Capacity Of Health Facilities Research Articles

Multidisciplinary management of difficult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda

BackgroundPatients with drug resistant tuberculosis (DR-TB) with comorbidities and drug toxicities are difficult to treat. Guidelines recommend such patients to be managed in consultation with a multidisciplinary team of experts (the “TB consilium”) to optimise treatment regimens. We describe characteristics and treatment outcomes of DR-TB cases presented to the national DR-TB consilium in Uganda between 2013 and 2019.MethodsWe performed a secondary analysis of data from a nation-wide retrospective cohort of DR-TB patients with poor prognostic indicators in Uganda. Patients had a treatment outcome documented between 2013 and 2019. Characteristics and treatment outcomes were compared between cases reviewed by the consilium with those that were not reviewed.ResultsOf 1,122 DR-TB cases, 189 (16.8%) cases from 16 treatment sites were reviewed by the consilium, of whom 86 (45.5%) were reviewed more than once. The most frequent inquiries (N = 308) from DR-TB treatment sites were construction of a treatment regimen (38.6%) and management of side effects (24.0%) while the most frequent consilium recommendations (N = 408) were a DR-TB regimen (21.7%) and “observation while on current regimen” (16.6%). Among the cases reviewed, 152 (80.4%) were from facilities other than the national referral hospital, 113 (61.1%) were aged ≥ 35 years, 72 (40.9%) were unemployed, and 26 (31.0%) had defaulted antiretroviral therapy. Additionally, 141 (90.4%) had hepatic injury, 55 (91.7%) had bilateral hearing loss, 20 (4.8%) had psychiatric symptoms and 14 (17.7%) had abnormal baseline systolic blood pressure. Resistance to second-line drugs (SLDs) was observed among 9 (4.8%) cases while 13 (6.9%) cases had previous exposure to SLDs. Bedaquiline (13.2%, n = 25), clofazimine (28.6%, n = 54), high-dose isoniazid (22.8%, n = 43) and linezolid (6.7%, n = 13) were more frequently prescribed among cases reviewed by the consilium than those not reviewed. Treatment success was observed among 126 (66.7%) cases reviewed.ConclusionCases reviewed by the consilium had several comorbidities, drug toxicities and a low treatment success rate. Consilia are important “gatekeepers” for new and repurposed drugs. There is need to build capacity of lower health facilities to construct DR-TB regimens and manage adverse effects.

Abstract 19: Geospatial Analysis and Impact of Targeted Development of Breast Cancer Care in The Gambia: A Cross-Sectional Study

Abstract Purpose: To characterize the capacity of healthcare facilities to provide breast cancer care in The Gambia and calculate the proportion of the population with access to services. Methods: A facility-based service assessment tool was administered to all healthcare facilities in The Gambia. Proximity of service availability and population analysis were assessed using GPS coordinates and LandScan population density raster. Distance thresholds of 10km, 25km, and 45km were established to determine access to screening services, pathologic diagnosis, and surgical management, respectively. An additional population analysis was performed to observe the potential impact of targeted resource development. Results: All 102 healthcare facilities were included. Breast cancer screening was mainly performed through clinical breast examination and was available in 52 facilities. Seven facilities provided pathologic diagnosis and surgical management of breast cancer. The proportion of the Gambian population with access to screening, pathologic diagnosis and surgical management was 72%, 57%, and 62%, respectively. Patients living on the eastern side of the country have to travel up to 35 km for screening services and up to 300 km for pathologic diagnosis and surgical management. Widespread implementation of clinical breast examination for screening, and targeted expansion of diagnostic and surgical resources in two hospitals would increase the covered population to 95%, 67%, and 84%. This would decrease the maximum distance to access breast cancer care to 15 km for screening and 90 km for diagnosis and surgical management. Conclusion: Almost half of the Gambian population do not have access to pathologic diagnosis and surgical management of breast cancer within a reasonable travel distance, and all facilities offering these services are located in the capital city. Mapping and population analysis can identify key areas of need. This approach allows targeted development of resources to significantly increase access to breast cancer care in a low resource setting. Citation Format: Fidel Lopez-Verdugo, Meghan Mali, Moustafa Moustafa, Jonathan Nellermoe, Justin Sorensen, Mustapha Bittaye, Ramou Njie, Yankuba Singhateh, Alison Goldsmith, Nuredin I. Mohammed, Raymond R. Price, Edward Sutherland, Ousman Sanyang. Geospatial Analysis and Impact of Targeted Development of Breast Cancer Care in The Gambia: A Cross-Sectional Study [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 19.

Investigating burn cases, knowledge, attitudes and practices to burn care and prevention in Ethiopia: a community-survey

Background Burn injuries are thought to be preventable but are still a prevalent global health problem, especially in low- and middle- income countries, including Ethiopia. According to the 2016 Ethiopian Demographic and Health Survey report, burn injuries represent 8.7% of all significant injuries in Ethiopia. Such injuries result in catastrophic consequences for patients; to reduce this burden of injury, we need to ensure that future community-based burn prevention and treatment interventions are effective, available and evidence based. The main objective of this study was to assess the magnitude and causes of burn injuries as well as the knowledge, attitude and practice towards burns of community members to create an evidence base for improving basic burn care services focusing on prevention. Methods This cross sectional study was conducted in three districts (Dembiya, Limu Genet and Tula) found in Amhara, Oromia and Southern Nations, Nationalities, and People’s Region (SNNPR) regional states. 651 households were selected using multi-stage cluster sampling method. Results The survey team asked households if anyone in the selected household had experienced a burn injury within the past 12 months; 3.5% of these households reported a burn injury (using WHO definition), which was equivalent to 0.7% of all individuals from the surveyed households. Of the individuals who experienced a burn, the majority were female (14 of 23, 60.9%) and children under five (14 of 23, 60.9%); households with a separate ‘house’ for cooking had an 85.9% reduction in their chances of experiencing a burn injury. The main causes of burn injuries were heat, flame and hot liquid water (89.7%) and all 23 burn injuries occurred at home. A significant number of community members still used traditional practices to treat a burn injury, like applying dough and oil. Conclusions This research highlights the importance of improving community awareness and knowledge on burn prevention methods, with recognition that women and children are high risk groups. The research also demonstrates the need to develop the capacity of health facilities at all levels, through appropriate training and resources, to enable them to provide quality health care service to the community.

Assessing service availability and readiness to manage cervical cancer in Bangladesh

BackgroundThe second most common cancer among females in Bangladesh is cervical cancer. The national strategy for cervical cancer needs monitoring to ensure that patients have access to care. In order to provide accurate information to policymakers in Bangladesh and other low and middle income countries, it is vital to assess current service availability and readiness to manage cervical cancer at health facilities in Bangladesh.MethodsAn interviewer-administered questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment Standard Tool was used to collect cross-sectional data from health administrators of 323 health facilities in Bangladesh. Services provided were categorized into domains and service readiness was determined by mean readiness index (RI) scores. Data analysis was conducted using STATA version 13.ResultsThere were seven tertiary and specialized hospitals, 118 secondary level health facilities, 124 primary level health facilities, and 74 NGO/private hospitals included in the study. Twenty-six per cent of the health facilities provided services to cancer patients. Among the 34 tracer items used to assess cancer management capacity of health facilities, four cervical cancer-specific tracer items were used to determine service readiness for cervical cancer. On average, tertiary and specialized hospitals surpassed the readiness index cutoff of 70% with adequate staff and training (100%), equipment (100%), and diagnostic facilities (85.7%), indicating that they were ready to manage cervical cancer. The mean RI scores for the rest of the health facilities were below the cutoff value, meaning that they were not prepared to provide adequate cervical cancer services.ConclusionThe health facilities in Bangladesh (except for some tertiary hospitals) lack readiness in cervical cancer management in terms of guidelines on diagnosis and treatment, training of staff, and shortage of equipment. Given that cervical cancer accounts for more than one-fourth of all female cancers in Bangladesh, management of cervical cancer needs to be available at all levels of health facilities, with primary level facilities focusing on early diagnosis. It is recommended that appropriate standard operating procedures on cervical cancer be developed for each level of health facilities to contribute towards attaining sustainable developmental goals.

Knowledge, Attitude, and Practice towards Labor Pain Management and Associated Factors among Skilled Birth Attendants Working at Hospitals Found in Central, West, and North Gondar Zones, Northwest Ethiopia, 2019: A Multicenter Cross-Sectional Study.

Introduction Delivery of the infant into the arms of a conscious and pain-free mother is the most exciting and rewarding moment in maternal care services. Physical and mental care of women during delivery requires good knowledge and a positive insight to the needs and rights of the mothers. Little was known regarding skilled birth attendants' knowledge, attitude, and practice towards labor pain management in the study area. Hence, the current study aimed at assessing knowledge, attitude, and practice, and associated factors towards labor pain management among skilled birth attendants working at hospitals found in central, west, and north Gondar zones, northwest Ethiopia, 2019. Method A multicenter institution-based cross-sectional study was conducted from June 1 to 30, 2019. A census sampling technique was used to include a total of 336 skill birth attendants. A pretested standardized self-administered questionnaire was used to collect the data. The data were then entered into Epi Info 7.1.2 and exported to SPSS version 25 for analysis. Multivariable logistic regression analyses were undertaken to identify factors associated with outcome variables. The level of significance of the study was declared based on adjusted odds ratio with 95% confidence interval at a p value of ≤0.05. Result The proportion of skill birth attendants having good knowledge, a favorable attitude, and a good practice on labor pain relief methods was 47%, 41.96%, and 57.14%, respectively. Age of ≤30 years (AOR = 5.43; 95% CI: 1.25, 23.53), educational status of 2nd degree and above (AOR = 3.56; 95% CI: 1.32, 9.60), working at a private primary hospital (AOR: = 6.55; 95% CI: 2.15, 19.93), and working at a referral hospital (AOR = 2.24 : 95% CI: 1.01, 4.93) are factors significantly associated with good knowledge while having good knowledge on labor pain relief methods (AOR = 2.26; 95% CI: 1.42, 3.60) and working at private primary hospitals (AOR = 7.01; 95% CI: 1.92, 25.65) had statistically significant association with favorable attitude and good practice on labor pain relief methods, respectively. Conclusion and Recommendations. Poor knowledge, unfavorable attitude, and poor practice towards labor pain management were found in this study. Strengthening the capacity of public health facilities and providing continuous professional development (CPD) training for the skilled birth attendants would be helpful in improving knowledge, attitude, and practice towards labor pain management.

Surgical and Trauma Capacity Assessment in Rural Haryana, India.

Background:Trauma is a major global health problem and majority of the deaths occur in low- and middle-income countries (LMICs), at even higher rates in the rural areas. The three-delay model assesses three different delays in accessing healthcare and can be applied to improve surgical and trauma healthcare delivery. Prior to implementing change, the capacities of the rural India healthcare system need to be identified.Objective:The object of this study was to estimate surgical and trauma care capacities of government health facilities in rural Nanakpur, Haryana, India using the Personnel, Infrastructure, Procedures, Equipment and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT) tools.Methods:The PIPES and INTACT tools were administered at eight government health facilities serving the population of Nanakpur in June 2015. Data analysis was performed per tool subsection, and an overall score was calculated. Higher PIPES or INTACT indices correspond to greater surgical or trauma care capacity, respectively.Findings:Surgical and trauma care capacities increased with higher levels of care. The median PIPES score was significantly higher for tertiary facilities than primary and secondary facilities [13.8 (IQR 9.5, 18.2) vs. 4.7 (IQR 3.9, 6.2), p = 0.03]. The lower-level facilities were mainly lacking in personnel and procedures.Conclusions:Surgical and trauma care capacities at healthcare facilities in Haryana, India demonstrate a shortage of surgical resources at lower-level centers. Specifically, the Primary Health Centers were not operating at full capacity. These results can inform resource allocation, including increasing education, across different facility levels in rural India.

Transnational Mobility and Utilization of Health Services in Northern Thailand: Implications and Challenges for Border Public Health Facilities.

Introduction/Objective:Transnational populations from the Association of Southeast Asian Nations are crossing borders regardless of whether their status is legal or undocumented, to receive health services in the border regions of Thailand. The implications and challenges of transnational mobility and the utilization of public health facilities in Thailand’s border regions are therefore investigated in this study.Methods:Four public health facilities were selected, located in 2 economically-active border areas in Northern Thailand: Mae Sai–Tachileik at the Thailand–Myanmar border and Chiang Saen–Ton Phueng at the Thailand–Lao PDR border. Qualitative data were obtained from in-depth interviews with 8 medical and non-medical hospital staff responsible for implementing facility-level policies and providing health services for the transnational population.Results:Five themes were identified through analysis of the implications and challenges for transnational mobility and the utilization of public health facilities under study: contextual determinants of illness in specific border areas; uncompensated care as opposed to financial management in serving the transnational population; health service opportunities for the transnational population; cross-border collaboration on public health; and the remaining challenges of transnational mobility in border regions.Conclusion:Conventional content analysis with interpretative induction of in-depth interview data offers recommendations for improving the capacity of border health facilities to reduce the burden placed upon them to provide services to the transnational population.

Collaboration for preliminary design of a mobile health solution for ambulance dispatch in Rwanda

The first 60 minutes after a trauma are described as “the golden hour.” For each minute of prehospital time, the risk of dying increases by 5% (Sampalis et al., 1999). Since 90% of the global burden of injuries occur in low- and middle-income countries and lead to 5.8 million deaths annually, addressing rapid access to emergency services is critical in these settings (Nielsen et al., 2012). In most low- and middle-income countries (LMICs), there are no formal trauma systems, and many lack organized prehospital care (Nielsen et al., 2012). Emergency medical dispatch and communication systems are a foundational component of emergency medical services (World Health Organization, 2005). Yet there are no established recommendations of creating these systems inLMICs.Rwanda, a country of over 12 million people, is a rapidly developing leader in East Africa. The Ministry of Health of Rwanda established the Service d’Aide Medicale Urgente (SAMU) in 2007, recognizing the need for public emergency medical services. SAMU’s national dispatch center receives roughly 3,000 calls per month through a national 912 hotline. It organizes regional transportation with 260 total ambulances located at hospitals throughout the country and provides prehospital emergency services in the capital city of Kigali with a fleet of 12 ambulances. In the city, each ambulance has a driver, nurse and anesthetist dispatched for every call. Emergency department nursing and anesthetist staff are dispatched from hospitals around the country to respond to regional emergencies. No formal prehospital cadre of the workforce exists although the SAMU staffhave extensive field experience in prehospital care. SAMU has several challenges to rapid prehospital emergency care including lack of addresses beyond the capital city, unclear location data in densely populated areas, complex communication processes with little information about health facility capacity, and no established electronic dispatch system. The average response time for SAMU ambulances was 59 minutes in 2018, but 39% of calls were not completed within the golden hour.

Perceived Quality of Healthcare and Availability of Supplies Determine Household-Level Willingness to Join a Community-Based Health Insurance Scheme in Amhara Region, Ethiopia.

PurposeThe Ethiopian health system has been challenged by a shortage of funds and is heavily reliant on foreign donation. However, voluntary community-based health insurance (CBHI) has been implemented to reach and cover the very large agricultural sector since 2010. Thus, the level of acceptability of the scheme needs to be regularly assessed through households’ willingness to join before the nationwide rollout of the scheme. This study was intended to assess the level of willingness to join in community-based health insurance and associated factors in northwest Ethiopia.Patients and MethodsUsing a pretested structured questionnaire, a cross-sectional community-based study was conducted in 2017 in Amhara Region, northwest Ethiopia. Using a multi-stage sampling method, from 15 clusters in which CBHI was implemented, 1,179 households without CBHI membership were included as a sample for the study. Bivariable and multivariable logistic regression was fitted to assess the association between predictor variables and the outcome of interest.ResultsOut of the total (1,179) participants, 60.5% (713) were willing to join the scheme. Households’ occupation (AOR=2.26; 95% CI:=1.12–5.07), perceived good (AOR=2.21; 95% CI:=1.53−3.21), and medium (AOR=1.44; 95% CI=1.22–2.0) healthcare quality and richer wealth status (AOR=1.72; 95% CI=1.08–2.73) were associated with higher odds of willingness to join the scheme.ConclusionAs The study revealed that level of willingness to join is lower compared to other studies. Therefore, social protection activities for the low-income population and enhancement of the capacity of health facilities are crucial.

Essential Emergency Surgical Care in Remote Hilly Districts of Karnali - A Cross-Sectional Survey

Background: Remote hilly areas of Karnali Province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali Province to perform basic surgical procedures. The aim is to assess the status of Essential Emergency Surgical Care in remote hilly districts of Karnali region of Nepal.
 Method: The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care, to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus.
 Results: on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures.
 Conclusion: The capacity for essential surgery is severely limited in Karnali region of Nepal. Limitations was seen in basic equipment, human resources, infrastructure, and supplies.

COVID-19-Related Knowledge, Attitude and Practice Among Hospital and Community Pharmacists in Addis Ababa, Ethiopia.

PurposeThis study was launched to assess COVID-19-related knowledge, attitude and practice among hospital and community pharmacists in Addis Ababa, Ethiopia.MethodsSelf-administered questionnaire was distributed to pharmacists working in hospitals and community pharmacies by physically delivering the questionnaire to study subjects. Data collected were entered into and analyzed by IBM SPSS Statistics® Version 25. Binary logistic analysis was used to determine the association between independent and outcome variables.ResultsAll 295 participants who completed the survey stated that they had heard about COVID-19. Almost all of the participants were aware of the causative agent, the clinical manifestations and the ways of transmission of COVID-19. Most participants (92.2%) identified elderly individuals as one of the high-risk groups for severe complications and death while 89.5% identified supportive therapy and life support as recommended management options to date. More than half (53.2%) of the respondents were found to have adequate knowledge about COVID-19. Among respondents, 89.8% had a positive attitude on the importance of following WHO recommendations in reducing the transmission of COVID-19. Only 9.8% had confidence in the capacity of healthcare facilities in the country to properly handle potential COVID-19 pandemic. Inadequate protective measures were taken to protect the staff from COVID-19 in the institutions of 70.2% of the participants. Among the WHO recommended prevention measures, hand washing was exercised by 97.3% of the study participants.ConclusionThe study findings confirmed that there is a high level of knowledge on each specific aspect of COVID-19 among the study participants. However, only about half of the participants had adequate knowledge about the disease. The pharmacists showed a predominantly positive attitude towards the importance of WHO recommendations and predominantly negative attitude towards the country’s capacity to deal with the pandemic. The practice related to COVID-19 was inadequate at institutional level. Nevertheless, most of the pharmacists individually exercised self-protective measures against COVID-19. All stakeholders should work on ensuring the adequate supply of materials and services that aid in controlling the pandemic.

Assessing capacity of health facilities to provide routine maternal and newborn care in low-income settings: what proportions are ready to provide good-quality care, and what proportions of women receive it?

BackgroundGood quality maternal and newborn care at primary health facilities is essential, but in settings with high maternal and newborn mortality the evidence for the protective effect of facility delivery is inconsistent. We surveyed samples of health facilities in three settings with high maternal mortality to assess their readiness to provide routine maternal and newborn care, and proportions of women using facilities that were ready to offer good quality care. Surveys were conducted in 2012 and 2015 to assess changes over time.MethodsSurveys were conducted in Ethiopia, the Indian state of Uttar Pradesh and Gombe State in North-Eastern Nigeria. At each facility the staffing, infrastructure and commodities were quantified. These formed components of four “signal functions” that described aspects of routine maternal and newborn care. A facility was considered ready to perform a signal function if all the required components were present. Readiness to perform all four signal functions classed a facility as ready to provide good quality routine care. From facility registers we counted deliveries and calculated the proportions of women delivering in facilities ready to offer good quality routine care.ResultsIn Ethiopia the proportion of deliveries in facilities classed as ready to offer good quality routine care rose from 40% (95% confidence interval (CI) 26–57) in 2012 to 43% (95% CI 31–56) in 2015. In Uttar Pradesh these estimates were 4% (95% CI 1–24) in 2012 and 39% (95% CI 25–55) in 2015, while in Nigeria they were 25% (95% CI 6–66) in 2012 and zero in 2015. Improved facility readiness in Ethiopia and Uttar Pradesh arose from increased supplies of commodities, while in Nigeria facility readiness fell due to depleted commodity supplies and fewer Skilled Birth Attendants.ConclusionsThis study quantified the readiness of health facilities to offer good quality routine maternal and newborn care, and may help explain inconsistent outcomes of facility care in some settings. Signal function methodology can provide a rapid and inexpensive measure of such facility readiness. Incorporating data on facility deliveries and repeating the analyses highlighted adjustments that could have greatest impact upon routine maternal and newborn care.

"If You Have No Money, You Might Die": A Qualitative Study of Sociocultural and Health System Barriers to Care for Decedent Febrile Inpatients in Northern Tanzania.

Infectious diseases are a leading cause of mortality in low- and middle-income countries (LMICs) despite effective treatments. To study the sociocultural and health system barriers to care, we conducted a qualitative social autopsy study of patients who died from febrile illness in northern Tanzania. From December 2016 through July 2017, we conducted in-depth interviews in Arusha and Kilimanjaro regions with a purposive sample of 20 family members of patients who had died at two regional referral hospitals. Of the deceased patients included in this study, 14 (70%) were adults and 10 (50%) were female. Patients identified their religion as Catholic (12, 60%), Lutheran (six, 30%), and Muslim (two, 10%), and their ethnicity as Chagga (14, 70%) and Sambaa (two, 10%), among others. Family members reported both barriers to and facilitators of receiving health care. Barriers included a perceived lack of capacity of local health facilities, transportation barriers, and a lack of formal referrals to higher levels of care. Family members also reported the cost of health care as a barrier. However, one facilitator of care was access to financial resources via families' social networks-a phenomenon we refer to as social capital. Another facilitator of care was families' proactive engagement with the health system. Our results suggest that further investment in lower level health facilities may improve care-seeking and referral patterns and that future research into the role of social capital is needed to fully understand the effect of socioeconomic factors on healthcare utilization in LMICs.

Patterns in Pediatric Dental Surgery under General Anesthesia across 7 State Medicaid Programs.

Children's access to dental general anesthesia (DGA) is limited, with highly variable wait times. Access factors occur at the levels of facility, dental provider, and anesthesia provider. It is unknown if these factors also influence utilization of dental surgery. We characterized patterns in DGA utilization by system, provider, population, and individual disease levels to explain variation. We conducted a cross-sectional analysis of Medicaid-enrolled children (≤9 y) who received DGA in Massachusetts, Maryland, Texas, Connecticut, Washington, Illinois, and Florida from 2011 to 2012. DGA events were characterized by the place of service, measures of disease burden, average reimbursements for dental provider and anesthesia provider, and average total expenditures. A total of 10,149,793 children met study eligibility criteria. States with similar patterns of caries-related visits, such as Illinois (16% of Medicaid enrollees had a caries-related claim) and Washington (22%), had different DGA rates (1% and 17%, respectively). Reimbursement rates for dental providers, DGA services, and nonhospital places of services did not consistently align in states with higher DGA rates. Surgical extraction rates, as a proxy for the most severe disease, exceeded 75% in Maryland, which had the lowest DGA rate (0.3%). Variation in DGA rates across states was not explained by reimbursements rates (provider, DGA services, place of service) or population or individual level of caries burden. Efforts to evaluate and alter utilization of DGA should consider factors such as dental and anesthesia provider capacity, health facility capacity (hospital vs. ambulatory surgery center vs. office), and population- and individual-level disease burden. Our negative findings suggest the presence of other social determinants of oral health that influence utilization of services (e.g., race/ethnicity, language preference, immigration status, policy and budget goals), which should be explored. Our findings also raise the specter that variation in surgical rates may represent instances of unmet needs or overtreatment. The results of this study can be used by clinicians and policy makers as they address policy and clinical interventions to influence children with severe caries. Interventions to change utilization of surgical services on a population level may need to include state-specific factors that extend beyond reimbursement, disease burden, anesthesia provider type, or facility type.

Assessment of emergency and essential surgical service in primary hospitals of South Gondar zone, Amhara region, Ethiopia, 2019

IntroductionSurgical service at the first level referral hospitals are an important aspect of comprehensive health care. Surgical disease has been estimated to constitute 11% of the total global burden of disease, of which a substantial fraction unfortunately remains unmet in resource limited area. Surgical volume is large and continues to grow in all economic environments, yet many low-income countries fail to achieve basic levels of surgical service. ObjectiveThe objective of this study was to evaluate the capacity of emergency and essential surgical service in primary hospital facilities of south Gondar zone in Amhara regional state. DesignA cross sectional survey was employed in seven primary hospitals of south Gondar zone. MaterialThe WHO tool for situational analysis to assess emergency and essential surgical care was employed to capture a health facility's capacity to perform basic surgical (including obstetrics and trauma) and anesthesia interventions by investigating four categories of data: infrastructure, human resources, interventions available and equipment. The tool queried the availability of eight types of care providers, 35 surgical interventions and 67 items of equipment. ResultOf the 35 basic interventions listed in the tool, 51.4% basic interventions including caesarean section were available at all facilities. Averaging of 51 beds per facility was reported. The mean distance travelled prior to admission was 42 km. A total of 170 healthcare providers were reported in the seven facilities. This survey found that essential equipment was not consistently available at all of the facilities. ConclusionDiscrepancies in infrastructure, human resources, service provision, and essential equipment and supplies demonstrate the significant gaps in capacity of hospitals to deliver emergency and essential surgical care and effectively addressing the increasing surgical burden of disease and injury in south Gondar zone primary hospitals.

Analysis of distribution, capacity and utilization of public health facilities in Borno, North-Eastern Nigeria

IntroductionThis study aimed to analyze the spatial distribution and capacities of public health facilities and assess utilization of the facilities in Biu area of Borno State, Nigeria.MethodsA descriptive survey of health facilities and households were conducted by stratifying the area into 11 electoral wards. Data collection instruments include a hand-held GPS (Garmin 76CSx) and 2 sets of structured questionnaires (facility and household). The hand-held GPS was used in taking the coordinates of each health facility in the area. Twenty-five facility-based and 400 household-based questionnaires were administered.ResultsIt was identified that 138 public health personnel serve the area’s population of 240,838. Medical professionals (doctors/nurses/midwives) to patient ratio is 1:2973, about 7 times less than the minimum WHO recommendation of 2.5 medical personal per 1000 population. Uneven distribution of facilities exists, which impact on utilisation. For instance, a ward (Mandaragrau) with a population of 18,732 have 5 facilities (4 dispensaries and 1 primary health care) in comparison to a ward (Miringa) with a population of 21,343 with only one Dispensary. Income level and distance were significant socio-economic factors affecting service utilisation (p < 0.001). Area’s households Gini index was 26.7, most of which (49.7%) survive on less than USD2/day and majority (33.6%) spend an average cost of treatment of ₦2,750 (approx. $8) per clinic visit.ConclusionIt was concluded that insufficiency and inequity in distribution of healthcare services exist in Borno State. It is thus recommended that future policies be directed toward improving healthcare in under-served areas.

The management of microbial keratitis within Uganda’s primary health system: a situational analysis

Background: Microbial keratitis (MK) frequently leads to sight-loss, especially when the infection is severe and/or appropriate treatment is delayed. The primary health system as an entry point plays a central role in facilitating and directing patient access to appropriate care. The purpose of this study was to describe the capacity of primary health centres in Uganda in managing MK. Methods: We carried out a rigorous assessment of primary health centres and mid-cadre training schools in South Western Uganda. Through interviews, checklists and a picture quiz, we assessed capacity and knowledge of MK management. In addition, we interviewed the heads of all the mid-cadre training schools to determine the level of eye health training provided in their curricula. Results: In total, 163 health facilities and 16 training schools were enrolled. Of the health facilities, only 6% had an Ophthalmic Clinical Officer. Only 12% of the health workers could make a diagnosis of MK based on the clinical signs in the picture quiz. Although 35% of the facilities had a microscope, none reported doing corneal scraping. None of the facilities had a stock of the recommended first line treatment options for MK (ciprofloxacin and natamycin eye drops). Among the training schools, 15/16 had an eye health component in the curriculum. However, the majority (56%) of tutors had no formal expertise in eye health. In 14/16 schools, students spent an average of two weeks in an eye unit. Conclusions: Knowledge among health workers and capacity of health facilities in diagnosis and management of MK was low. Training for eye health within mid-cadre training schools was inadequate. More is needed to close these gaps in training and capacity.

Assessment of Health Facilities Delivering HIV Services among Patients in Bonny, South-South Nigeria

Background: The growing spread of HIV and AIDS among the people of Bonny Kingdom and capacity of medical facilities and service providers to respond to the dire situation have long posed public health concern of immeasurable proportion right from the inception of the Ibani-Se HIV/AIDS Baseline Survey Initiative in 2006 to the implementation of a three-year (2008-2011) intervention programme and thereafter. The impact of the provision of ART and other medical services related to HIV on the quality of care and satisfaction of all, HIV and non-HIV patients is unknown, and any available evidence is limited and arguable. The survey sought to know the number of health facility in the locality, the services they offer and most importantly the number of qualified personnel in such health facilities.&#x0D; Methods: A standardized questionnaire was designed for facility assessment to measure the capacity of health facilities to undertake VCT and ART services. The survey was conducted in sixteen (16) health facilities; fourteen (14) public and two (2) private health facilities located within Bonny town and in the creeks. In each facility, the manager and health providers were surveyed, with at least one provider selected from the HIV/AIDS department; 10 randomly selected persons in the Outpatients Department/Unit including 5 from the HIV/AIDS services were interviewed. A standard health facility assessment checklist was developed to measure the quality of care, capacity of providers, developmental and training needs. Others included conformity to standard of practice and quality of medical equipment. Data was entered with Census and Survey Processing System (CSPro) and exported to SPSS or Stata for analysis.&#x0D; Results: Of the sixteen health facilities, only seven provided both VCT and PMTCT services (Abalamabia health centre, Comprehensive health centre, NLNG RA Hospital, General Hospital, Finima health centre, Good shepherd Health medical lab and Chanel clinic) while one (Island Medical lab) provided VCT services; the others provided neither of the two services. Although, there are fairly adequate number and distribution of health facilities in the LGA, utilization of the general health services was found to have improved when compared to the previous survey. However, lack of structured unit for the provision of VCT and PMTCT services, specifically trained and designated counselors; and poorly motivated public healthcare providers have given rise to concerns about poor access of rural dwellers and inequitable distribution of the few available services, particularly to people most in need.&#x0D; Conclusion: Implications of this survey were highlighted for a more effective HIV prevention and control programme for wide coverage.

The management of microbial keratitis within Uganda's primary health system: a situational analysis.

Background: Microbial keratitis (MK) frequently leads to sight-loss, especially when the infection is severe and/or appropriate treatment is delayed. The primary health system as an entry point plays a central role in facilitating and directing patient access to appropriate care. The purpose of this study was to describe the capacity of primary health centres in Uganda in managing MK. Methods: We carried out a rigorous assessment of primary health centres and mid-cadre training schools in South Western Uganda. Through interviews, checklists and a picture quiz, we assessed capacity and knowledge of MK management. In addition, we interviewed the heads of all the mid-cadre training schools to determine the level of eye health training provided in their curricula. Results: In total, 163 health facilities and 16 training schools were enrolled. Of the health facilities, only 6% had an Ophthalmic Clinical Officer. Only 12% of the health workers could make a diagnosis of MK based on the clinical signs in the picture quiz. Although 35% of the facilities had a microscope, none reported doing corneal scraping. None of the facilities had a stock of the recommended first line treatment options for MK (ciprofloxacin and natamycin eye drops). Among the training schools, 15/16 had an eye health component in the curriculum. However, the majority (56%) of tutors had no formal expertise in eye health. In 14/16 schools, students spent an average of two weeks in an eye unit. Conclusions: Knowledge among health workers and capacity of health facilities in diagnosis and management of MK was low. Training for eye health within mid-cadre training schools was inadequate. More is needed to close these gaps in training and capacity.

Increasing Family Planning Access in Kenya Through Engagement of Faith-Based Health Facilities, Religious Leaders, and Community Health Volunteers.

Health facilities managed by faith-based organizations (FBOs) are important providers of health care in Kenya but provide only a small proportion of family planning services in the country. From 2013 to 2017, the Christian Health Association of Kenya (CHAK) implemented a project with 6 FBO-managed health facilities to increase voluntary family planning services in western Kenya, in partnership with religious leaders and community health volunteers (CHVs). The project aimed to build capacity of FBO-managed health facilities, increase religious leaders' knowledge of family planning, mobilize communities, improve family planning access and referrals for services, and advocate for improved family planning commodity security from the public sector. Project impact was evaluated using facility-level service statistics, project records and reports, and feedback from religious leaders and CHVs who implemented the project. Facility service statistics showed large increases in family planning visits. Phase 1 (2013-2014) was implemented at 2 health facilities, where client visits for family planning increased sixfold (from 705 to 4,286 visits) with tenfold increases seen in client visits for pills, intrauterine devices, and implants. In Phase 2 (2015-2017), the project was expanded to an additional 4 health facilities and total client visits for family planning nearly doubled (from 7,925 to 14,832 visits). During Phase 2, new client visits for implants increased threefold, making implants the most popular family planning method. Religious leaders who implemented the project reported reaching nearly 700,000 people with family planning messages and referring more than 87,000 clients to health facilities for family planning services. The religious leaders expressed confidence in the effectiveness of the project and in their role in enhancing access to voluntary family planning. Health facilities, religious leaders, and CHVs also reported multiple challenges to implementation, including inconsistent supply of family planning commodities from county health departments. This project demonstrates the potential of FBO-managed facilities and faith leaders to increase family planning demand and service provision, as well as the importance of coordination with the public sector to ensure supply of commodities and support for FBO-managed facilities.