor quality obstetric care. These behaviours have serious consequences on the life chances of pregnant and parturient women. The need to adapt to a more responsive and affordable maternal healthcare delivery system is essential for uptake of services in rural areas. Also, standardised guidelines to regulate health worker behaviour is critical to instil trust in the healthcare system.
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Affiliation(s)
- Alice Ayawine
- Faculty of Health and Allied Sciences, Catholic University College, Fiapre-Sunyani, Ghana
| | - Roger A Atinga
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
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Hussien M, Azage M, Bayou NB. Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a community-based, cross-sectional study. BMJ Open 2022; 12:e063098. [PMID: 36253038 PMCID: PMC9577901 DOI: 10.1136/bmjopen-2022-063098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To examine how clients perceived the quality of healthcare they received and identify associated factors both at the individual and facility levels. DESIGN A community-based, cross-sectional study. SETTING Two rural districts of northeast Ethiopia, Tehulederie and Kallu. PARTICIPANTS 1081 rural households who had ever been enrolled in community-based health insurance and visited a health centre at least once in the previous 12 months. Furthermore, 194 healthcare providers participated in the study to provide cluster-level data. OUTCOME MEASURES The outcome variable of interest was the perceived quality of care, which was measured using a 17-item scale. Respondents were asked to rate the degree to which they agreed on 5-point response items relating to their experiences with healthcare in the outpatient departments of nearby health centres. A multilevel linear regression analysis was used to identify predictors of perceived quality of care. RESULTS The mean perceived quality of care was 70.28 (SD=8.39). Five dimensions of perceived quality of care were extracted from the factor analysis, with the patient-provider communication dimension having the highest mean score (M=77.84, SD=10.12), and information provision having the lowest (M=64.67, SD=13.87). Wealth status, current insurance status, perceived health status, presence of chronic illness and time to a recent health centre visit were individual-level variables that showed a significant association with the outcome variable. At the cluster level, the work experience of healthcare providers, patient volume and an interaction term between patient volume and staff job satisfaction also showed a significant association. CONCLUSIONS Much work remains to improve the quality of care, especially on information provision and access to care quality dimensions. A range of individual-level and cluster-level characteristics influence the perceived quality of care. For a better quality of care, it is vital to optimise the patient-provider ratio and enhance staff job satisfaction.
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Affiliation(s)
- Mohammed Hussien
- Health Systems Management and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Muluken Azage
- Environmental Health, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
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Patient satisfaction and its health provider-related determinants in primary health facilities in rural China. BMC Health Serv Res 2022; 22:946. [PMID: 35883080 PMCID: PMC9316702 DOI: 10.1186/s12913-022-08349-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/18/2022] [Indexed: 12/17/2022] Open
Abstract
Background Patient satisfaction is an important outcome measure of health service and is one of the main reasons for the gradual deterioration of doctor–patient relationships in China. This study used the standardized patient (SP) method to explore patient satisfaction and its health provider-related determinants among primary health facilities in rural China. Methods The dataset comprised 1138 clinic cases in 728 rural primary health facilities in 31 counties, spread across four provinces. Information regarding the consultation interaction between the unannounced SPs and primary physicians was recorded. Patient satisfaction was gathered from the feedback of SPs after the visit. Results The overall average score of SP satisfaction with rural primary health facilities was only 13.65 (SD = 3.22) out of 20. The SP scores were found to be consistent with those of real patients. After controlling variances in patient population via the SP method, the regression analysis demonstrated that health provider-related factors, such as physician-level characteristics, consultation process, affordability, and convenience, have a significant correlation with patient satisfaction among primary physicians. Among factors relating to physician-level characteristics, affordability, convenience and the consultation process of the visit, the quality of the consultation process (e.g., consultation time, proactively providing necessary instructions and other crucial information) were found to be the prominent determinants. Conclusions This study revealed the need to improve patient satisfaction in primary health facilities in rural China. To solve this issue, we recommend that policies to increase medical service quality be implemented in rural primary healthcare systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08349-9.
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Chakraborty NM, Pearson E, Gerdts C, Baum SE, Powell B, Montagu D. Toward a Standard Measure of Abortion Service Quality-A Stakeholder First Approach. Front Glob Womens Health 2022; 3:903914. [PMID: 35859730 PMCID: PMC9289106 DOI: 10.3389/fgwh.2022.903914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Measurement of the quality of abortion services is essential to service improvement. Currently, its measurement is not standardized, and some of the tools which exist are very long, and may deter use. To address this issue, this study describes a process used to create a new, more concise measure of abortion care quality, which was done with the end users in mind. Using a collaborative approach and engaging numerous stakeholders, we developed an approach to defining and selecting a set of indicators, to be tested against abortion outcomes of interest. Indicators were solicited from 12 abortion service provision entities, cataloged, and grouped within a theoretical framework. A resource group of over 40 participants was engaged through surveys, webinars, and one in-person meeting to provide input in prioritizing the indicators. We began with a list of over 1,000 measures, and engaged stakeholders to reduce the list to 72 indicators for testing. These indicators were supplemented with an additional 39 indicators drawn from qualitative research with clients, in order to ensure the client perspective is well represented. The selected indicators can be applied in pharmacies, facilities, or with hotlines, and for clients of surgical or medical abortion services in all countries. To ensure that the final suggested measures are most impactful for service providers, indicators will be tested against outcomes from 2,000 abortion clients in three countries. Those indicators which are well correlated with outcomes will be prioritized.
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Affiliation(s)
- Nirali M. Chakraborty
- Metrics for Management, Baltimore, MD, United States
- *Correspondence: Nirali M. Chakraborty
| | | | | | - Sarah E. Baum
- Ibis Reproductive Health, Oakland, CA, United States
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Hailu GA, Weret ZS, Adasho ZA, Eshete BM. Quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia, a cross-sectional study. PLoS One 2022; 17:e0269710. [PMID: 35687552 PMCID: PMC9187099 DOI: 10.1371/journal.pone.0269710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Potentially, the risk of morbidity and mortality during pregnancy and child birth can be prevented through comprehensive, quality antenatal care services. The high maternal mortality rate in developing countries, including Ethiopia, is related to poor quality of antenatal care services and is still a major public health problem. The aim of this study is to assess the quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted using a quantitative method from December 10 to January 30, 2020. A total of 616 study participants were selected by a systematic random sampling technique. Data was collected using pre-tested structured interview administered questionnaires. The data was entered into Epi-info version 7.2.1 and analyzed by SPSS version 24. Bivariate and multivariable logistic regressions were performed to identify the presence and strength of the association between the outcome and predictor variables. Results Overall, 33% of pregnant women received good-quality antenatal care. Satisfaction with antenatal care service, antenatal care initiation time, maintaining confidentiality, and waiting time become significant predictors of the quality of antenatal care. As a result, a lack of confidential care (AOR = 0.37; 95% CI, (0.40, 0.88)), a long waiting time (AOR = 0.6, 95% CI, (0.48, 0.88)), and no satisfaction with ANC services (AOR = 0.26; 95% CI, (0.109, 0.36)) were identified as factors impeding the quality of antenatal care. While starting ANC later than four months of pregnancy was found to be a positive predictor of the quality of antenatal care (AOR = 1.9, 95% CI: (1.21, 3.12)). Conclusion Only one-third of pregnant mothers received good quality antenatal care. Lack of confidential care, long waiting time and no satisfaction with antenatal care services were factors hindering the quality of antenatal care. While initiation of antenatal care after four months of pregnancy was a positive predictor of the quality of antenatal care.
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Affiliation(s)
- Genet Atlabachew Hailu
- Department of Midwifery, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Zewdu Shewngizaw Weret
- Department of Psychiatry, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Zerihun Adraro Adasho
- Department of Neonatal Nursing, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
- * E-mail:
| | - Belete Melesegn Eshete
- Department of Psychiatry, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
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22
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Kinney M, Bergh AM, Rhoda N, Pattinson R, George A. Exploring the sustainability of perinatal audit in four district hospitals in the Western Cape, South Africa: a multiple case study approach. BMJ Glob Health 2022; 7:bmjgh-2022-009242. [PMID: 35738843 PMCID: PMC9226866 DOI: 10.1136/bmjgh-2022-009242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/29/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Maternal and perinatal death surveillance and response (MPDSR) is an intervention process that uses a continuous cycle of identification, notification and review of deaths to determine avoidable causes followed by actions to improve health services and prevent future deaths. This study set out to understand how and why a perinatal audit programme, a form of MPDSR, has sustained practice in South Africa from the perspectives of those engaged in implementation. Methods A multiple case study design was carried out in four rural subdistricts of the Western Cape with over 10 years of implementing the programme. Data were collected from October 2019 to March 2020 through non-participant observation of seven meetings and key informant interviews with 41 purposively selected health providers and managers. Thematic analysis was conducted inductively and deductively adapting the extended normalisation process theory to examine the capability, contribution, potential and capacity of the users to implement MPDSR. Results The perinatal audit programme has sustained practice due to integration of activities into routine tasks (capability), clear value-add (contribution), individual and collective commitment (potential), and an enabling environment to implement (capacity). The complex interplay of actors, their relationships and context revealed the underlying individual-level and organisational-level factors that support sustainability, such as trust, credibility, facilitation and hierarchies. Local adaption and the broad social and structural resources were required for sustainability. Conclusion This study applied theory to explore factors that promote sustained practice of perinatal audit from the perspectives of the users. Efforts to promote and sustain MPDSR will benefit from overall good health governance, specific skill development, embedded activities, and valuing social processes related to implementation. More research using health policy and system approaches, including use of implementation theory, will further advance our understanding on how to support sustained MPDSR practice in other settings.
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Affiliation(s)
- Mary Kinney
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Anne-Marie Bergh
- Maternal and Infant Health Care Strategies Research Unit, Medical Research Council of South Africa, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Natasha Rhoda
- Department of Neonatology, Mowbray Maternity Hospital, Cape Town, South Africa.,Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robert Pattinson
- Maternal and Infant Health Care Strategies Research Unit, Medical Research Council of South Africa, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Asha George
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
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23
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Halmin M, Abou Mourad G, Ghneim A, Rady A, Baker T, Von Schreeb J. Development of a quality assurance tool for intensive care units in Lebanon during the COVID-19 pandemic. Int J Qual Health Care 2022; 34:6580928. [PMID: 35512363 PMCID: PMC9129220 DOI: 10.1093/intqhc/mzac034] [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: 10/06/2021] [Revised: 01/05/2022] [Accepted: 05/04/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, low- and middle-income countries have rapidly scaled up intensive care unit (ICU) capacities. Doing this without monitoring the quality of care poses risks to patient safety and may negatively affect patient outcomes. While monitoring the quality of care is routine in high-income countries, it is not systematically implemented in most low- and middle-income countries. In this resource-scarce context, there is a paucity of feasibly implementable tools to monitor the quality of ICU care. Lebanon is an upper middle-income country that, during the autumn and winter of 2020-1, has had increasing demands for ICU beds for COVID-19. The World Health Organization has supported the Ministry of Public Health to increase ICU beds at public hospitals by 300%, but no readily available tool to monitor the quality of ICU care was available. OBJECTIVE The objective with this study was to describe the process of rapidly developing and implementing a tool to monitor the quality of ICU care at public hospitals in Lebanon. METHODS In the midst of the escalating pandemic, we applied a systematic approach to develop a realistically implementable quality assurance tool. We conducted a literature review, held expert meetings and did a pilot study to select among identified quality indicators for ICU care that were feasible to collect during a 1-hour ICU visit. In addition, a limited set of the identified indicators that were quantifiable were specifically selected for a scoring protocol to allow comparison over time as well as between ICUs. RESULTS A total of 44 quality indicators, which, using different methods, could be collected by an external person, were selected for the quality of care tool. Out of these, 33 were included for scoring. When tested, the scores showed a large difference between hospitals with low versus high resources, indicating considerable variation in the quality of care. CONCLUSIONS The proposed tool is a promising way to systematically assess and monitor the quality of care in ICUs in the absence of more advanced and resource-demanding systems. It is currently in use in Lebanon. The proposed tool may help identifying quality gaps to be targeted and can monitor progress. More studies to validate the tool are needed.
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Affiliation(s)
- Märit Halmin
- Address reprint requests to: Märit Halmin, Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden. Tel: +46737108550; E-mail:
| | - Ghada Abou Mourad
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Adam Ghneim
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Alissar Rady
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Johan Von Schreeb
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
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24
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Valente EP, Covi B, Mariani I, Morano S, Otalea M, Nanu I, Nanu MI, Elden H, Linden K, Zaigham M, Vik ES, Kongslien S, Nedberg I, Costa R, Rodrigues C, Dias H, Drandić D, Kurbanović M, Sacks E, Muzigaba M, Lincetto O, Lazzerini M. WHO Standards-based questionnaire to measure health workers' perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries. BMJ Open 2022; 12:e056753. [PMID: 35396296 PMCID: PMC8995570 DOI: 10.1136/bmjopen-2021-056753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Develop and validate a WHO Standards-based online questionnaire to measure the quality of maternal and newborn care (QMNC) around the time of childbirth from the health workers' perspective. DESIGN Mixed-methods study. SETTING Six countries of the WHO European Region. PARTICIPANTS AND METHODS The questionnaire is based on lessons learnt in previous studies, and was developed in three sequential phases: (1) WHO Quality Measures were prioritised and content, construct and face validity were assessed through a Delphi involving a multidisciplinary board of experts from 11 countries of the WHO European Region; (2) translation/back translation of the English version was conducted following The Professional Society for Health Economics and Outcomes Research guidelines; (3) internal consistency, intrarater reliability and acceptability were assessed among 600 health workers in six countries. RESULTS The questionnaire included 40 items based on WHO Standards Quality Measures, equally divided into four domains: provision of care, experience of care, availability of human and physical resources, organisational changes due to COVID-19; and its organised in six sections. It was translated/back translated in 12 languages: Bosnian, Croatian, French, German, Italian, Norwegian, Portuguese, Romanian, Russian, Slovenian, Spanish and Swedish. The Cronbach's alpha values were ≥0.70 for each questionnaire section where questions were hypothesised to be interrelated, indicating good internal consistence. Cohen K or Gwet's AC1 values were ≥0.60, suggesting good intrarater reliability, except for one question. Acceptability was good with only 1.70% of health workers requesting minimal changes in question wording. CONCLUSIONS Findings suggest that the questionnaire has good content, construct, face validity, internal consistency, intrarater reliability and acceptability in six countries of the WHO European Region. Future studies may further explore the questionnaire's use in other countries, and how to translate evidence generated by this tool into policies to improve the QMNC. TRAIL REGISTRATION NUMBER NCT04847336.
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Affiliation(s)
- Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Sandra Morano
- Medical School and Midwifery School, Genoa University, Genoa, Italy
| | - Marina Otalea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- SAMAS Association, Bucharest, Romania
| | - Ioana Nanu
- National Institute for Mother and Child Health "Alessandrescu - Rusescu", Bucharest, Romania
| | - Micaela Iuliana Nanu
- National Institute for Mother and Child Health "Alessandrescu - Rusescu", Bucharest, Romania
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mehreen Zaigham
- Department of Obstetrics and Gynecology - Institution of Clinical Sciences Lund, Lund University, Lund and Skåne University Hospital, Malmö, Sweden
| | - Eline Skirnisdottir Vik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sigrun Kongslien
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ingvild Nedberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Raquel Costa
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Human-Environment Interaction Lab, Universidade Lusófona, Porto, Portugal
| | - Carina Rodrigues
- EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Heloísa Dias
- Regional Health Administration of the Algarve, IP (ARS - Algarve), Albufeira, Portugal
| | | | | | - Emma Sacks
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Moise Muzigaba
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ornella Lincetto
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
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Kovacs R, Lagarde M. Does high workload reduce the quality of healthcare? Evidence from rural Senegal. JOURNAL OF HEALTH ECONOMICS 2022; 82:102600. [PMID: 35196633 PMCID: PMC9023795 DOI: 10.1016/j.jhealeco.2022.102600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 02/05/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
There is a widely held perception that staff shortages in low and middle-income countries (LMICs) lead to excessive workloads, which in turn worsen the quality of healthcare. Yet there is little evidence supporting these claims. We use data from standardised patient visits in Senegal and determine the effect of workload on the quality of primary care by exploiting quasi-random variation in workload. We find that despite a lack of staff, average levels of workload are low. Even at times when workload is high, there is no evidence that provider effort or quality of care are significantly reduced. Our data indicate that providers operate below their production possibility frontier and have sufficient capacity to attend more patients without compromising quality. This contradicts the prevailing discourse that staff shortages are a key reason for poor quality primary care in LMICs and suggests that the origins likely lie elsewhere.
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Affiliation(s)
- Roxanne Kovacs
- Department of Economics and Centre for Health Governance, University of Gothenburg, Vasagatan 1, Gothenburg, Sweden.
| | - Mylene Lagarde
- London School of Economics and Political Science, Department of Health Policy, Houghton Street, London, UK
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26
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Hussien M, Azage M, Bayou NB. Continued adherence to community-based health insurance scheme in two districts of northeast Ethiopia: application of accelerated failure time shared frailty models. Int J Equity Health 2022; 21:16. [PMID: 35123498 PMCID: PMC8817608 DOI: 10.1186/s12939-022-01620-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background The sustainability of a voluntary community-based health insurance scheme depends to a greater extent on its ability to retain members. In low- and middle-income countries, high rate of member dropout has been a great concern for such schemes. Although several studies have investigated the factors influencing dropout decisions, none of these looked into how long and why members adhere to the scheme. The purpose of this study was to determine the factors affecting time to drop out while accounting for the influence of cluster-level variables. Methods A community-based cross-sectional study was conducted among 1232 rural households who have ever been enrolled in two community-based health insurance schemes. Data were collected using an interviewer-administered questionnaire via a mobile data collection platform. The Kaplan–Meier estimates were used to compare the time to drop out among subgroups. To identify predictors of time to drop out, a multivariable analysis was done using the accelerated failure time shared frailty models. The degree of association was assessed using the acceleration factor (δ) and statistical significance was determined at 95% confidence interval. Results Results of the multivariable analysis revealed that marital status of the respondents (δ = 1.610; 95% CI: 1.216, 2.130), household size (δ = 1.168; 95% CI: 1.013, 1.346), presence of chronic illness (δ = 1.424; 95% CI: 1.165, 1.740), hospitalization history (δ = 1.306; 95% CI: 1.118, 1.527), higher perceived quality of care (δ = 1.322; 95% CI: 1.100, 1.587), perceived risk protection (δ = 1.218; 95% CI: 1.027, 1.444), and higher trust in the scheme (δ = 1.731; 95% CI: 1.428, 2.098) were significant predictors of time to drop out. Contrary to the literature, wealth status did not show a significant correlation with the time to drop out. Conclusions The fact that larger households and those with chronic illness remained longer in the scheme is suggestive of adverse selection. It is needed to reconsider the premium level in line with household size to attract small size households. Resolving problems related to the quality of health care can be a cross-cutting area of intervention to retain members by building trust in the scheme and enhancing the risk protection ability of the schemes.
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27
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Siseho GM, Mathole T, Jackson D. Baseline assessment of the WHO/UNICEF/UNFPA maternal and newborn quality-of-care standards around childbirth: Results from an intermediate hospital, northeast Namibia. Front Pediatr 2022; 10:972815. [PMID: 36699289 PMCID: PMC9869061 DOI: 10.3389/fped.2022.972815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Quality of care around childbirth can reduce above half of the stillbirths and newborn deaths. Northeast Namibia's neonatal mortality is higher than the national level. Yet, no review exists on the quality of care provided around childbirth. This paper reports on baseline assessment for implementing WHO/UNICEF/UNFPA quality measures around childbirth. METHODS A mixed-methods research design was used to assess quality of care around childbirth. To obtain good saturation and adequate women opinions, we purposively sampled the only high-volume hospital in northeast Namibia; observed 53 women at admission, of which 19 progressed to deliver on the same day/hours of data collection; and interviewed 20 staff and 100 women who were discharged after delivery. The sampled hospital accounted for half of all deliveries in that region and had a high (27/1,000) neonatal mortality rate above the national (20/1,000) level. We systematically sampled every 22nd delivery until the 259 mother-baby pair was reached. Data were collected using the Every Mother Every Newborn assessment tool, entered, and analyzed using SPSS V.27. Descriptive statistics was used, and results were summarized into tables and graphs. RESULTS We reviewed 259 mother-baby pair records. Blood pressure, pulse, and temperature measurements were done in 98% of observed women and 90% of interviewed women at discharge. Above 80% of human and essential physical resources were adequately available. Gaps were identified within the WHO/UNICEF/UNFPA quality standard 1, a quality statement on routine postpartum and postnatal newborn care (1.1c), and also within standards 4, 5, and 6 on provider-client interactions (4.1), information sharing (5.3), and companionship (6.1). Only 45% of staff received in-service training/refresher on postnatal care and breastfeeding. Most mothers were not informed about breastfeeding (52%), postpartum care and hygiene (59%), and family planning (72%). On average, 49% of newborn postnatal care interventions (1.1c) were practiced. Few mothers (0-12%) could mention any newborn danger signs. CONCLUSION This is the first study in Namibia to assess WHO/UNICEF/UNFPA quality-of-care measures around childbirth. Measurement of provider-client interactions and information sharing revealed significant deficiencies in this aspect of care that negatively affected the client's experience of care. To achieve reductions in neonatal death, improved training in communication skills to educate clients is likely to have a major positive and relatively low-cost impact.
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Affiliation(s)
- Gloria Mutimbwa Siseho
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa.,Maternal Newborn and Child Health, United Nations Children s Fund (UNICEF), Windhoek, Namibia
| | - Thubelihle Mathole
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Debra Jackson
- Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, Bellville, South Africa.,Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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28
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Horton R, Lee H, Perosky JE, Kofa A, Lori JR. Comparison of quality, birth outcomes, and service utilization between health facilities with and without maternity waiting homes in Liberia. Midwifery 2021; 105:103235. [PMID: 34959000 PMCID: PMC8811480 DOI: 10.1016/j.midw.2021.103235] [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: 07/22/2020] [Revised: 11/29/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE 1) To assess the quality of health facilities associated with functional Maternity Waiting Homes and health facilities without functional maternity waiting homes in Liberia. 2) To examine birth outcomes and care utilization amongst health facilities with and without functional maternity waiting homes in Liberia. DESIGN Secondary analysis design using data from a facility capacity checklist and Liberia's Health Management Information System. SETTING 71 health facilities associated with functional maternity waiting homes and 14 health facilities without functional maternity waiting homes across 14 counties of Liberia. PARTICIPANTS No human participants were used in this study. METHODS Independent t-test, Pearson chi-square test, and logistic regression were performed to assess quality, birth outcomes, and service utilization between health facilities with and without functional maternity waiting homes. FINDINGS The overall health facility quality was not significantly different between health facilities associated with functional maternity waiting homes and those without. However, health facilities with functional maternity waiting homes had better infection control with the presence of soap and sharps boxes. Health facilities with functional maternity waiting homes were also more likely to have parenteral oxytocic drugs and were better able to perform assisted vaginal deliveries. The presence of functional maternity waiting homes were not significantly associated with health facility quality, birth outcomes, or care utilization. CONCLUSION AND IMPLICATIONS Health facilities with functional MWHs were better prepared to prevent infection and manage complicated deliveries. This study further highlights specific areas for quality improvement amongst these health facilities, including labor complications management.
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Affiliation(s)
- Rachel Horton
- Undergraduate Student, University of Michigan, School of Nursing, 400 North Ingalls, Ann Arbor, MI 48104, United States.
| | - Haeun Lee
- Graduate Student, University of Michigan, School of Nursing, 400 North Ingalls, Ann Arbor, MI 48104, United States.
| | - Joseph E Perosky
- Resident Physician, Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, 400 North Ingalls, Ann Arbor, MI 48104, United States.
| | | | - Jody R Lori
- Professor & Associate Dean for Global Affairs, University of Michigan, School of Nursing, 400 North Ingalls, Ann Arbor, MI 48104, United States.
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29
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Young AMP, Marx MA, Frost E, Hazel E, Kabanywanyi AM, Mohan D. Assessing provider performance of intrapartum care using simulated encounters and clinical vignettes: A comparison study from Tanzania. Int J Gynaecol Obstet 2021; 158:57-63. [PMID: 34559888 PMCID: PMC9292807 DOI: 10.1002/ijgo.13947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/24/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023]
Abstract
Objective To compare clinical vignettes and objective structured clinical examinations (OSCE) as methods for assessing the quality of intrapartum care among skilled providers in rural primary‐level health facilities in Tanzania. Methods Cross‐sectional study conducted at six health facilities in the Simiyu region of Tanzania. Providers were assessed using OSCE and clinical vignettes in spontaneous delivery, neonatal resuscitation, and management of postpartum hemorrhage. Trained researchers used a structured clinical checklist. The frequencies of items are presented as percentages and the agreement of the methods of assessment are reported using kappa statistics (high: kappa > 0.80, moderate: kappa = 0.60–0.80, low: kappa < 0.60). Results Most healthcare providers were female (60.7%), registered nurses by training (29.0%), and worked in a dispensary (56.1%), with an average age of 33 years and an average of 7.4 years of experience in their respective professions. Five items had high agreement between OSCE and clinical vignettes: postpartum vital signs every 15 min, oxytocin within 1 min of birth, diagnosis of postpartum hemorrhage, elevating legs of the mother, and deciding on manual compression of the uterus. Conclusion OSCE and clinical vignettes should be viewed as complimentary to one another in the assessment of provider knowledge and skill, with priority given to OSCE, particularly in intrapartum care. Clinical vignettes and objective structured clinical examinations are complimentary methods of assessment of intrapartum care in Tanzania, with priority given to objective structured clinical examinations.
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Affiliation(s)
- Anna Marie P Young
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melissa A Marx
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily Frost
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Hazel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Diwakar Mohan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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30
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Carter ED, Leslie HH, Marchant T, Amouzou A, Munos MK. Methodological considerations for linking household and healthcare provider data for estimating effective coverage: a systematic review. BMJ Open 2021; 11:e045704. [PMID: 34446481 PMCID: PMC8395298 DOI: 10.1136/bmjopen-2020-045704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess existing knowledge related to methodological considerations for linking population-based surveys and health facility data to generate effective coverage estimates. Effective coverage estimates the proportion of individuals in need of an intervention who receive it with sufficient quality to achieve health benefit. DESIGN Systematic review of available literature. DATA SOURCES Medline, Carolina Population Health Center and Demographic and Health Survey publications and handsearch of related or referenced works of all articles included in full text review. The search included publications from 1 January 2000 to 29 March 2021. ELIGIBILITY CRITERIA Publications explicitly evaluating (1) the suitability of data, (2) the implications of the design of existing data sources and (3) the impact of choice of method for combining datasets to obtain linked coverage estimates. RESULTS Of 3805 papers reviewed, 70 publications addressed relevant issues. Limited data suggest household surveys can be used to identify sources of care, but their validity in estimating intervention need was variable. Methods for collecting provider data and constructing quality indices were diverse and presented limitations. There was little empirical data supporting an association between structural, process and outcome quality. Few studies addressed the influence of the design of common data sources on linking analyses, including imprecise household geographical information system data, provider sampling design and estimate stability. The most consistent evidence suggested under certain conditions, combining data based on geographical proximity or administrative catchment (ecological linking) produced similar estimates to linking based on the specific provider utilised (exact match linking). CONCLUSIONS Linking household and healthcare provider data can leverage existing data sources to generate more informative estimates of intervention coverage and care. However, existing evidence on methods for linking data for effective coverage estimation are variable and numerous methodological questions remain. There is need for additional research to develop evidence-based, standardised best practices for these analyses.
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Affiliation(s)
- Emily D Carter
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hannah H Leslie
- Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Tanya Marchant
- Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Agbessi Amouzou
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda K Munos
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Letaief M, Hirschhorn LR, Leatherman S, Sayed AA, Sheikh A, Siddiqi S. Implementation research on measuring quality in primary care: balancing national needs with learning from the Eastern Mediterranean Region. Int J Qual Health Care 2021; 33:6349076. [PMID: 34383049 DOI: 10.1093/intqhc/mzab119] [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: 03/09/2021] [Revised: 05/30/2021] [Accepted: 08/11/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) is a core element of ensuring healthy lives, marking the third Sustainable Development Goal. It requires providing quality primary health-care (PHC) services. Assessment of quality of care considering a wide variety of contexts is a challenge. This study lists practical indicators to enhance the quality of PHC. OBJECTIVES Demonstrating quality indicators for PHC that are feasible, comprehensive and adaptable to wide array of health systems and resource settings. METHODS We applied the research framework: Exploration, Preparation, Implementation and Sustainment. Exploration included a scoping review to identify quality indicators. Preparation included an eDelphi to refine the primary indicators' list. A panel of 27 experts reviewed the list that was later pilot tested in PHC facilities. The outcomes were presented to two further expert consultations, to refine indicators and plan for broader testing. Implementation included testing the indicators through a five-step process in 40 facilities. A regional consultation in May 2016 discussed the testing outcomes. RESULTS Initial efforts identified 83 quality indicators at the PHC level that were then refined to a 34-indicator list covering the six domains of quality. A toolkit was also developed to test the feasibility of each indicator measurement, data availability, challenges and gaps. Pilot testing provided insight into modifying and adding some indicators. Wide variability was encountered within and in between facilities, and timely initiation of antenatal care, for example, ranged 31-90% in Oman and 11-98% in Tunisia. Indicators were highly feasible, and 29 out of 34 were measured in 75% of facilities or more. While challenges included gaps in capacity for data collection, the tool showed high adaptability to the local context and was adopted by countries in the Eastern Mediterranean Region (EMR) including Libya, Oman, Iran, Pakistan, Sudan and Palestine. Stakeholders agreed on the high relevance and applicability of the proposed indicators that have been used to inform improvement. CONCLUSION A cross-regional set of 34 quality indicators of PHC in the EMR was developed and adopted by a diverse group of countries. The toolkit showed high feasibility in pilot testing reflecting the practicality needed to encourage local uptake and sustainability. The core quality indicators are highly adaptable to different local and regional contexts regardless of current PHC strength or available resources. Continuous evaluation and sharing lessons of implementation and use are needed to ascertain the indicators' effectiveness in driving improvements in PHC and to refine and strengthen the evidence supporting the set of indicators for wider adoption.
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Affiliation(s)
- Mondher Letaief
- Quality and Patient Safety, Health System Development, World Health Organisation Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Str, Extension of Abdel Razak El Sanhouri Street, P.O. Box 7608, Nasr City, Cairo 11371, Egypt
| | - Lisa R Hirschhorn
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, 14-013, Chicago, IL 60611-3008, USA
| | - Sheila Leatherman
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, 135 Dauer Drive, 263 Rosenau Hall, CB #7400, Chapel Hill, NC 27599-7400, (919) 966-2499, USA
| | - Alaa A Sayed
- Quality and Patient Safety, Universal Health Coverage - Health Systems, World Health Organisation Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Str, Extension of Abdel Razak El Sanhouri Street, P.O. Box 7608, Nasr City, Cairo 11371, Egypt
| | - Aziz Sheikh
- Division of Medical and Radiological Sciences, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Sameen Siddiqi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Sindh 74800, Pakistan
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Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis. Sci Rep 2021; 11:16263. [PMID: 34381150 PMCID: PMC8357794 DOI: 10.1038/s41598-021-95886-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/29/2021] [Indexed: 11/28/2022] Open
Abstract
Each year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.
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Titi-Ofei R, Osei-Afriyie D, Karamagi H. Monitoring Quality of Care in the WHO Africa Region-A study design for measurement and tracking, towards UHC attainment. Glob Health Action 2021; 14:1939493. [PMID: 34320908 PMCID: PMC8330734 DOI: 10.1080/16549716.2021.1939493] [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: 11/05/2022] Open
Abstract
This paper reports on the design of a study to generate a quality of care index for countries in the World Health Organization Africa Region. Quality of care, for all people at all times, remains pivotal to the advancement of the 2030 agenda and the attainment of Universal Health Coverage. We present a study protocol for deriving a quality of care index, hinged on indicators and data elements currently monitored through routine information systems and institutionalized facility assessments in the World Health Organization Africa Region. This paper seeks to offer more insight into options in the Region for strengthening monitoring processes of quality of care, as a step towards generating empirical evidence which can galvanize action towards an improved care process. The methodology proposed in this study design has broad implications for policymaking and priority setting for countries, emphasizing the need for robust empirical measures to understand the functionality of health systems for the delivery of quality essential services. Application of this protocol will guide policymaking, as countries work to increasingly improve quality of care and adopt policies that will best facilitate their advancement towards Universal Health Coverage.
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Affiliation(s)
- Regina Titi-Ofei
- Data, Analytics and Knowledge Management Unit, WHO Regional Office for Africa, Brazzaville, Congo
| | - Doris Osei-Afriyie
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Humphrey Karamagi
- Data, Analytics and Knowledge Management Unit, WHO Regional Office for Africa, Brazzaville, Congo
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Kinney MV, Walugembe DR, Wanduru P, Waiswa P, George A. Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors. Health Policy Plan 2021; 36:955-973. [PMID: 33712840 PMCID: PMC8227470 DOI: 10.1093/heapol/czab011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Maternal and perinatal death surveillance and response (MPDSR), or any form of maternal and/or perinatal death review or audit, aims to improve health services and pre-empt future maternal and perinatal deaths. With expansion of MPDSR across low- and middle-income countries (LMIC), we conducted a scoping review to identify and describe implementation factors and their interactions. The review adapted an implementation framework with four domains (intervention, individual, inner and outer settings) and three cross-cutting health systems lenses (service delivery, societal and systems). Literature was sourced from six electronic databases, online searches and key experts. Selection criteria included studies from LMIC published in English from 2004 to July 2018 detailing factors influencing implementation of MPDSR, or any related form of MPDSR. After a systematic screening process, data for identified records were extracted and analysed through content and thematic analysis. Of 1027 studies screened, the review focuses on 58 studies from 24 countries, primarily in Africa, that are mainly qualitative or mixed methods. The literature mostly examines implementation factors related to MPDSR as an intervention, and to its inner and outer setting, with less attention to the individuals involved. From a health systems perspective, almost half the literature focuses on the tangible inputs addressed by the service delivery lens, though these are often measured inadequately or through incomparable ways. Though less studied, the societal and health system factors show that people and their relationships, motivations, implementation climate and ability to communicate influence implementation processes; yet their subjective experiences and relationships are inadequately explored. MPDSR implementation contributes to accountability and benefits from a culture of learning, continuous improvement and accountability, but few have studied the complex interplay and change dynamics involved. Better understanding MPDSR will require more research using health policy and systems approaches, including the use of implementation frameworks.
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Affiliation(s)
- Mary V Kinney
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - David Roger Walugembe
- School of Health Studies and Faculty of Information and Media Studies, The University of Western Ontario, London, ON, Canada
| | - Phillip Wanduru
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- Global Health Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Asha George
- School of Public Health, University of the Western Cape, Bellville, South Africa
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Getachew T, Abebe SM, Yitayal M, Bergström A, Persson LA, Berhanu D. Health extension workers' perceived health system context and health post preparedness to provide services: a cross-sectional study in four Ethiopian regions. BMJ Open 2021; 11:e048517. [PMID: 34108171 PMCID: PMC8191611 DOI: 10.1136/bmjopen-2020-048517] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The health system context influences the implementation of evidence-based practices and quality of healthcare services. Ethiopia aims at reaching universal health coverage but faces low primary care utilisation and substandard quality of care. We assessed the health extension workers' perceived context and the preparedness of health posts to provide services. SETTING This study was part of evaluating a complex intervention in 52 districts of four regions of Ethiopia. This paper used the endline data collected from December 2018 to February 2019. PARTICIPANTS A total of 152 health posts and health extension workers serving selected enumeration areas were included. OUTCOME MEASURES We used the Context Assessment for Community Health (COACH) tool and the Service Availability and Readiness Assessment tool. RESULTS Internal reliability of COACH was satisfactory. The dimensions community engagement, work culture, commitment to work and leadership all scored high (mean 3.75-4.01 on a 1-5 scale), while organisational resources, sources of knowledge and informal payments scored low (1.78-2.71). The general service readiness index was 59%. On average, 67% of the health posts had basic amenities to provide services, 81% had basic equipment, 42% had standard precautions for infection prevention, 47% had test capacity for malaria and 58% had essential medicines. CONCLUSION The health extension workers had a good relationship with the local community, used data for planning, were highly committed to their work with positive perceptions of their work culture, a relatively positive attitude regarding their leaders, and reported no corruption or informal payments. In contrast, they had insufficient sources of information and a severe lack of resources. The health post preparedness confirmed the low level of resources and preparedness for services. These findings suggest a significant potential contribution by health extension workers to Ethiopia's primary healthcare, provided that they receive improved support, including new information and essential resources.
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Affiliation(s)
- Theodros Getachew
- Health System and Reproductive Health Research Directtorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Mezgebu Yitayal
- Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | | | - Lars-Ake Persson
- Health System and Reproductive Health Research Directtorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Della Berhanu
- Health System and Reproductive Health Research Directtorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- London School of Hygiene and Tropical Medicine, London, UK
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Aujla N, Chen YF, Samarakoon Y, Wilson A, Grolmusová N, Ayorinde A, Hofer TP, Griffiths F, Brown C, Gill P, Mallen C, Sartori J, Lilford RJ. Comparing the use of direct observation, standardized patients and exit interviews in low- and middle-income countries: a systematic review of methods of assessing quality of primary care. Health Policy Plan 2021; 36:341-356. [PMID: 33313845 PMCID: PMC8058951 DOI: 10.1093/heapol/czaa152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/31/2022] Open
Abstract
Clinical records in primary healthcare settings in low- and middle-income countries (LMIC) are often lacking or of too poor quality to accurately assess what happens during the patient consultation. We examined the most common methods for assessing healthcare workers' clinical behaviour: direct observation, standardized patients and patient/healthcare worker exit interview. The comparative feasibility, acceptability, reliability, validity and practicalities of using these methods in this setting are unclear. We systematically review and synthesize the evidence to compare and contrast the advantages and disadvantages of each method. We include studies in LMICs where methods have been directly compared and systematic and narrative reviews of each method. We searched several electronic databases and focused on real-life (not educational) primary healthcare encounters. The most recent update to the search for direct comparison studies was November 2019. We updated the search for systematic and narrative reviews on the standardized patient method in March 2020 and expanded it to all methods. Search strategies combined indexed terms and keywords. We searched reference lists of eligible articles and sourced additional references from relevant review articles. Titles and abstracts were independently screened by two reviewers and discrepancies resolved through discussion. Data were iteratively coded according to pre-defined categories and synthesized. We included 12 direct comparison studies and eight systematic and narrative reviews. We found that no method was clearly superior to the others-each has pros and cons and may assess different aspects of quality of care provision by healthcare workers. All methods require careful preparation, though the exact domain of quality assessed and ethics and selection and training of personnel are nuanced and the methods were subject to different biases. The differential strengths suggest that individual methods should be used strategically based on the research question or in combination for comprehensive global assessments of quality.
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Affiliation(s)
- Navneet Aujla
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Yen-Fu Chen
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Yasara Samarakoon
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Anna Wilson
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Natalia Grolmusová
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Abimbola Ayorinde
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Timothy P Hofer
- Department of Medicine, UM Institute for Health Policy and Innovation, Building 16 3rd Floor, North Campus Research Centre, University of Michigan Medical School, Ann Arbor, MI 48109-2800 USA
| | - Frances Griffiths
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Celia Brown
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Paramjit Gill
- W-CAHRD, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christian Mallen
- Keele School of Medicine, David Wetherall Building, Keele University, Keele, ST5 5BG, UK
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Chen L, Luo M, Xu Y, Xia Y, Zhou X, Chen W, Wang H, Jiang T, Chen W, Luo Y, Ma Q, Jiang J, Pan X. The first 90: Progress in HIV detection in Zhejiang Province, 2008-2018. PLoS One 2021; 16:e0249517. [PMID: 33831067 PMCID: PMC8031385 DOI: 10.1371/journal.pone.0249517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/19/2021] [Indexed: 11/20/2022] Open
Abstract
To analyze the results of HIV screening and the HIV-positive rate based on different HIV detection strategies in Zhejiang Province, China. Data were downloaded from the AIDS Prevention and Control Information System on May 1, 2019. HIV screening, prevalence, and incidence data were analyzed from 2008 to 2018. The incidence of HIV was calculated from the results of BED testing. SPSS software (ver. 19.0) was used for the analysis. The number of people screened for HIV increased by 229.7% from 2008 to 2018, while the incidence of HIV increased from 1.14‱ (2010) to 1.67‱ (2018), peak by 2015 (2.28‱). The proportion of people screened for HIV in medical institutions increased from 62.0% in 2008 to 67.1% in 2018, while of all positive tests, 47.9% were conducted at medical institutions in 2008, which increased to 63.2% in 2018. VCT and STD clinic attendees, who had only 4.5% of all those undergoing HIV tests, accounted for 23.7% of all HIV positive in 2018. The rate of HIV-positive people and incidence of HIV both increased in Zhejiang Province between 2008 and 2015. The most effective strategy for detecting HIV new cases is screening visitors to VCT and STD clinics.
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Affiliation(s)
- Lin Chen
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Mingyu Luo
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Yun Xu
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Yan Xia
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Xin Zhou
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Wanjun Chen
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Hui Wang
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Tingting Jiang
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Weiyong Chen
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Yan Luo
- Department of AIDS/STD Control and Prevention, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, People’s Republic of China
| | - Qiaoqin Ma
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianmin Jiang
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaohong Pan
- Department of AIDS/STD Control and Prevention, Zhejiang Provincial Center for Disease Control, Hangzhou, Zhejiang, People’s Republic of China
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Whitaker J, Chirwa L, Munthali B, Dube A, Amoah AS, Leather AJM, Davies J. Development and use of clinical vignettes to assess injury care quality in Northern Malawi. Injury 2021; 52:793-805. [PMID: 33487406 DOI: 10.1016/j.injury.2021.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is known that outcomes after injury care in low-and-middle income countries (LMICs) are poorer than those in high income countries. However, little is known about healthcare provider competency to deliver quality injury care in these settings. We developed and used clinical vignettes to evaluate injury care quality in an LMIC setting. METHOD Four serious injury scenarios, developed from agreed best practice, testing diagnostic and management skills, were piloted with high and low-income setting clinicians. Scenarios were used with primary and referral facility clinicians in Malawi. Participants described their clinical course of action (assessment, diagnostic, treatment and management approaches) for each scenario, registering one point per agreed best practice response. Mean percentage total scores were calculated and univariable and multivariable comparison made across provider groups, facility types, injury care frequency and training level. RESULTS Fourteen Doctors, 51 Clinical Officers, 20 Medical Assistants from 11 facilities participated. Mean percentage total vignette scores varied significantly with clinician provider group (Doctors 63.1% vs Clinical Officers 49.6%, p<0.001, Clinical Officers vs Medical Assistants 39.4% p=0.001). Important care aspects most frequently included or omitted were: following chest injury, 88.2% reported chest drain insertion, 7.1% checked for tracheal deviation; following penetrating abdominal injury and shock, 98.8% secured IV access, 0% mentioned tranexamic acid; following severe head injury, 88.2% proposed CT or neurosurgical transfer, 7.1% ensured normotension; and following isolated open lower leg fracture, 90.1% arranged orthopaedic consultation, 2.4% assessed distal neurological status. CONCLUSION These clinical vignettes proved easy to use and collected rich data. This supports their use for assessing and monitoring clinical care quality in other similar settings.
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Affiliation(s)
- John Whitaker
- King's Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Lindani Chirwa
- Karonga District Hospital, Karonga District Health Office, Karonga, Malawi
| | - Boston Munthali
- Mzuzu Central Hospital, Department of Orthopaedic Surgery, Mzuzu, Malawi
| | - Albert Dube
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Chilumba, Karonga District Malawi
| | - Abena S Amoah
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Chilumba, Karonga District Malawi; Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Justine Davies
- King's Centre for Global Health and Health Partnerships, School of Population Health & Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Centre for Applied Health Research, University of Birmingham, Birmingham, UK; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Extraordinary Professor, Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town
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Rokicki S, Mwesigwa B, Cohen JL. Know-do gaps in obstetric and newborn care quality in Uganda: a cross-sectional study in rural health facilities. Trop Med Int Health 2021; 26:535-545. [PMID: 33529436 DOI: 10.1111/tmi.13557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Variable and inadequate quality of maternity care is a critical factor in persistently high rates of maternal and neonatal mortality in Uganda. We investigated whether provider quality of care deviates from knowledge and the factors associated with these 'know-do gaps' in Ugandan maternity facilities. METHODS Data were collected from 109 providers in 40 facilities. Quality was measured using direct observations of intrapartum care, and scores were based on the percentage of essential care actions provided out of a 20-item validated quality index. Knowledge was measured based on the percentage of items that providers reported knowing to do using vignette surveys. The know-do gap was the difference between knowledge and quality. Multivariable models were used to assess the association between provider- and facility-level characteristics and knowledge, quality and know-do gaps. RESULTS The average quality score was 45%, with quality varying widely within and across providers. The mean knowledge score was 70%, yielding a mean know-do gap of 25%. Know-do gaps were largest for practices related to infection control, vitals monitoring, and prevention of postpartum haemorrhage. The association between quality and knowledge scores was positive but small (P = 0.08), so know-do gaps were largest for providers with the highest knowledge scores. Greater provider training was positively associated with knowledge (P = 0.005) but not with quality (P = 0.60). Having 10 or more years of work experience was associated with higher quality scores (5.3, 95%CI: 0.6 to 10.1), while higher patient volumes were associated with lower quality scores (-2.2, 95%CI: -3.7 to - 0.07). None of the factors of provider motivation, cadre, availability of essential medicines and supplies or facility staffing were associated with quality or know-do gaps. CONCLUSIONS Our results indicate that, in Uganda, gaps between knowledge and quality do not appear to be explained by factors such as lack of motivation, education, training or supplies. Gaps are particularly large for essential practices related to prevention of postpartum haemorrhage, a leading cause of maternal mortality in Uganda and similar settings.
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Affiliation(s)
- Slawa Rokicki
- Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ, USA.,Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | | | - Jessica L Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement. Semin Fetal Neonatal Med 2021; 26:101199. [PMID: 33546999 PMCID: PMC8026747 DOI: 10.1016/j.siny.2021.101199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improving quality of care in low-and middle-income countries (LMICs) is a global priority, specifically around maternal and newborn care, where mortality and morbidity remain unacceptably high. Cesarean delivery is the most common procedure in women, thus evaluating quality around the provision of this intervention provides insight into overall quality of care around childbirth. In this review we provide an overview on the quality of care around cesarean delivery using the six domains of quality proposed by the Institute of Medicine: equity, effectiveness, efficiency, safety, timeliness and patient-centered care. We review evidence of potential quality gaps in each of these domains around cesarean delivery in LMICs, discuss opportunities for improvement and provide suggestions on metrics for tracking quality in each of these domains. As cesarean delivery rates increase globally, efforts to ensure quality will be essential to drive continued and sustained improvements in global maternal and newborn outcomes.
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Lecocq D, Delmas P, Antonini M, Lefebvre H, Laloux M, Beghuin A, Van Cutsem C, Bustillo A, Pirson M. Comparing feeling of competence regarding humanistic caring in Belgian nurses and nursing students: A comparative cross-sectional study conducted in a French Belgian teaching hospital. Nurs Open 2021; 8:104-114. [PMID: 33318817 PMCID: PMC7729661 DOI: 10.1002/nop2.608] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/06/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Aim The aim of the study was to describe and compare feeling of competence regarding humanistic caring in Registered Nurses (RN) and nursing students (NS). Design A quantitative comparative cross-sectional research design was used. Methods A convenience sample of 196 RN and 47 NS in a teaching hospital in Belgium completed a self-administered questionnaire composed of a sociodemographic survey and the Caring Nurse-Patient Interactions Scale (CNPI-23) developed by Cossette et al. Results The four dimensions of the CNPI-23 were compared using the Skillings-Mack test. Both groups scored higher on "humanistic" and "comforting" than on "clinical" and "relational" care and both scored lowest on this last dimension. Linear regressions showed that none of the variables had a statistically significant influence on the CNPI-23 scores, except for NS "state of health," which influenced their feeling of competence regarding "relational care."
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Affiliation(s)
- Dan Lecocq
- Centre de recherche en économie de la santé, gestion des institutions de soins et sciences infirmièresEcole de santé publiqueUniversité libre de BruxellesBrusselsBelgium
- School of NursingHaute Ecole Libre de Bruxelles Ilya PrigogineBrusselsBelgium
- La SourceSchool of NursingHES‐SO University of Applied Sciences WesternLausanneSwitzerland
| | - Philippe Delmas
- Centre de recherche en économie de la santé, gestion des institutions de soins et sciences infirmièresEcole de santé publiqueUniversité libre de BruxellesBrusselsBelgium
- La SourceSchool of NursingHES‐SO University of Applied Sciences WesternLausanneSwitzerland
| | - Matteo Antonini
- La SourceSchool of NursingHES‐SO University of Applied Sciences WesternLausanneSwitzerland
| | - Hélène Lefebvre
- Faculté des sciences infirmièresUniversité de MontréalMontrealQCCanada
| | - Martine Laloux
- Centre de recherche en économie de la santé, gestion des institutions de soins et sciences infirmièresEcole de santé publiqueUniversité libre de BruxellesBrusselsBelgium
- School of NursingHaute Ecole Libre de Bruxelles Ilya PrigogineBrusselsBelgium
| | - Amélie Beghuin
- School of NursingHaute Ecole Libre de Bruxelles Ilya PrigogineBrusselsBelgium
| | | | - Aurélia Bustillo
- Cliniques Universitaires de Bruxelles Hôpital ErasmeBrusselsBelgium
| | - Magali Pirson
- Centre de recherche en économie de la santé, gestion des institutions de soins et sciences infirmièresEcole de santé publiqueUniversité libre de BruxellesBrusselsBelgium
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O‘Neil S, Taylor S, Sivasankaran A. Data Equity to Advance Health and Health Equity in Low- and Middle-Income Countries: A Scoping Review. Digit Health 2021; 7:20552076211061922. [PMID: 34992789 PMCID: PMC8725220 DOI: 10.1177/20552076211061922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 01/15/2023] Open
Abstract
Objective To assess a common hypothesis that data serve as a mechanism to improve
health and health equity in low-and middle-income countries (LMICs), we
conducted a synthesis of the evidence about the linkage between data
capabilities in LMICs and health outcomes. Methods We searched and reviewed peer-reviewed and grey literature published in the
past decade that focused on at least one aspect of health data or health
equity or provided insights on the relationship between data use and
improved health outcomes, decision-making, or both. We supplemented this
with expert interviews and convenience-sampled literature. Results Of the 50 included articles, 33 discussed data collection, with 23 stating
that poor accuracy, reliability, and completeness hindered data-informed
decision-making. Of 27 articles discussing data access, 18 described how
lack of interoperability between data systems hampered governments’ and
other organizations’ ability to leverage the full value of data available.
Of 19 articles discussing data use, 13 discussed how data were not getting
to those doing work on the ground. Although key informants postulated a
virtuous cycle between data and improved health outcomes, evidence did not
support this connection. Conclusions Findings indicate better data might improve health service delivery. However,
more work is needed to examine whether improvements in data yield
improvements in health outcomes in LMICs. Our conceptual framework of data
equity for health and health equity developed through this scoping review
helps identify the key components along which to assess improvements in
LMICs’ data capabilities.
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Affiliation(s)
- So O‘Neil
- Health Foundations, Mathematica, Cambridge, MA 02139, United States
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Neubert A, Brito Fernandes Ó, Lucevic A, Pavlova M, Gulácsi L, Baji P, Klazinga N, Kringos D. Understanding the use of patient-reported data by health care insurers: A scoping review. PLoS One 2020; 15:e0244546. [PMID: 33370405 PMCID: PMC7769438 DOI: 10.1371/journal.pone.0244546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 12/11/2020] [Indexed: 12/03/2022] Open
Abstract
Background Patient-reported data are widely used for many purposes by different actors within a health system. However, little is known about the use of such data by health insurers. Our study aims to map the evidence on the use of patient-reported data by health insurers; to explore how collected patient-reported data are utilized; and to elucidate the motives of why patient-reported data are collected by health insurers. Methods The study design is that of a scoping review. In total, 11 databases were searched on. Relevant grey literature was identified through online searches, reference mining and recommendations from experts. Forty-two documents were included. We synthesized the evidence on the uses of patient-reported data by insurers following a structure-process-outcome approach; we also mapped the use and function of those data by a health insurer. Results Health insurers use patient-reported data for assurance and improvement of quality of care and value-based health care. The patient-reported data most often collected are those of outcomes, experiences and satisfaction measures; structure indicators are used to a lesser extent and often combined with process indicators. These data are mainly used for the purposes of procurement and purchasing of services, quality assurance, improvement and reporting, and strengthening the involvement of insured people. Conclusions The breadth to which insurers use patient-reported data in their business models varies greatly. Some hindering factors to the uptake of such data are the varying and overlapping terminology in use in the field and the limited involvement of insured people in a health insurer’s business. Health insurers are advised to be more explicit in regard to the role they want to play within the health system and society at large, and accommodate implications for the use of patient-reported data accordingly.
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Affiliation(s)
- Anne Neubert
- Department of Orthopaedics and Traumatology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Service Research and Health Economics, Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Germany
| | - Óscar Brito Fernandes
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- * E-mail:
| | - Armin Lucevic
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Kinney MV, Ajayi G, de Graft-Johnson J, Hill K, Khadka N, Om’Iniabohs A, Mukora-Mutseyekwa F, Tayebwa E, Shittu O, Lipingu C, Kerber K, Nyakina JD, Ibekwe PC, Sayinzoga F, Madzima B, George AS, Thapa K. "It might be a statistic to me, but every death matters.": An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries. PLoS One 2020; 15:e0243722. [PMID: 33338039 PMCID: PMC7748147 DOI: 10.1371/journal.pone.0243722] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 11/29/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016-2017, the US Agency for International Development's Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe. METHODS A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0-30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 ('evidence of MPDSR practice'). RESULTS The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75-27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment. Some facilities (44%) could demonstrate evidence that a change occurred due to MPDSR. Factors enabling implementation included clear support from leadership, commitment from staff, and regular occurrence of meetings. Barriers included lack of health worker capacity, limited staff time, and limited staff motivation. CONCLUSION This study was the first to apply a standardised scoring methodology to assess subnational- and facility-level MPDSR implementation progress. Structures and processes for implementing MPDSR existed in all four countries. Many implementation gaps were identified that can inform priorities and future research for strengthening MPDSR in low-capacity settings.
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Affiliation(s)
- Mary V. Kinney
- Save the Children US, Washington, DC, United States of America
- University of the Western Cape, Cape Town, South Africa
| | - Gbaike Ajayi
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
- Jhpiego, Baltimore, Maryland, United States of America
| | - Joseph de Graft-Johnson
- Save the Children US, Washington, DC, United States of America
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
| | - Kathleen Hill
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
- Jhpiego, Baltimore, Maryland, United States of America
| | - Neena Khadka
- Save the Children US, Washington, DC, United States of America
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
| | - Alyssa Om’Iniabohs
- Save the Children US, Washington, DC, United States of America
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
| | | | | | | | | | - Kate Kerber
- Save the Children US, Washington, DC, United States of America
| | | | - Perpetus Chudi Ibekwe
- Maternal and perinatal death surveillance and response, Abakaliki, Ebonyi State, Nigeria
| | - Felix Sayinzoga
- Maternal, Child, and Community Health Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Bernard Madzima
- Family Health Directorate, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | - Kusum Thapa
- US Agency for International Development (USAID)’s Maternal and Child Survival Program (MCSP), Washington, DC, United States of America
- Jhpiego, Baltimore, Maryland, United States of America
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Boydell V, Steyn PS, Cordero JP, Habib N, Nguyen MH, Nai D, Shamba D. Adaptation and validation of social accountability measures in the context of contraceptive services in Ghana and Tanzania. Int J Equity Health 2020; 19:183. [PMID: 33059681 PMCID: PMC7565324 DOI: 10.1186/s12939-020-01286-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Changes in the values, attitudes, and interactions of both service users and health care providers are central to social accountability processes in reproductive health. However, there is little consensus on how best to measure these latent changes. This paper reports on the adaptation and validation of measures that capture these changes in Tanzania and Ghana. METHODS The CaPSAI theory of change determined the dimensions of the measure, and we adapted existing items for the survey items. Trained data collectors used a survey to collect data from 752 women in Tanzania and 750 women in Ghana attending contraceptive services. We used reliability analysis, exploratory, and confirmatory factor analysis to assess the validity and reliability of these measures in each country. RESULTS The measure has high construct validity and reliability in both countries. We identified several subscales in both countries, 10 subscales in Tanzania, and 11 subscales in Ghana. Many of the domains and items were shared across both settings. CONCLUSION The study suggests that the multi-dimensional scales have high construct validity and reliability in both countries. Though there were differences in the two country contexts and in items and scales, there was convergence in the analysis that suggests that this measure may be relevant in different settings and should be validated in new settings. TRIAL REGISTRATION ACTRN12619000378123 .
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Affiliation(s)
- Victoria Boydell
- Global Health Institute, Geneva Graduate Institute, Geneva, Switzerland.
| | - Petrus S Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
| | - Joanna Paula Cordero
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
| | - Ndema Habib
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
| | - My Huong Nguyen
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), World Health Organization, Geneva, Switzerland
| | - Dela Nai
- Population Council, Accra, Ghana
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
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Patry J, Tourigny A, Mercier MP, Dionne CE. Quality of Diabetic Foot Ulcer Care: Evaluation of an Interdisciplinary Wound Care Clinic Using an Extended Donabedian Model Based on a Retrospective Cohort Study. Can J Diabetes 2020; 45:327-333.e2. [PMID: 33229195 DOI: 10.1016/j.jcjd.2020.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 08/07/2020] [Accepted: 09/28/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Diabetic foot ulcer (DFU), a serious complication of diabetes, is associated with increased morbidity and mortality and presents a substantial socioeconomic burden. However, DFU quality of care has been insufficiently studied. Therefore, the aim of this study was to evaluate the quality of DFU care at an interdisciplinary wound care clinic in Canada, based on an extended Donabedian model: structure, process and outcome quality indicators combined with patient characteristics. METHODS This was a retrospective cohort study of 140 adult patients with diabetes who were treated between 2012 and 2018 at a wound care clinic in a university-affiliated hospital in the Québec City area of Canada. Twenty-two internationally recognized quality-of-care indicators were identified from the literature. Data were collected from medical files, and the results were used to document the selected quality-of-care indicators. RESULTS The principal indicators regarding structure and process were met, and outcome indicators were influenced by study population characteristics, particularly peripheral artery disease and critical limb ischemia. Moreover, this study highlights that quality-of-care indicators are essential when evaluating DFU outcomes, as structure and process indicators can also affect wound healing outcomes. CONCLUSIONS This study suggests that DFU care at a Canadian wound care clinic, with an interdisciplinary approach, meets most quality-of-care indicators. The socioeconomic burden of DFUs for patients, health-care organizations and policymakers, and the paucity of quality and performance evaluations, call for more studies evaluating DFU care.
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Affiliation(s)
- Jérôme Patry
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Quebec, Canada; Department of Physical Activity Sciences, Podiatric Medicine Program, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
| | - André Tourigny
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada; Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Quebec, Canada
| | - Marie-Philippe Mercier
- Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Quebec, Canada; Department of Physical Activity Sciences, Podiatric Medicine Program, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Clermont E Dionne
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, Quebec, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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Eglseer D, Huppertz V, Kammer L, Saka B, Schols J, Everink I. The quality of nutritional care in hospitals: Austria, Switzerland, and Turkey compared. Nutrition 2020; 79-80:110990. [PMID: 32987336 DOI: 10.1016/j.nut.2020.110990] [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: 03/10/2020] [Revised: 07/29/2020] [Accepted: 08/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the differences in the quality of nutritional care among Austria, Switzerland, and Turkey. METHODS This was a cross-sectional multicenter study. Data were collected using a standardized questionnaire. Descriptive statistics and univariate and multivariate logistic regression (adjusted for age, sex, number of diagnoses, and care dependency) analyses were performed. RESULTS Taking part in the study were 6293 patients from 62 hospitals. The prevalence of risk for malnutrition and the patients was 14.5% in Austria, 16.5% in Switzerland, and 33.7% in Turkey. Standardized screening procedures were applied in 51.3% of Austrian, 53.6% of Swiss, and 38.4% of Turkish patients. The interventions applied in patients at risk varied significantly between Austrian, Swiss, and Turkish hospitals for all but two interventions. Referrals to dietitians were lower in Austria (35.8%) and Switzerland (37.7%) compared with Turkey (61%). Turkish patients received more frequent oral nutritional supplementation, an energy-protein-enriched diet, or parenteral nutrition compared with those in Austrian or Swiss hospitals. The differences in the quality of nutritional care between Austrian and Swiss hospitals were only marginal. Of at-risk patients, 15.3% in Austria, 11.4% in Switzerland, and 5.5% in Turkey did not receive any intervention. CONCLUSIONS The findings of this study indicated that significant differences exist in the prevalence, identification and treatment of malnutrition, and the fulfillment of structural quality indicators. Standards and guidelines need to be developed that can be used by all countries. The severity of the malnutrition situation in hospitals needs further attention in future management policies.
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Affiliation(s)
- Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Graz, Austria.
| | - Viviënne Huppertz
- Nutrition and Translational Research in Metabolism (School NUTRIM), Department of Respiratory Medicine, Maastricht University, Maastricht, The Netherlands
| | - Leonie Kammer
- Department of Health, Division of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Bulent Saka
- Istanbul Medical Faculty, Department of Internal Medicine, Istanbul, Turkey
| | - Jos Schols
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Irma Everink
- Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
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Assessment of Quality of Antenatal Care Services and Its Determinant Factors in Public Health Facilities of Hossana Town, Hadiya Zone, Southern Ethiopia: A Longitudinal Study. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/5436324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Antenatal care is a care that links the woman and her family with the formal health system, increases the chance of using a skilled attendant at birth, and contributes to good health through the life cycle. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and babies. Therefore, the main aim of this study was to determine the quality of ANC in Hadiya Zone, Southern Ethiopia. Method. A longitudinal facility-based study design was conducted among 1123 mothers whose gestational age of less than 16 weeks was identified and followed until birth and 40 days after birth to detect whether they gained the acceptable standard of quality of ANC from July 2017 to June 2018. A structured, predefined, and pretested observation check list and Likert scales were employed to obtain the necessary information after getting both written and verbal consent from the concerned bodies and study participants. Data was entered into Epi Info version 3.5 and transferred to STATA Version 14 software and cleaned by reviewing frequency tables, logical errors, and checking outliers. Generalized estimating equation (GEE) analysis was applied to get the average response observation of each visit of quality of ANC in the health facilities. Result. This study showed that the overall magnitude of good quality of antenatal care service that was provided in the whole visit at Hosanna Town’s public health facilities was 1230 (31.38%). The most frequently identified problems were inability to take full history, lack of proper counseling, poor healthcare provider and client interaction, and improper registration and there was a variation in providing quality of care in each visit. Quality of antenatal care was significantly associated with residence, educational status gravidity, parity, and visit. In conclusion, the overall quality of antenatal care is low, so the health facilities need further modification on the identified problems.
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Adebayo PB, Aziz OM, Mwakabatika RE, Makakala MC, Mazoko MC, Adamjee SM, Mushi N, Jusabani AM, Aris E. Out-patient neurological disorders in Tanzania: Experience from a private institution in Dar es Salaam. eNeurologicalSci 2020; 20:100262. [PMID: 32802973 PMCID: PMC7417890 DOI: 10.1016/j.ensci.2020.100262] [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: 05/25/2020] [Revised: 07/20/2020] [Accepted: 08/01/2020] [Indexed: 12/18/2022] Open
Abstract
Background and introduction Low and middle-income countries (LMIC) have a considerable burden of neurological disorders. Available profile of neurological disorders in our environment is biased towards neurological admissions. There is a paucity of data on out-patient neurological conditions in sub-Saharan Africa. Objective To determine the frequency and demographic data of neurological illnesses being managed at the adult out-patient neurology clinic of the Aga Khan Hospital, Dar es Salaam (AKHD). Materials and methods The electronic medical records of all cases with neurological diseases who presented to the adult neurology clinic of the AKHD between January 2018, and December 2019 were retrospectively reviewed and analyzed. Neurological disorders are categorized according to the international classification of diseases version-11(ICD-11). Results Of the 1186 patients seen in a period of 2 years, there were 597 (50.4%) females and 588(49.6%) males, with median age (IQR) of 38 (30.0–52.0) and 42 (33.0–54.5) years respectively (p = 0.001). Headache disorders (27.0%); disorders of the nerve root, plexus or peripheral nerves (23.4%); epilepsy (9.3%), cerebrovascular disorders (8.9%); movement disorders (3.6%) and disorders of cognition (3.5%) were the primary neurological conditions encountered. Musculoskeletal disorders (7.5%) and mental/behavioral disorders (5.4%) were other conditions seen in the clinic. Conclusion The pattern of neurological disorders in this cohort mirrors that of high-income countries. However, the manpower to tackle these conditions pales in comparison. Increasing the neurology workforce and paying extra attention to non-communicable disorders in SSA is advocated. Available profile of neurological disorders in our environment is biased towards neurological admissions. We Profile neurological out-patient consultations in Aga Khan Hospital, Dar es Salaam. Headache, peripheral nerve disorders, epilepsy and stroke were leading neurological disorders encountered. Non-communicable neurological conditions are becoming prevalent in sub-Sahara Africa and they deserve attention.
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Affiliation(s)
- Philip B Adebayo
- Neurology Section, Aga Khan Hospital, Dar es Salaam, Tanzania.,Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Omar M Aziz
- Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | | | - Mandela C Makakala
- Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Mugisha C Mazoko
- Neurosurgery Section, Department of Surgery, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Shabbir M Adamjee
- Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Noureen Mushi
- Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Ahmed M Jusabani
- Department of Radiology, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Eric Aris
- Neurology Section, Aga Khan Hospital, Dar es Salaam, Tanzania
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50
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Deribew A, Dejene T, Defar A, Berhanu D, Biadgilign S, Tekle E, Asheber K, Deribe K. Health system capacity for tuberculosis care in Ethiopia: evidence from national representative survey. Int J Qual Health Care 2020; 32:306-312. [PMID: 32232364 DOI: 10.1093/intqhc/mzaa024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/02/2019] [Accepted: 01/29/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the tuberculosis (TB) health system capacity and its variations by location and types of health facilities in Ethiopia. DESIGN We used the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all hospitals and randomly selected health centers and private facilities in all regions of Ethiopia. We assessed structural, process and overall health system capacity based on the Donabedian quality of care model. Multiple linear regression and spatial analysis were done to assess TB capacity score variation across regions. SETTING The study included 873 public and private health facilities all over Ethiopia. PARTICIPANTS None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) None. RESULTS A total of 873 health facilities were included in the analysis. The overall TB care capacity score was 76.7%, 55.9% and 37.8% in public hospitals, health centers and private facilities, respectively. The health system capacity score for TB was higher in the urban (60.4%) facilities compared to that of the rural (50.0%) facilities (β = 8.0, 95% CI: 4.4, 11.6). Health centers (β = -16.2, 95% CI: -20.0, -12.3) and private health facilities (β = -38.3, 95% CI: -42.4, -35.1) had lower TB care capacity score than hospitals. Overall TB care capacity score were lower in Western and Southwestern Ethiopia and in Benishangul-Gumuz and Gambella regions. CONCLUSIONS The health system capacity score for TB care in Ethiopia varied across regions. Health system capacity improvement interventions should focus on the private sectors and health facilities in the rural and remote areas to ensure equity and improve quality of care.
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Affiliation(s)
- Amare Deribew
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia.,Nutrition International, Ethiopia
| | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atkure Defar
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Della Berhanu
- Ethiopia Public Health Institute, Addis Ababa, Ethiopia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Sibhatu Biadgilign
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Ephrem Tekle
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK.,College of Health Science, School of Public Health, Addis Ababa University, Ethiopia
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