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Sales J, Normandin L, Pomey MP. Care and services partnership in Quebec birthing centres: myth or reality? BMC Pregnancy Childbirth 2024; 24:177. [PMID: 38454331 PMCID: PMC10918890 DOI: 10.1186/s12884-024-06362-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
CONTEXT Working with women to best meet their needs has always been central to midwifery in Quebec, Canada. The creation of birthing centres at the end of the 1990s consolidated this desire to prioritize women's involvement in perinatal care and was intended to encourage the establishment of a care and services partnership between care providers and users. The aim of this pilot study is to evaluate the perceptions of clients, midwives and birth assistants of the way in which women are involved in partnership working in Quebec birthing centres. METHODS A single qualitative case and pilot study was conducted with midwives (n = 5), birth assistants (n = 4), a manager (n = 1), clients (n = 5) and members of the users' committee (n = 2) at a birthing centre in Quebec, Canada in July and August 2023. The partnership was evaluated using the dimensions of a validated CADICEE questionnaire. RESULTS The women and professionals stressed that the relationship was established in a climate of trust. The caregivers also attached importance to autonomy, information sharing and decision-making, adaptation to context, empathy and recognition of the couple's expertise. The women confirmed that they establish a relationship of trust with the professionals when the latter show empathy and that they adapt the follow-up to their knowledge and life context. Key factors in establishing this kind of care relationship are the time given, a de-medicalized environment, the comprehensive care received, and professionals who are well-informed about the partnership. In addition, the birthing centre has a users' committee that can put forward ideas but has no decision-making powers. CONCLUSIONS Both the women and the professionals at the birthing centre appear to be working in partnership. However, at the organizational level, the women are not involved in decision-making. A study of all birthing centres in Quebec would provide a more comprehensive picture of the situation.
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Affiliation(s)
| | - Louise Normandin
- Research Centre, University of Montreal Hospital Centre, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre, University of Montreal Hospital Centre, Montréal, QC, Canada.
- Centre d'excellence sur le partenariat avec les patients et le public, Montréal, QC, Canada.
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montréal, 7101 Av du Parc 3e étage, Montréal, QC, H3N 1X9, Canada.
- Department of Family Medicine and Emergency, University of Montreal, Montréal, QC, Canada.
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Saito A, Kondo M. Continuum of care for maternal and child health and child undernutrition in Angola. BMC Public Health 2024; 24:680. [PMID: 38439029 PMCID: PMC10910721 DOI: 10.1186/s12889-024-18144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Continuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status. METHODS We used nationally representative data from the Angola 2015-2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels. RESULTS The prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight. CONCLUSIONS The completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.
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Affiliation(s)
- Akiko Saito
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan.
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 3058577, Japan
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Kerr J, Smith A, Nzama N, Bullock NAA, Chandler C, Osezua V, Johnson K, Rozema I, Metzger IW, Harris LM, Bond K, LaPreze D, Rice BM. Systematic Review of Neighborhood Factors Impacting HIV Care Continuum Participation in the United States. J Urban Health 2024; 101:31-63. [PMID: 38093034 PMCID: PMC10897076 DOI: 10.1007/s11524-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/07/2024]
Abstract
Social determinants have been increasingly implicated in accelerating HIV vulnerability, particularly for disenfranchised communities. Among these determinants, neighborhood factors play an important role in undermining HIV prevention. However, there has been little research comprehensively examining the impact of neighborhood factors on HIV care continuum participation in the US. To address this, we conducted a systematic review (PROSPERO registration number CRD42022359787) to determine neighborhood factors most frequently associated with diminished HIV care continuum participation. Peer-reviewed studies were included if published between 2013 - 2022, centralized in the US, and analyzed a neighborhood factor with at least one aspect of the HIV care continuum. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Study quality was guided by LEGEND (Let Evidence Guide Every New Decision) evaluation guidelines. Systematic review analysis was conducted using Covidence software. There were 3,192 studies identified for initial screening. Forty-four were included for review after eliminating duplicates, title/abstract screening, and eligibility assessment. Social and economic disenfranchisement of neighborhoods negatively impacts HIV care continuum participation among persons living with HIV. In particular, five key neighborhood factors (socioeconomic status, segregation, social disorder, stigma, and care access) were associated with challenged HIV care continuum participation. Race moderated relationships between neighborhood quality and HIV care continuum participation. Structural interventions addressing neighborhood social and economic challenges may have favorable downstream effects for improving HIV care continuum participation.
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Affiliation(s)
- Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA.
| | - Adrienne Smith
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nqobile Nzama
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nana Ama Aya Bullock
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Cristian Chandler
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Victory Osezua
- Public Health Program, Gwynedd Mercy University, Gwynedd Valley, PA, USA
| | - Karen Johnson
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Isabel Rozema
- University of Louisville Health, Louisville, KY, USA
| | - Isha W Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lesley M Harris
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Keosha Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
| | - Dani LaPreze
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, USA
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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Mirza M, Verma M, Aggarwal A, Satpathy S, Sahoo SS, Kakkar R. Indian Model of Integrated Healthcare (IMIH): a conceptual framework for a coordinated referral system in resource-constrained settings. BMC Health Serv Res 2024; 24:42. [PMID: 38195544 PMCID: PMC10777560 DOI: 10.1186/s12913-023-10454-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION With the escalating burden of chronic disease and multimorbidity in India, owing to its ageing population and overwhelming health needs, the Indian Health care delivery System (HDS) is under constant pressure due to rising public expectations and ambitious new health goals. The three tired HDS should work in coherence to ensure continuity of care, which needs a coordinated referral system. This calls for optimising health care through Integrated care (IC). The existing IC models have been primarily developed and adopted in High-Income Countries. The present study attempts to review the applicability of existing IC models and frame a customised model for resource-constrained settings. METHODS A two-stage methodology was used. Firstly, a narrative literature review was done to identify gaps in existing IC models, as per the World Health Organization framework approach. The literature search was done from electronic journal article databases, and relevant literature that reported conceptual and theoretical concepts of IC. Secondly, we conceptualised an IC concept according to India's existing HDS, validated by multiple rounds of brainstorming among co-authors. Further senior co-authors independently reviewed the conceptualised IC model as per national relevance. RESULTS Existing IC models were categorised as individual, group and disease-specific, and population-based models. The limitations of having prolonged delivery time, focusing only on chronic diseases and being economically expensive to implement, along with requirement of completely restructuring and reorganising the existing HDS makes the adoption of existing IC models not feasible for India. The Indian Model of Integrated Healthcare (IMIH) model proposes three levels of integration: Macro, Meso, and Micro levels, using the existing HDS. The core components include a Central Gateway Control Room, using existing digital platforms at macro levels, a bucket overflow model at the meso level, a Triple-layered Concentric Circle outpatient department (OPD) design, and a three-door OPD concept at the micro level. CONCLUSION IMIH offers features that consider resource constraints and local context of LMICs while being economically viable. It envisages a step toward UHC by optimising existing resources and ensuring a continuum of care. However, health being a state subject, various socio-political and legal/administrative issues warrant further discussion before implementation.
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Affiliation(s)
- Moonis Mirza
- Department of Hospital Administration, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
| | - Arun Aggarwal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sidhartha Satpathy
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya Swaroop Sahoo
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Rakesh Kakkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
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Shakir M, Altaf A, Irshad HA, Hussain N, Pirzada S, Tariq M, Trillo-Ordonez Y, Enam SA. Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and Middle-Income Countries: A Systematic Review. World Neurosurg 2023; 180:169-193.e3. [PMID: 37689356 DOI: 10.1016/j.wneu.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs. METHODS A systematic review was conducted with PubMed, Scopus, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively. RESULTS A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to prehospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%), and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house computed tomography scanners (35%), malfunctioning computed tomography scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%), and financial constraints (14%) were identified. CONCLUSIONS Several factors, both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Ahmed Altaf
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Nowal Hussain
- Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sonia Pirzada
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Mahnoor Tariq
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Rahman MH, Akter E, Ameen S, Jabeen S, Ahmed A, Rahman AE, Hossain AT. Disparities in the maternal healthcare continuum among Bangladeshi women: evidence from nationally representative surveys. Midwifery 2023; 127:103814. [PMID: 37806164 DOI: 10.1016/j.midw.2023.103814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Utilisation of maternal healthcare is low, and it consistently decreases across antenatal to postnatal period in Bangladesh. However, there is paucity of knowledge in Bangladesh to understand gaps and associated factors in seeking continuum of maternal healthcare along the pathway. Therefore, we aimed to assess the trend in socioeconomic and demographic factors and wealth inequity in maternal CoC using the Bangladesh Multiple Indicator Cluster Survey (MICS). METHODS We performed a secondary analysis on nationally representative data from the last two MICS survey, carried out in 2012-13 and 2019. The study included women of reproductive age (15-49 years) with a live birth within two years preceding the survey. Total of 7,950 and 9,183 respondents were identified from these two surveys, respectively. We used multivariable logistic regression and concentration index to examine the covariates and inequity, respectively, in the utilisation of CoC. RESULTS Utilisation of ≥4 antenatal care, skilled delivery, and postnatal care for both mother and newborn increased from 13 percent in 2012-13 to 25 percent in 2019 survey. Moreover, wealth inequity persists favouring the rich in utilisation of CoC in Bangladesh. Women belonging to wealthier quintile, urban areas, and non-Muslim families, with higher education, a household head with higher education, media use, and fewer children were most likely to avail complete CoC in both the surveys. CONCLUSION Overall utilisation of maternal CoC increased between 2012 and 13 and 2019, however, women in Bangladesh still lack the CoC with persistent wealth inequality. Integrated provision of ANC, delivery by SBA, and PNC should be introduced, comprising both private and public health facilities, and targeting women in poor and rural communities. Efforts should also focus on women's education, autonomy, fertility rate, and exposure to media.
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Affiliation(s)
- Md Hafizur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).
| | - Ema Akter
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Sabrina Jabeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
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Bobo FT, Asante A, Woldie M, Dawson A, Hayen A. Evaluating equity across the continuum of care for maternal health services: analysis of national health surveys from 25 sub-Saharan African countries. Int J Equity Health 2023; 22:239. [PMID: 37978385 PMCID: PMC10656898 DOI: 10.1186/s12939-023-02047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Ensuring access to the continuum of care for maternal, neonatal, and child health is an effective strategy for reducing maternal and child mortality. We investigated the extent of dropout, wealth-related inequalities, and drivers of inequality in the continuum of care for maternal health services in sub-Saharan Africa. METHODS We analysed Demographic and Health Surveys (DHS) conducted between 2013 and 2019 across 25 sub-Saharan African countries. We defined the continuum of care for maternal health services as women who had received at least four ANC contacts (ANC 4 + contacts), skilled care at birth, and immediate postnatal care (PNC). We used concentration index to estimate wealth-related inequalities across the continuum of care. Multilevel logistic regression models were used to identify predictors of inequality in completing the continuum of care. RESULTS We included data on 196,717 women with the most recent live birth. About 87% of women reported having at least one ANC contact, but only 30% of women received the recommended care package that includes ANC 4 + contacts, skilled care at birth, and PNC. The proportion of women who had completed the continuum of care ranged from 6.5% in Chad to 69.5% in Sierra Leone. Nearly 9% of women reported not having contact with the health system during pregnancy or childbirth; this ranged from 0.1% in Burundi to 34% in Chad. Disadvantaged women were more likely to have no contact with health systems and less likely to have the recommended care package than women from wealthier households. Women with higher education levels, higher exposure to mass media (radio and TV), and higher household wealth status had higher odds of completing the continuum of care. CONCLUSIONS Persistent and increasing inequalities were observed along the continuum of care from pregnancy to the postnatal period, with socioeconomically disadvantaged women more likely to drop out of care. Improving access to and integration of services is required to improve maternal health. Initiatives and efforts to improve maternal health should prioritise and address the needs of communities and groups with low coverage of maternal health services.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
- Department of Health Systems and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Hayen
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Latronico N, Rasulo FA, Eikermann M, Piva S. Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, treatment, and long-term outcomes. Crit Care 2023; 27:439. [PMID: 37957759 PMCID: PMC10644573 DOI: 10.1186/s13054-023-04676-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/04/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Severe weakness associated with critical illness (CIW) is common. This narrative review summarizes the latest scientific insights and proposes a guide for clinicians to optimize the diagnosis and management of the CIW during the various stages of the disease from the ICU to the community stage. MAIN BODY CIW arises as diffuse, symmetrical weakness after ICU admission, which is an important differentiating factor from other diseases causing non-symmetrical muscle weakness or paralysis. In patients with adequate cognitive function, CIW can be easily diagnosed at the bedside using manual muscle testing, which should be routinely conducted until ICU discharge. In patients with delirium or coma or those with prolonged, severe weakness, specific neurophysiological investigations and, in selected cases, muscle biopsy are recommended. With these exams, CIW can be differentiated into critical illness polyneuropathy or myopathy, which often coexist. On the general ward, CIW is seen in patients with prolonged previous ICU treatment, or in those developing a new sepsis. Respiratory muscle weakness can cause neuromuscular respiratory failure, which needs prompt recognition and rapid treatment to avoid life-threatening situations. Active rehabilitation should be reassessed and tailored to the new patient's condition to reduce the risk of disease progression. CIW is associated with long-term physical, cognitive and mental impairments, which emphasizes the need for a multidisciplinary model of care. Follow-up clinics for patients surviving critical illness may serve this purpose by providing direct clinical support to patients, managing referrals to other specialists and general practitioners, and serving as a platform for research to describe the natural history of post-intensive care syndrome and to identify new therapeutic interventions. This surveillance should include an assessment of the activities of daily living, mood, and functional mobility. Finally, nutritional status should be longitudinally assessed in all ICU survivors and incorporated into a patient-centered nutritional approach guided by a dietician. CONCLUSIONS Early ICU mobilization combined with the best evidence-based ICU practices can effectively reduce short-term weakness. Multi-professional collaborations are needed to guarantee a multi-dimensional evaluation and unitary community care programs for survivors of critical illnesses.
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Affiliation(s)
- Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy.
- "Alessandra Bono" Interdepartmental University Research Center On Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy.
| | - Frank A Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy
- "Alessandra Bono" Interdepartmental University Research Center On Long-Term Outcome (LOTO) in Critical Illness Survivors, University of Brescia, Brescia, Italy
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Emergency, ASST Spedali Civili University Hospital, Piazzale Ospedali Civili, 1, 25123, Brescia, Italy
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Aoki A, Mochida K, Balogun OO, Tomo CK, Tchicondingosse L, Sapalalo P, Aiga H, Francisco KR, Takehara K. Association between the continuum of care and postpartum depression among Angolan mothers. J Affect Disord 2023; 339:325-332. [PMID: 37442453 DOI: 10.1016/j.jad.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/08/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND This study investigated the association between maternal and child health service utilization patterns and postpartum depression (PPD). METHODS This study analyzed a dataset of women who participated in a randomized controlled trial to examine the effectiveness of the Maternal and Child Health Handbook in Angola. We defined probable PPD as an Edinburgh Postpartum Depression Scale (EPDS) score ≥ 10. The EPDS was administered at approximately 6 months postpartum. Service utilization patterns were defined using numbers of antenatal care (ANC), facility delivery, and vaccination visits by 6 months postpartum. The association between service utilization patterns and PPD was examined using logistic regression analyses adjusting for socioeconomic factors and parity. The continuum of care (CoC) complete pattern (four ANC/facility delivery/four vaccination) was used as a reference. RESULTS The data of 7087 participants whose children were alive and aged 6 months or older at the endline survey were analyzed. Prevalence of PPD was 17.9 % in urban and 43.2 % in rural municipalities. In urban municipalities, dropouts from the CoC at delivery and after delivery had significantly higher odds of PPD (AOR = 1.45, 95 % CI = 1.00-2.10; AOR = 1.57, 95 % CI = 1.24-1.99). In rural municipalities, dropouts from the CoC after delivery (AOR = 1.60, 95 % CI = 1.12-2.28) had significantly higher odds of PPD. LIMITATIONS The onset of depressive symptoms was not assessed. The EPDS was validated in some Portuguese speaking countries but not in Angola. CONCLUSION PPD was associated with irregular service utilization patterns such as dropouts from the CoC. Therefore, CoC and mental health must be promoted simultaneously.
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Affiliation(s)
- Ai Aoki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
| | - Keiji Mochida
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | | | - Caroline Kaori Tomo
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | | | - Pedro Sapalalo
- Domus Custodius (SU) Lda. Tchikos Agency, Luanda, Angola
| | - Hirotsugu Aiga
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Human Development Department, Japan International Cooperation Agency, Tokyo, Japan
| | | | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rustagi N, Dileepan S, Mittal A, Solanki HK, Kelly D, Raghav P. Untapped potential of commercial drivers in providing post-crash care to road traffic accident victims: A cross-sectional study from fast urbanizing city of Jodhpur, India. J Neurosci Rural Pract 2023; 14:629-636. [PMID: 38059251 PMCID: PMC10696313 DOI: 10.25259/jnrp_145_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Most road traffic accident (RTA) deaths occur before victim reaches a definitive trauma care facility. The aim of the study was to determine the role of commercial drivers toward providing post-crash care to RTA victims in Jodhpur, Rajasthan. Materials and Methods This cross-sectional study assessed the role of commercial auto-rickshaw and cab drivers for providing post-crash care in urban Jodhpur during 2019-2020. Eligible participants volunteering for the study were included from taxi and auto stands in urban Jodhpur. A pre-tested questionnaire was administered by a trained interviewer. Data analysis was done using SPSS v23.0. Summary measures in terms of frequencies, means, and range are reported. Chi-square test, Fisher's Exact test, and Multivariate Logistic Regression analysis were done for statistical associations. Results Two hundred male participants completed the study with a mean age of 37.74 (8.96) years having an average work experience as commercial drivers of more than 10 years. Over 70% of participants witnessed RTA in the past year and 52% provided care to victims. The knowledge of post-crash care was most affected by their education level (adjusted odds ratio [aOR]: 1.778, 95% confidence interval [CI]: 0.958, 3.301), whereas the intended post-crash care practices were significantly better among participants with previous training (aOR: 15.376, 95% CI: 2.149, 110.017). Conclusion The current study establishes the role of commercial drivers as first responders at accident sites in the fast urbanizing city of Jodhpur, Rajasthan. Systematic capacity building initiatives of commercial drivers to salvage RTA victims have potential to strengthen pre-hospital trauma care continuum in non-metro districts of India experiencing high burden of accidents.
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Affiliation(s)
- Neeti Rustagi
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - S. Dileepan
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Ankit Mittal
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Hariom Kumar Solanki
- Department of Community Medicine, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Dervla Kelly
- Department of Medical Education, School of Medicine, University of Limerick, Limerick, Ireland
| | - Pankaja Raghav
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences Jodhpur, Jodhpur, Rajasthan, India
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Bhaumik S, Norton R, Jagnoor J. Structural capacity and continuum of snakebite care in the primary health care system in India: a cross-sectional assessment. BMC Prim Care 2023; 24:160. [PMID: 37563556 PMCID: PMC10416377 DOI: 10.1186/s12875-023-02109-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND In 2019, the World Health Organization, set a target to halve the burden of snakebite, by 2030, and identified 'health systems strengthening' as a key pillar of action. In India, the country with most snakebite deaths, the Union Government identified (in September 2022) training of health workers as a priority action area. In this policy context, we provide empirical evidence by analysing the most recent nationwide survey data (District Level Household and Facility Survey - 4), to assess structural capacity and continuum of snakebite care in primary health care system in India. METHODOLOGY We evaluated structural capacity for snakebite care under six domains: medicines, equipment, infrastructure, human resources, governance and finance, and health management information systems (HMIS). We categorised states (aspirant, performer, front-runner, achiever) based on the proportion of primary health centres (PHC) and community health centres (CHC), attaining highest possible domain score. We assessed continuum of snakebite care, district-wise, under five domains (connectivity to PHC, structural capacity of PHC, referral from PHC to higher facility, structural capacity of CHC, referral from CHC to higher facility) as adequate or not. RESULTS No state excelled ( front-runner or achiever) in all six domains of structural capacity in PHCs or CHCs. The broader domains (physical infrastructure, human resources for health, HMIS) were weaker compared to snakebite care medicines in most states/UTs, at both PHC and CHC levels. CHCs faced greater concerns regarding human resources and equipment availability than PHCs in many states. Among PHCs, physical infrastructure and HMIS were aspirational in all 29 assessed states, while medicines, equipment, human resources, and governance and finance were aspirational in 8 (27.6%), 2 (6.9%), 17 (58.6%), and 12 (41.4%) states respectively. For CHCs, physical infrastructure was aspirational in all 30 assessed states/UTs, whereas HMIS, medicines, equipment, human resources, and governance and finance were aspirational in 29 (96.7%), 11 (36.7%), 27 (90%), 26 (86.7%), and 3 (10%) states respectively. No district had adequate continuum of snakebite care in all domains. Except for transport availability from CHC to higher facilities (48% of districts adequate) and transport availability from PHC to higher facilities (11% of districts adequate), fewer than 2% of districts were adequate in all other domains. CONCLUSION Comprehensive strengthening of primary health care, across all domains, and throughout the continuum of care, instead of a piece-meal approach towards health systems strengthening, is necessitated to reduce snakebite burden in India, and possibly other high-burden nations with weak health systems. Health facility surveys are necessitated for this purpose.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
- Injury Division, The George Institute for Global Health, New Delhi, India.
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Imperial College, London, UK
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Yang X, Li L, Zhang N, Hao L, Zhu X, Yu H, Wang G, Kang D. Analysis on epidemiological characters and HIV care continuum of HIV-infected students: a retrospective cohort study in Shandong province, China. BMC Infect Dis 2023; 23:496. [PMID: 37501181 PMCID: PMC10373422 DOI: 10.1186/s12879-023-08476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUD The proportion of HIV-infected students in China showed an increasing trend. This study aimed to identify the epidemiological characteristics and the HIV care continuum for HIV-infected students in Shandong Province, China. METHODS Case report and follow-up data of HIV-infected students were obtained from the National HIV/AIDS comprehensive response information management system. Logistic regression analyses were used to analyze the associating factors of HIV-infected students accepting CD4 + T cells (CD4) test and antiviral therapy (ART) in 30 days, and ArcGIS software was used for the spatial anlysis. RESULTS From 2017 to 2019, 403 HIV-infected students were reported in Shandong Province. The majority of them were male (99.5%) and transmitted through homosexual sexual activity(92.1%). Most of them lived in Jinan city and Qingdao city. 68.5% (276 cases) accepted CD4 test in 30 days, and 48.6% (196 cases) started ART in 30 days. The heterosexual transmitted cases (AOR = 0.458, 95%CI: 0.210-0.998), patients accepting HIV care in western area (AOR = 0.266,95%CI: 0.147-0.481) were less likely to test CD4 within 30 days; patients aged 23-25 (AOR = 2.316, 95%CI: 1.009-5.316) and patients who had tested CD4 within 30 days (AOR = 4.377; 95%CI: 2.572-7.447) prefered to receive ART within 30 days; patients accepted HIV care in central area (AOR = 0.407; 95%CI: 0.251-0.657) and western area (AOR = 0.508; 95%CI: 0.261-0.989) and patients diagnosed by voluntary blood donation (AOR = 0.352; 95%CI: 0.144-0.864) were less willing to receive ART in 30 days. CONCLUSIONS The HIV care continuum of HIV-infected students in Shandong Province still needed strenghthing. More health education and case management should be done for cases transmitted through heterosexual behavior, accepted HIV care in central and western area, and diagnosed by voluntary blood donation.
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Affiliation(s)
- Xingguang Yang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Ling Li
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Na Zhang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Lianzheng Hao
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Xiaoyan Zhu
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Haiying Yu
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Guoyong Wang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China.
| | - Dianmin Kang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, China
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Birhanu F, Yitbarek K, Woldie M. Client retention in the continuum of maternal health services in Ethiopia. BMC Health Serv Res 2023; 23:569. [PMID: 37268946 DOI: 10.1186/s12913-023-09602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Even though the global maternal mortality has shown an impressive decline over the last three decades, the problem is still pressing in low-income countries. To bring this to an end, women in a continuum of maternity care should be retained. This study aimed to assess the status of Ethiopian women's retention in the continuum of maternity care with their possible predictors. METHODS We used data from the 2019 Ethiopian Mini-Demographic and Health Survey. The outcome variable in this study was retention in the continuum of maternity care, which consists of at least four ANC contacts, delivery in a health facility, and postnatal check within 48 h of delivery. We analyzed the data using STATA version 14 and a binary logistic regression model was used. In the multiple logistic regression model, variables with a p-value ≤ 0.05 were considered as significantly associated with the outcome variable. A weighted analysis was also done. RESULTS Of the 3917 women included in this study, only 20.8% of women completed all of the recommended services. Besides, the use of maternal health services favors women living in the biggest city administrations, followed by women living in agrarian regions; however, those living in the pastoralist area were disadvantaged. Having four or more ANC was explained by the maternal secondary level of education [AOR: 2.54; 95% CI: 1.42, 4.54], wealth status [AOR: 2.59; 95% CI: 1.45, 4.62], early initiation of ANC [AOR: 3.29; 95% CI: 2.55, 4.24], and being in a union [AOR: 1.95; 95% CI: 1.16,3.29]. After having four ANC, factor-affecting delivery in a health facility was wealth status [AOR: 8.64; 95% CI: 4.07, 18.36]. The overall completion of care was associated with women's higher level of education [AOR: 2.12; 95% CI: 1.08, 4.25], richest wealth status [AOR: 5.16; 95% CI: 2.65, 10.07], timeliness of the first ANC visit [AOR: 2.17; 95% CI: 1.66, 2.85], and third birth order [AOR: 0.58; 95% CI: 0.35, 0.97]. CONCLUSIONS Despite the efforts by the Ethiopian government and other stakeholders, the overall completion of care was quite low. There is also a clear inequality because of women's background characteristics and regional variation. Strategies aiming to empower women through improved educational experience and economic standing have to be implemented in collaboration with other relevant sectors.
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Affiliation(s)
- Frehiwot Birhanu
- School of Public Health, College of Health Science, Mizan-Tepi University, P.O.B. 260, Mizan-Aman, Ethiopia.
| | - Kiddus Yitbarek
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
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Abate Y, Solomon K, Azmera YM, de Fouw M, Kaba M. Barrier analysis for continuity of palliative care from health facility to household among adult cancer patients in Addis Ababa, Ethiopia. BMC Palliat Care 2023; 22:57. [PMID: 37173667 PMCID: PMC10175902 DOI: 10.1186/s12904-023-01181-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Annually 57 million people across the globe require palliative care, 76% are from low- and-middle income countries. Continuity of palliative care contributes to a decline in emergency room visits., decreased hospital deaths, improved patient satisfaction, better utilization of services, and cost savings. Despite efforts made to develop the palliative care guideline in Ethiopia, the service is not yet organized and linked to primary health care. This study aimed to explore barriers to the continuum of palliative care from facility to household for cancer patients in Addis Ababa. METHODS Qualitative exploratory study was conducted with face-to-face interviews with a total of 25 participants. The study population was adult cancer patients, primary caregivers, healthcare providers, volunteers, and nationwide advocates. Data were audio recorded, transcribed verbatim and finally imported to Open code version 4.02 software for coding and analysis. Thematic analysis was guided by Tanahashi's framework. RESULTS The key barriers to continuity of palliative care included opioid scarcity and turnover and shortage of healthcare workers. A shortfall of diagnostic materials, cost of medications, lack of government backing, and home-based center's enrollment capacity hampered accessibility. Care providers were instruments of cultural barriers in delivering appropriate end-of-life care, on the other hand, patients' preference for conventional medicine hindered acceptability. Lack of community volunteers, failure of health extension workers to link patients, and spatial limits fraught utilization. The lack of defined roles and services at several levels and the workload on healthcare professionals affected the effectiveness of the nexus. CONCLUSION The continuum of palliative care service from health facility to household in Ethiopia is yet in its infancy compromised by factors related to availability, accessibility, acceptability, utilization, and effectiveness. Further research is required to delineate the roles of various actors; the health sector should smudge out the continuum of palliation to cope with the growing need for palliative care.
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Affiliation(s)
- Yonas Abate
- School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kalkidan Solomon
- School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Marlieke de Fouw
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirgissa Kaba
- School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Ridgway JP, Massey R, Mason JA, Devlin S, Friedman EE. Measuring Retention in HIV Care in the First Year of the COVID-19 Pandemic: The Impact of Telehealth. AIDS Behav 2023; 27:1403-1408. [PMID: 36194349 PMCID: PMC9531214 DOI: 10.1007/s10461-022-03875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/22/2022]
Abstract
It is unknown how the COVID-19 pandemic impacted traditional measures of retention in HIV care. We calculated six different retention measures at an urban HIV care clinic for two time periods: pre-pandemic, and during the first year of the COVID-19 pandemic, with and without inclusion of telehealth appointments. Spearman rank correlation was used to assess correlation between different measures of retention. For both the pre-pandemic and pandemic time periods, there was strong correlation among measures of missed visits (range 0.857-0.957). More patients were considered retained in care during the pandemic when telehealth appointments were included in the analysis.
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Affiliation(s)
- Jessica P Ridgway
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA.
| | - Ruby Massey
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Joseph A Mason
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Samantha Devlin
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
| | - Eleanor E Friedman
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, Chicago, IL, 60637, USA
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Oliff MS, Muniina P, Babigumira K, Phuka J, Rietveld H, Sande J, Nsona H, Lugand MM. The five continuum of care criteria that should accompany rectal artesunate interventions: lessons learned from an implementation study in Malawi. Malar J 2023; 22:108. [PMID: 36966327 PMCID: PMC10039536 DOI: 10.1186/s12936-023-04514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/24/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Rectal artesunate (RAS) is a World Health Organization (WHO) recommended intervention that can save lives of children 6 years and younger suffering from severe malaria and living in remote areas. Access to RAS and a referral system that ensures continuity of care remains a challenge in low resource countries, raising concerns around the value of this intervention. The objective of this study was to inform RAS programming, using practical tools to enhance severe malaria continuum of care when encountered at community level. METHODS A single country two-arm-controlled study was conducted in Malawi, where pre-referral interventions are provided by community health workers (CHWs). The study populations consisted of 9 and 14 village health clinics (VHCs) respectively, including all households with children 5 years and younger. CHWs in the intervention arm were trained using a field-tested toolkit and the community had access to information, education, and communication (IEC) mounted throughout the zone. The community in the control arm had access to routine care only. Both study arms were provided with a dedicated referral booklet for danger signs, as a standard of care. RESULTS The study identified five continuum of care criteria (5 CoC Framework) to reinforce RAS programming: (1) care transitions emerged as to be dependent on a strong cue to action and proximity to an operational VHC with a resident CHWs; (2) consistency of supplies assured the population of the VHC's functionality for severe danger signs management; (3) comprehensiveness care ensured correct assessment and dosing; (4) connectivity of care between all tiers using the referral slip was feasible and perceived positively by caregivers and CHWs and (5) communication between providers from different points of care. Compliance was high throughout but optimized when administered by a sensitized CHW. Over 93% experienced a rapid improvement in the status of their child post RAS. CONCLUSION RAS cannot operate within a vacuum. The impact of this lifesaving intervention can be easily lost, unless administered as part of a system-based approach. Taken together, the 5CC Framework, identified in this study, provides a structure for future RAS practice guidelines. Trial registration number and date of registration PACTR201906720882512- June 20, 2019.
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Affiliation(s)
| | | | | | - John Phuka
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Hans Rietveld
- Medicines for Malaria Venture, MMV, Geneva, Switzerland
| | - John Sande
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Humphreys Nsona
- Integrated Management of Childhood Illness (IMCI), Ministry of Health, Lilongwe, Malawi
| | - Maud M Lugand
- Medicines for Malaria Venture, MMV, Geneva, Switzerland.
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Behera BK, Patro BK, Padhi B. Continuum Diabetes Care among Tuberculosis Patients in a Rural Block of Eastern Odisha. Indian J Community Med 2023; 48:172-176. [PMID: 37082393 PMCID: PMC10112750 DOI: 10.4103/ijcm.ijcm_293_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/30/2022] [Indexed: 02/10/2023] Open
Abstract
Introduction Interaction between TB and DM shows that 10% of the TB cases globally are linked to DM. The weaker immunity of patients with chronic diseases like DM is at higher risk of progressing from latent to active TB. A large portion of DM and TB patients remain undiagnosed or get diagnosed later. TB-DM comorbidity complication appears and leads to high treatment costs and out-of-pocket expenditure. Glycemic control in TB patients can improve treatment outcomes. All TB patients diagnosed and registered under RNTCP will be referred for screening for diabetes. The present study was conducted to describe the continuum of TB-DM care among TB patients. Material and Methods Retrospective record reviews in three randomly selected TU, which included all the patients registered during October 2017-March 2018. Results A total of 145 patients' treatment cards were available for review and analysis. More than half, i.e., 52%, were in the 14-44 age-group. During the anti-tuberculosis treatment (ATT), 46.2% were unemployed. 15.9% of patients were not screened for DM, ten patients were known cases of DM, 11 TB patients were found to be newly diagnosed as having DM, and out of them, only two patients could be initiated with DM treatment. So, in the present study, 21 out of 145 TB patients, 14.5% had DM. Conclusions It is evident from this study that TB patients with DM, either known case or newly diagnosed, are not receiving the proper DM care that they should receive as per the program provision.
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Affiliation(s)
- Binod K. Behera
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Binod K. Patro
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Biswanath Padhi
- Ex-District Tunberculosis Officer, District Khordha, Odisha, India
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Sserwanja Q, Gatasi G, Musaba MW. Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019-2020 Rwanda demographic health survey. BMC Pregnancy Childbirth 2022; 22:781. [PMID: 36261801 PMCID: PMC9583497 DOI: 10.1186/s12884-022-05109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to a complete continuum of maternal and child health care has been recommended globally for better pregnancy outcomes. Hence this study determined the level (pooled prevalence) and predictors of successfully completing continuum of care (CoC) in Rwanda. METHODS We analyzed weighted secondary data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS) that included 6,302 women aged 15 to 49 years who were selected using multistage stratified sampling. We analyzed complete continuum of care as a composite variable of three maternal care services: at least four ANC contacts, SBA, maternal and neonatal post-natal care. We used the SPSS version 25 complex samples package to conduct multivariable logistic regression. RESULTS Of the 6,302 women, 2,131 (33.8%) (95% CI: 32.8-35.1) had complete continuum of care. The odds of having complete continuum of care were higher among women who had exposure to newspapers (adjusted odds ratio (AOR): 1.30, 95% CI: 1.11-1.52), those belonging to the eastern region (AOR): 1.24, 95% CI: 1.01-1.52), southern region (AOR): 1.26, 95% CI: 1.04-1.53), those with health insurance (AOR): 1.55, 95% CI: 1.30-1.85), those who had been visited by a field health worker (AOR: 1.31, 95% CI: 1.15-1.49), those with no big problems with distance to health facility (AOR): 1.25, 95% CI: 1.07-1.46), those who were married (AOR): 1.35, 95% CI: 1.11-1.64), those with tertiary level of education (AOR): 1.61, 95% CI: 1.05-2.49), those belonging to richer households (AOR): 1.33, 95% CI: 1.07-1.65) and those whose parity was less than 2 (AOR): 1.52, 95% CI: 1.18-1.95). CONCLUSION We have identified modifiable factors (exposure to mass media, having been visited by a field health worker, having health insurance, having no big problems with distance to the nearest health facility, belonging to richer households, being married and educated), that can be targeted to improve utilization of the entire continuum of care. Promoting maternity services through mass media, strengthening the community health programmes, increasing access to health insurance and promoting girl child education to tertiary level may improve the level of utilization of maternity services.
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Affiliation(s)
| | - Ghislaine Gatasi
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Ministry of Education, Southeast University, 210009, Nanjing, Jiangsu Province, China
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.,Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
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Andriani H, Rachmadani SD, Natasha V, Saptari A. Continuum of care in maternal, newborn and child health in Indonesia: Evidence from the Indonesia Demographic and Health Survey. J Public Health Res 2022; 11:22799036221127619. [PMID: 36249543 PMCID: PMC9554135 DOI: 10.1177/22799036221127619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/02/2022] [Indexed: 11/07/2022] Open
Abstract
Background Maternal and child health improved considerably due to the Sustainable Development Goals of the United Nations. However, the rate of preventable death worldwide remains high. Nevertheless, implementation was insufficient in low- and middle-income countries, including Indonesia. The study aims to assess the relationships between continuum of care (CoC) in maternal, neonatal and child health (MNCH) services and levels of care in Indonesia, examine the distribution of utilisation and investigate the associations between CoC in MNCH. Design and methods Data were derived from the recent 2017 Indonesia Demographic and Health Survey. Fieldwork took place from July 24 to September 30, 2017. The sample included ever-married women aged 15-49 years who had given birth in the last 5 years prior to the survey. The total sample size is 15,288. Results Only 52.6% (n = 8038) continued to receive the three levels of MNCH services. Multivariate analysis revealed that variables, such as socioeconomic status, parity and distance from health facilities were statistically significantly associated with the continuum from antenatal to postnatal care (PNC). The use of each level of MNCH care is correlated with the next level of care. Antenatal care is associated with delivery care which is subsequently associated with postnatal care. Conclusions Identifying populations that contribute significantly to overall health inequalities and a well-established follow-up system from pregnancy to PNC may enhance maternal and child health and equity outcomes.
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Affiliation(s)
- Helen Andriani
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia,Helen Andriani, Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, Depok 16424, Indonesia.
| | - Salma Dhiya Rachmadani
- Public Health Science Undergraduate Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Valencia Natasha
- Public Health Science Undergraduate Study Program, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Adila Saptari
- Master of Public Health Program, School of Public Health, Boston University, Boston, MA, USA
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Zelka MA, Yalew AW, Debelew GT. The effects of completion of continuum of care in maternal health services on adverse birth outcomes in Northwestern Ethiopia: a prospective follow-up study. Reprod Health 2022; 19:200. [PMID: 36209163 PMCID: PMC9548133 DOI: 10.1186/s12978-022-01508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Globally, around 4 million babies die within the first month of birth annually with more than 3 million stillbirths. Of them, 99% of newborn deaths and 98% of stillbirths occur in developing countries. Despite giving priority to maternal health services, adverse birth outcomes are still major public health problems in the study area. Hence, a continuum of care (CoC) is a core key strategy to overcome those challenges. The study conducted on the effectiveness of continuum of care in maternal health services was scarce in developing countries and not done in the study area. We aimed to assess the effectiveness of continuum of care and determinants of adverse birth outcomes. Methods Community and health facility-linked prospective follow-up study designs were employed from March 2020 to January 2021 in Northwestern Ethiopia. A multistage clustered sampling technique was used to recruit 2198 pregnant women. Data were collected by using a semi-structured and pretested questionnaire. Collected data were coded, entered, cleaned, and analyzed by STATA 14. Multilevel logistic regression model was used to identify community and individual-level factors. Finally, propensity score matching was applied to determine the effectiveness of continuum of care. Results The magnitude of adverse birth outcomes was 12.4% (95% CI 12.2–12.7): stillbirth (2.8%; 95% CI 2.7–3.0), neonatal mortality (3.1%; 95% CI 2.9–3.2), and neonatal morbidity (6.8%; 95% CI 6.6–7.0). Risk factors were poor household wealth (AOR = 3.3; 95% CI 1.07–10.23), pregnant-related maternal complications during pregnancy (AOR = 3.29; 95% CI 1.68–6.46), childbirth (AOR = 6.08; 95% CI 2.36–15.48), after childbirth (AOR = 5.24; 95% CI 2.23–12.33), an offensive odor of amniotic fluid (AOR = 3.04; 95% CI 1.37–6.75) and history of stillbirth (AOR = 4.2; 95% CI 1.78–9.93). Whereas, receiving iron-folic acid (AOR = 0.44; 95% CI 0.14–0.98), initiating breastfeeding within 1 h (AOR = 0.22; 95% CI 0.10–0.50) and immunizing newborn (AOR = 0.33; 95% CI 0.12–0.93) were protective factors. As treatment effect, completion of continuum of care via time dimension (β = − 0.03; 95% CI − 0.05, − 0.01) and space dimension (β = − 0.03; 95% CI − 0.04, − 0.01) were significantly reduce perinatal death. Conclusions Adverse birth outcomes were high as compared with national targets. Completion of continuum of care is an effective intervention for reducing perinatal death. Efforts should be made to strengthen the continuum of care in maternal health services, iron supplementation, immunizing and early initiation of breastfeeding. Adverse birth outcomes are a major public health problem and a big challenge in Ethiopia, particularly in the study area. They encompass stillbirth, neonatal death, and neonatal illness within 28 days after birth. Globally, about 4 million babies die within the first month of birth annually with more than 3 million stillbirths. Of these, about 99% of newborn deaths and 98% of stillbirths occur in developing countries. As a solution to overcome those problems, a continuum of care in maternal health services is a core strategy. Therefore, this study was planned to determine how effective continuum of care in maternal health service is in reducing perinatal death and factors contributing to the adverse birth outcomes. In this study, 2198 pregnant women were recruited and followed for 11 months. The health condition of women was frequently assessed and recorded during pregnancy, childbirth and the period until 42 days after childbirth, as well as the health condition of the babies until 28 days after the birth, the package of maternal health services received, and adverse birth outcomes. Among the 2198 pregnant women enrolled in the study, 248 women encountered adverse birth outcomes (52 had stillbirths, 58 had neonatal death and 138 had neonatal illness). Risk factors of adverse birth outcomes were a poor household wealth index quintile, pregnancy-related maternal complications, offensive odor amniotic fluid, and history of stillbirth. On the other hand, protective interventions against adverse birth outcomes were receiving iron supplementation during pregnancy, initiating breastfeeding within 1 h, and immunizing the newborn. Moreover, completions of continuum of care in maternal health services via time and space dimensions reduced perinatal death. In conclusion, neonatal and perinatal deaths were high in the study areas. Completions of continuum of care in maternal health services via time and space dimensions reduced perinatal death, neonatal death, and stillbirth. The results of this study can inform national health policymakers, maternal and child programmers, and other stakeholders to prioritize and strengthen protective intervention and continuum of care in maternal health services.
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Affiliation(s)
- Muluwas Amentie Zelka
- Department of Public Health, College of Health Sciences, Assosa University, Assosa, Ethiopia. .,Department of Reproductive Health, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Alemayehu Worku Yalew
- Department of Biostatistics and Epidemiology, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia
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22
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Abebe GF, Belachew DZ, Girma D, Aydiko A, Negesse Y. Multilevel analysis of the predictors of completion of the continuum of maternity care in Ethiopia; using the recent 2019 Ethiopia mini demographic and health survey. BMC Pregnancy Childbirth 2022; 22:691. [PMID: 36071407 PMCID: PMC9450293 DOI: 10.1186/s12884-022-05016-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Despite the significant benefit of the continuum of care to avert maternal and neonatal mortality and morbidity, still the dropout from the continuum of care remains high and continued to become a challenge in Ethiopia. Therefore, this study aimed to assess the level of completion along the continuum of maternity care and its predictors among reproductive-age women in Ethiopia. Methods A secondary data analysis was done using the 2019 mini Ethiopian demographic health survey. A total weighted sample of 2,905 women aged 15–49 years who gave birth in the last five years preceding the survey and who had antenatal care visits was included. A multilevel mixed-effects logistic regression model was used to examine the predictors that affect the completion of the continuum of maternity care services. Finally, statistical significance was declared at a p-value < 0.05. Results In this study, the overall prevalence of completion along the continuum of maternity care was 12.9% (95%CI: 11.1 – 14.9%). Attending higher education (AOR = 2.03: 95%CI; 1.14 - 3.61), belonged to medium wealth status (AOR = 1.69: 95%CI; 1.07 - 2.66), belonged to rich wealth status (AOR = 2.05: 95%CI; 1.32, 3.17), and informed about danger signs during pregnancy (AOR = 2.23: 95%CI; 1.61, 3.10) were positively associated with the completion of the maternity continuum of care. However, late initiaton of first antenatal care visits (AOR = 0.66: 95%CI; 0.49, 0.89), being rural resident (AOR = 0.67: 95%CI; 0.42 - 0.93), lived in the Afar (AOR = 0.36: 95%CI; 0.12 – 0.83) and Gambella (AOR = 0.52: 95%CI; 0.19 – 0.95) regional states were negatively associated with the completion of the continuum of maternity care. Conclusion Despite most of the women using at least one of the maternity services, the level of completion along the continuum of care after antenatal care booking remains low in Ethiopia. Therefore, enhancing female education and economic transitions with special consideration given to rural, Afar, and Gambella regional state residents. Counseling towards the danger signs of pregnancy and its complications during antenatal care follow-upshould be strengthened. . Furthermore, the identified predictors should be considered when designing new policies or updating policies and strategies on maternity services uptake to step-up its full utilization, which in turn helps in the achievement of the sustainable development goals of ending preventable causes of maternal, neonatal, and child death by 2030.
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Affiliation(s)
- Gossa Fetene Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia.
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Desalegn Girma
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Alemseged Aydiko
- Department of Midwifery, College of Medicine and Health Sciences, Mizan-Tepi University, P.O.Box-260, Mizan Teferi, Ethiopia
| | - Yilkal Negesse
- Department of Public health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Sserwanja Q, Mutisya LM, Nuwabaine L, Kamara K, Mutebi RK, Musaba MW. Continuum of maternal and newborn health in Sierra Leone: a 2019 national survey. Arch Public Health 2022; 80:186. [PMID: 35945622 PMCID: PMC9364565 DOI: 10.1186/s13690-022-00946-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/27/2022] [Indexed: 12/26/2022]
Abstract
Introduction Globally, Sierra Leone has some of the worst maternal and child health indicators. The situation is worsened by a dearth of evidence about the level of continuum of care, an evidence-based intervention aimed at reducing maternal and perinatal morbidity and mortality. Hence this study aimed to assess the level of and factors associated with continuum of maternal and newborn care in Sierra Leone. Method This study analyzed secondary data from the 2019 Sierra Leone Demographic Health Survey. Analysis was restricted to women who had a live birth in the 5 years preceding the survey (n = 7326). Complete continuum of care was considered when a woman reported having had at least eight antenatal care contacts, skilled birth attendance and mother and baby had at least one postnatal check-up. Bi-variable and multivariable logistic regression were performed using the statistical package for the social sciences software version 25. Results Only 17.9% (95% CI: 17.4–19.1) of the women utilized complete continuum of care for maternal and newborn health services in Sierra Leone. About 22% (95% CI: 21.3–23.1) utilized 8 or more antenatal care contacts, 88% (95% CI: 87.9–89.4) had skilled birth attendance while 90.7% (95% CI: 90.2–91.5) and 90.4% (95% CI: 89.9–91.2) of mothers and neonates utilized postnatal care respectively. Having started antenatal care within the first trimester (aOR 1.71, 95% CI: 1.46–2.00), being resident in the Southern region (aOR 1.85, 95% CI: 1.23–2.80), belonging to richer wealth quintile (aOR 1.76, 95% CI: 1.27–2.44), using internet (aOR 1.49, 95% CI: 1.12–1.98) and having no big problems seeking permission to access healthcare (aOR 1.34, 95% CI: 1.06–1.69) were significantly associated with utilization of continuum of care. Conclusion The overall completion of continuum of maternal care is low, with ANC being the lowest utilized component of continuum of care. These findings call for urgent attention for maternal health stakeholders to develop and implement tailored interventions prioritizing women empowerment, access to affordable internet services, timely initiation of ANC contacts, women in developed regions such as the Western and those from poor households.
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Affiliation(s)
- Quraish Sserwanja
- Programmes Department, GOAL Global, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
| | - Linet M Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Ministry of Health and Sanitation, Free town, Sierra Leone
| | - Ronald K Mutebi
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda.,Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.,Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
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Alem AZ, Shitu K, Alamneh TS. Coverage and factors associated with completion of continuum of care for maternal health in sub-Saharan Africa: a multicountry analysis. BMC Pregnancy Childbirth 2022; 22:422. [PMID: 35590260 PMCID: PMC9121540 DOI: 10.1186/s12884-022-04757-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/13/2022] [Indexed: 01/18/2023] Open
Abstract
Background Many maternal and neonatal deaths are largely preventable by expanding the continuum of care (at least four antenatal visits, skilled birth attendance and postnatal care). Even though ensuring the Continuum of Care (CoC) has advantages over separate services, evidence from the globe suggests that completion of the CoC for maternal health is very low. From our search of the literature, there is limited evidence on the completion of the entire CoC and its associated factors in sub-Saharan Africa (sSA). Therefore, this study aimed to assess coverage and associated factors of completion of the CoC for maternal health in sSA. Methods Data for the study were drawn from a recent nationally representative survey of 32 Demographic and Health Surveys (DHS). A total weighted sample of 225,135 women of reproductive-age, who gave birth in the two preceding years were included. Due to the hierarchical nature of DHS data, a multilevel logistic regression model was applied to investigate individual and community-level factors that may influence completion of CoC. Adjusted Odds Ratios (aORs) with 95% Confidence Interval (CI) were reported and variables with 95% CI not including 1 were considered as significant factors of the completion of CoC. Results Only, 56,172 (25.0%; 95% CI, 20.5%, 29.4%) of the women in sSA utilized the CoC for maternal health which varied from 11,908 (17.9.0%) in East Africa to 7,418 (51.5% in Southern Africa. Factors associated with higher odds of CoC were women aged 24–34 years (aOR 1.22, 95% CI: 1.17, 1.25), aged ≥ 35 years (aOR 1.40, 95% CI: 1.35, 1.47), attending primary education (aOR 1.44, 95% CI: 1.41, 1.49), secondary education (aOR 1.95, 95% CI: 1.89, 2.03), higher education (aOR 2.15, 95% CI: 2.01, 2.25), having mass media exposure (aOR 1.35, 95% CI: 1.28, 1.39), women from female-headed households (aOR 1.18, 95% CI: 1.15, 1.21) and women from communities with high maternal education (aOR 1.12, 95% CI: 1.09, 1.16). However, perceiving distance from the health facility as a big problem (aOR 0.88, 95% CI: 0.85, 0.91), residing in rural areas (aOR 0.78, 95% CI: 0.75, 0.81), delayed ANC initiation (aOR 0.43, 95% CI: 0.41, 0.47) and unintended pregnancy (aOR 0.87, 95% CI: 0.84, 0.91) were associated with lower odds of CoC. Conclusion This study showed a low proportion of women, who utilized the CoC in sSA. Both individual and community-level factors were associated with CoC completion rates among women in sSA. Therefore, policymakers in sSA must consider both individual and community-level factors and undertake multi-sectorial approaches to address barriers of CoC at different levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04757-1.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kegnie Shitu
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kothavale A, Meher T. Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: a population-based cross-sectional study. BMC Pregnancy Childbirth 2021; 21:731. [PMID: 34706680 PMCID: PMC8554854 DOI: 10.1186/s12884-021-04198-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 10/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India? Methods The study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. The analysis was limited to 107,016 women aged 15–49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC. Results Nearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion. Conclusion The major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04198-2.
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Affiliation(s)
- Ajinkya Kothavale
- International Institute for Population Sciences (IIPS), Mumbai, Deonar, 400088, India.
| | - Trupti Meher
- International Institute for Population Sciences (IIPS), Mumbai, Deonar, 400088, India.
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Vourli G, Katsarolis I, Pantazis N, Touloumi G. HIV continuum of care: expanding scope beyond a cross-sectional view to include time analysis: a systematic review. BMC Public Health 2021; 21:1699. [PMID: 34535096 PMCID: PMC8447660 DOI: 10.1186/s12889-021-11747-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The continuum of care (CoC) model has been used to describe the main pillars of HIV care. This study aims to systematically review methods and elucidate gaps in the CoC analyses, especially in terms of the timing of the progression through steps, recognized nowadays as a critical parameter for an effective response to the epidemic. METHODS A PubMed and EMBASE databases search up to December 2019 resulted in 1918 articles, of which 209 were included in this review; 84 studies presented in major HIV conferences were also included. Studies that did not provide explicit definitions, modelling studies and those reporting only on metrics for subpopulations or factors affecting a CoC stage were excluded. Included articles reported results on 1 to 6 CoC stages. RESULTS Percentage treated and virally suppressed was reported in 78%, percentage diagnosed and retained in care in 58%, percentage linked to care in 54% and PLHIV in 36% of the articles. Information for all stages was provided in 23 studies. Only 6 articles use novel CoC estimates: One presents a dynamic CoC based on multistate analysis techniques, two base their time-to-next-stage estimates on a risk estimation method based on the cumulative incidence function, weighted for confounding and censoring and three studies estimated the HIV infection time based on mathematical modelling. CONCLUSION A limited number of studies provide elaborated time analyses of the CoC. Although time analyses lack the straightforward interpretation of the cross-sectional CoC, they provide valuable insights for the timely response to the HIV epidemic. A future goal would be to develop a model that retains the simplicity of the cross-sectional CoC but also incorporates timing between stages.
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Affiliation(s)
- Georgia Vourli
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, M. Asias 75, 115 27, Athens, Greece.
| | | | - Nikos Pantazis
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, M. Asias 75, 115 27, Athens, Greece
| | - Giota Touloumi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, M. Asias 75, 115 27, Athens, Greece
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Sserwanja Q, Musaba MW, Mutisya LM, Olal E, Mukunya D. Continuum of maternity care in Zambia: a national representative survey. BMC Pregnancy Childbirth 2021; 21:604. [PMID: 34482830 PMCID: PMC8420052 DOI: 10.1186/s12884-021-04080-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia. Methods We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25. Results Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces. Conclusion Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04080-1.
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Affiliation(s)
- Quraish Sserwanja
- Programs Department, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Linet M Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | | | - David Mukunya
- Department of Community and Public Health, Busitema University, Mbale, Uganda.,Sanyu Africa Research Institute, Mbale, Uganda
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Erickson M, Shannon K, Ranville F, Pooyak S, Howard T, McBride B, Pick N, Martin RE, Krüsi A. "They look at you like you're contaminated": how HIV-related stigma shapes access to care for incarcerated women living with HIV in a Canadian setting. Can J Public Health 2021; 113:282-292. [PMID: 34472049 DOI: 10.17269/s41997-021-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Given the gender disparities in HIV outcomes for women living with HIV (WLWH) who experience incarceration, and the impact of HIV-related stigma on HIV care, this qualitative study investigated how HIV-related stigma within prison settings shapes HIV care for WLWH. METHODS Drawing from SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community-based research project with cisgender and transgender WLWH in Metro Vancouver, peer and community interviewers conducted 19 qualitative interviews (May 2017-February 2018) with recently incarcerated WLWH focused on factors that shape incarceration trajectories. Drawing on socio-ecological frameworks and using participatory analysis, this analysis sought to characterize how HIV-related stigma shapes experiences and access to care for incarcerated WLWH. RESULTS Participants' responses focused predominately on experiences in provincial correctional facilities and the ways through which HIV-related stigma within correctional settings was linked to access to HIV care. Experiences of HIV-related stigma within prisons led to isolation and discrimination for WLWH which was reinforced through institutional processes, compromised privacy, and uncertainty about confidentiality. Experiences of HIV-related stigma informed decisions for some participants to withhold HIV status from healthcare staff, compromising access to HIV treatment during incarceration. CONCLUSION Amid ongoing efforts to improve healthcare delivery within Canadian correctional facilities, these findings have important implications for the provision of HIV care for incarcerated WLWH. Culturally safe, trauma-informed programming focused on reducing HIV-related stigma, improved communication regarding medical privacy, and interventions to change processes that compromise privacy is critical to improve healthcare access in correctional facilities.
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Affiliation(s)
- Margaret Erickson
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Flo Ranville
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada
| | - Sherri Pooyak
- Canadian Aboriginal AIDS Network, SK, Fort Qu'Appelle, Canada
| | | | - Bronwyn McBride
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada
| | - Neora Pick
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Ruth Elwood Martin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada. .,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Kim ET, Ali M, Adam H, Abubakr-Bibilazu S, Gallis JA, Lillie M, Hembling J, McEwan E, Baumgartner JN. The Effects of Antenatal Depression and Women's Perception of Having Poor Health on Maternal Health Service Utilization in Northern Ghana. Matern Child Health J 2021; 25:1697-1706. [PMID: 34405361 DOI: 10.1007/s10995-021-03216-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the effects of antenatal depression and women's perceived health during the antenatal period on maternal health service utilization in rural northern Ghana; including how the effect of antenatal depression on service use might be modified by women's perceived health. METHODS Probable antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9). Linear regression was used for the outcome of number of antenatal care (ANC) visits, and logistic regression was used for the outcomes of facility delivery, postnatal care (PNC) within 7 days and completion of continuum of care. Continuum of care was defined as having had four or more ANC visits, delivered at a health facility and had PNC visit within 7 days. RESULTS Antenatal depression had very small or no association with maternal health service utilization. Women with self-perceived fair or poor health were significantly less likely to use PNC within 7 days and less likely to complete the continuum of care. As for effect modification, we found that for women with probable moderate or severe antenatal depression (a score of 10 or greater), those with perceived fair or poor health used fewer ANC visits and were less likely to use PNC within 7 days than those with perceived excellent, very good or good health. CONCLUSIONS Women experiencing moderate or severe antenatal depression and/or who self-perceive as having poor health should be identified and targeted for additional support to access and utilize maternal health services.
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Affiliation(s)
- Eunsoo Timothy Kim
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Mohammed Ali
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - Haliq Adam
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - Safiyatu Abubakr-Bibilazu
- Catholic Relief Services, Bolga Municipal Health Insurance Office, Tamale-Navrongo, Bolgatanga, Ghana
| | - John A Gallis
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,Department of Biostatistics & Bioinformatics, Duke University, 2424 Erwin Rd, Suite 1102 Hock Plaza, Durham, NC, 27710, USA
| | - Margaret Lillie
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA
| | - John Hembling
- Catholic Relief Services, 228 W Lexington St, Baltimore, MD, 21201, USA
| | - Elena McEwan
- Catholic Relief Services, 228 W Lexington St, Baltimore, MD, 21201, USA
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.,School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St, Chapel Hill, NC, 27599, USA
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30
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Corcorran MA, Ludwig-Baron N, Cheng DM, Lioznov D, Gnatienko N, Patts G, So-Armah K, Blokhina E, Bendiks S, Krupitsky E, Samet JH, Tsui JI. The Hepatitis C Continuum of Care Among HIV-Positive Persons with Heavy Alcohol Use in St. Petersburg, Russia. AIDS Behav 2021; 25:2533-2541. [PMID: 33730255 DOI: 10.1007/s10461-021-03214-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
This study describes the self-reported prevalence of hepatitis C virus (HCV) coinfection and the HCV care continuum among persons enrolled in the St PETER HIV Study, a randomized controlled trial of medications for smoking and alcohol cessation in HIV-positive heavy drinkers and smokers in St. Petersburg, Russia. Baseline health questionnaire data were used to calculate proportions and 95% confidence intervals for self-reported steps along the HCV continuum of care. The cohort included 399 HIV-positive persons, of whom 387 [97.0% (95% CI 95.3-98.7%)] reported a prior HCV test and 315 [78.9% (95% CI 74.9-82.9%)] reported a prior diagnosis of HCV. Among those reporting a diagnosis of HCV, 43 [13.7% (95% CI 9.9-17.4%)] had received treatment for HCV, and 31 [9.8% (95% CI 6.6-13.1%)] had been cured. Despite frequent HCV testing in this HIV-positive Russian cohort, the proportion reporting prior effective HCV treatment was strikingly low. Increased efforts are needed to scale-up HCV treatment among HIV-positive Russians in St. Petersburg.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | | | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Dmitry Lioznov
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Smorodintsev Research Institute of Influenza, St. Petersburg, Russian Federation
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Kaku So-Armah
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith I Tsui
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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31
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Khatri RB, Alemu Y, Protani MM, Karkee R, Durham J. Intersectional (in) equities in contact coverage of maternal and newborn health services in Nepal: insights from a nationwide cross-sectional household survey. BMC Public Health 2021; 21:1098. [PMID: 34107922 PMCID: PMC8190849 DOI: 10.1186/s12889-021-11142-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/25/2021] [Indexed: 01/15/2023] Open
Abstract
Background Persistent inequities in coverage of maternal and newborn health (MNH) services continue to pose a major challenge to the health-care system in Nepal. This paper uses a novel composite indicator of intersectional (dis) advantages to examine how different (in) equity markers intersect to create (in) equities in contact coverage of MNH services across the continuum of care (CoC) in Nepal. Methods A secondary analysis was conducted among 1978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The three outcome variables included were 1) at least four antenatal care (4ANC) visits, 2) institutional delivery, and 3) postnatal care (PNC) consult for newborns and mothers within 48 h of childbirth. Independent variables were wealth status, education, ethnicity, languages, residence, and marginalisation status. Intersectional (dis) advantages were created using three socioeconomic variables (wealth status, level of education and ethnicity of women). Binomial logistic regression analysis was employed to identify the patterns of (in) equities in contact coverage of MNH services across the CoC. Results The contact coverage of 4ANC visits, institutional delivery, and PNC visit was 72, 64, and 51% respectively. Relative to women with triple disadvantage, the odds of contact coverage of 4ANC visits was more than five-fold higher (Adjusted Odds Ratio (aOR) = 5.51; 95% CI: 2.85, 10.64) among women with triple forms of advantages (literate and advantaged ethnicity and higher wealth status). Women with triple advantages were seven-fold more likely to give birth in a health institution (aOR = 7.32; 95% CI: 3.66, 14.63). They were also four times more likely (aOR = 4.18; 95% CI: 2.40, 7.28) to receive PNC visit compared to their triple disadvantaged counterparts. Conclusions The contact coverage of routine MNH visits was low among women with social disadvantages and lowest among women with multiple forms of socioeconomic disadvantages. Tracking health service coverage among women with multiple forms of (dis) advantage can provide crucial information for designing contextual and targeted approaches to actions towards universal coverage of MNH services and improving health equity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11142-8.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia. .,Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Yibeltal Alemu
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Melinda M Protani
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Rajendra Karkee
- School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Jo Durham
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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32
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Sangaramoorthy T, Haddix M, Agopian A, Yellin H, Mouhanna F, Abdi H, Dorsey K, Peterson J, Kharfen M, Castel AD. Measuring Unmet Needs among Persons Living with HIV at Different Stages of the Care Continuum. AIDS Behav 2021; 25:1954-1967. [PMID: 33537918 DOI: 10.1007/s10461-020-03125-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 12/11/2022]
Abstract
Unmet needs can impede optimal care engagement, impacting the health and well-being of people living with HIV (PLWH); yet, whether unmet needs differ by care engagement status is not well understood. Using surveys and qualitative interviews, we examined and compared unmet needs for PLWH (n = 172) at different levels of care engagement. Unmet needs varied only slightly by care status. Survey findings revealed that provision of housing, emergency financial assistance, employment assistance, and food security were the greatest unmet need; for those in care, housing was the greatest unmet need, whereas for those sporadically in care or out of care, employment assistance was the greatest unmet needs. Qualitative interviews likewise illustrated that a lack of financial resources including insurance, housing, employment, and transportation presented barriers to care engagement across all care groups. Our findings indicate that unmet needs among PLWH are complex and multi-faceted across care engagement status.
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Affiliation(s)
| | - Meredith Haddix
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Anya Agopian
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Hannah Yellin
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Farah Mouhanna
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Hibo Abdi
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Kerri Dorsey
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - James Peterson
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michael Kharfen
- District of Columbia Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - Amanda D Castel
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
- Department of Epidemiology, The Milken Institute School of Public Health, 950 New Hampshire Ave NW, Suite 500, Washington, DC, 20052, USA.
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Afolaranmi TO, Hassan ZI, Ugwu OJ, Ofakunrin AOD, Bello KK, Chingle MP, Shugaba AI. Retention in HIV care and its predictors among HIV-infected men who have sex with men in Plateau state, North Central Nigeria. J Family Med Prim Care 2021; 10:1596-1601. [PMID: 34123898 PMCID: PMC8144791 DOI: 10.4103/jfmpc.jfmpc_1748_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/27/2020] [Accepted: 02/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Retention in HIV care is the constancy of engagement in HIV treatment, care and support services which is essential to reducing morbidity and mortality associated with the infection as well as halting the development of resistance to antiretroviral therapy (ART). In most African countries, Nigeria inclusive, men who have sex with men (MSM) are major contributors to HIV/AIDS burden. HIV-positive MSM are generally understudied and mostly underserved due to social, political and legislation factors resulting in limited characterization and documentation of the existing health disparities particularly with regards to retention in HIV care. It was against this backdrop that we conducted this study to assess the level of retention in HIV care and its predictors among MSM linked to HIV care. Methods: A cross-sectional study conducted among 114 HIV-positive MSM in 2019 using interviewer-administered questionnaire. Data analysis was carried out using version 7 of Epi Info statistical software version 7 and a probability value of less than 0.05 used as the cut-off for drawing statistically significant conclusion. Results: The average age in years of the respondents was 26.0 ± 5.4 while 43 (37.7%) of the participants were adequately retained in HIV care. Adequate retention in HIV care was found to be predicted by awareness of regular male partner's HIV status (AOR = 11.2; 95% confidence interval [CI] = 1.924–65.167) and financial difficulty (AOR = 0.1; 95% CI = 0.022–0.840). Conclusions: A suboptimal level of retention in HIV care was demonstrated in the study with awareness of male partner's HIV status and financial buoyancy as its main predictors.
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Affiliation(s)
- Tolulope O Afolaranmi
- Department of Community Medicine, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Zuwaira I Hassan
- Department of Community Medicine, Abubakar Tafawa Balewa University, Bauchi, Bauchi State, Nigeria
| | | | - Akinyemi O D Ofakunrin
- Department of Pediatrics, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Kayode K Bello
- Department of Community Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Moses P Chingle
- Department of Community Medicine, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Ali I Shugaba
- Department of Human Anatomy, University of Jos, Plateau State, Nigeria
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Tarigan YN, Woodman RJ, Miller ER, Wisaksana R, Ward PR. Impact of strategic use of antiretroviral therapy intervention to the HIV continuum of care in 13 cities in Indonesia: an interrupted time series analysis. AIDS Res Ther 2021; 18:22. [PMID: 33902631 PMCID: PMC8074419 DOI: 10.1186/s12981-021-00340-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/08/2021] [Indexed: 12/01/2022] Open
Abstract
Background In 2013 the Indonesian government introduced the strategic use of antiretroviral therapy (SUFA) initiative of expanding access to HIV test and treatment, to help achieve the UNAIDS 90–90–90 targets. However, there has been no comprehensive evaluation of the impact of this intervention in Indonesia. We conducted an interrupted time series (ITS) analysis across 6-years to assess its immediate and medium-term impact. Methods Monthly aggregated HIV data from all HIV care clinics for persons aged ≥ 15 years were collected from 13 pilot cities. The data period encompassed 3-years prior to SUFA (26 Dec 2010–25 Dec 2013) and 3-years post-SUFA (26 Dec 2013–25 Dec 2016). The ITS was performed using a multilevel negative binomial regression model to assess the immediate and trend changes in each stage of the HIV continuum of care. Results In the pre-SUFA period, the overall coverage in the respective risk populations for HIV tests, cases, enrolments, eligible cases and ARV initiation were 1.0%, 8.6%, 98.9%, 76.9% and 75.8% respectively. In the post-SUFA period coverage was 3%, 3.8%, 98.6%, 90.3% and 81.2% respectively—with a significant increase in the median number of HIV tests, HIV cases, those eligible for ARV treatment and treatment initiation (p < 0.05 for each). The ITS analysis demonstrated immediate increases in HIV tests (IRR = 1.41, 95% CI 1.25, 1.59; p < 0.001) and an immediate decrease in detected HIV cases per person tested (IRR = 0.77, 95% CI 0.69–0.86; p < 0.001) in the month following commencement of SUFA. There was also a 3% decline in the monthly trend for HIV tests performed (IRR = 0.97; 95% CI 0.97–0.98, p < 0.001), a 1% increase for detected cases (IRR = 1.01, 95% CI 1.0–1.02, p < 0.001), and a 1% decline for treatment initiation (IRR = 0.99,95% CI 0.99–1.0 p < 0.05). Conclusions SUFA was associated with an immediate and sustained increase in the absolute number of HIV tests performed, detected HIV cases, and close to complete coverage of detected cases that were enrolled to care and defined as eligible for treatment. However, treatment initiation remained sub-optimal. The findings of this study provide valuable information on the real-world effect of accelerating ARV utilizing Treatment as Prevention for the full HIV continuum of care in limited resource countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00340-4.
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35
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Krishnamoorthy Y, Rehman T, Sakthivel M. Effectiveness of Financial Incentives in Achieving UNAID Fast-Track 90-90-90 and 95-95-95 Target of HIV Care Continuum: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. AIDS Behav 2021; 25:814-825. [PMID: 32968885 DOI: 10.1007/s10461-020-03038-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
Financial incentives influence behavioural changes and the current review was done to assess the effectiveness of this intervention in improving HIV care continuum. We conducted systematic searches in MEDLINE, Cochrane library, ScienceDirect and Google Scholar from inception until July 2019. We carried out a meta-analysis with random-effects model quantifying inconsistency (I2) for heterogeneity and reported pooled Risk Ratios (RR) with 95% confidence intervals (CIs). A total of 22 studies with 38,119 participants were included. All the six outcomes showed better results in financial incentive arm compared to standard care with statistical significance in three outcomes-HIV testing uptake (pooled RR: 2.42; 95%CI 1.06-5.54; I2 = 100%), antiretroviral therapy (ART) adherence (pooled RR: 1.30; 95%CI 1.13-1.50; I2 = 44%), and continuity in care (pooled RR: 1.24; 95%CI 1.09-1.41; I2 = 86%). To summarize, financial incentives can be helpful in improving the uptake of HIV testing, ART adherence and continuity of care while it was better for achieving viral load suppression among studies conducted in high-income countries.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
| | - Tanveer Rehman
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India
| | - Manikandanesan Sakthivel
- State Program and Technical Manager, Cap TB project, AP/TS Unit, Solidarity and Action against The HIV Infection in India (SAATHII), Hyderabad, India
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36
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Corcorran MA, Tsui JI, Scott JD, Dombrowski JC, Glick SN. Age and gender-specific hepatitis C continuum of care and predictors of direct acting antiviral treatment among persons who inject drugs in Seattle, Washington. Drug Alcohol Depend 2021; 220:108525. [PMID: 33461152 DOI: 10.1016/j.drugalcdep.2021.108525] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Direct acting antivirals (DAAs) have revolutionized management of hepatitis C virus (HCV), but treatment uptake remains low among persons who inject drugs (PWID). We report the continuum of care for HCV and describe predictors of treatment with DAAs among PWID in Seattle. METHODS We analyzed data from the 2018 Seattle area National HIV Behavioral Surveillance (NHBS) survey of PWID. Persons ≥18 years of age who injected drugs in the past year and completed the core NHBS survey, a local survey supplement, and rapid HCV antibody testing were included. Among those who screened HCV antibody positive, we calculated proportions and 95 % confidence intervals for self-reported steps along the HCV care continuum. Multivariable logistic regression was used to calculate the adjusted odds (AOR) of having received DAA therapy. RESULTS The sample included 533 PWID, 376 (71 %) of whom tested positive for antibodies to HCV. Among those who were HCV antibody positive, 94 % reported any prior HCV test, 81 % reported a prior confirmatory test, and 68 % reported a prior HCV diagnosis. Of those diagnosed, 26 % had undergone treatment and 18 % had been cured. In a multivariate model, being one year older (AOR 1.05 per year, 1.01-1.08) was predictive of DAA treatment, while homelessness (AOR 0.39, 0.19-0.80) and female gender (AOR 0.36, 0.16-0.78) were associated with a lower odds of DAA therapy. CONCLUSIONS Despite widespread HCV testing among PWID in Seattle, treatment uptake remains low in the DAA era. In particular, treatment of women, younger adults and persons living homeless is lagging behind.
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Bausch FJ, Beran D, Hering H, Boulle P, Chappuis F, Dromer C, Saaristo P, Perone SA. Operational considerations for the management of non-communicable diseases in humanitarian emergencies. Confl Health 2021; 15:9. [PMID: 33632275 PMCID: PMC7905755 DOI: 10.1186/s13031-021-00345-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
Non-communicable diseases (NCD) represent an increasing global challenge with the majority of mortality occurring in low- and middle-income countries (LMICs). Concurrently, many humanitarian crises occur in these countries and the number of displaced persons, either refugees or internally displaced, has reached the highest level in history. Until recently NCDs in humanitarian contexts were a neglected issue, but this is changing. Humanitarian actors are now increasingly integrating NCD care in their activities and recognizing the need to harmonize and enhance NCD management in humanitarian crises. However, there is a lack of a standardized response during operations as well as a lack of evidence-based NCD management guidelines in humanitarian settings. An informal working group on NCDs in humanitarian settings, formed by members of the World Health Organization, Médecins Sans Frontières, the International Committee of the Red Cross, the International Federation of the Red Cross and others, and led by the United Nations High Commissioner for Refugees, teamed up with the University of Geneva and Geneva University Hospitals to develop operational considerations for NCDs in humanitarian settings. This paper presents these considerations, aiming at ensuring appropriate planning, management and care for NCD-affected persons during the different stages of humanitarian emergencies. Key components include access to treatment, continuity of care including referral pathways, therapeutic patient education/patient self-management, community engagement and health promotion. In order to implement these components, a standardized approach will support a consistent response, and should be based on an ethical foundation to ensure that the "do no harm" principle is upheld. Advocacy supported by evidence is important to generate visibility and resource allocation for NCDs. Only a collaborative approach of all actors involved in NCD management will allow the spectrum of needs and continuum of care for persons affected by NCDs to be properly addressed in humanitarian programmes.
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Affiliation(s)
- F. Jacquerioz Bausch
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Michel-Servet 1, 1206 Geneva, Switzerland
| | - D. Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Michel-Servet 1, 1206 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland
| | - H. Hering
- United Nations High Commissioner for Refugees, Rue de Montbrillant 94, 1202 Geneva, Switzerland
| | - P. Boulle
- Médecins Sans Frontières, Rue de Lausanne 78, 1202 Geneva, Switzerland
| | - F. Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Michel-Servet 1, 1206 Geneva, Switzerland
| | - C. Dromer
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
| | - P. Saaristo
- International Federation of the Red Cross, Chemin des Crêts 17, 1209 Geneva, Switzerland
| | - S. Aebischer Perone
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Michel-Servet 1, 1206 Geneva, Switzerland
- Health Unit, International Committee of the Red Cross (ICRC), 19, avenue de la Paix, 1202 Geneva, Switzerland
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Haghighat R, Toska E, Bungane N, Cluver L. The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study. BMC Infect Dis 2021; 21:60. [PMID: 33435861 PMCID: PMC7805141 DOI: 10.1186/s12879-020-05742-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 12/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. METHODS All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014-2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. RESULTS Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14-5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06-1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29-4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04-11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06-1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12-2.58], p=0.013) were more likely to be fully viral suppressed. CONCLUSIONS Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.
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Affiliation(s)
- Roxanna Haghighat
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 3DW, UK.
| | - Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.,Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Nontuthuzelo Bungane
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, Alice, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 3DW, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Gummidi B, John O, Jha V. Continuum of care for non-communicable diseases during COVID-19 pandemic in rural India: A mixed methods study. J Family Med Prim Care 2020; 9:6012-6017. [PMID: 33681035 PMCID: PMC7928131 DOI: 10.4103/jfmpc.jfmpc_1805_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/25/2020] [Accepted: 11/26/2020] [Indexed: 11/12/2022] Open
Abstract
Background: COVID-19 pandemic has resulted in disruption to routine health services delivery as strict lockdowns were implemented in India and health workforce redeployed for COVID-19 focused responses. We assess the perceptions about COVID-19, the impact of the lockdown on access to health services and continuum of care for Non-communicable diseases (NCDs) among a cohort of adults in rural India. Methodology: Since 2018, we have been following up a cohort of persons with non-communicable diseases in a high NCD burden region in Srikakulam District of Andhra Pradesh under the STOP CKDu study. We conducted this mixed methods study, administered through a structured telephonic questionnaire and interview to determine the awareness, perceptions and their compliance to ongoing treatment schedules. Results: Overall, 68% of the participants exhibited adequate knowledge of symptoms of COVID-19, while 43% were not aware of the mode of transmission of the virus. In all, 822 (36.1%) participants reported at least one NCD condition. Among them, 115 (14%) missed their follow-up visit, 110 (13.4%) reported facing challenges in medication procurement and 11.6% either developed new complaints or experienced worsening of pre-existing symptoms. A total of 233 (28.5%) used a telemedicine facility and took telephonic advice from (private) physicians. As the access to medicines was restricted due to the lockdown, majority of the respondents were depending on rural medical practitioners (RMPs) for the procurement of medication. Conclusion: Our finding implies the need for the future guidelines on adaptation of telehealth approaches within health systems to maintain the continuum of care, digital health tools to facilitate the patient's appointments including virtual follow-up visits for those with NCDs coupled with regular engagement by frontline healthcare workers at the local levels, evidence informed public health messaging taking into consideration the social and behavioural aspect and uninterrupted essential primary healthcare services.
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Affiliation(s)
- Balaji Gummidi
- George Institute for Global Health, UNSW, New Delhi, India
| | - Oommen John
- George Institute for Global Health, UNSW, New Delhi, India.,Manipal Academy of Higher Education, Manipal, India
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India.,Manipal Academy of Higher Education, Manipal, India.,George Institute for Global Health, University of Oxford, Oxford, UK
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Winhusen T, Walley A, Fanucchi LC, Hunt T, Lyons M, Lofwall M, Brown JL, Freeman PR, Nunes E, Beers D, Saitz R, Stambaugh L, Oga EA, Herron N, Baker T, Cook CD, Roberts MF, Alford DP, Starrels JL, Chandler RK. The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study. Drug Alcohol Depend 2020; 217:108325. [PMID: 33091842 PMCID: PMC7533113 DOI: 10.1016/j.drugalcdep.2020.108325] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND The number of opioid-involved overdose deaths in the United States remains a national crisis. The HEALing Communities Study (HCS) will test whether Communities That HEAL (CTH), a community-engaged intervention, can decrease opioid-involved deaths in intervention communities (n = 33), relative to wait-list communities (n = 34), from four states. The CTH intervention seeks to facilitate widespread implementation of three evidence-based practices (EBPs) with the potential to reduce opioid-involved overdose fatalities: overdose education and naloxone distribution (OEND), effective delivery of medication for opioid use disorder (MOUD), and safer opioid analgesic prescribing. A key challenge was delineating an EBP implementation approach useful for all HCS communities. METHODS A workgroup composed of EBP experts from HCS research sites used literature reviews and expert consensus to: 1) compile strategies and associated resources for implementing EBPs primarily targeting individuals 18 and older; and 2) determine allowable community flexibility in EBP implementation. The workgroup developed the Opioid-overdose Reduction Continuum of Care Approach (ORCCA) to organize EBP strategies and resources to facilitate EBP implementation. CONCLUSIONS The ORCCA includes required and recommended EBP strategies, priority populations, and community settings. Each EBP has a "menu" of strategies from which communities can select and implement with a minimum of five strategies required: one for OEND, three for MOUD, and one for prescription opioid safety. Identification and engagement of high-risk populations in OEND and MOUD is an ORCCArequirement. To ensure CTH has community-wide impact, implementation of at least one EBP strategy is required in healthcare, behavioral health, and criminal justice settings, with communities identifying particular organizations to engage in HCS-facilitated EBP implementation.
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Affiliation(s)
- Theresa Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA.
| | - Alexander Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Laura C Fanucchi
- Division of Infectious Diseases, Department of Medicine, University of Kentucky College of Medicine, Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Tim Hunt
- Columbia University, School of Social Work, Center for Healing of Opioid and Other Substance Use Disorders (CHOSEN), 1255 Amsterdam, Avenue, Rm 806, New York, NY 10027, USA
| | - Mike Lyons
- Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA; Department of Emergency Medicine, University of Cincinnati College of Medicine 231 Albert Sabin Way, Cincinnati, OH 45267, USA
| | - Michelle Lofwall
- Departments of Behavioral Science and Psychiatry, University of Kentucky College of Medicine, Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Jennifer L Brown
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, 789 S Limestone St, Lexington, KY 40536, USA
| | - Edward Nunes
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, Division on Substance Use, 1051 Riverside Drive, New York, NY 10032, USA
| | - Donna Beers
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Richard Saitz
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA; Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue 4th Floor, Boston, MA, 02118, USA
| | - Leyla Stambaugh
- Center for Applied Public Health Research, Research Triangle Institute (RTI) International, 6110 Executive Boulevard, Suite 902, Rockville. MD 20852, USA
| | - Emmanuel A Oga
- Center for Applied Public Health Research, Research Triangle Institute (RTI) International, 6110 Executive Boulevard, Suite 902, Rockville. MD 20852, USA
| | - Nicole Herron
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA
| | - Trevor Baker
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Christopher D Cook
- Opioid/Substance Use Priority Research Area, University of Kentucky, 845 Angliana Ave Lexington, KY 40508, USA
| | - Monica F Roberts
- Opioid/Substance Use Priority Research Area, University of Kentucky, 845 Angliana Ave Lexington, KY 40508, USA
| | - Daniel P Alford
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, USA
| | - Redonna K Chandler
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Rockville, MD 20892, USA
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Maticic M, Pirnat Z, Leicht A, Zimmermann R, Windelinck T, Jauffret-Roustide M, Duffell E, Tammi T, Schatz E. The civil society monitoring of hepatitis C response related to the WHO 2030 elimination goals in 35 European countries. Harm Reduct J 2020; 17:89. [PMID: 33213481 PMCID: PMC7678126 DOI: 10.1186/s12954-020-00439-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) account for the majority of new cases of hepatitis C virus (HCV) infection in Europe; however, HCV testing, and treatment for PWID remain suboptimal. With the advent of direct acting antivirals (DAAs) the World Health Organization (WHO) adopted a strategy to eliminate HCV as public health threat by 2030. To achieve this, key policies for PWID must be implemented and HCV continuum of care needs to be monitored. This study presents results of the first monitoring led by civil society that provide harm reduction services for PWID. METHODS In 2019, harm reduction civil society organizations representing focal points of Correlation-European Harm Reduction Network in 36 European countries were invited to complete a 27-item online survey on four strategic fields: use/impact of guidelines on HCV testing and treatment for PWID, availability/functioning of continuum of care, changes compared to the previous year and, the role of harm reduction services and non-governmental organizations (NGOs) of PWID. A descriptive analysis of the responses was undertaken. RESULTS The response rate was 97.2%. Six countries reported having no guidelines on HCV treatment (17.1%). Twenty-three (65.7%) reported having treatment guidelines with specific measures for PWID; guidelines that impact on accessibility to HCV testing/treatment and improve access to harm reduction services in 95.6% and 86.3% of them, respectively. DAAs were available in 97.1% of countries; in 26.4% of them they were contraindicated for active drug users. HCV screening/confirmatory tests performed at harm reduction services/community centers, prisons and drug dependence clinics were reported from 80.0%/25.7%, 60.0%/48.6%, and 62.9%/34.3% of countries, respectively. Provision of DAAs at drug dependence clinics and prisons was reported from 34.3 to 42.9% of countries, respectively. Compared to the previous year, HCV awareness campaigns, testing and treatment on service providers' own locations were reported to increase in 42.9%, 51.4% and 42.9% of countries, respectively. NGOs of PWID conducted awareness campaigns on HCV interventions in 68.9% of countries, and 25.7% of countries had no such support. CONCLUSION Further improvements in continuum-of-care interventions for PWID are needed, which could be achieved by including harm reduction and PWID organizations in strategic planning of testing and treatment and in efforts to monitor progress toward WHO 2030 elimination goal.
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Affiliation(s)
- M Maticic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. .,Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.
| | - Z Pirnat
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - R Zimmermann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | - E Duffell
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - E Schatz
- Correlation-European Harm Reduction Network, Amsterdam, The Netherlands
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Patel SA, Sharma H, Mohan S, Weber MB, Jindal D, Jarhyan P, Gupta P, Sharma R, Ali M, Ali MK, Narayan KMV, Prabhakaran D, Gupta Y, Roy A, Tandon N. The Integrated Tracking, Referral, and Electronic Decision Support, and Care Coordination (I-TREC) program: scalable strategies for the management of hypertension and diabetes within the government healthcare system of India. BMC Health Serv Res 2020; 20:1022. [PMID: 33168004 PMCID: PMC7652581 DOI: 10.1186/s12913-020-05851-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023] Open
Abstract
Background Hypertension and diabetes are among the most common and deadly chronic conditions globally. In India, most adults with these conditions remain undiagnosed, untreated, or poorly treated and uncontrolled. Innovative and scalable approaches to deliver proven-effective strategies for medical and lifestyle management of these conditions are needed. Methods The overall goal of this implementation science study is to evaluate the Integrated Tracking, Referral, Electronic decision support, and Care coordination (I-TREC) program. I-TREC leverages information technology (IT) to manage hypertension and diabetes in adults aged ≥30 years across the hierarchy of Indian public healthcare facilities. The I-TREC program combines multiple evidence-based interventions: an electronic case record form (eCRF) to consolidate and track patient information and referrals across the publicly-funded healthcare system; an electronic clinical decision support system (CDSS) to assist clinicians to provide tailored guideline-based care to patients; a revised workflow to ensure coordinated care within and across facilities; and enhanced training for physicians and nurses regarding non-communicable disease (NCD) medical content and lifestyle management. The program will be implemented and evaluated in a predominantly rural district of Punjab, India. The evaluation will employ a quasi-experimental design with mixed methods data collection. Evaluation indicators assess changes in the continuum of care for hypertension and diabetes and are grounded in the Reach, Effectiveness, Adoption Implementation, and Maintenance (RE-AIM) framework. Data will be triangulated from multiple sources, including community surveys, health facility assessments, stakeholder interviews, and patient-level data from the I-TREC program’s electronic database. Discussion I-TREC consolidates previously proven strategies for improved management of hypertension and diabetes at single-levels of the healthcare system into a scalable model for coordinated care delivery across all levels of the healthcare system hierarchy. Findings have the potential to inform best practices to ultimately deliver quality public-sector hypertension and diabetes care across India. Trial registration The study is registered with Clinical Trials Registry of India (registration number CTRI/2020/01/022723). The study was registered prior to the launch of the intervention on 13 January 2020. The current version of protocol is version 2 dated 6 June 2018.
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Affiliation(s)
- Shivani A Patel
- Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA.
| | | | - Sailesh Mohan
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | - Mary Beth Weber
- Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA
| | - Devraj Jindal
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Priti Gupta
- Centre for Chronic Disease Control, New Delhi, India
| | - Rakshit Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Mumtaj Ali
- Centre for Chronic Disease Control, New Delhi, India
| | - Mohammed K Ali
- Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA.,Department of Family and Preventive Medicine, Emory University, Atlanta, USA
| | - K M Venkat Narayan
- Department of Global Health, Emory University, 1518 Clifton Rd NE / Rm 7037, Atlanta, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | - Yashdeep Gupta
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
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George LS, Rakesh PS, Sunilkumar M, Vijayakumar K, Kunoor A, Kumar V A. TB patient support systems in Kerala: A qualitative analysis. Indian J Tuberc 2020; 68:9-15. [PMID: 33641857 DOI: 10.1016/j.ijtb.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tuberculosis (TB) is one of the leading causes of death due to infectious diseases in the world. Kerala a southern state in India aims to eliminate TB in the near future. In order to achieve its goal Kerala is providing various social support services to TB patients to ensure their smooth transition as they pass through the treatment cascade. Therefore, the objective of the current study was to qualitatively analyse the support systems provided for TB patients in Kerala and to assess the enablers and challenges faced during the provision of these services. METHODOLOGY A qualitative study using grounded theory approach was carried out among TB survivors, current TB patients and healthcare workers from all 14 districts of Kerala along with district health officials. A total of 14 in depth interviews were conducted among healthcare workers from all the districts of Kerala. Three FGDs were conducted, out of which two were among TB survivors and another one among current TB patients. The data was collected till data saturation was reached. The audio recorded data was transcribed, translated, manually coded and emerging themes and sub themes were identified. Using data triangulation, conclusions were made. RESULTS It was observed that different TB support services were being provided across all the 14 districts of Kerala. Each of these initiatives were found to be unique in their own way for bridging the gaps in the in the continuum of care provided for TB patients. The main domains identified were grouped as support services provided for getting diagnosis, services provided after diagnosis of TB, prevention of TB and support provided to the patients reaching private sector. Under each of these domains a wide range of TB support initiatives that facilitated early diagnosis, good adherence to treatment, minimising patient inconveniences, stigma reduction, prevention out of pocket expenditure and emotional support were identified. Majority of these supportive measures were found not to be uniform throughout. Those are locally customised initiatives, evolved at different time periods with common objective of patient support. Community ownership, proactive health care system and political commitment contributed to these patient support systems. CONCLUSION These support services offered to TB patients were found to be very effective in paving the way towards the goal of TB elimination in Kerala.
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Affiliation(s)
- Leyanna Susan George
- Department of Community Medicine & Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India.
| | - P S Rakesh
- World Health Organisation, National TB elimination program TSN, India
| | - M Sunilkumar
- State TB Cell, Directorate of Health Services, Kerala, India
| | - K Vijayakumar
- Department of Community Medicine & Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Akhilesh Kunoor
- Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Anil Kumar V
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
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Alhassan RK, Owusu-Agyei S, Ansah EK, Gyapong M, Ashinyo A, Ashinyo ME, Nketiah-Amponsah E, Akorli-Adzimah E, Ekpor E. Trends and correlates of maternal, newborn and child health services utilization in primary healthcare facilities: an explorative ecological study using DHIMSII data from one district in the Volta region of Ghana. BMC Pregnancy Childbirth 2020; 20:543. [PMID: 32943004 PMCID: PMC7499957 DOI: 10.1186/s12884-020-03195-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Sustainable Development Goal 3 aims at reducing global neonatal mortality to at least 12 per 1000 livebirths, under-five mortality to at least 25 per 1000 livebirths and maternal mortality ratio to less than 70 per 100,000 livebirths by 2030. Considering the achievement so far, many countries in sub-Saharan Africa, including Ghana are not likely to achieve these targets. Low utilization of maternal, newborn and child health (MNCH) services partly account for this predicament. This study explored the trend and correlates of MNCH services utilization in one administrative district in the Volta Region of Ghana. Methods This is an explorative ecological study employing trend analysis of 2015–2017 data from Ghana Health Service District Health Information Management System II. Univariate Poisson regression models were used to determine the factors associated with MNCH services utilization at 95% confidence level. Results Cumulative record of 17,052 antenatal care (ANC) attendance and 2162 facility-based spontaneous vaginal deliveries (SVDs) was discovered. Compelling evidence of potential unskilled deliveries was observed in 23% of the 26 facilities reported in the DHIMSII data. High cumulative number of midwives in health facilities associated positively with high records of ANC visits (IRR = 1.30, [95% CI:1.29, 1.32]; p = 0.0001), facility-based SVDs (IRR = 1.30 [95% CI:1.25, 1.35]; p = 0.0001) and BCG immunizations (IRR = 1.32 [95% CI:1.29, 1.34]; p = 0.0001). Likewise, high records of ANC visits correlated positively with high facility-based SVDs and child immunizations records (p < 0.0001). Conclusion Targeted health system and community level interventions alongside progressive frontline health staff motivation and retention strategies could further enhance enrollment and retention of mothers in pre-natal and postnatal care services throughout the continuum of care to guarantee better MNCH health outcomes. Investments in universal coverage for quality ANC services has the potential to enhance utilization of supervised deliveries and post-natal care services such as immunizations.
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Affiliation(s)
- Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
| | - Seth Owusu-Agyei
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Evelyn Korkor Ansah
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Anthony Ashinyo
- Ghana AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
| | - Mary Eyram Ashinyo
- Department of Quality Assurance and Safety, Ghana Health Service, Accra, Ghana
| | | | | | - Edith Ekpor
- Ho West District Health Directorate, Volta Region, Ho, Ghana
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Usman M, Anand E, Siddiqui L, Unisa S. Continuum of maternal health care services and its impact on child immunization in India: an application of the propensity score matching approach. J Biosoc Sci 2021; 53:643-62. [PMID: 32830633 DOI: 10.1017/S0021932020000450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015-16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of children. A total of 33,422 survey women aged 15-49 were included in the analysis of maternal health care indicators, and 8246 children aged 12-23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children.
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Balogun OO, Tomo CK, Mochida K, Mikami M, da Rosa Vasconcelos H, Neves I, Hiraoka H, Aiga H, Mori R, Takehara K. Impact of the Maternal and Child Health handbook in Angola for improving continuum of care and other maternal and child health indicators: study protocol for a cluster randomised controlled trial. Trials 2020; 21:737. [PMID: 32838803 PMCID: PMC7445894 DOI: 10.1186/s13063-020-04664-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/08/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Maternal and Child Health (MCH) handbook is an integrated home-based record (HBR) designed to record in a single document all the information regarding health services provided to a pregnant woman and her child. The MCH handbook has the potential to support continuity of care which is key to strengthening maternal, newborn and child health. However, there is a lack of an integrated system to manage the health of pregnant women and young children on an ongoing basis in Angola. Thus, the Angolan Ministry of Health is partnering with the Japan International Cooperation Agency to build the capacity of healthcare providers through trainings and implementation of the MCH handbook to improve service utilisation. In this study, we will estimate the impact of an intervention package including distribution of MCH handbook and its supplementary interventions to women, on the utilisation of services provided at healthcare facilities from pregnancy through the postnatal and early childhood period. METHODS This study is a cluster randomised controlled trial involving public healthcare facilities across all the municipalities located in Benguela Province, Angola. All women who go to participating healthcare facilities and with confirmed pregnancy around the beginning of the trial period will be included in the study. Women will be randomised according to the municipality where their primary maternity and/or childcare services are located. The intervention package will consist of MCH handbook distribution at all public healthcare facilities, MCH handbook utilisation training for healthcare providers and community mobilisation for women on the use of the MCH handbook. The intervention will be administered to all women in the intervention arm while those in the control arm will continue the traditional use of two stand-alone HBRs. The primary outcome measure for this study is to compare the proportion of women who achieve a complete continuum of care in both study arms. DISCUSSION The findings from the study are expected to form a basis for revising the current trial version of the Angola MCH handbook and provide a framework for policy guiding nationwide scale-up and distribution of the MCH handbook. TRIAL REGISTRATION ISRCTN Registry ISRCTN20510127 . Registered on 4 June 2019.
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Affiliation(s)
| | | | - Keiji Mochida
- TA Networking Corp., Tokyo, Japan
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Masashi Mikami
- National Center for Child Health and Development, Tokyo, Japan
| | | | - Isilda Neves
- National Directorate of Public Health, Luanda, Angola
| | | | - Hirotsugu Aiga
- Japan International Cooperation Agency, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Takehara
- National Center for Child Health and Development, Tokyo, Japan
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Lutz BJ, Reimold AE, Coleman SW, Guzik AK, Russell LP, Radman MD, Johnson AM, Duncan PW, Bushnell CD, Rosamond WD, Gesell SB. Implementation of a Transitional Care Model for Stroke: Perspectives From Frontline Clinicians, Administrators, and COMPASS-TC Implementation Staff. Gerontologist 2020; 60:1071-1084. [PMID: 32275060 PMCID: PMC7427484 DOI: 10.1093/geront/gnaa029] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke is a chronic, complex condition that disproportionally affects older adults. Health systems are evaluating innovative transitional care (TC) models to improve outcomes in these patients. The Comprehensive Post-Acute Stroke Services (COMPASS) Study, a large cluster-randomized pragmatic trial, tested a TC model for patients with stroke or transient ischemic attack discharged home from the hospital. The implementation of COMPASS-TC in complex real-world settings was evaluated to identify successes and challenges with integration into the clinical workflow. RESEARCH DESIGN AND METHODS We conducted a concurrent process evaluation of COMPASS-TC implementation during the first year of the trial. Qualitative data were collected from 4 sources across 19 intervention hospitals. We analyzed transcripts from 43 conference calls with hospital clinicians, individual and group interviews with leaders and clinicians from 9 hospitals, and 2 interviews with the COMPASS-TC Director of Implementation using iterative thematic analysis. Themes were compared to the domains of the RE-AIM framework. RESULTS Organizational, individual, and community factors related to Reach, Adoption, and Implementation were identified. Organizational readiness was an additional key factor to successful implementation, in that hospitals that were not "organizationally ready" had more difficulty addressing implementation challenges. DISCUSSION AND IMPLICATIONS Multifaceted TC models are challenging to implement. Facilitators of implementation were organizational commitment and capacity, prioritizing implementation of innovative delivery models to provide comprehensive care, being able to address challenges quickly, implementing systems for tracking patients throughout the intervention, providing clinicians with autonomy and support to address challenges, and adequately resourcing the intervention. CLINICAL TRIAL REGISTRATION NCT02588664.
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Affiliation(s)
- Barbara J Lutz
- School of Nursing, University of North Carolina at Wilmington
| | | | - Sylvia W Coleman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amy K Guzik
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Laurie P Russell
- Division of Public Health Sciences, Wake Forest University Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Meghan D Radman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Sabina B Gesell
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Wilson Dib R, Dandachi D, Matar M, Shayya A, Davila JA, Giordano TP, Mokhbat JE. HIV in Lebanon: Reasons for Testing, Engagement in Care, and Outcomes in Patients with Newly Diagnosed HIV Infections. AIDS Behav 2020; 24:2290-2298. [PMID: 31965431 DOI: 10.1007/s10461-020-02788-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about clinical presentation and cascade of care among patients living with HIV (PLWH) in Beirut, Lebanon. The study aims to examine the reasons for HIV testing and to evaluate the clinical characteristics of, predictors of advanced HIV stage at presentation in, and rates of ART initiation, retention in care, and viral load suppression among PLWH in Lebanon. We conducted a retrospective study of PLWH presenting to a tertiary-care centre-affiliated outpatient clinic from 2008 to 2016 with new HIV infection diagnoses. We identified a total of 423 patients: 89% were men, 55% were 30-50 years old, and 58% self-identified as men who have sex with men. About 35% of the patients had concurrent sexually transmitted diseases at the time of HIV diagnosis. Thirty percent of infection cases were identified by provider-initiated HIV testing, 36% of cases were identified by patient-initiated testing, and 34% of patients underwent testing for screening purposes. The proportion of individuals presenting with advanced HIV disease decreased from 40% in 2008-2009 to 24% in 2014-2015. Age older than 50 years and identification of HIV by a medical provider were independent predictors of advanced HIV infection at presentation. Among patients having indications for treatment (n = 253), 239 (94%) were prescribed antiretroviral therapy, and 147 (58%) had evidence of viral suppression at 1 year. Furthermore, 266 patients (63%) were retained in care. The care continuum for PLWH in Lebanon is comparable with those in high-income countries yet still far behind the Joint United Nations Programme on HIV/AIDS 90-90-90 set target.
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Affiliation(s)
- Rita Wilson Dib
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Division of Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
| | - Dima Dandachi
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Mireille Matar
- Division of Infectious Diseases, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Annoir Shayya
- Department of Medicine, Division of Infectious Diseases, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Jessica A Davila
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Thomas P Giordano
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Jacques E Mokhbat
- Department of Medicine, Division of Infectious Diseases, Lebanese American University School of Medicine, Beirut, Lebanon
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Nkemdirim Okere A, Sanogo V, Balkrishnan R, Diaby V. A quantitative analysis of the effect of continuity of care on 30-day readmission and in-hospital mortality among patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2020; 29:105053. [PMID: 32807459 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Continuity of care is a core element of high-quality patient care in a primary care setting and one of a national priority. OBJECTIVE To assess and quantify the impact of continuity of care on 30-day readmissions, 30-day inpatient mortality, and hospital length of stay (LOS), among hospitalized patients with acute ischemic stroke disease. DESIGN AND SUBJECTS Observational retrospective cohort (n = 356,134) using a 2.75% random sample (n=1,036,753) from the State of Florida Agency for Health Care Administration (AHCA) database from 2006 to 2016. MEASURES We assessed continuity of care using an integrated continuity of care CoC score, calculated by merging three standard indices of continuity of care - Bice-Boxerman Continuity of Care Index (COCI), Herfindahl Index (HI), and Usual Provider of Care (UPC) Index via a Principal Component Analysis (PCA). We measured 30-day hospital readmissions, 30-day inpatient mortality, and LOS. RESULTS Our analysis revealed that hospital LOS was significantly affected by CoC. The statistically significant average treatment effect (ATEs), expressed in risk difference (RD), ranged between 0.27 [95%CI: (0.07, 0.48)] and 1.0 day [95%CI: (0.57, 1.43)]. A similar trend was observed for 30-day readmission (ATEs ranging from 0.0067 [95%CI: (0.0002, 0.0132) to 0.0071 [95%CI: (0.0005, 0.0136)]), and inpatient mortality (ATEs ranging from 0.0006 [95% confidence interval (CI): (0.0001, 0.0012)] to 0.0007 [95%CI: (0.0001, 0.0012)]). CONCLUSIONS Our findings suggest a strong association between continuity of care and clinical outcomes. Continuity of care leads to a reduction in mortality, rehospitalization, and hospital length of stay.
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Affiliation(s)
- Arinze Nkemdirim Okere
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL 32307, USA.
| | - Vassiki Sanogo
- Department of Pharmaceutical outcomes and Policy, College of Pharmacy, University of Florida, USA.
| | - Rajesh Balkrishnan
- Public Health Sciences, Cancer Population Health Core, UVA Cancer Center, Population Health and Prevention Research, University of Virginia School of Medicine, University of Virginia School of Nursing, P.O. Box 800717, Charlottesville, VA 22908, USA.
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, HPNP 3317, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA.
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Abstract
Purpose of Review The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic increases in antiretroviral therapy (ART) coverage among HIV-infected Chinese patients. Despite limitations in the number of available free antiretroviral drugs, the overall mortality associated with HIV/AIDS has dropped from 39.3 per 100 person-years in 2002 to 3.1 in 2014. In this review, we summarize the challenges, responses, and achievements of antiretroviral therapy (ART) in China over the past 20 years. Recent Findings Continuous optimization of the Chinese National Guidelines for HIV/AIDS Diagnosis and Treatment has been guided by data from serial domestic multi-center studies aimed at evaluating efficacy and toxicity of available ART regimens among Chinese patients with HIV, with the goal of maximizing adherence, access, and efficacy. In addition, increasing attention has been focused on the importance of continuity in the HIV care cascade to promote linkage to care, and address the multidisciplinary chronic care needs HIV/AIDS patients on lifelong ART. Summary Great progress has been achieved in the past 20 years in terms of access to and optimization of antiretroviral treatment in China. As the number of patients receiving long-term ART continues to grow, the focus of HIV/AIDS treatment has gradually transitioned from urgent care to the management of non-AIDS-related chronic complications and control of chronic inflammation.
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Affiliation(s)
- Wei Cao
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Evelyn Hsieh
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Section of Rheumatology, Department of Internal Medicine, Allergy and Immunology, Yale School of Medicine, New Haven, CT, USA
| | - Taisheng Li
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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