Area Health Service Research Articles

Utilisation of village health workers' services for tuberculosis screening in Lesotho.

BackgroundVillage health workers (VHWs) play an essential role because they extend the capacity of primary healthcare, particularly for developing countries. In Lesotho, VHWs are part of the primary healthcare connecting the community with clinics in their respective villages. They contribute to the prevention of the spread of tuberculosis (TB) within their catchment areas by encouraging communities to partake in TB screening. This study aimed at identifying factors associated with the utilisation of VHWs’ service to undertake TB screenings in Lesotho.MethodsThis study emanates from the main study that used a cross-sectional descriptive design. A total of 19 health service areas (HSAs) comprised 17 catchment areas and two clinics, each randomly selected from the District Health Management Team (DHMT) and the Lesotho Flying Doctors Service (LFDS), respectively. A total of 2928 individual household members aged 15 and above were included in the study. Data analysis included descriptive and inferential statistics.ResultsThere were more female than male respondents, with a majority (77%) below 65 years of age. Tuberculosis knowledge of respondents was mostly on the TB symptoms and curability of TB, but they were less knowledgeable about the causes of TB. The use of VHWs’ services for TB screening was very low (23.3%).ConclusionThe study revealed that while respondents were to some extent knowledgeable about TB, their utilisation of VHWs’ services for TB screening varied with education level, having worked in South Africa and the household size at α = 0.01.

Studying the Performance, Achievements and Challenges of Providing Community-Oriented Mental Health Services: A Preliminary Case Study

Background. Primary health care system provides appropriate prevention and primary mental care services for the rural population, but not in urban areas. Therefore, the Community Mental Health Center (CMHC) was developed to provide mental health services in urban areas. The present study aimed to outline the performance, achievements and challenges of CMHC in one of the main cities in north west of Iran. Methods. This was a case study with in-depth interview approach. The outcomes, implications, and challenges of CMHC in Tabriz city of Iran were evaluated from 2015 to 2019 using three methods: 1) in-depth interviews with two executive managers, 2) focus group discussion with managers and mental healthcare providers, and 3) collection of mental health care indicators which was collected from patient health records. After the final evaluations, the challenges and appropriate recommendations were presented for improving mental health services in urban areas. Results. A total of 17 specialists and general medical doctors collaborated in conducting the study. During the study, 1053 initial visits and/or screenings, and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, with many sub-themes were identified during in-depth interviews and focus group discussions. Conclusion. It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context.

Evaluation of the Impact of the First Wave of COVID-19 and Associated Lockdown Restrictions on Persons with Disabilities in 14 States of India.

Background: There is a paucity of data to assess the impact of the COVID-19 pandemic on persons with disabilities (PwDs) in India. About 27.4 million cases were reported as of 27 May 2021. The continuing pandemic in the form of subsequent waves is expected to have negative repercussions for the disabled globally, particularly in India, where access to health, rehabilitation, and social care services is very limited. Therefore, this study aimed to assess the impact of the COVID-19 pandemic and lockdown restrictions on PwDs in India. Objective: To determine the level of disruption due to COVID-19 and the associated countrywide lockdown restrictions on PwD in India during the first wave. Methods: Using a cross-sectional, mixed-methods approach, data were collected from a representative sample of 403 persons with disabilities in 14 states in India during the COVID-19 first wave at two different points in time (Lockdown and post-lockdown phase). Factors associated with the negative impact were examined using the Chi-square test for associations. The paired comparisons between ‘lockdown’ with the ‘post-lockdown’ phase are presented using McNemar’s test and the marginal homogeneity test to compare the proportions. Additionally, a subsample of the participants in the survey was identified to participate in in-depth interviews and focus group discussions to gain in-depth insights on the study question and substantiate the quantitative findings. The framework approach was used to conduct a thematic analysis of the qualitative data. Results: About 60% of the PwDs found it difficult to access emergency medical services during the lockdown, and 4.6% post lockdown (p < 0.001). Likewise, 12% found it difficult to access rehabilitation services during the lockdown, and 5% post lockdown (p = 0.03). About 76% of respondents were apprehensive of the risk of infection during the lockdown, and this increased to 92% post lockdown (p < 0.001). Parents with children were significantly impacted due to lockdown in the areas of Medical (p = 0.007), Rehabilitation (p = 0.001), and Mental health services (p = 0.001). The results from the qualitative study supported these quantitative findings. PWDs felt that the lockdown restrictions had negatively impacted their productivity, social participation, and overall engagement in everyday activities. Access to medicines and rehabilitation services was felt to be extremely difficult and detrimental to the therapeutic benefits that were gained by them during the pre-pandemic time. None of the pandemic mitigation plans and services was specific or inclusive of PWDs. Conclusions: COVID-19 and the associated lockdown restrictions have negatively impacted persons with disabilities during the first wave in India. It is critical to mainstream disability within the agenda for health and development with pragmatic, context-specific strategies and programs in the country.

O94 - COVID-19 Vaccination in Pregnancy: Factors influencing uptake by women

IntroductionCOVID-19 infection in pregnancy is associated with increased morbidity and mortality for the mother as well as complications for the baby. In July 2021, the Australian Technical Advisory Group on Immunisation and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women should be prioritised for COVID-19 vaccines and routinely offered Pfizer vaccine at any stage of pregnancy. There is no evidence on the pregnant women’s perceptions and acceptance of COVID-19 vaccine after this recommendation.AimThe aim of this research was to map COVID-19 vaccination in pregnancy acceptance, hesitancy and a change in original vaccination intentions.MethodsA cross-sectional, anonymous, online survey was conducted in one area health service in New South Wales, including one large tertiary referral hospital and two smaller metropolitan hospitals. Descriptive analysis was done using SPSS.ResultsDuring September 2021 to January 2022, 1103 women responded to the survey and 1,026 completed the questions, with the completion rate of 93%. Women who did not complete the survey beyond demographics (8%) or were not pregnant (3%) were excluded. The mean age of the women was 33.3 years and most were either in their second (31%) or third (49%) trimester of pregnancy. Around half of the women were having their first pregnancy (51%) and born in Australia (47%). The majority of women agreed that COVID-19 vaccine was important for their health (84%) and important to protect others in the community (81%). Although 66% of women reported that at some stage they felt unsure about having the vaccine, the majority (87%) of women had at least one dose of vaccine.ConclusionThis is the largest survey of pregnant women in Australia, providing evidence that acceptance of COVID-19 vaccination in pregnancy appears to be high among Australian women living in metropolitan areas.

Mental health service areas in Switzerland.

Small area analysis is a health services research technique that facilitates geographical comparison of services supply and utilization rates between health service areas (HSAs). HSAs are functionally relevant regions around medical facilities within which most residents undergo treatment. We aimed to identify HSAs for psychiatric outpatient care (HSA-PSY) in Switzerland. We used HSAr, a new and automated methodological approach, and comprehensive psychiatric service use data from insurances to identify HSA-PSY based on travel patterns between patients' residences and service sites. Resulting HSA-PSY were compared geographically, demographically and regarding the use of inpatient and outpatient psychiatric services. We identified 68 HSA-PSY, which were reviewed and validated by local mental health services experts. The population-based rate of inpatient and outpatient service utilization varied considerably between HSA-PSY. Utilization of inpatient and outpatient services tended to be positively associated across HSA-PSY. Wide variation of service use between HSA-PSY can hardly be fully explained by underlying differences in the prevalence or incidence of disorders. Whether other factors such as the amount of services supply did add to the high variation should be addressed in further studies, for which our functional mapping on a small-scale regional level provides a good analytical framework.

Indigenous initiative for the start-up of health services in urban areas: The Holistic Strategy Project

Background: The report of the Public Inquiry Commission on relations between Indigenous Peoples and certain public services in Québec (2019) reported problems in accessing health and social services, specifically in urban areas. In order to better serve their members, the Centre d’amitié autochtone de Trois-Rivières (CAATR) launched the Holistic Health Strategy Project. The objectives were: 1) to assess the needs of CAATR members and of the partners in health and social services, and 2) to create a directory of resources intended for the Indigenous people in the region. Methods: An assessment of health and services needs was completed through consultation with members of the community. A literature review was carried out to draw a portrait of the health and social care services and models intended for Indigenous people. Results: A total of 25 participants took part in the consultation. Better access to services (e.g., transport and daycare) and a need for liaison with non-native institutions (e.g., interpreters in hospitals and liaison officers with schools) are expressed. A directory of resources intended for Aboriginals has been created, bringing together more than 20 services and organizations. Conclusion: The results of the Holistic Health Strategy Project highlight the health needs and health particularities of Indigenous people living in urban areas. Measures adapted to the realities of Aboriginal people in urban areas must support and facilitate their access to services.

Assessment of dental pain in population catering urban health training centre of Shyam Shah Medical College, Rewa (MP)

Self medication was leading cause of failure to improve dental status of study population. Dental treatment was unmet due to this reason. Dental caries progressing to pain and difficulty in chewing food and overall deterioration in quality of life among the participants may be attributed to lack of awareness and practices regarding use of dental floss and mouthwash. Focus should be laid on formulating and implementing oral health promotion programs that aim to provide accessible and economic oral health services in rural and urban areas. This will motivate the patients with oral diseases to get treatment done by dental specialists rather than opting for self medication.

Integrating Telepsychiatry Based Care in Rural Acute Community Mental Health Services? A systematic literature review

BACKGROUND: There is limited local literature specific to emergency department assessment and subsequent telepsychiatry follow up in the community and most literature on telepsychiatry does not cover the case of urgent assessment and crisis follow up in the community. AIM: This literature review explores the use of videoconferencing technology to overcome the burden of distance and access to tertiary mental health services in regional and remote areas of Australia. METHODS: A systematic search in Medline, CINAHL, Psychiatry Online, Google Scholar, and the NSW Health Clinical Info Access Program (CIAP) was conducted. A combination of key terms: “Telepsychiatry” OR “Mental Health Telemedicine” OR “Telemedicine” OR “Telehealth” OR “Videoconferencing” OR “Mental Health Videoconferencing” OR “Telepsychiatry Ethics” AND “Acute Community” AND “Emergency Assessment” were used. Based on the screening and eligibility criteria, 21 peer-reviewed articles published in English between 2005 and 2020 were included in the review. RESULTS: Key themes were found which support the use of remote telepsychiatry. Common in the literature were themes of equivalence to in-person review, as well as themes of convenience, overcoming remoteness and timely access to specialist assessment. Ethical and technical considerations was also commonly cited. The literature search found no direct examples of an acute psychiatric assessment in the emergency department with a subsequent follow-up in the community using videoconferencing technology. CONCLUSION: Telepsychiatry in both the home and emergency department areas had merit and equivalence to face to face review, with the added benefit of wider access and timeliness to specialist assessment and treatment.

Regional Disparities in the Use and Delivery of Adjuvant Radiation Therapy after Lumpectomy for Breast Cancer in the Medicare Population

PurposeWe examined radiation therapy (RT) use among patients with early-stage breast cancer and analyzed the contribution of patient, cancer, and regional factors to the likelihood of RT receipt across Health Service Areas. Methods and MaterialsWe identified 13,176 patients aged 66 to 79 years in the Surveillance, Epidemiology, and End Results (SEER) Program–Medicare database who were diagnosed with lymph node–negative breast cancer in 2007 to 2011 and were treated with breast-conserving surgery. Patients were stratified as being at high risk or low risk for recurrence based on National Comprehensive Cancer Network Guidelines. Receipt of RT was studied with 5 modeling approaches to determine whether RT use and regional variation in its use changed based on the risk level of the cohort. Multivariable mixed-effects logistic regression was performed for each outcome. Choropleth maps were used to describe patterns of RT use. ResultsAmong high-risk patients, 70.1% received RT, compared with 72.6% of low-risk patients (P = .002). Among patients receiving RT, 60.9% were classified as high-risk, compared with 63.0% of patients who did not receive RT (P = .002). In multivariable analyses, patients in all rural areas had lower odds of receiving RT compared with the entire cohort (odds ratio [OR], 0.73; P < .001) and had lower odds of being high-risk and receiving RT (OR, 0.69; P < .001). Black patients (OR, 0.73; P = .001) and Asian patients (OR, 0.74; P = .004) had decreased likelihood of receiving RT compared with the entire cohort. The regional interclass correlation coefficient (ICC) for the model predicting receipt of RT among all patients was 0.05 and among low-risk patients was 0.06. The regional ICC dropped to 0.02 for the model predicting being both high-risk and receiving RT among all patients. ConclusionsWe observed regional and racial and ethnic disparities in RT receipt among our cohort. Reassuringly, less regional variability was observed for RT receipt among those at high risk for recurrence. Future work is needed to understand the causes of these regional disparities to better serve patients who may benefit from treatment.

Improving allocative efficiency from network consolidation: a solution for the health workforce shortage

BackgroundPublic hospitals are facing a critical shortage of health workers. The area-based network consolidations could be the solution to increase the system capacity for human resources by improving local allocative efficiency.MethodsThis study develops counterfactual simulations for area-based network allocations for the health workforce in 10500 public hospitals in Thailand and examines improvements in allocative efficiency from the health workforce redistribution at different administrative levels such as sub-districts, districts, provinces, and health service areas. The workload per worker is calculated from the output measured by numbers of outpatient and inpatient cases and the input measured by numbers of health workers. Both output and input are weighted with their economic values and controlled for heterogeneity through regression analysis. Finally, this study compares the workload per worker and economic valuation of the area-based networks or ex-ante scenarios with the hospital-level or status quo scenario.ResultsNetwork consolidations of the sub-district primary-level hospitals within the same district could reduce workload per worker by seven percentage points. Another practical policy option is to consolidate similar hospital levels such as primary, first-level secondary, and mid-level secondary hospitals altogether within the same province which could result in the reduction of the workload per worker by 6–7 percentage points. The total economic value gained from consolidating similar hospital levels within the same province is about 15–18 percentage points of total labor cost in the primary hospitals.ConclusionThis study illustrates the improvement in allocative efficiency of the health workforce in public hospitals from the area-based network consolidations. The results provide an insightful example of economic gains from efficiently reallocating the medical workforce within the same local areas. Major reforms are required such that the health care delivery units can automate their resources in corresponding to the population's health needs through a strengthening gatekeeping system.

Measuring age-friendliness based on the walkability indices of older people to urban facilities

This study aims to measure age-friendliness based on the walkability indices of the older people to urban facilities in the sample area of Istanbul, Turkey and the various districts within. It focuses on three key urban facilities in age-friendly cities: open public spaces, health services and basic needs; Quantitative datasets are also utilised in order to measure the age-friendliness of the urban environment. There are two main quantitative dimensions of the study: to generate accessible areas to facilities and to identify age-friendly values within the identified accessibility areas. To measure age-friendliness, new index sets were created using the Age-Friendly Approach Index and the Weighted Age-Friendly Approach Index. The results underline that the most age-friendly areas of open spaces are in the districts: Fatih, Beyoğlu and Üsküdar; the most age-friendly areas of health services are in Kadıköy, Şişli, Beyoğlu, Fatih, Bayrampaşa, Güngören and Bahçelievler; the most age-friendly areas of basic needs are in Fatih, Kadıköy, Şişli and Gaziosmanpaşa. Overall, Fatih, Kadıköy, Beyoğlu and Şişli districts were found to have the widest age-friendly accessible areas, whilst districts moving towards the periphery of the city decrease in terms of age-friendliness. The least accessible areas are found in Beykoz, Çekmeköy, Büyükçekmece and Silivri. The results allow us to discuss, compare and better understand age-friendliness and local government policies.Supplementary InformationThe online version contains supplementary material available at 10.1057/s41289-022-00194-w.

Rural-urban disparities in post-discharge outcomes following alcohol-related hospitalizations in Ontario, Canada: A retrospective cohort study

BackgroundLimited access to mental health and addiction (MHA) services in rural areas may increase the risk of recurrent alcohol-related harm among rural, relative to urban, residents. This study evaluated (1) rural-urban differences in clinical trajectories following alcohol-related hospitalizations and (2) whether limited access to MHA services mediates an increased risk of adverse post-discharge outcomes in rural areas. MethodsThis was a population-based retrospective cohort study of individuals in Ontario, Canada, who experienced an alcohol-related hospitalization between 2016 and 2018. The primary exposure was rurality. The outcomes of interest were outpatient MHA care, alcohol-related emergency department visits, alcohol-related hospitalizations, and all-cause mortality within one-year of discharge from the index alcohol-related hospitalization. Data were collected using provincial health administrative databases. The associations between rurality and the time to each outcome were assessed using multivariable time-to-event regression. Mediation analyses were conducted using a counterfactual approach. Results46,657 individuals were included. 11.5% of the cohort died within one year of discharge from the index alcohol-related hospitalization. Relative to urban residents, rural residents were less likely to receive MHA outpatient care (adjusted hazard ratio (aHR): 0.80, 95% confidence interval (CI): 0.75–0.86) and more likely to die (aHR: 1.19, 95% CI: 1.06–1.34) in the year following discharge. The lower likelihood of post-discharge MHA-related care among rural residents mediated 31% (95% CI: 13–46%) of the increased risk of mortality. ConclusionsA lack of follow-up MHA care mediates an increased risk of short-term mortality following alcohol-related hospitalizations in rural, relative to urban, communities.

The State of Care for Persons With a Diagnosis of Depression.

Depression is one of the most common mental illnesses. There are well-known deficiencies in the care of patients with depression, particularly at the interfaces between health service areas or sectors. The aim of this study was to analyze the characteristics and state of care of persons with a diagnosis of depression. The analysis was based on diagnosis and billing data obtained from a statutory health insurance carrier in Germany. Patients carrying a diagnosis of depression in 2018 (ICD-10 F32, F33, F34.1) were identified and studied with respect to their utilization of care services for depression. Sociodemographic characteristics and the degree of severity of depression were also taken into account. More than 285 000 individuals with a diagnosis of depression were included in the analysis. Their mean age was 57.5 years, and 67.5% were female. About three-quarters had at least one comorbid mental disorder. Primary care physicians were involved in the treatment of depression for 82.8% of patients with severe depression; 41.1% of such patients had contact with a medical specialist, and 9.2% with a psychologist-psychotherapist. Antidepressants were prescribed for 60.3% of patients with severe depression, and 10.2% were receiving psychotherapeutic services in accordance with the psychotherapy directive. Our findings point to existing deficiencies in the care of patients with depression, particularly in the establishment of the diagnosis and in the assessment of disease severity. These are essential matters for the initiation of guideline-oriented therapy and therefore deserve to be more strongly emphasized in continuing medical education.

Mental health services in conflict areas - An experience from Libya.

The Libyan mental health system has long been seen as inefficient and insufficient for the demands of the country. Thousands of Libyans require mental health therapy now more than ever before. Libya's Ministry of Health has worked to improve access to mental health services. Despite international assistance, Libya continues to face issues due to stigma and a shortage of competent psychiatrists. The majority of Libyan individuals are unable to obtain private psychiatric care. This places the burden on the public sector to care for the majority's psychological pain and suffering and this needs to be addressed.

Instagram Use among Czech Young Generation during COVID-19 Lockdown Period with Restricted Travel and Services

The paper focuses on the social network Instagram and its use by Czech university students during the COVID-19 pandemic lockdowns with restricted travel and services in comparison to typical Instagram activity in the pre-pandemic period. As Instagram specializes in visuals, it is perceived as an attractive online tool for promoting a wide range of products and services, including hospitality services and tourism destinations. The research aimed to determine which aspects of the use of this social network were affected by the pandemic lockdown period in 2020 among the young generation of active Instagram users. The analysis of data collected from a survey of 1138 respondents, for example, showed that students often started to follow new topics - especially in the areas of politics, health, personal development, sports, or hospitality services - in the context of the pandemic and its associated restrictions. At the same time, they started to spend more time on Instagram daily, typically 1-3 hours longer than they did in the pre-pandemic period. The analysis findings suggest that this social network should be seen as an increasingly important tool for effective online communication with the younger generation with tertiary education.

The Nutritional Quality of Kids' Menus from Cafés and Restaurants: An Australian Cross-Sectional Study.

Australian families increasingly rely on eating foods from outside the home, which increases intake of energy-dense nutrient-poor foods. ‘Kids’ Menus’ are designed to appeal to families and typically lack healthy options. However, the nutritional quality of Kids’ Menus from cafes and full-service restaurants (as opposed to fast-food outlets) has not been investigated in Australia. The aim of this study was to evaluate the nutritional quality of Kids’ Menus in restaurants and cafés in metropolitan Perth, Western Australia. All 787 cafes and restaurants located within the East Metropolitan Health Service area were contacted and 33% had a separate Kids’ Menu. The validated Kids’ Menu Healthy Score (KIMEHS) was used to assess the nutritional quality of the Kids’ Menus. Almost all Kids’ Menus (99%) were rated ‘unhealthy’ using KIMEHS. The mean KIMEHS score for all restaurants and cafés was −8.5 (range −14.5 to +3.5) which was lower (i.e., more unhealthy) than the mean KIMEHS score for the top 10 most frequented chain fast-food outlets (mean −3.5, range −6.5 to +3). The findings highlight the need for additional supports to make improvements in the nutritional quality of Kids’ Menus. Local Government Public Health Plans provide an opportunity for policy interventions, using locally relevant tools to guide decision making.

The Kidney Transplant Equity Index

To develop a scalable metric which quantifies kidney transplant (KT) centers' performance providing equitable access to KT for minority patients, based on the individualized prelisting prevalence of end-stage renal disease (ESRD). Racial and ethnic disparities for access to transplant in patients with ESRD are well described; however, variation in care among KT centers remains unknown. Furthermore, no mechanism exists that quantifies how well a KT center provides equitable access to KT for minority patients with ESRD. From 2013 to 2018, custom datasets from the United States Renal Data System and United Network for Organ Sharing were merged to calculate the Kidney Transplant Equity Index (KTEI), defined as the number of minority patients transplanted at a center relative to the prevalence of minority patients with ESRD in each center's health service area. Markers of socioeconomic status and recipient outcomes were compared between high and low KTEI centers. A total of 249 transplant centers performed 111,959 KTs relative to 475,914 nontransplanted patients with ESRD. High KTEI centers performed more KTs for Black (105.5 vs 24, P <0.001), Hispanic (55.5 vs 7, P <0.001), and American Indian (1.0 vs 0.0, P <0.001) patients than low KTEI centers. In addition, high KTEI centers transplanted more patients with higher unemployment (52 vs 44, P <0.001), worse social deprivation (53 vs 46, P <0.001), and lower educational attainment (52 vs 43, P <0.001). While providing increased access to transplant for minority and low socioeconomic status populations, high KTEI centers had improved patient survival (hazard ratio: 0.86, 95% confidence interval: 0.77-0.95). The KTEI is the first metric to quantify minority access to KT incorporating the prelisting ESRD prevalence individualized to transplant centers. KTEIs uncover significant national variation in transplant practices and identify highly equitable centers. This novel metric should be used to disseminate best practices for minority and low socioeconomic patients with ESRD.

Impact of Covid-19 Pandemic on the Nigerian Girl-Child and Suggested Remedies

This paper assessed the impact of COVID-19 pandemic on the Nigerian girl-child and suggested remedies to the problem. The objectives of the paper were to assess the impact of COVID-19 on educational development of the girl-child, the relationship between COVID-19 and gender-based violence, as well as COVID-19 and protection rights of the child. The scope of the study covers the Nigerian society particularly northern Nigeria where girl-child education is predominantly low. The methodology of the study was based on quantitative approach and data were collected from secondary sources mainly journals articles, bulletins and magazine publications on COVID-19. From the assessment, it was discovered that the major impact of COVID-19 on the Nigerian girl-child are basically in the areas of education, child protection, gender-based violence, health services and economic well-being. It was discovered that COVID-19 has led to the drop-out of the girl-child from school as well as a learning gap due to the lockdown and other strategies put in place curtail the spread of the disease. Schools were temporarily closed after which many students did not resumed after the schools were re-opened. From the fidnings of the study, it was therefore concluded that COVID-19 has negative consequences on girl-child education in Nigeria. The suggested remedies to the impact of COVD-19 on the girl-child include government looked into investing in alternate pathways to education. No one should be left behind. Structures should be put in place by all levels of government using tools like print, radio to ensure students are learning. There should be more community engagement in these areas since an online solution might not work for them because of poor internet connection and electricity. A support system should be created for them with the structures on ground already. Teachers and volunteers can have a well-organized way of engaging the children and the private sector helping to sponsor relevant infrastructure in order to bridge the gap.Corporate Social Organisations (CSOs) and Non-Governmental Organisations(NGOs) have to be engaged, to create a pool of volunteers that can engage students in an informal setting following the government’s social distancing guidelines to bridge the gap for these children.

Are Traditional Health Practitioners in Tanzania Walking a Tightrope? Lessons from the Policy and Legal Frameworks Guiding Health Service Delivery in Tanzania

Abstract In Tanzania Traditional Medicine (TM) provides primary health services to more than 60% of the population. Tanzania incorporated TM into the 1996 Health Policy and enacted the Traditional Medicine Act, 2002, to formalise TM practices. This article argues that the legal and policy frameworks guiding the provision of health services in the country undermine the practices of Traditional Health Practitioners (THPs) with respect to the provision of primary health services in the rural areas. This study was conducted in Bukoba District, Tanzania, to find out how TM coexisted with the biomedical system in the provision of health services. Data was collected by reviewing the National Health Policy and the Traditional Medicine Act, 2002, observing the facilities that THPs used and interviewing 50 respondents who were purposefully selected. The findings of the study revealed that the government didn’t fund TM, that there was no proper administrative coordination of TM, poor representation of THPs in the TM administration organs and that THPs were unaware of the laws that guided their practices. We recommend reviewing the health policy to includes a detailed administrative structure for TM, a source of funds for TM and proper representation of THPs in the TM administration organs.

Investigation of Different Gastrointestinal Parasites in Stray Dogs in Garmian Administration Area, Kurdistan Region, Iraq

The aims of the study were to diagnose and investigate the prevalence of different gastrointestinal parasites species in dog feces in various locations of the study area. The study was conducted between April and July 2021, during this period a total of 269 fresh fecal samples were collected from adult stray dogs of both gender in public areas from eleven municipalities of Garmian administration, then they were directly processed and analyzed using different standard coprological techniques: screening by dissecting microscope, direct fecal smear with normal saline and Lugol’s solution staining, centrifugal sedimentation, and centrifugal flotation. The results of the study showed that 172 (63.94%) of the total examined dogs were found to be infected with one or more gastrointestinal parasite species (protozoa, cestodes, nematodes, and trematode) with the prevalence 57.620% (155/269), 28.252% (76/269), 10.037% (27/269), and 0.371% (1/269) respectively, as well as indicated that there were statistically significant differences among these rates (p&lt;0.05). The detected parasites significantly differ in their prevalence include: Echinococcus granulosus 21.933% (59/269), Cystoisospora canis 21.561% (58/269), Sarcocystis spp. 12.639% (34/269), Giardia spp. 11.524% (31/269), Ancylostoma canis 5.204% (14/269), Cryptosporidium spp. 4.089% (11/269), Eimeria spp. 5.204% (14/269), Dipylidium caninum 3.345% (9/269), Mesocestoid lineatus 2.973% (8/269), Balantidium spp. 2.602% (7/269), Toxocara canis 1.486% (4/269), Trichuris vulpis 1.486% (4/269), Uncinaria stenocephala 1.115% (3/269), Toxascaris leonina 0.743% (2/269) and Nanophyetus salmincola 0.371% (1/269). This was the first record of these parasites in stray dogs from Garmian Administration area/Iraqi Kurdistan region, in which the types of infection showed that 62.209% (107/172) dogs had single, and 37.790% (65/172) mixed infections which included; double 25.581% (44/172), triple 11.046% (19/172), and quadruple 1.162% (2/172), these types of infection were showed statistically significant difference among each other (p&lt;0.05). The highest prevalence of intestinal infection among dogs was found in May at 72% (36/50) followed by 65.625% (63/96) in April, 61.29% (38/62) in June, and the lowest was 54.098% (33/61) in July with significant difference among them (p&lt;0.05). The results also revealed that all sampled locations examined were positive for the majority of the above-identified parasites, the most prevalent location was Kifri district 100 % (19/19), followed by Qorato sub-district 76.47% (13/17), Shekh Taweel sub.district 75% (12/16), Khanaqin district 69.696% (23/33), Rizgari sub-district 65% (13/20), Pebaz (Bawanur) sub-district 64.285% (18/28), Kalar district 62.5% (20/32), Serqela sub-district 61.29% (19/31), Maidan sub-district 58.333% (14/24), Awaspi sub.district 52.38% (11/21), while Kokiz sub-district was appeared to be the lowest prevalence rate of infection 35.714% (10/28), the statistical analysis showed significant differences in infection rates among these locations (p&lt;0.05).It was that all the identified parasites were recorded for the first time in this area and they were potentially hazardous zoonotic agents, so it was recommended that human beings should avoid fecal contamination of stray dogs in public areas, moreover serious attention by the veterinarians, municipality of the study area and public health service is necessary to generate awareness of these parasites' potential threat.