Care Attendance Research Articles

The Day-Level Association Between Child Care Attendance and 24-Hour Movement Behaviors in Preschool-Aged Children.

Twenty-four hour movement behaviors (ie,physical activity [PA], screen time [ST], and sleep) are associated with children's health outcomes. Identifying day-level contextual factors, such as child care, that positively influence children's movement behaviors may help identify potential intervention targets, like improving access to child care programs. This study aimed to examine the between- and within-person effects of child care on preschoolers' 24-hour movement behaviors. Children (N = 74, 4.7 [0.9]y, 48.9% girls, 63.3% White) wore an Axivity AX3 accelerometer on their nondominant wrist 24hours per day for 14days to measure PA and sleep. Parents completed surveys each night about their child's ST and child care attendance that day. Linear mixed effects models predicted day-level 24-hour movement behaviors from hours spent in child care. Children spent an average of 5.0 (2.9)hours per day in child care. For every additional hour of child care above their average, children had 0.3hours (95%CI,-0.3 to -0.2) less ST that day. Between-person effects showed that compared with children who attended fewer overall hours of child care, children who attended more hours had less overall ST (B = -0.2h; 95% CI, -0.4 to 0.0). Child care was not significantly associated with PA or sleep. Child care attendance was not associated with 24-hour PA or sleep; however, it was associated with less ST. More research utilizing objective measures of ST and more robust measures of daily schedules or structure is necessary to better understand how existing infrastructure may influence preschool-aged children's 24-hour movement behaviors. In addition, future research should consider how access to child care may influence child care attendance.

Using machine learning for targeted advance care planning (ACP) conversations in patients with cancer: A quality improvement initiative.

1552 Background: Despite improvements, patients with advanced cancer often do not receive goal-concordant care at the end of life (EOL). Challenges with prognostication contribute to delays ACP conversations and result in more aggressive care, gaps in symptom management, and hospice underuse. Early identification of patients at high risk for mortality provides an avenue to implement targeted ACP conversations. Methods: We used a validated machine learning model that integrates demographics, lab values, vital signs, and medications to predict in-hospital, 30-day, and 6-month mortality risk for patients with a solid malignancy admitted from the emergency department (ED) to a dedicated solid malignancy oncology unit at Duke University Hospital. This unit includes one oncology and one palliative care attending physician, advance practice providers, and nurse coordinators. Providers received an email when a patient was identified as high risk for mortality. A pre-post study design compared ACP documentation and other EOL healthcare utilization before and after the notification intervention. The pre-intervention cohort included patients hospitalized from 1/7/2019 to 10/25/2019 and the post-intervention cohort from 9/19/2020 to 8/31/2021. We excluded patients admitted to the intensive care unit in the first 24 hours. We used chi-square or Fisher’s exact tests for categorical variables and Kruskal-Wallis tests for continuous variables; we stratified comparisons of categorical variables by physician division using Cochran-Mantel-Haenszel tests. Results: The pre-intervention cohort comprised 105 hospitalizations and 88 unique patients. Mean (SD) age was 64.9 (11.4); 60.0% (n=63) were White, 3.8% (4) Hispanic/Latino, and 65.7% (69) married. The post-intervention cohort comprised 84 hospitalizations and 77 patients. Mean (SD) age was 66.0 (12.2); 52.4% (44) were White, 2.4% (2) Hispanic/Latino, and 60.7% (51) married. Considering index hospitalizations, an ACP note was written for 2.3% (2) of hospitalizations pre-intervention vs. 80.5% (62) post-intervention (p <0.0001). This relationship held even if the physician was in palliative care (4.1% [2] vs. 84.6% [33]) or oncology (0% [0] vs. 76.3% [29]) (p <0.0001). Inpatient length of stay (LOS), hospice referral, code status change, ICU admission rate or LOS, 30-day readmissions, 30-day ED visits, and inpatient and 30-day deaths did not differ significantly between groups. Conclusions: Identification of hospitalized cancer patients with high mortality risk via machine learning led to a substantial increase in documented ACP conversations but did not impact EOL healthcare utilization. Further integration of the model in clinical practice is ongoing. Our intervention showed promise in changing clinician behavior, and additional work is needed to evaluate downstream impacts.

Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation.

Older adults with multimorbidity are at high risk of mortality following COVID-19 hospitalisation. However, the potential benefit of timely primary care follow-up on severe outcomes post-COVID-19 has not been well established. To examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged ≥85 years, with multimorbidity. We emulated a target trial using a comprehensive public healthcare database in Hong Kong. The cloning-censoring-weighting technique was used to minimise immortal time bias and confounding bias by adjusting for demographics, hospitalisation duration and ICU admission, baseline chronic conditions, and medication history. The outcome included all-cause and cause-specific mortality. Of 6183 eligible COVID-19 survivors, the all-cause mortality rate following COVID-19 hospitalisation was lower in general out-patient clinics (GOPC) group compared to non-GOPC group (17.1 versus 42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI = 8.1% to 14.4%). We also observed better survival from respiratory diseases in the GOPC group. In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a GOPC visit after COVID-19 discharge, the better the survival. Timely primary care consultations after discharge may improve survival following COVID-19 hospitalisation among older adults aged ≥85 years, with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population's recovery and well-being.

Prevalence of and factors associated with chronic kidney disease among patients infected with human immunodeficiency virus attending care and treatment centers at tertiary hospitals in dodoma, Tanzania

BackgroundThe burden and risk of developing chronic kidney disease (CKD) among patients with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is higher than in the general population. This study aimed to determine prevalence of and associated factors with CKD among adults infected with human immunodeficiency virus at tertiary hospitals in Dodoma, Tanzania. Methodology: A cross-sectional study was carried out between November 2022 to April 2023. Patients’ demographic data, and clinical measurements were obtained on the day of the visit. Laboratory investigations were performed as standard of care. Descriptive and inferential analyses were performed, and variables associated with CKD were identified by multivariable logistic regression. ResultsA total of 223 patients were enrolled, with a median age of 47 (IQR 38–56) years, and 72.2 % were female. The CKD prevalence was 23.3 % whereby 18.4 % had CKD stage 3a, 4.5 % had CKD stage 3 b, and 0.4 % had CKD stage 4. CKD was observed largely among patients with obesity (34.15 %), anemia (29.41 %), hypertension (45.00 %), and diabetes mellitus (50.00 %). Variables with higher odds for CKD after adjusted analysis were hypertension (OR 3.03, 95 %% CI 1.29–7.11, P = 0.0109), diabetes mellitus (OR 4.50, 95 % CI 1.35–15.03, P = 0.0144), obesity (OR 3.07, 95 % CI 1.11–8.47, P = 0.0301), anaemia (OR 2.42, 95 % CI 1.12–5.26, P = 0.0252) and for each one-unit increase in age (years), there was statistically significant increase in the odds of having CKD by 1.084 folds (OR = 1.084, 95 % CI 1.039–1.131, p = 0.0002). ConclusionThe prevalence of CKD among patients with HIV/AIDS is high. Age, obesity, anaemia, hypertension, and diabetes mellitus were strongly associated with CKD suggesting a need for integrating initiatives for non-communicable disease control in this population.

Antenatal care attendance, intermittent preventive treatment in pregnancy, and malaria knowledge: A cross-sectional study in government and private district hospitals

Ghana has made significant strides in maternal health care under the National Health Insurance Scheme, but more effort is required to achieve the Sustainable Development Goal (SDG) 3.1 target of fewer than 70 maternal deaths/100,000 live births, down from the current rate of 308 maternal deaths/100,000 live births. This study aimed to explore knowledge about antenatal care (ANC), antenatal attendance, malaria, and intermittent preventive treatment in pregnancy (IPTp) among pregnant women from two high malaria endemic areas: Mafi-Adidome (a rural community) visiting Adidome Government Hospital and Battor Dugame (a rural-urban community) visiting Battor Catholic Hospital. A total of 1295 consenting pregnant women participated in the study. Information on sociodemographic characteristics, as well as knowledge about ANC, IPTp, and malaria, were collected via questionnaires. Chi-square tests were used to compare the proportions of variables across the two study sites. A higher proportion of participants at Battor Catholic Hospital (70.8%) showed adequate knowledge about ANC compared to those at Adidome Government Hospital (38.1%) (χ2[7] = 105.11; p < 0.001). In addition, more participants at Battor Catholic Hospital (46.6%) showed adequate knowledge about the timing for IPTp administration compared to those at Adidome Government Hospital (21.1%) (χ2[2] = 83.37; p < 0.001). Although knowledge about malaria was generally low (0–33.3%) at both health centers, a high proportion of participants (>80%) possessed and used mosquito bed nets for malaria prevention. A lower proportion (46.6%) of participants at Battor Catholic Hospital made the WHO-recommended four to seven visits compared to 50.2% of participants at Adidome Government Hospital. Age, marital status, employment, and education influenced the utilization of antenatal and delivery services. Increased sensitization on the importance of ANC and hospital delivery is needed in these study areas.

Disparities in Postpartum Care Visits: The Dynamics of Parental Leave Duration and Postpartum Care Attendance

ObjectivesTo understand differences in the relationship between parental leave duration and postpartum care across sociodemographic and income groups.MethodsWe used data from six states participating in the Center for Disease Control and Prevention’s yearly PRAMS study from 2016 to 2019 with a total sample of 12,442 people. Bivariable analyses assessed demographics among those who took more or less parental leave and estimated the prevalence of not accessing postpartum care by demographics, stratified by leave length. We used propensity score weighting to estimate the predicted risk and risk ratios of not accessing postpartum care with < 7 as compared to > = 7 weeks of leave, stratified by income.ResultsThere were significant differences in the prevalence of not accessing care stratified by leave duration, and disparities in utilization by race, ethnicity, and income. A shorter leave duration was associated with a higher risk of not accessing care (RR: 1.98 [CI 1.25–3.20] in higher income group, RR: 1.45 [CI 1.08, 1.99] in lower). The absolute risk of not accessing care was highest in the lower income group regardless of leave duration, though patterns of increased utilization with longer leave duration were consistent in both groups.Conclusions for practiceWhile shorter leave durations increased the risk of not attending postpartum care, those with lower incomes had the highest absolute risk of not attending care. Policies to support paid leave and extended leave duration are necessary, along with additional supports to increase postpartum care utilization, particularly among low-income families.

Exploring Loneliness, Trust, and Psychosocial Meanings Among Primary Care Attendees: A Cross-Sectional Study From a General Practice Setting in Crete, Greece.

Loneliness is often associated with behavioral, psychological, social, and mental and physical health aspects, while the relationship between trust and loneliness is still challenging in terms of research. The present study aimed to investigate to what extent loneliness and trust interact and if there is any association between loneliness and routine events or behaviors that affect overall well-being. This cross-sectional sample of 120 participants, aged between 40 and 75 years, was collected from an urban Primary Health Care Unit, between May and July 2023, in a consecutive manner, after criteria application. The University of California, Los Angeles (UCLA) Loneliness Scale (Version 3) and the Personal Trust and Connections Scale (PerTC) were completed. Hierarchical multiple linear regression analysis in steps and multiple logistic regression analysis were performed. The mean age of the participants was 59.8 years and the majority were females (73.3%). Only 10.8% were found to have no Behavioral Risk Factors (BRFs). A higher sense of loneliness was associated with being widowed/unmarried/divorced (unstandardized β=-4.10, p=0.045), not having children (β=-2.80, p=0.038), having more BRFs (β=2.03, p=0.032), or being in contact with fewer friends (β=-0.56, p<0.001). A higher sense of loneliness was related to lower levels of trust (β=-1.29, p=0.032). Lower odds of demonstrating high levels of loneliness were found among married individuals (odds ratio (OR): 0.38; 95% confidence interval (CI) 0.15, 0.95; p=0.039) and those who reported six or more routine contacts or meetings with friends (OR: 0.31; 95% CI 0.13, 0.74; p=0.008). A lower score on the total PerTC scale was related to higher odds of increased loneliness (OR: 2.78; 95%CI 1.01, 7.62; p=0.048). Being married and coming in contact or meeting with more friends was associated with lower odds of reporting high feelings of loneliness, while lower trust was correlated with increased odds of loneliness. Also, persons with more BRFs were found to have a higher loneliness score. Given their inverse correlation, tools that measure levels of loneliness and trust, like the UCLA and PerTC scales, may be used within primary care consultation to offer new insights on health risk behaviors and their possible synergistic influences.

"If I am alive, I am happy": Defining quality of care from the perspectives of key maternal and newborn health stakeholders in Papua New Guinea.

Quality maternal and newborn healthcare is essential to improve experiences and health outcomes for mothers and babies. In many low to middle income countries, such as Papua New Guinea, there are initiatives to increase antenatal care attendance and facility births. To develop and implement initiatives that are appropriate, relevant, and contextualised to a community, it is important to understand how quality of care is perceived and defined by different maternal and newborn healthcare stakeholders. The aim of this study was to understand how women, their partners, healthcare professionals, healthcare managers, and provincial health administrators in East New Britain, Papua New Guinea define quality of pregnancy, childbirth, and immediate postnatal care. An exploratory qualitative study underpinned by a partnership-defined quality approach was undertaken. In total, 42 participants from five different healthcare facilities in East New Britain, Papua New Guinea, were interviewed. These included women, partners, healthcare professionals, healthcare managers, and provincial health administrators. Interviews were analysed using thematic analysis, assisted by NVivo computer software. Four themes were identified aligning with the journey a woman takes throughout the health system. These included (I) Ensuring Access: Arriving at the health centre, (II) Experiencing Positive Care: What the staff do, (III) Having the Bare Minimum: Resources available to the service, and (IV) Meeting Expectations: Outcomes of care. Stakeholder groups had significant overlap in how quality of care was defined, however women and partners focussed more on elements relating to experience of care, while clinical stakeholders focussed on elements relating to provision of care. There is a gap in how stakeholders define quality maternal and newborn healthcare, and the quality of the care which is administered and received.

Prompt treatment of fever and its associated factors among under-five children in sub-Saharan Africa: A multilevel analysis of evidence from 36 countries.

Despite the decrease in the global under-five mortality rate, the highest rates of mortality are reported in sub-Saharan Africa. More than one-third of all deaths among under-five children are either from lower respiratory tract infections, diarrhea, or malaria. Poor treatment-seeking behavior for fever among mothers of under-five children is a big concern in sub-Saharan Africa. However, the pooled prevalence of prompt treatment of fever and its associated factors among under-five children in the region using nationally representative data is not known. Therefore, the findings of this study will inform policymakers and program managers who work on child health to design interventions to improve the timely and appropriate treatment of fever among under-five children. Data from the recent demographic and health surveys of 36 countries in sub-Saharan Africa conducted between 2006 and 2022 were used. A total weighted sample of 71,503 living children aged under five years with a fever was included in the study. Data extracted from DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value <0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. The pooled prevalence of prompt treatment of fever among under-five children in sub-Saharan African countries was 26.11% (95% CI: 25.79%, 26.44%). Factors like maternal education [AOR = 1.18; 95% CI (1.13, 1.25)], maternal working status [AOR = 1.34; 95% CI (1.27, 1.41)], media exposure [AOR = 1.05; 95% CI (1.01, 1.10)], household wealth index [AOR = 1.13; 95% CI (1.06, 1.19)], distance to a health facility [AOR = 1.18; 95% CI (1.13, 1.23)], healthcare decisions [AOR = 1.34; 95% CI (1.01, 1.77)], visited healthcare facility last 12 months [AOR = 1.45; 95% CI (1.38, 1.52)], antenatal care attendance [AOR = 1.79; 95% CI (1.61, 1.99)], place of delivery [AOR = 1.55; 95% CI (1.47, 1.63)], and community-level antenatal care utilization [AOR = 1.08; 95% CI (1.02,1.14)] were significantly associated with prompt treatment of fever among under-five children. The pooled prevalence of prompt treatment of fever among under-five children in sub-Saharan African countries was low. Educated women, working mothers, having media exposure, rich household wealth status, perceiving distance to a health facility was not a big problem, making healthcare decisions with husband or partner, visiting healthcare facility in the last 12 months, antenatal care attendance, health facility delivery, and high community-level antenatal care utilization increase the odds of prompt treatment of fever. Therefore, women's empowerment, information dissemination through mass media, maintaining regular visits to healthcare facilities, and strengthening health facility delivery and antenatal care services are strongly recommended.

Prevalence, Associated Factors, Barriers and Facilitators for Oral HIV Self-Testing among Partners of Pregnant Women Attending Antenatal Care Clinics in Wakiso, Uganda.

Oral HIV self-testing (HIVST) among men is relatively low and still inadequate in Sub-Saharan Africa. Delivering HIVST kits by pregnant women attending antenatal care to their partners is a promising strategy for increasing HIV testing among men. However, even amidst the interventions, most men do not know their HIV status. This study, aimed to determine the proportion of partners who received and used oral HIVST kits delivered by pregnant women, associated factors, barriers, and facilitators for uptake among partners. We conducted an exploratory sequential mixed methods study among 380 sampled partners. Lists of partners in the HIVST log books whose women picked an HIVST kit were obtained and systematic random sampling was done to obtain participants. 14 male partners were purposively selected for in-depth interviews (IDIs) to identify barriers and facilitators. We used modified poison regression to determine the association between oral HIVST and independent variables. We used an inductive analysis for the qualitative analysis. Out of 380 participants, 260(68.4%) received an oral HIVST kit from their pregnant women, and 215(82.7%) used the kit for HIVST. Oral HIVST was associated with; Information Education and Communication (CPR = 1.64, 95%CI 1.48-1.82), being reached at home (CPR = 1.04, 95%CI 1.01-1.08), and being aware of the woman's HIV status (CPR = 1.04, 95%CI 0.99-1.09). In-depth results identified barriers to uptake as, lack of trust in the HIVST kit results, fear of test outcome in the presence of the partner and inclination that the HIV status of their women is the same as theirs, and facilitators included convenience, ease to use, prior awareness of their HIV status, and fear of relationship consequences and breakup. Delivery of oral HIVST kits to men through pregnant women reached a high number of men and achieved a high uptake. Accessing information, education, communication and convenience nature were the major reasons for uptake among men who received the Oral HIVST kit as trust issues of the kit affected use among partners. Scaling up the delivery of oral HIVST kits at all departments of the hospital through women seeking health services is paramount to support HIV screening among men to reach the UNAIDS 95 strategy.

Determinants of low birth weight among newborns delivered in public hospitals of North Shewa Zone, Amhara region, Ethiopia: A case-control study (2023).

Low birth weight (LBW), defined as a birth weight less than 2500 g, irrespective of gestational age, poses a significant health concern for newborns. Despite efforts, the incidence of LBW in sub-Saharan Africa has remained stagnant over the past decade, warranting attention from healthcare providers, policymakers, and researchers. This study aimed to identify factors associated with LBW among newborns delivered in public hospitals of North Shewa Zone, Amhara Region, Ethiopia, from May 2 to June 10, 2023. An unmatched case-control study was conducted from May 2 to June 10, 2023, involving 318 participants (106 cases and 212 controls). Data were collected using pretested interviewer-administered structured questionnaires, medical record reviews, and direct anthropometric measurements. Bivariate analyses were conducted, and variables with a p-value ≤ 0.25 were included in a multivariable logistic regression model to determine significant determinants of LBW. A significance level of p < 0.05 was used. A total of 309 newborns (103 cases and 206 controls) were included, yielding a response rate of 97.2%. Among the findings, females exhibited a higher risk of LBW (adjusted odds ratio [AOR]: 3.13, 95% CI: 1.34, 7.32, p = 0.008), as did mothers aged 20 or younger (AOR: 3.42, 95% CI: 1.35, 8.66, p = 0.009). Lack of formal education was associated with increased risk (AOR: 6.82, 95% CI: 2.94, 15.3, p < 0.001), as were unplanned pregnancies (AOR: 3.08, 95% CI: 1.38, 6.84, p = 0.006) and missed antenatal care visits (AOR: 2.74, 95% CI: 1.16, 6.49, p = 0.021). No significant associations were found with residency type or maternal age above 35. Mothers aged ≤ 20 years, with inadequate minimum dietary diversity, lack of antenatal care attendance, and unplanned pregnancies, faced heightened risks of LBW. Addressing these factors is vital for reducing LBW occurrences and improving newborn health outcomes in Ethiopia.

Impact of community nutrition project on malnutrition in children under five: a case of SPRING Ghana project

This study examines the effects of the Strengthening Partnership, Results, and Innovations in Nutrition Globally (SPRING) project on malnutrition, stunting, acute malnutrition, and underweight among children under the age of five. The project was implemented in the northern and upper-East regions of Ghana in 2014 and ended in December 2017. We employed the Difference-in-Difference (DID) estimation approach to analyze the project's impact. Our analysis showed a strong positive association between the project's effect on the probability of stunting and underweight by 11% (p=0.01) and 9% (p=0.003), respectively, in the treated regions compared with the untreated regions. However, we found no evidence of the project’s effect on acute malnutrition. We also provide suggestive evidence that the project may have influenced child nutrition status through antenatal care attendance. This study demonstrated that tackling child nutrition deficiencies through an integrated holistic approach, such as early Antenatal Care (ANC) attendance, increased access to high-quality foods, improving women's nutrition knowledge, and improving agricultural practices, can significantly reduce childhood stunting and underweight.

Prevalence of anemia and associated factors among pregnant women at Hargeisa Group Hospital, Somaliland

BackgroundAnemia remains a major global public health issue, affecting around 24.8% of the world’s population in both developing and developed countries. Pregnant women in developing countries are particularly susceptible, with 38.2% affected worldwide. Anemia is also a major contributor to maternal mortality, with 510,000 maternal deaths globally, of which 20% occur in developing countries and are related to anemia. Iron deficiency anemia is the most prevalent form, impacting 1.3 to 2.2 billion individuals, with 50% being women of reproductive age.AimThis study aimed to assess the prevalence and associated factors of anemia in pregnant women attending antenatal care (ANC) at Hargeisa Group Hospital (HGH), Somaliland.MethodsA cross-sectional study included 360 pregnant women, who sought ANC at HGH from July 15 to August 6, 2023. The study subjects were selected using systematic random sampling. Data were collected through structured questionnaires and participants’ current medical charts, including hemoglobin levels. Data analysis was performed using SPSS software (version 20).ResultsThe study revealed an overall prevalence of anemia among pregnant women at 50.6% (95% CI: 45.40 − 55.72%). Anemia severity was categorized as mild (33.0%), moderate (54.9%), and severe (12.1%). Factors statistically associated with anemia included gestational age in the third trimester (AOR = 3.248, 95% CI: 1.491–7.074), lack of ANC visits (AOR = 6.828, 95% CI: 1.966–23.721), and absence of iron supplementation (AOR = 29.588, 95% CI: 2.922–299.713). Notably, a higher consumption of meat per week was associated with a reduced risk of anemia (AOR = 0.198, 95% CI: 0.104–0.379).ConclusionThe study underscores the severity of anemia in pregnant women within the range considered as severe public health problem by WHO. It is crucial to emphasize effective prenatal care, improve dietary practices, and promote the provision of iron supplements. Enhanced maternal education on Anemia during ANC visits has the potential to reduce Anemia prevalence and mitigate adverse maternal and neonatal outcomes.

Newborn care knowledge and practices among care givers of newborns and young infants attending a regional referral hospital in Southwestern Uganda.

A child born in developing countries has a 10 times higher mortality risk compared to one born in developed countries. Uganda still struggles with a high neonatal mortality rate at 27/1000 live births. Majority of these death occur in the community when children are under the sole care of their parents and guardian. Lack of knowledge in new born care, inappropriate new born care practices are some of the contributors to neonatal mortality in Uganda. Little is known about parent/caregivers' knowledge, practices and what influences these practices while caring for the newborns. We systematically studied and documented newborn care knowledge, practices and associated factors among parents and care givers. To assess new born care knowledge, practices and associated factors among parents and care givers attending MRRH. We carried out a quantitative cross section methods study among caregivers of children from birth to six weeks of life attending a regional referral hospital in south western Uganda. Using pretested structured questionnaires, data was collected about care givers' new born care knowledge, practices and the associated factors. Data analysis was done using Stata version 17.0. We interviewed 370 caregivers, majority of whom were the biological mothers at 86%. Mean age was 26 years, 14% were unemployed and 74% had monthly earning below the poverty line. Mothers had a high antenatal care attendance of 97.6% and 96.2% of the deliveries were at a health facility Care givers had variant knowledge of essential newborn care with associated incorrect practices. Majority (84.6%) of the respondents reported obliviousness to putting anything in the babies' eyes at birth, however, breastmilk, water and saliva were reportedly put in the babies' eyes at birth by some caregivers. Hand washing was not practiced at all in 16.2% of the caregivers before handling the newborn. About 7.4% of the new borns received a bath within 24 hours of delivery and 19% reported use of herbs. Caregivers practiced adequate thermal care 87%. Cord care practices were inappropriate in 36.5%. Only 21% of the respondents reported initiation of breast feeding within 1 hour of birth, Prelacteal feeds were given by 37.6% of the care givers, water being the commonest prelacteal feed followed by cow's milk at 40.4 and 18.4% respectively. Majority of the respondents had below average knowledge about danger signs in the newborn where 63% and mean score for knowledge about danger signs was 44%. Caretaker's age and relationship with the newborn were found to have a statistically significant associated to knowledge of danger signs in the newborn baby. There are variable incorrect practices in the essential new born care and low knowledge and awareness of danger signs among caregivers of newborn babies. There is high health center deliveries and antenatal care attendance among the respondents could be used as an opportunity to increase caregiver awareness about the inappropriate practices in essential newborn care and the danger signs in a newborn.

Women’s involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger

BackgroundThough women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women’s participation in decision-making and its influence on reproductive health behaviors.MethodsCross-sectional survey with married women (15–49 years, N = 2,672) in Maradi and Zinder Niger assessed women’s participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women’s participation in decision-making.ResultsOnly 16% of the respondents were involved—either autonomously or jointly with their spouse—in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06–1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage.ConclusionWomen’s engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women’s involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women’s decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women’s voice either before women enter marital partnerships or after (for instance, using health and social programming).

Risk of Hospitalization Associated with Use of Consumer-Directed Attendant Care

ABSTRACT Older people with disabilities living independently often use attendant care, also known as Personal Assistive Services (PAS). The aides providing care can come from a home health agency contracted by the state Medicaid authority, known as agency-directed PAS, or the Medicaid recipient can receive a monthly budget and arrange their own care, known as consumer-directed care. Consumer-directed care is hypothesized to have some possible benefits but could also potentially lead to health hazards. This study examined whether people receiving consumer-directed PAS versus people receiving agency-directed PAS faced a higher risk of hospitalization. The data for this study came from Pennsylvania Medicaid claims, enrollment files, standardized assessments, and hospitalization claims from Medicare and Medicaid. The analysis used two-stage least square regression, with the percentage of people in a county using consumer-directed care as an instrument for the type of PAS. People using consumer-directed care did not have a statistically significant difference in risk for hospitalization compared to people using agency-directed PAS (p = .976). Risk of hospitalization was not different for people using consumer-directed care compared to people using agency-directed care.

The use of antibiotics during pregnancy: A cross-sectional study of knowledge, attitude, and practices among antenatal care attendees in Northern Ghana.

The promotion of rational use of antibiotics among pregnant women is eminent not only for the risk of teratogenicity in the developing fetus but also the risk of drug resistance with its concomitant high cost of health care. Studies on antibiotic self-medication among pregnant women in Northern Ghana are rare. Improving the knowledge and awareness among the vulnerable groups about the appropriate use of antibiotics can help in limiting the antibiotic resistance menace. We, therefore, conducted this study to assess the knowledge, attitude, and practice (KAP) toward antibiotic use among pregnant women attending an antenatal clinic at a primary health care in Tolon, Northern Region, Ghana. We conducted a cross-sectional study using an interviewer-administered questionnaire to assess the KAP of 702 pregnant women on antibiotic use. This study was conducted in the Tolon Health Center (THC) from March 2021 and ended in October 2021. In this study, 55.6% of pregnant women had good knowledge and 45.3% of them had engaged in self-medication with antibiotics while pregnant. There were statistically significant associations between participants' background and obstetric characteristics and knowledge of antibiotic use and antibiotic resistance, except for age, marital status, and parity. Also, there was a significant association between pregnant women's knowledge and self-medication or over-the-counter purchase of antibiotics. We concluded that higher education level, monthly income, good practice, and good knowledge were significantly associated with a reduced likelihood of self-medication with antibiotics. A well-structured education that could be easily accepted and understood by pregnant women on the risks of antibiotic self-medication should be included in the routine education at the antenatal clinics.

Effect of HIV-Integrated Care on Uptake of Maternal Health and Routine Childhood Immunization Services at Primary Health Care Facility in Northern Nigeria: An Interrupted Time Series Analysis

Background: This study assessed the effect of HIV-integrated care delivered within routine primary health care (PHC) in Kano, Nigeria, on the uptake of maternal health and routine childhood immunization services. Methods: A retrospective cohort design was used to review and collect anonymized data from medical records of women and children who accessed health care from the PHC facility between January 2009 and December 2016. Data were analyzed using SPSS version 22. Interrupted time series analysis (ITS) was performed to estimate changes in maternal and childhood immunization service usage over time following the delivery of the integrated care. Results: Uptake of maternal health services increased over time: antenatal care attendance (effect/month [95% confidence interval (CI)]: 6.6 [44.55–8.65], P = 0.0001), family planning (effect/month [95% CI]: 1.3 [0.26–2.26], P = 0.014), and delivery (effect/month [95% CI]: 0.9 [0.39–1.45], P = 0.0009). Uptake of routine immunization also increased over time with the integrated care: Bacille Calmette Guerin (BCG) (Effect/month [95% CI]: 1.8 [0.64–2.88], P = 0.002), and diphtheria, tetanus, and pertussis 1 (DPT1)/Penta 1 vaccinations (Effect/month [95% CI]: 1.0 [0.20–1.73], P = 0.013) also showed a moderate increase over time, but DPT3/Penta 3 vaccination dropped gradually over time (Effect/month [95% CI]: −0.1 [−0.74–0.46], P = 0.649). Conclusion: The integrated care resulted in increased uptake of both maternal health and childhood routine immunization services. This suggests that the reorganization and restructuring of the HIV-integrated care in the Kumbotso Comprehensive Health Centre has had a positive impact on non-HIV services provided at the center. There are still opportunities for further research to refine and elaborate on the novel findings of this study.

Pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana: A retrospective cohort study.

The COVID-19 pandemic affected expectant mothers seeking maternal health services in most developing countries. Access and utilization of maternal health services including antenatal care (ANC) attendance and skilled delivery declined drastically resulting in adverse pregnancy outcomes. This study assessed pregnancy outcomes before and during COVID-19 pandemic in Tamale Metropolis, Ghana. A retrospective cohort study design was employed. A random sampling technique was used to select 450 women who delivered before or during the COVID-19 pandemic in Tamale Metropolis, Ghana. The respondents were interviewed using structured questionnaire at their homes. In this study, the data collected were socio-demographics characteristics, ANC attendance, before or during pandemic delivery, place of delivery and birth outcomes. Chi-square test and bivariate logistic regression analyses were performed under significant level of 0.05 to determine factors associated with the outcome variables. Of the 450 respondents, 51.8% were between 26 and 30 years of age. More than half (52.2%) of the respondents had no formal education and 93.3% were married. The majority (60.4%) of the respondents described their residence as urban setting. About 31.6% of the women delivered before the pandemic. The COVID-19 pandemic influenced place of delivery. The proportion of women who attended at least one ANC visit (84.5% before vs 70.5% during), and delivered at a hospital (76.8% before vs 72.4% during) were higher before the pandemic. More women were likely to deliver at home during COVID-19 (OR: 2.38, 95%CI: 1.52-3.74, p<0.001). Similarly, there was statistically significance difference between before and during COVID-19 delivery on at least one ANC attendance (OR: 2.72, 95%CI: 1.58-1.67, p<0.001). Women who delivered during COVID-19 were about twice more likely to develop complications (OR: 1.72, 95%CI: 1.03-2.87, p = 0.04). ANC attendance and health facility delivery decreased while pregnancy complications increased during COVID-19. During disease outbreaks, outreach engagement strategies should be devised to increase access and utilization of maternal health services for marginalized and underserved populations. The capacity of health workers should be strengthened through skills training to manage adverse birth outcomes.

Assessment of Attitude, Knowledge and Prevention of Anemia in Pregnancy among Women Attending Antenatal Care in Udi LGA in Enugu State, Nigeria

This study evaluated the knowledge, attitude and preventive practices towards anemia among women attending ANC in Udi LGA, Enugu State. Anemia is one of the most common nutritional deficiency disorders affecting pregnant women in developing countries, including Nigeria. Anemia during pregnancy is commonly associated with poor pregnancy outcomes and can result in complications that threaten the life of both the mother and fetus. Specific objectives of this study are; to determine the knowledge level of women attending ANC in selected clinics in Udi LGA on anemia, to determine the attitude towards anemia among women attending ANC clinic and to evaluate the knowledge level on preventive measures against anemia among women attending ANC in Udi LGA. A questionnaire-based study was implored to obtain direct information from the respondents and a total of three hundred and eighty-seven (387) respondents were captured. The mean age of the respondents is 32 years. Those between the ages of 26-30 and 31-35 are the highest in number with the frequency of 100 (25.83). Majority of the respondents 159 (46.08) had tertiary education. The results showed that most of the respondents (74.0%) had a good knowledge of anemia in pregnancy. About, 19.2% had an average level of knowledge while 6.8% had a poor knowledge of anemia in pregnancy. It also showed that (59.5%) had a right or excellent attitude towards anemia in pregnancy. About, 27.7% had an average or fair attitude. More so, (75.7%) had an excellent preventive measure towards anemia during pregnancy. Therefore, this study shows that the majority of the respondents have good knowledge, the right attitude and preventive measures towards anemia during pregnancy. Thus more effort is encouraged in sensitization of the public.