Outbreaks of COVID-19 in indoor places of worship: a systematic review

AIMS

This review aimed to describe what has been published on COVID-19 outbreaks originating from indoor places of worship.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist by searching PubMed, Scopus and Embase from 1 January 2020 to 29 March 2021. Citation chasing was also performed. Studies with information about COVID-19 outbreaks originating in indoor places of worship of any religion were included.

RESULTS

A total of 9729 records were identified and 36 were selected. The articles reported 119 descriptions of outbreaks linked to churches, mosques, synagogues, and temples, referring to approximately 52-74 unique outbreaks. The outbreaks were mostly located in three major areas: East and Southeast Asia (46%), the USA (27%), Europe (22%). All the outbreaks began in 2020. Mainly, there were no restrictive measures, or such measures were not followed at the time of the outbreak. Choir practices presented the highest attack rate (up to 0.867).

CONCLUSIONS

The lack of preventive measures and the role of singing practices were highlighted. Reports were often lacking contact tracing and sometimes did not report the date of outbreak extinction. Moreover, reports came from few geographical areas. Thus, the impact of transmission in places of worship may be largely underestimated.

Impact of the COVID-19 pandemic on quality of tuberculosis care in private facilities in Bandung, Indonesia: a repeated cross-sectional standardized patients study

BACKGROUND

Indonesia has the second highest incidence of tuberculosis in the world. While 74% of people with tuberculosis in Indonesia first accessed the private health sector when seeking care for their symptoms, only 18% of tuberculosis notifications originate in the private sector. Little is known about the impact of the COVID-19 pandemic on the private sector. Using unannounced standardized patient visits to private providers, we aimed to measure quality of tuberculosis care during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted using standardized patients in Bandung City, West Java, Indonesia. Ten standardized patients completed 292 visits with private providers between 9 July 2021 and 21 January 2022, wherein standardized patients presented a presumptive tuberculosis case. Results were compared to standardized patients surveys conducted in the same geographical area before the onset of COVID-19.

RESULTS

Overall, 35% (95% confidence interval (CI): 29.2-40.4%) of visits were managed correctly according to national tuberculosis guidelines. There were no significant differences in the clinical management of presumptive tuberculosis patients before and during the COVID-19 pandemic, apart from an increase in temperature checks (adjusted odds ratio (aOR): 8.05, 95% CI: 2.96-21.9, p < 0.001) and a decrease in throat examinations (aOR 0.16, 95% CI: 0.06-0.41, p = 0.002) conducted during the pandemic.

CONCLUSIONS

Results indicate that providers successfully identify tuberculosis in their patients yet do not manage them according to national guidelines. There were no major changes found in quality of tuberculosis care due to the COVID-19 pandemic. As tuberculosis notifications have declined in Indonesia due to the COVID-19 pandemic, there remains an urgent need to increase private provider engagement in Indonesia and improve quality of care.

Is the quality of public health facilities always worse compared to private health facilities: Association between birthplace on neonatal deaths in the Indian states

BACKGROUND

The role of place of delivery on the neonatal health outcomes are very crucial. Although the quality of care is being improved, there is no consensus about who is the better healthcare provider in low and middle-income countries (LMICs), public or private facilities. The aim of this study is to assess the differentials in neonatal mortality by the type of healthcare providers in India and its states.

METHODS

We used the data from the fourth wave of the National Family Health Survey 2015-16 (NFHS-4). Information on 259,627 live births to women within the five years preceding the survey was examined. Neonatal mortality rates for state and national levels were calculated using DHS methodology. Multi-variate logistics regression was performed to find the effect of birthplace on neonatal deaths. Propensity score matching (PSM) was used to evaluate the relationship between place of delivery and neonatal deaths to account for the bias attributable to observable covariates.

RESULTS

The rise in parity of the women and purchasing power influences the choice of healthcare providers. Increased neonatal mortality was found in private hospital delivery compared to public hospitals in Punjab, Rajasthan, Chhattisgarh, Madhya Pradesh, Bihar, Jharkhand, Odisha, Goa, Maharashtra, Andhra Pradesh and Karnataka states using propensity score matching analysis. However, analysis on the standard of pre-natal and post-natal care indicates that private hospitals generally outperformed public hospitals.

CONCLUSIONS

The study observed a significant variation in neonatal mortality among public and private health care systems in India. Findings of the study urges that more attention be paid to the improve care at the place of delivery to improve neonatal health. There is a need of strengthened national health policy and public-private partnerships in order to improve maternal and child health care in both private and public health facilities.

Timeliness of Delivery Care and Maternal and Neonatal Health Outcomes in Private Facilities in Masaka Area, Uganda: A Quasi-Experimental Study

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.

Characteristics of Women Seeking Cervical Cancer Cytology Screening in a Private Health Facility

Background and Objectives: Over 80% of cervical cancer cases in sub-Saharan Africa are detected at late stages, predominantly due to the lack or inaccessibility of prevention services. Public health facilities in Ethiopia offer free cervical cancer screening for eligible women. Besides the public health facilities, private providers also offer a variety of screening services at the patients' expense. As the overall cervical cancer screening uptake in Ethiopia is still far below the 90% WHO target, coordination between all actors of the health system is key. This includes a close cooperation between the public and private sectors to combine the advantages of both to the benefit of all patients as well as media campaigns and community involvement to promote the self-initiation of screening. Materials and Methods: To gain insights into the utilization of cervical cancer screening in the private health sector, we conducted an institution-based cross-sectional study at Arsho medical laboratories in Addis Ababa. Every woman who came there for cervical cancer screening between 1 May and 30 June 2020 was asked to participate in a questionnaire-based, face-to-face interview about their socio-demographic background, cervical cancer screening experience and self-initiation of screening. A total of 274 women participated in the interviews. We further assessed the reproductive status of the patients, their risk factors for cervical cancer, source of information about the screening and barriers to cervical cancer screening. Results: The ages of the participants ranged between 20-49 years. The majority (over 70%) were married. A total of 37.6% reported self-initiating the screening. More than three-quarters of all interviewed women reported mostly using the private health care sector for all kinds of health services. Conclusions: While the Ethiopian government efforts on scaling up cervical cancer screening focus mainly on public health facilities, the private sector often does not get as much attention from policy makers. Efforts should be made to extend the government's interest in cervical cancer screening and implementation research to the private healthcare sector.

Integrating private health facilities in government-led health systems: a case study of the public-private mix approach in Ethiopia

BACKGROUND

Private health care facilities working in partnership with the public health sector is one option to create sustainable health systems and ensure health and well-being for all in low-income countries. As the second-most populous country in Africa with a rapidly growing economy, demand for health services in Ethiopia is increasing and one-quarter of its health facilities are privately owned. The Private Health Sector Program (PHSP), funded by the United States Agency for International Development, implemented a series of public-private partnership in health projects from 2004 to 2020 to address several public health priorities, including tuberculosis, malaria, HIV/AIDS, and family planning. We assessed PHSP's performance in leadership and governance, access to medicines, health management information systems, human resources, service provision, and finance.

METHODS

The World Health Organization's health systems strengthening framework, which is organized around six health system building blocks, guided the assessment. We conducted 50 key informant interviews and a health facility assessment at 106 private health facilities supported by the PHSP to evaluate its performance.

RESULTS

All six building blocks were addressed by the program and key informants shared that several policy and strategic changes were conducive to supporting the functioning of private health facilities. The provision of free medicines from the public pharmaceutical logistics system, relaxation of strict regulatory policies that restricted service provision through the private sector, training of private providers, and public-private mix guidelines developed for tuberculosis, malaria, and reproductive, maternal, newborn, child, and adolescent health helped increase the use of services at health facilities.

CONCLUSIONS

Some challenges and threats to sustainability remain, including fragile partnerships between public and private bodies, resource constraints, mistrust between the public and private sectors, limited incentives for the private sector, and oversight of the quality of services. To continue with gains in the policy environment, service accessibility, and other aspects of the health system, the government and international communities must work collaboratively to address public-private partnerships in health areas that can be strengthened. Future efforts should emphasize a mechanism to ensure that the private sector is capable, incentivized, and supervised to deliver continuous, high-quality and equitable services.

Implementing use of sucrose analgesia (non-pharmacological management of neonatal pain) in a standalone private facility level 3 neonatal care unit using point of care quality improvement methodology

Background

Neonatal pain not only has negative impact on the acute physiological parameters of the neonate but also has got the potential to cause long-term neurodevelopmental disabilities. However, neonatal pain especially related to procedures is not well recognised and often poorly managed in neonatal intensive care unit (NICU).

Local problem

Oral sucrose solution became available commercially in late 2017 and this provided us the opportunity to alleviate some of the procedural pain in neonates admitted in our NICU.

Methods

Point of care quality improvement method (POCQI) was leveraged to identify root causes, change ideas and solutions were tested using PDSA cycles. Four procedures were selected by team for sucrose analgesia namely intravenous cannula insertion, tracheal suctioning, removal of tapes and phlebotomy. Change ideas tested included training of staff and doctors, providing dosage chart in NICU, method of administration of sucrose, affixing sucrose vial to baby bed, using prefilled sucrose syringe and bedside availability of sucrose and checklist for documentation. The study was conducted over a period of 8 weeks from 15 June 2017 on all eligible babies getting admitted.

AIM statement

We aim to increase compliance to administration of sucrose analgesia to all eligible newborns (undergoing 4 selected procedures intravenous cannula insertion, tracheal suctioning, removal of tapes and phlebotomy) in NICU prior to painful procedure from current 0% to >80% by 8 weeks.

Results

This quality improvement study implementing the use of evidence-based sucrose analgesia using PDSA cycles found that percentage of babies getting sucrose analgesia has increased from baseline 0% to 96.27% in the study period and is sustained at >80% for 4 years.

Conclusions

POCQI methodology can be used effectively to implement a new simple strategy of administering oral sucrose solution to address procedural pain in care pathway of neonates admitted in NICU. Sustaining the gains achieved by POCQI needs active leadership involvement and addressing adaptive or behavioural challenges with solutions like team huddles.

Attitude of health professionals towards COVID-19 vaccination and associated factors among health professionals, Western Ethiopia: A cross-sectional survey

Introduction

Even though people of the world were eagerly waiting for the hope of vaccine development, vaccine hesitancy is becoming the top concern in both developed and developing countries. However, there is no adequate evidence regarding the attitude and perception of health professionals towards the COVID 19 vaccine in resource-limited settings like Ethiopia. The aim of this study was to assess health professionals’ attitudes and perceptions towards COVID 19 vaccine in Western Ethiopia.

Methods

An institution-based cross-sectional study was conducted among health care workers found in Nekemte town from April 14–21, 2021. A total of 439 health professionals present on duty during the study period was included in the study. The data were collected by using self-administered questionnaire. Epidata version 3.2 was used for data entry, and STATA version 14 was used for data analysis. The binary logistic regression model was employed to determine factors associated with the attitude towards COVID-19 vaccination. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared at a 5% level (p-value < 0.05).

Result

A total of 431 health professionals participated in the study yielding a response rate of 98.1%. The results indicated that 51.28% (95%CI: 45.12%, 57.34%) of health professionals had a favorable attitude towards COVID-19 vaccination. Having good knowledge about the COVID-19 vaccine (AOR = 0.38, 95%CI: 0.22, 0.64, P-value <0.001) was negatively associated with unfavorable attitude towards COVID-19 vaccine, whereas age less than 30 years (AOR = 2.14, 95%CI:1.25,3.67, P-value <0.001), working in a private clinic (AOR = 7.77, 95% CI: 2.19, 27.58, P-value <0.001) and health center (AOR = 2.45, 95%CI: 1.01, 5.92, P-value = 0.045) were positively associated with unfavorable attitude towards COVID-19 vaccine.

Conclusion and recommendation

In general, the attitude and perception of health care professionals toward the COVID-19 vaccine in the study area were unsatisfactory. Knowledge about the COVID-19 vaccine, age of health care workers, and place of work are the factors which affects attitude towards COVID-19 vaccine. Thus, we recommend the media outlets and concerned bodies to work to develop trust among the public by disseminating accurate and consistent information about the vaccine.

Knowledge and Utilization of PMTCT Services among Women accessing Antenatal Care in Private Health Facilities in Abakaliki, Nigeria

Prevention of mother-to-child transmission (PMTCT) of HIV programme provides antiretroviral treatment to HIV-positive pregnant women to reduce the likelihood of transmission to their infants. Despite concerted efforts to scale-up PMTCT services in Nigeria, coverage and uptake of the services by Antenatal Care (ANC) attendees is below the acceptable. Private health facilities provide ANC services to large number of women, but they are sparingly involved in PMTCT capacity enhancement interventions. This study assessed the knowledge and utilization of PMTCT services among women accessing antenatal care in Private Health facilities in Abakaliki, Ebonyi State. It was a descriptive cross-sectional study in ANC clinics of the health facilities. Data was collected using interviewer administered questionnaire and analysed with Statistical Package for Social Sciences (SPSS) version 22.0 and test of association was by Chi square at P<0.05 level of significance. Results showed mean age of the respondents was 27± 4.6 years. Majority of the respondents (83.4%) had good knowledge of PMTCT but only 68.4% accessed HIV Counselling and Testing (HCT) in the index pregnancy, with fear of stigmatization given as the major reason for not doing HCT. Only 54.5% of sero-positive attendees took anti-retroviral drugs (ARVs) during pregnancy though they all used ARVs during labour/ delivery. Utilization of PMTCT services of HIV wassignificantly associated with educational status and occupation. CONCLUSION: There was good knowledge of PMTCT but utilization of the services was suboptimal. Training and mentoring of health care workers in private facilities on HIV testing programmes is important to improve uptake of PMTCT services and allay fears of stigmatization among the pregnant women.

Comparing Antenatal and Delivery Care Services in Public and Private Health Facilities: Evidence from 2018 Nigeria Demographic and Health Survey

BACKGROUND

There have been calls for privatisation of public health facilities to improve quality of care received. The study compared antenatal and delivery services received in public and private health facilities in Nigeria.

METHODS

The study was based on 2018 Nigeria Demographic and Health Survey data collected from women aged 15-49 years, concerning their pregnancy and delivery. Data on those that attended antenatal clinic (ANC) in public or private facilities and had live births in the preceding five years was analysed. Simple logistic regression was used to test for association between type of facility for ANC and delivery and the care received.

RESULTS

A total of 15,811 women attended ANC in public (12,921, 81.7%) and private (2,890, 18.3%) facilities, and 12,399 delivered in public (8,583, 69.2%) and private (3,817, 30.8%) facilities. Type of facility attended was associated with number of ANC visits (OR=3.89; p<0.001), blood sample taken (OR=1.16; p=0.029), iron supplementation (OR=0.49; p<0.001), deworming (OR=0.74; p<0.001), receiving all the components of ANC service (OR=0.79; p<0.001), and skilled birth attendance (OR=3.81; p<0.001). However, it was not associated with blood pressure measurement (OR=1.07; p=0.459), urine sample taken (OR=1.05; p=0.486), postnatal check (OR=0.94; p=0.171) and timing of postnatal check (OR=0.73; p=0.185).

CONCLUSION

While private facilities had more ANC visits and skilled birth attendance, overall provision of ANC services was better in the public facilities. Therefore, antenatal and delivery services were not necessarily better in private facilities. Beyond availability, further studies are needed to compare the quality of antenatal and delivery services in public and private facilities.

Health services utilization and out-of-pocket (OOP) expenditures in public and private facilities in Pakistan: an empirical analysis of the 2013-14 OOP health expenditure survey

BACKGROUND

As low- and middle-income countries progress toward Universal Health Coverage, there is an increasing focus on measuring out-of-pocket (OOP) expenditure and health services utilization within countries. While there have been several reforms to improve health services coverage and financial protection in Pakistan, there is limited empirical research comparing OOP expenditure and health services utilization between public and private facilities and exploring their determinants, a knowledge gap addressed in this study.

METHODS

We used data from 2013 to 14 OOP Health Expenditure Survey, a population-based household survey carried out for Pakistan's National Health Accounts. The analysis included 7969 encounters from 4293 households. We conducted bivariate analyses to describe patterns of care utilization, estimated annualized expenditures by type and sector of care, and assessed expenditure composition. We used multivariable logistic regression modeling to identify factors associated with sector of care and generalized linear model (GLM) with log link and gamma distribution to identify determinants of OOP expenditures stratified by type of care (inpatient and outpatient).

RESULTS

Most encounters (82.5%) were in the private sector and were for outpatient visits (85%). Several public-private differences were observed in annualized expenditures and expenditure components. Logistic regression results indicate males, wealthier individuals, Punjab and Sindh residents, and those in smaller households were more likely to access private outpatient care. In the inpatient model, rural residents were more likely to use a private provider, while Khyber Pakhtunkhwa residents were less likely to use private care. GLM results indicate private sector inpatient expenditures were approximately PKR 6660 (USD 61.8) higher than public sector expenditures, but no public-private differences were observed for outpatient expenditures. Several demographic factors were significantly associated with outpatient and inpatient expenditures. Of note, expenditures increased with increasing wealth, decreased with increasing household size, and differed by province and region.

CONCLUSIONS

This is the first study comprehensively investigating how healthcare utilization and OOP expenditures vary by sector, type of care, and socio-economic characteristics in Pakistan. The findings are expected to be particularly useful for the next phase of social health protection programs and supply side reforms, as they highlight sub-populations with higher OOP and private sector utilization.

Person-centred care for abortion services in private facilities to improve women's experiences in Kenya

Globally, access to good quality abortion services and post-abortion care is a critical determinant for women's survival after unsafe abortion. Unsafe abortions account for high levels of maternal death in Kenya. We explored women's experiences and perceptions of their abortion and post-abortion care experiences in Kenya through person-centred care. This qualitative study included focus group discussions and in-depth interviews with women aged 18-35 who received safe abortion services at private clinics. Through thematic analyses of women's testimonies, we identified gaps in the abortion care and person-centred domains which seemed to be important throughout the abortion process. When women received clear communication and personalised comprehensive information on abortion and post-abortion care from their healthcare providers, they reported more positive experiences overall and higher reproductive autonomy. Communication and supportive care were particularly valued during the post-abortion period, as was social support more generally. Further research is needed to design, implement and test the feasibility and acceptability of person-centred abortion care interventions in community and clinical settings with the goal of improving women's abortion experiences and overall reproductive health outcomes.

Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania

OBJECTIVES

To identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania.

DESIGN

A cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation.

SETTING

Exit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July-August 2018.

PARTICIPANTS

Representative sample of 629 adults ≥18 years of age.

MAIN OUTCOMES MEASURES

(1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients' decision to attend a given provider. Data were analysed using mixed logistic regression models.

RESULTS

Nearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were 'quality of care' and 'healthcare professionals' attitudes. Solely looking at patients using a public provider, 'geographical proximity' was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider's patients, the 'availability of diagnostic devices' was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56).

CONCLUSION

The use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed.

Advancing toward normal operations for arenas and stadiums

The reopening of arenas and stadiums following closures due to the 2019 coronavirus disease (COVID-19) pandemic presents unique challenges related to large crowds and close contact between players, vendors, and spectators. While each venue should be assessed individually for development and implementation of reopening plans, the general guidance presented in this document can serve as a minimum baseline for considerations to reduce the risk of COVID-19 transmission in these venues. The intention of these guidelines is to provide a layered approach to risk mitigation for various aspects of particular concern in arenas and stadiums, including crowd management, tailgating and parking, restrooms, high-contact surfaces, face masks, food and merchandising, communications, athletes and support staff, press and third parties, intermissions/breaks, and downtime. The implementation of these multifaceted approaches in each area of concern, along with the integration of regulations and requirements from local, state, and federal government bodies and agencies, will reduce the risk of a single point of failure and offer some protection to those at arenas and stadiums from COVID-19 transmission. The approaches outlined are dynamic and should be regularly reviewed and revised as new information becomes available regarding the transmission of COVID-19.

Stroke in Sierra Leonean Africans:Perspectives from a Private Health Facility

BACKGROUND

Several stroke studies in West Africans have demonstrated a high proportion of haemorrhagic stroke and poor outcomes. This may be due to the socioeconomic status of patients and inadequate clinical care. Outcomes may well be different if more informed patients treated in better facilities are studied.

OBJECTIVE

To study the pattern of stroke and stroke outcomes in African patients attending a private hospital in Sierra Leone METHODS: 150 consecutive African stroke patients admitted to a private hospital in Sierra Leone were studied. Demographic details, risk factors, clinical features including blood pressure were recorded. CT scans, ECG, serum cholesterol, and blood sugar were done. Patients were reviewed at day 30 and Rankin scores allocated. Two sample independent t-test was used to compare means, and chi square to compare variables.

RESULTS

Hypertension was the most common risk factor present in 77.6% of patients prior to admission with diabetes in 29.5%. Other risk factors include previous stroke (11.7%), smoking (6.3%), hypercholesterolemia (23.4%), high alcohol intake (28.8%) and lack of exercise according to self-evaluation (87.5%). 76.3% of patients had ischaemic and 18.2% haemorrhagic stroke. 41% of patients aged 50 years or less had haemorrhagic stroke and 9.3% of patients had atrial fibrillation. In-patient mortality was 10.6%.

CONCLUSION

Stroke types and outcomes are different from those generally reported from the sub-region. This may well be due to the population studied, and the level of care provided by a private facility. Socio-economic factors, literacy and clinical care are likely determinants of stroke types and outcomes in African patients. . More detailed studies to confirm the effects of socioeconomic factors on stroke pattern and outcomes in Africa are needed.

How Do Public and Private Facilities Compare?

Background: Family planning (FP) is among the important interventions that reduce maternal mortality. Poor quality FP service is associated with lower services utilisation, in turn undermining the efforts to address maternal mortality. There is currently little research on the quality of FP services in the private sector in Ethiopia, and how it compares to FP services in public facilities. Methods: A secondary data analysis of two national surveys, Ethiopia Services Provision Assessment Plus Survey 2014 and Ethiopian Demographic and Health Survey 2016, was conducted. Data from 1094 (139 private, 955 public) health facilities were analysed. In total, 3696 women were included in the comparison of users’ characteristics. Logistic regression was conducted. Facility type (public vs. private) was the key exposure of interest. Results: The private facilities were less likely to have implants (Adjusted Odds Ratio (AOR) = 0.06; 95% Confidence Interval (CI): 0.03, 0.12), trained FP providers (AOR = 0.23; 95% CI: 0.14, 0.41) and FP guidelines/protocols (AOR = 0.33; 95% CI: 0.19, 0.54) than public facilities but were more likely to have functional cell phones (AOR = 8.20; 95% CI: 4.95, 13.59) and water supply (AOR = 3.37; 95% CI: 1.72, 6.59). Conclusion: This study highlights the need for strengthening both private and public facilities for public–private partnerships to contribute to increased FP use and better health outcomes.

Trends and patterns of second-hand smoke exposure amongst the non-smokers in India-A secondary data analysis from the Global Adult Tobacco Survey (GATS) I & II

Objectives

The primary objective of the present study was to compare the prevalence and patterns of second-hand smoke (SHS) exposure in the home, workplace, public places, and at all three places amongst the non-smoker respondents between the two rounds of Global Adult Tobacco Survey (GATS) in India. The secondary objectives were to assess the differences in various factors associated with SHS exposure among non-smokers.

Study design

This secondary data analysis incorporated data generated from the previous two rounds of the cross-sectional, nationally representative GATS India, which covered 69,296 and 74,037 individuals aged 15 years and above. Exposure to the SHS at home, workplace, and public places amongst the non-smokers were the primary outcome variables. Standard definitions of the surveys were used.

Results

The overall weighted prevalence of exposure to SHS amongst the non-smokers inside the home and public places reduced. In contrast, the prevalence in the workplace increased marginally in round II compared to I. The proportion of adults who were exposed to SHS at all three places did not change much in two rounds of surveys. A decrease in the knowledge of the respondents exposed to SHS at home and public places was observed about the harmful effects of smoking in round II. Age, gender, occupation, place, and region of respondents were found to be significant determinants of SHS exposure at all the three places on multinomial logistic regression analysis.

Conclusions

The study calls for focused interventions in India and stringent implementation of anti-tobacco legislation, especially in the workplaces for reducing the exposure to SHS amongst the non-smokers and to produce encouraging and motivating results by next round of the survey.

[Health protection guideline of hotels reconstructed as isolation places for close contacts during COVID-19 outbreak]

This guideline stipulates the health protection requirements for hotels reconstructed as isolation places for close contacts during COVID-19 outbreak, including requirements for hotels, personal health protection, and management. It is applicable to hotels reconstructed as isolation places for close contacts, such as general hotels, conference center, sanitariums, etc.

[Health protection guideline of conference designated hotel during COVID-19 outbreak]

This guideline stipulates the management requirements, personal protection and comprehensive security of conference designated hotels. It is applicable to the unified standard prevention and control of conference designated hotels during COVID-19 outbreak.

A comparison of long-term medium secure patients within NHS and private and charitable sector units in England

BACKGROUND

In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings.

AIMS

To describe and compare characteristics of long-stay patients in NHS and in PCS medium security hospital units.

METHODS

Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total.

RESULTS

178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients.

CONCLUSIONS

The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.

Treatment of Urethral Pain Syndrome (UPS) in Sweden

Background

Urethral Pain Syndrome (UPS) in women is a recurrent urethral pain without any proven infection or other obvious pathology. There are few studies on UPS, and evidence-based treatment is lacking. The primary aim was to study what treatments are used, and to compare the treatment tradition of UPS in Sweden in 2018, with what was used in 2006.

Methods

A questionnaire on the treatment of women with UPS was sent to all public gynecology, urology, gynecologic oncology and venereology clinics, and one public general practice in each county in Sweden in 2018. Private practice clinics in gynecology responded to the survey in 2017. Comparisons were made with the same survey sent to gynecology and urology clinics in 2006.

Findings

Of 137 invited clinics in 2018, 99 (72.3%) responded to the survey. Seventy-seven (77.8%) of them saw women with UPS and 79.2% (61/77) of these clinics treated the patients using 19 different treatment methods. Local corticosteroids and local estrogens were the methods most used. Treatments were similar in gynecology and urology clinics in 2006 and 2018, although strong corticosteroids had increased in use in the treatment regimens of 2018. More than half of the clinics used antibiotics.

Interpretation

Since there is no evidence-based treatment of UPS, a wide spectrum of treatments is used, and different specialties use different treatment strategies. Despite the lack of proven infection, a large number of clinics also treated the syndrome with antibiotics. There is thus a need for well-designed randomized controlled clinical trials to find evidence-based treatments of UPS.

From situated space to social space: Dyke bar commemoration as reparative action

Drawing on an ethnography of dyke bar commemoration in four U.S. cities, this article applies Sedgwick's concept of "reparative reading" to commemorative practices, tracing how commemorators leverage this reading to guide a logic of reparative action. They commemorate material spaces rooted in place, but cultivate mobile and inclusive space. That is, commemorators, most of whom have had limited exposure to the spaces that they mourn, carefully situate the lost dyke bar, highlighting geographic, esthetic, demographic, and temporal attributes. The images they construct of the situated bar contrast with their commemorative events, which emphasize social over alternate attributes. Commemorators repair and critique the situated bar - not to restore it, but to harness it for their forward-facing efforts - by using memory to advocate for a move from specificity to generality; from situated to mobile and inclusive social spaces. I elucidate how this turn toward social space and bar commemoration itself emerges not merely from institutional and territorial loss, but from commitments to diversity, inclusivity, and queer identities and politics.

Maternal dissatisfaction with their children's body size in private schools in the Federal District, Brazil

We investigated the prevalence of maternal dissatisfaction with their child's body size and its associated factors among mothers of first- to third-grade elementary school students in private schools in the Federal District, Brazil. This is a cross-sectional study with 548 mother-schoolchildren pairs. We measured children's weight and height, and collected their mother's sociodemographic data and Body Mass Index using an online questionnaire. We also verified maternal body dissatisfaction and maternal dissatisfaction with their child's body size using Shape Scales. Most mothers (50.5%) were dissatisfied with their child's body size. Mothers of boys (Adjusted OR = 2.85) were more likely to want a larger silhouette for their child, while mothers of girls (Adjusted OR = 3.18), overweight (Adjusted OR = 24.83) and obese (Adjusted OR = 189.86) children were more likely to want a thinner silhouette for their child. A positive correlation was observed between maternal dissatisfaction with their own body and maternal dissatisfaction with their children's body size (rs = 0.178). There was a high prevalence of maternal dissatisfaction with their child's body size, particularly among mothers of overweight and obese children. Additional studies should be conducted to better understand the influence of this dissatisfaction on maternal practices and attitudes related to their child's body, food consumption, and lifestyle.

Barriers to Shared Use of Indoor and Outdoor Facilities at US Elementary Schools

BACKGROUND

School policies and practices, such as the sharing of school facilities with the surrounding community, support physical activity among students and community members, but are often underutilized. This study examined variations in shared use practices, and associations with perceived barriers.

METHODS

Surveys were completed by a nationally representative sample of 640 public elementary schools across the United States. Administrators reported on their school's practices related to the shared use of indoor and outdoor facilities, and perceived barriers to sharing. Multivariate logistic regression models were used to examine associations between barriers and practices.

RESULTS

Liability or legal concerns, staffing expenses, and facility operation costs were most frequently reported as barriers, while lack of adequate facilities and perceived lack of community interest were less common. Cost concerns and perceived lack of community interest were most strongly associated with lack of sharing.

CONCLUSIONS

Although liability or legal concerns are common, such concerns are not necessarily associated with less sharing when other factors are taken into account. Administrators' perceptions about lack of community interest were associated with less sharing, but these perceptions may not accurately reflect the community's perspective. Active development of partnerships could increase access to school facilities.

Airborne particles in indoor environment of homes, schools, offices and aged care facilities: The main routes of exposure

It has been shown that the exposure to airborne particulate matter is one of the most significant environmental risks people face. Since indoor environment is where people spend the majority of time, in order to protect against this risk, the origin of the particles needs to be understood: do they come from indoor, outdoor sources or both? Further, this question needs to be answered separately for each of the PM mass/number size fractions, as they originate from different sources. Numerous studies have been conducted for specific indoor environments or under specific setting. Here our aim was to go beyond the specifics of individual studies, and to explore, based on pooled data from the literature, whether there are generalizable trends in routes of exposure at homes, schools and day cares, offices and aged care facilities. To do this, we quantified the overall 24h and occupancy weighted means of PM₁₀, PM_2.5 and PN - particle number concentration. Based on this, we developed a summary of the indoor versus outdoor origin of indoor particles and compared the means to the WHO guidelines (for PM₁₀ and PM_2.5) and to the typical levels reported for urban environments (PN). We showed that the main origins of particle metrics differ from one type of indoor environment to another. For homes, outdoor air is the main origin of PM₁₀ and PM_2.5 but PN originate from indoor sources; for schools and day cares, outdoor air is the source of PN while PM₁₀ and PM_2.5 have indoor sources; and for offices, outdoor air is the source of all three particle size fractions. While each individual building is different, leading to differences in exposure and ideally necessitating its own assessment (which is very rarely done), our findings point to the existence of generalizable trends for the main types of indoor environments where people spend time, and therefore to the type of prevention measures which need to be considered in general for these environments.

Focus on patient dignity

What does your job involve? It is hands-on and strategic. I spend intensive time with five dementia care communities. This involves practical clinical supervision on the floor, reviewing dementia training and helping to develop the overall dementia strategy.

External quality assessment of AFB smear microscopy performances and its associated factors in selected private health facilities in Addis Ababa, Ethiopia

Tuberculosis (TB) is still a public health problem in sub Saharan African countries. In resource-limited settings, TB diagnosis relies on sputum smear microscopy, with low and variable sensitivities, especially in paucibacillary pediatric and HIV-associated TB patients. Tuberculosis microscopy centers have several weaknesses like overworking, insufficiently trained personnel, inconsistent reagent supplies, and poorly maintained equipments; thus, there is a critical need for investments in laboratory infrastructure, capacity building, and quality assurance schemes. The performance of TB microscopy centers in the private health facilities in Addis Ababa is not known so far. The main objective of the study was to assess laboratory performance of acid fast bacilli (AFB) smear microscopy and its associated factors in selected private health facilities in Addis Ababa, Ethiopia. A cross-sectional study was conducted in 33 selected private health facilities of Addis Ababa, Ethiopia comprising 7 hospitals, 2 NGO health centers, 23 higher clinics and 1 diagnostic laboratory that provide AFB smear microscopy services. The study was conducted from January to April 2014. A total of 283 stained sputum smears were randomly collected from participant laboratories for blinded rechecking, 320 panel slides were sent to 32 microscopy centers to evaluate their performance on AFB reading, staining and reporting. Checklists were used to assess quality issues of laboratories. Data were captured, cleaned, and analyzed using SPSS version 16.0; χ(2) tests, kappa statistics were used for comparison purpose. P value < 0.05 considered statistically significant. Among the 32 participant laboratories, 2-scored 100%, 15 scored 80-95% & the remaining 15 scored 50-75% for overall proficiency test performance. There were 10 (3.15%) major errors and 121 (37.8%) minor errors. The sensitivity, specificity, PPV and NPV of panel reading by microscopy centers were 89%, 96%, 96%, and 90% respectively. Out of 283 randomly selected slides for blind rechecking, 11 (3.9%) slides interpreted falsely for AFB, with overall agreement of 97.5%, sensitivity of 88.4% and specificity of 99.3%. In terms of slide quality assessment, 71.6% of AFB slides were graded as good for evenness, cleanness, thickness, size, staining and labeling. The performance score for AFB slide evenness was 56.9% (161 slides) and for labeling quality was 90.8% (257 slides); having significant difference in slide quality (p value < 0.05). On-site evaluation indicated problems in terms of infrastructure, standard operating procedure, reagent quality; equipment maintenance, data management and training issues. Most of the health facilities had poor maintenance scheme for microscope (53.5%) and poor inventory management (25.0%) system. Microscopy centers that scored a proficiency of 75.5%; which is below the acceptable minimum score of 80% and an overall error rate of 3.9% for blinded rechecking needs attention. Moreover, there are gaps identified through on site assessment including poor SOP, reagent quality, equipment maintenance, data management & lack of updated training on AFB microscopy techniques, requiring a concerted effort to alleviate the bottle neck problems and strengthening the public private partnership to control TB.

First-trimester medical abortion practices in Canada: National survey

OBJECTIVE

To understand the current availability and practice of first-trimester medical abortion (MA) in Canada.

DESIGN

Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013.

SETTING

Canada.

PARTICIPANTS

A total of 94 abortion facilities were identified.

MAIN OUTCOME MEASURES

Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ² and t tests.

RESULTS

A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine.

CONCLUSION

In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed.