Delivery Of Care Services Research Articles

FINDINGS FROM HIGH USERS OF VIDEO TELEHEALTH TO DELIVER OCCUPATIONAL THERAPY SERVICES DURING COVID-19

Abstract Occupational therapy (OT) helps older adults improve their ability to perform day-to-day tasks. Veterans Health Administration (VHA) is the single largest employer of occupational therapy (OT) practitioners in the United States and a forerunner in telehealth. As a result of COVID, OT video visits increased by nearly 2000% from 2019 to 2020. To ascertain barriers and facilitators to this shift in care delivery, we conducted interviews between January and April 2021 with OT practitioners (N=27) who were high users of VA Video Connect (VVC), VHA’s videoconferencing software. OT participants were from rural and urban settings, and had completed an average of 536 VVC appointments each in 2020. Participants used VVC to deliver a variety of OT services, including mental health groups and home safety interventions. Facilitators to VVC included, a) Patient characteristics, such as positive perceptions of VVC and technological skill, b) OT clinician characteristics, like flexibility, level of experience, and desire to increase patient access to care, and, c) VHA’s telehealth infrastructure. Barriers included, a) Patients’ lack of familiarity or skills with technology, particularly older patients, b) challenges translating traditionally hands-on care to video, and c) unreliable internet connectivity, particularly for rural patients. This study broadens our understanding of video telehealth service delivery for care which has historically been delivered in brick-and-mortar settings. Understanding challenges and enablers to video telehealth highlights opportunities to increase access to those who face barriers, such as older, rural patients.

Dying in hospital-staff perceptions on providing quality care.

To understand what healthcare staff perceive contributes to the quality of patient and family/whānau experiences of dying and death on a hospital inpatient ward. A survey was created, piloted and sent to all staff members who had cared for a deceased patient within two working days of their death, at Christchurch Hospital (CH), New Zealand. The survey comprised questions evaluating whether the patients physical, emotional, social or family/whānau needs were met, using both a Likert scale and free-text options. The survey was sent over a three-month period in 2016/2017. A total of 169 staff responded to the deaths of 51 patients. The majority (71.3%) of staff agreed that "end-of-life care was of a high standard", with the physical symptoms domain holding the highest score for both agreement (68%) and disagreement (13%) that "physical symptoms were well managed". Qualitative analysis of free-text responses revealed three themes: coordinated care (service delivery, complex case or communication needs, teamwork); culture of practice (dignity, trust, respect and relationships); and complexity of care (encompassing complex physical symptoms or patient or family/whānau interpersonal dynamics). Evaluation of quality of death in hospitals can be enhanced by routine use of surveys of staff who cared for the deceased person. Such surveys could comprise part of a suite of tools to provide a holistic view of dying and death, complementing methods such as retrospective audits and family/whānau interviews.

1439. Latent tuberculosis infection treatment location and association with care completion

Abstract Background Location and type of clinic where pediatric latent TB infection (LTBI) care is provided are associated with treatment completion and retention in care. Prior research has not evaluated joint clinical management occurring between care settings. Understanding care transfer dynamics and accessibility of clinics can inform pediatric LTBI care service delivery. Methods We conducted a retrospective cohort study of LTBI in children 0-17 years old who were prescribed outpatient treatment in two Boston-area health systems from 2017-2019. We defined “initial clinical setting” (categorized as primary care or TB/infectious diseases clinic) as the location where the first LTBI medication was prescribed. Through chart review, we determined if care was transferred to a different (“final”) clinic setting during treatment. We calculated driving time between a child’s home address and initial and final treatment clinics. The primary outcome was frequency of care transfer after starting treatment. In a secondary analysis, we used two multivariable logistic regression models (adjusted for age, sex, and use of rifamycin-based treatment) to evaluate associations between completion and distance to and type of initial and final treatment clinic. Results We identified 142 children who started LTBI treatment as outpatients; 110 started treatment in primary care clinics and 32 in TB/infectious diseases clinics. Overall, 20/142 (14%) transferred TB care to a different clinic after starting treatment. A total of 101/142 (71%) patients completed treatment. Neither initial treatment location nor driving time to initial clinic were significantly associated with treatment completion (Table 1). However, final treatment in a TB clinic was associated with higher odds of treatment completion than final treatment in a primary care clinic (aOR 2.71 [95%CI 1.06-6.91], P=0.04); time to clinic was not associated with completion (Table 2). Figure 1.Patient transfers after starting LTBI treatment.Table 1.Initial treatment location: Univariable and multivariable analysis of factors associated with treatment completion.1Adjusted for time to clinic and location of initial treatment as well as age, sex, and use of rifamycin-based treatment.Table 2.Final treatment location: Univariable and multivariable analysis of factors associated with treatment completion.1Adjusted for time to clinic and location of final treatment as well as age, sex, and use of rifamycin-based treatment. Conclusion Among children with LTBI in a large metropolitan area, more patients received treatment in primary care clinics than in TB clinics. Care transfers were relatively uncommon after starting treatment. A TB clinic as a final treatment location was associated with increased odds of treatment completion. Disclosures Jessica Haberer, MD, MS, Merck: Advisor/Consultant|Natera: Stocks/Bonds.

Modular structures and the delivery of inpatient care in hospitals: a Network Science perspective on healthcare function and dysfunction

Reinforced by the COVID-19 pandemic, the capacity of health systems to cope with increasing healthcare demands has been an abiding concern of both governments and the public. Health systems are made up from non-identical human and physical components interacting in diverse ways in varying locations. It is challenging to represent the function and dysfunction of such systems in a scientific manner. We describe a Network Science approach to that dilemma. General hospitals with large emergency caseloads are the resource intensive components of health systems. We propose that the care-delivery services in such entities are modular, and that their structure and function can be usefully analysed by contemporary Network Science. We explore that possibility in a study of Australian hospitals during 2019 and 2020. We accessed monthly snapshots of whole of hospital administrative patient level data in two general hospitals during 2019 and 2020. We represented the organisations inpatient services as network graphs and explored their graph structural characteristics using the Louvain algorithm and other methods. We related graph topological features to aspects of observable function and dysfunction in the delivery of care. We constructed a series of whole of institution bipartite hospital graphs with clinical unit and labelled wards as nodes, and patients treated by units in particular wards as edges. Examples of the graphs are provided. Algorithmic identification of community structures confirmed the modular structure of the graphs. Their functional implications were readily identified by domain experts. Topological graph features could be related to functional and dysfunctional issues such as COVID-19 related service changes and levels of hospital congestion. Contemporary Network Science is one of the fastest growing areas of current scientific and technical advance. Network Science confirms the modular nature of healthcare service structures. It holds considerable promise for understanding function and dysfunction in healthcare systems, and for reconceptualising issues such as hospital capacity in new and interesting ways.

Characterizing the use of virtual care in primary care settings during the COVID-19 pandemic: a retrospective cohort study.

In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. METHODS: Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescriptions) and provider (sex, age, clinic location, provider type, remuneration, country of graduation, return visit rate) characteristics describe the study population by visit type. Generalized estimating equation models describe factors associated with virtual care. RESULTS: There were 146,372 visits provided by 154 primary care providers between 03/14/20 and 06/30/20, of which 33.6% were virtual care. Female patients (OR 1.16, CI 1.09-1.22), patients with ≥ 3 comorbidities (OR 1.71, CI 1.44-2.02), and patients with ≥ 10 prescriptions (OR 2.71, 2.2-1.53) had higher odds of receiving at least one virtual care visit compared to male patients, patients with no comorbidities and patients with no prescriptions. There was no significant difference between the number of follow-up visits that were provided as a clinic visit compared to a virtual care visit (8.7% vs. 5.8%) (p = 0.6496). Early in the pandemic restrictions, approximately one-third of visits were virtual. Virtual care was utilized by patients with more comorbidities and prescriptions, suggesting that patients with chronic disease requiring ongoing care utilized virtual care. Virtual care as a primary care visit type continues to evolve. Ongoing provision of virtual care can enhance quality, patient-centered care moving forward.

A critical look at synergies and fragmentations of universal health coverage, global health security, and health promotion in delivery of frontline health care services: A case study of Bangladesh

Universal Health Coverage (UHC) and Global Health Security (GHS) activities encompass mitigation of risks to health and well-being rights posed by infectious disease outbreaks and facilitated by health promotion (HP) activities. This case study investigated Bangladesh's readiness and capacity to ‘prevent, detect and respond’ to such outbreaks of an epidemic/pandemic nature. A rapid review of relevant documents, key informant interviews with policymakers/practitioners, and a deliberative dialogue with a crisscross of stakeholders were used to identify challenges and opportunities for ‘synergy’ among these streams of activities. Findings reveal conceptual ambiguity among respondents about the scope of the three `agendas and their inter-linkages. They perceived the synergy between UHC and GHS superfluous and were obsessed with losing their respective constituencies and resources. Poor coordination among the focal agencies in field activities, lack of supporting infrastructure, and shortage of human and financial resources posed additional challenges for better pandemic/epidemic preparation in future. This study, “Researching the UHC-GHS-HP Triangle in Bangladesh,” was funded by the Wellcome Trust, UK

Effect of household couple counselling for male involvement on the utilization of postnatal services at 1 week in Ibanda district, Uganda; A cluster randomized community trial

Introduction: Prompt and Skilled postnatal care attendance coupled with skilled Antenatal and delivery care can drastically reduce maternal morbidity and mortality and also improve newborn outcomes. Research shows that men are decision makers in the home but they may also restrict resources, hence preventing women and children from health care seeking. But however if involved men may lead to better health care seeking behavior and better utilization of Antenatal care, delivery and postnatal care services. The postnatal care attendance at 1 week is low in Uganda, Ibanda district reported 4% in 2018. The aim of this study was to innovate, implement and document an intervention of house hold couple counseling for male involvement and compare the intervention and control clusters on the utilization of postnatal care services at 1 week. Methods: This was a two arm cluster randomized Community trial with a parallel design with the aim of comparing utilization of postnatal care services. It was carried out in two intervention parishes and two control parishes and was a superiority trial to test if the intervention of household couple counseling would improve utilization of postnatal care services. Results: The intervention arm had 200 respondents while the control had 213. The mean age was 27.3years (SD 6.8). Ninety one point five percent of mother had used skilled delivery services in the intervention compared to 78.4% in the control. Seventy Five percent attended postnatal care at 1week in the intervention as compared to 21.1% in the control (OR 11.2, P<0.001). The activity that are statistically significantly associated with utilization of postnatal services utilization is providing transport to the postnatal clinic (AOR 30.8, P<0.001) comparing the intervention and control clusters. The others included; accompanying to antenatal clinic, partner attending antenatal clinic, providing transport for delivery, escorting partner for delivery, providing psychological support during delivery and providing necessary drugs during delivery and PNC period but these were not statistically significant. Conclusion: The study demonstrated that the intervention of household couple counseling for increased male partner involvement improved significantly utilization of postnatal care services. Interventions to improve utilization of postnatal care services should focus on involving male partners to do the supportive activities which help their partners utilize the health care services.

The remarkable invisibility of NHS 111 online.

In 2017, the NHS 111 telephone service was augmented by an online service. This is an exemplar of 'digital-first', the push to enrol digital technologies to deliver services, and is viewed by policymakers as an important vehicle for managing demand for overburdened health services. This article reports the qualitative component of a larger multi-method study of NHS 111 online. Qualitative telephone interviews with 80 staff and stakeholders implicated in primary, urgent and emergency care service delivery explored the impact of NHS 111 online on health-care work. The analysis presented here draws on Susie Scott's work on the 'sociology of nothing' and theories of the marked and unmarked, which we reached for when confronted by the remarkable invisibility of this seemingly core NHS service in the wider landscape of health care. Despite the apparently high use by patients and the public (30 million visits over 6months in the 2020 pandemic), we were surprised to find very low awareness among our interviewees. Confusion about nomenclature, an exceedingly crowded digital field (littered with alternative technologies and ways of accessing care) and constant change in service provision provide some cogent reasons for this invisibility, and sociology helps explain our data about this digital technology.

Precision medicine in Australia: now is the time to get it right.

Precision medicine in Australia: now is the time to get it right.

Health Care During Incarceration: A Policy Position Paper From the American College of Physicians.

The American College of Physicians (ACP) has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP is committed to working toward fully understanding and supporting the unique needs of the incarcerated population and eliminating health disparities for these persons. In this position paper, ACP offers recommendations to policymakers and administrators to improve the health and well-being of persons incarcerated in adult correctional facilities.

Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria.

Background: The equitable distribution of a skilled health workforce is critical to health service delivery. Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, these investments are yet to yield the desired outcomes due to health workforce shortages and the inequitable distribution of those available. Methods: A Workload Indicator for Staffing Need (WISN) study was conducted at Kaduna state's primary health care level. The study focused on estimating staffing requirements; Nurses/Midwives and Community Health Worker practitioners, Community Health Officers, Community Health Extension Workers, and Junior Community Health Extension Workers in all government-prioritised primary health care facilities. A total of ten focal primary health care facilities in Kaduna North Local Government Area (LGA) were included in the study. Results: Findings from the study revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, nine of the ten PHCs have a WISN ratio < 1, indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a WISN ratio > 1 was calculated. Conclusion: The WISN study highlights staffing needs in Kaduna State's government-prioritised primary health care facilities. This evidence establishes the basis for applying an evidence-based approach to determining staffing needs across the primary health care sector in the State to guide workforce planning strategies and future investments in the health sector. The World Health Organisation (WHO) WISN tool is useful for estimating staffing needs required to cope with workload pressures, particularly in a resource-constrained environment like Kaduna State.

Students’ appraisal of a preparedness model for the provision of oral health care during a pandemic

BackgroundThe COVID-19 pandemic has impacted the provision of oral health care worldwide, prompting the discussion of preparedness. This study aimed to perform an initial appraisal of the usability, spatial representation, and clarity of a newly developed preparedness model from the perspective of senior undergraduate dental students at the University of British Columbia, Vancouver, Canada, enrolled in the 2020-21 academic year. Answers were analyzed thematically via an inductive coding process between March and June 2021.ResultsAll the 111 students in years 3 (#55) and 4 (#56) appraised the preparedness model, generating more than 200 pages of text. Four main themes were identified across the essays: streamlined depiction, information-based approach, adaptability to an ever-changing situation, and room for improvement. Although the majority of students appraised the model as being useful in fostering information-seeking behaviour, few students disagreed with the model’s portrayal and made further suggestions.ConclusionsPreparedness models can better guide oral health care providers during a health crisis such as a pandemic. The recently developed preparedness model was appraised as useful by senior undergraduate dental students, although alternative portrayals of the model were suggested. A comprehensive assessment of the newly developed model (and of its variations) is warranted to better support oral health care service delivery during a pandemic.

Institutional constraints and opportunities for public-private partnership development in telemedicine

Subject. The article considers problems of attracting investments into telemedicine in Russia. Objectives. The purpose is to analyze prospects for remote delivery of health care services, assess the legal framework for public-private partnership development in health care. Methods. The study employs methods of institutional analysis and economic statistics. Results. One of the most attractive options for the development of digital health services and telemedicine in Russia in conditions of its economic blockade and limited access to advanced global technologies is the use of public-private partnership mechanisms. There are many major players in the Russian telemedicine market, the software is being improved. Conclusions. To develop telemedicine in Russia, attract investment, including through the mechanisms of PPP, it is required to improve the methodological and regulatory framework in this area, accelerate processes of import substitution of high-tech equipment, implement mechanisms to ensure project payback, consistently solve problems of institutional and market constraints.

Benchmarking Paediatric Sickle Cell Care in Australia

Background: Sickle cell disease (SCD) is a severe, multisystem vasculopathy, associated with significant reduction in life expectancy, and high burden of care for patients/families and clinicians. Haematologists in Australia have observed an increase in numbers of children presenting for care with SCD in recent years that disproportionately affects migrant families with socio-economic challenge. Models of care for these patients in Australia are still evolving and there is a need for service benchmarking to define consensus best practice for service delivery. Key issues include access to affordable Hydroxyurea (HU) paediatric formulations, red cell exchange (RCE), antenatal/newborn screening policy and consideration of expanding indications for curative therapies (bone marrow transplantation). Aim: To survey aspects of health care service delivery for paediatric SCD at six specialist centres in Australia. Method: Lead clinicians at the six centres were surveyed to determine: basic demographics, availability of current treatment modalities, transfusion practices, service integration, care pathways and access to support services and transition services. Current challenges to optimal health care delivery were identified. Results: A total of 293 cases were identified. Variations in care included: inequity of funding for HU formulation, access to RCE as recommended transfusion method, screening protocols for stroke prevention, disease specific pain management pathways. Identified challenges to optimal care delivery were consistent across the centres, with common themes identified: difficulty accessing adequate support services (social work, mental health) and care co-ordinationinability to provide comprehensive care such as educational resources/neuropsychology testing (as is best practice in international centres)financial restrictions (variations in funding for paediatric formulations where HU is the only disease modifying therapy DMT available in Australia, liquid Hydroxyurea mixture is a special access product often requiring patient co-payment despite PBS coverage of capsules)limited networks of clinicians to provide multi-disciplinary care modelslack of designated transition pathways for young adults in some locations. Conclusion - This survey has identified key challenges in access to RCE, affordable HU formulations for children, as well as allied health support/care co-ordination for this disadvantaged population. We recommend the need for the development of consensus recommendations for standards of care for sickle cell services in Australia. These standards will provide a useful benchmark for advocacy and interactions with policymakers. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Developing consensus-based recommendations for the delivery of dementia services for the LGBTQIA+ community in the Republic of Ireland

Background: The number of older LGBTQIA+ adults is set to rise significantly in the coming years. The rising numbers sit together with the rise in the number of people in Ireland diagnosed with dementia. In Ireland, no dementia-specific services exist for people from the LGBTQIA+ community. The aim of this research was to 1) identify the future needs that older LGBTQIA+ people and their care partners living in Ireland have in relation to dementia care service delivery; and to 2) develop consensus-based recommendations for dementia service provision in Ireland. Methods: A six-phase consensus process was used to develop the lists of needs and recommendations: 1) development; 2) national survey; 3) interviews with key stakeholders; 4) international review of best practice; 5) consensus meeting; 6) final member checking. Participants, aged over 50, were based in Ireland, identified as a member of the LGBTQIA+ community or supported someone who is/was. Results: Results are reported from the survey (n=49), individual interviews (n=8), and the consensus meeting (n=10). Participants have concerns related to identity management and suppression, creating an LGBTQIA+ affirmative ethos and workforce, and respect and safety. From the results and consensus process, a full list of ten prioritised needs and recommendations have been developed that focus specifically on dementia care in Ireland for the LGBTQIA+ community. Conclusion: The older LGBTQIA+ community has identified essential priorities for improving healthcare access and safety. These priorities now need to be urgently implemented into clinical and dementia care services.

Exploring physicians' experiences under the national health insurance scheme in Southeastern Nigeria.

A number of low-and middle-income countries have implemented National Health Insurance Schemes (NHIS) as part of efforts to increase access to quality healthcare and financial protection from regressive out-of-pocket payments. This study explored physicians' experiences under the Nigerian (NHIS) to identify factors that may influence efficient health care delivery. A convenient sample of 85 physicians residing in South-East Nigeria who had active contracts with the NHIS were surveyed via self-administered questionnaire for this study. Descriptive statistics were used to summarize the data while Kruskal-Wallis tests were used to determine if there were statistically significant associations between physician professional characteristics and their responses to key statements that assessed their experiences and behavior. Also, thematic analysis was used to assess additional qualitative data provided by study participants. Provider experiences were affected by the perceived inadequacy of reimbursement rates, delays in payment and services not covered by the NHIS. Participants' responses to statements on inadequacy of reimbursement was significantly associated with location using Kruskal-Wallis test (χ2 (1)=7.24, p=0.027) while billing patients for services not covered under the NHIS was significantly associated with length of years of practice (χ2 (1)=15.5, p=0.001) and place of employment (χ2 (1)=5.82, p=0.054). Physician experiences and challenges they face under the NHIS program in Nigeria have unintended effects on the delivery of health care services. It is imperative that these issues are addressed to improve health service delivery.

The Taal Volcano Eruption and Landfall of Super Typhoon Odette: A Dilogy of Disasters in the Philippines, An Abstract on the Response Strategies of Dr. Jose N. Rodriguez Memorial Hospital and Sanitarium-Philippine Emergency Medical Assistance Team (DJNRMHS PEMAT) for the TAAL and DINAGAT Missions in the Years 2020 and 2021

Background/Introduction:The country’s location makes it vulnerable to natural disasters, hence, the PEMAT’s potential was tested during local disaster response for Taal Volcano Eruption in Batangas last January 2020 and during the aftermath of Super Typhoon Odette in Dinagat Islands last December 2021, amidst COVID-19 surge.Objectives:The primary objective of the deployment was to augment the DOH in the provision of safe, effective, and efficient quality health care services appropriate to the victims’ needs, timely, and coordinated mobilization of DJNRMHS PEMAT, and to evaluate the knowledge and skills acquired in the EMT Basic induction course in disaster response.Method/Description:As per WHO standards, disaster responses conducted by the DJNRMHS PEMAT followed three important phases: pre-mobilization, mobilization, and post-mobilization. The methods used during these phases in Taal and Dinagat missions were the simulation of drills and application of didactics learnt from the EMT Basic Induction Course for Disaster Response conducted by the DOH in collaboration with WHO in 2019.Results/Outcomes:The essential services rendered by DJNRMHS PEMAT, ensuring patient and responder safety despite being at the height of COVID-19 surge, were out-patient, acute emergency, trauma and basic obstetric care, basic laboratory, social welfare, public health, and pharmaceutical to 1,124 victims in the Taal Eruption and 1,089 victims of Typhoon Odette.Conclusion:Safe and effective delivery of quality health care services by PEMAT, a team equipped with knowledge and skills acquired through mentorship, can be achieved with thorough planning, setting of mission objectives, and most importantly, having full support from the management and all stakeholders.

How did living in temporary accommodation during the COVID-19 pandemic affect children younger than 5 years' access to health care and health outcomes? A qualitative study of key professionals in a socially and ethnically diverse and deprived area of London

BackgroundChildren younger than 5 years living in temporary accommodation due to homelessness (U5TA) are extremely vulnerable to the effects of the COVID-19 pandemic. Few qualitative studies have examined provider perspectives in family homelessness, but none focused on U5TA specifically. We aimed to qualitatively explore professionals' perspectives of pandemic-related challenges and barriers experienced by U5TA in accessing health care and optimising health outcomes, and their experiences of delivering U5TA services. Methods16 semi-structured interviews were done online. Professionals working in the London Borough of Newham with U5TA families were purposively sampled and recruited from non-profit organisations, the health sector, and local authority. A thematic codebook approach was used to analyse the data combining inductive and deductive codes using an adapted socioecological model as a guiding theoretical framework. FindingsTwo non-profit organisation professionals, seven health visitors, one GP, therapist, dietician, nurse, public health consultant, and two social workers from the local authority's No Recourse to Public Funds team described adverse pandemic effects on U5TA health: delay and regression in developmental milestones and behaviours—eg, toileting, feeding skills, emotional regulation, and social-communication skills. Pre-existing systemic barriers were exacerbated during the pandemic when the reduction of in-person services with professionals necessitated remote delivery of health and social care services. Differential effects of digital poverty, language discordance, and inability to register and track U5TA rendered this population invisible to services. Professionals highly agreed that barriers to optimal health outcomes and service access included poor mental health, unsuitable housing, no social support, mistrust of mainstream services, immigration administration, financial insecurity, and loss of informal jobs among U5TA families. Professionals sometimes mitigated these barriers with good communication skills, developing trusting relations, and through community facilitators. InterpretationCOVID-19 widened health inequalities and inequities, substantially affecting the lives of U5TA and ability of professionals to deliver quality care to U5TA. Innovative and tailored cross-sector strategies, including co-production of public health services, are required. Policies and services urgently need to focus on early development, mental health support, employment training, and opportunities for parents and carers, plus unambiguous definitions of what is deemed suitable accommodation and actionable planned steps to ensure enforcement. FundingNone.

POSTPARTUM MODERN CONTRACEPTIVE UTILIZATION IN ADDIS ABABA: ANTEPARTUM DECIDEDNESS FOR POSTPARTUM UPTAKE

Introduction: Family planning (FP) slows population growth and helps achieve national and international development goals. FP counselling is the first intervention in family planning programs and can be done during late pregnancy. Antepartum FP counseling is not practiced adequately during the antenatal care (ANC) service delivery at which time women can decide to use Post-Partum Modern Contraceptive (PPMC). Women’s antenatal decidedness rate to use PPMC is not known. Objective: To assess the prevalence of antenatal decidedness to use PPMC among pregnant women in Addis Ababa city. Methods: A cross-sectional study was conducted from Tir 01, 2012 to Tir 30, 2012 EC on a population of women who had their 4th ANC visits in 98 health centers in Addis Ababa. The calculated sample size was 422; and the sampling procedure was made in 2 stages: Cluster Sampling and Simple Random Sampling. Study subjects were enrolled in a continuous all-inclusive manner starting from the first woman who came on her scheduled 4th ANC visit on day one of the study period until the total number of study subjects was obtained. A semi-structured, anonymous, self-prepared &amp; pre-tested questionnaire was used to collect data; and data collection was as an exit interview. Data was entered &amp; analyzed using SPSS version 25 software. Results: During the routine ANC follow up only 153 (36.9%) have had FP counseling, and the study team delivered the service for 262 (63.1%). Three hundred eighteen (76.6%) have antenatally decided to use PPMC. The rate of antenatal decidedness to use PPMC was higher for those who had FP counseling by the study team compared to those counseled during the routine ANC follow up (77.9% Vs 74.5%). Religion, the round of ANC visit the FP counseling was given, and the number of topics covered during the FP counseling were found to be determining factors for women’s antenatal decidedness to use PPMC. Conclusion: The FP counseling service delivery rate during the routine ANC service is low. Women will decide to use PPMC antenatally if they get a FP planning counseling conducted during the ANC follow up. The FP counseling should include 4 major topics (available types, efficacy, advantages &amp; disadvantages, and side effects of each method), and an adequate duration should be allocated for it. Further study to find out why ANC care providers at health centers are not providing FP counseling service to all of their clients is recommended.

How did primary health care in Beira experience Cyclone Idai?

Beira, the biggest city of Mozambique's Sofala province, was struck by Cyclone Idai on 14 March 2019, with devastating impacts. The floods along with the cyclone destroyed road infrastructure and health facilities and disrupted primary health care (PHC) service delivery. In addition, destruction of farmland and food stocks resulted in malnutrition; the abundance of water fostered the reproduction of mosquitos, exacerbating the burden of malaria; and problems with water and sanitation led to epidemics of cholera. The exact role and contribution of human-induced climate change is very difficult to quantify, but there is little doubt that climate change is driving more frequent and severe cyclones, such as Idai. Considering the current climatic changes, it is expected that climate hotspots such as Beira will only experience more frequent extreme weather events. In these settings, with high risks but low adaptive capacity, dedicated efforts are required to strengthen PHC with a focus on preparedness for disasters. This should entail community awareness and education, strengthening infrastructure and service provision, as well as collaboration with important stakeholders across other sectors.Contribution: Using a case study approach, this article contributes climate resilient PHC for better preparedness to service continuity.