Health System Challenges Research Articles

The potential of digital health interventions to address health system challenges in Southeast Asia: A scoping review.

The World Health Organization (WHO) Southeast Asian region, comprising a quarter of the global population, faces significant healthcare challenges influenced by diverse economic and social conditions. The objective of this study is to map the Digital Health Intervention (DHI) functionalities across the nine axes of the healthcare system challenges (HSCs) model; we use WHO's DHIs classification framework and the Health System Challenges model. Our study findings help identify the gaps in the potential of the existing DHIs in addressing health system challenges in low- and middle-income countries. Using SCOPUS, EMBASE and PUBMED databases, a scoping review was conducted to identify the existing DHIs in the Southeast Asia region and map the DHIs with the HSCs related to availability, information, utilization, quality, accountability, efficiency, equity, cost and acceptability. Out of 278 studies, 337 DHI functionalities were identified. A majority of the identified DHIs address challenges related to information (35.6%), availability (34.7%) and utilization, while less than 10% of the DHIs address challenges related to quality (8.9%), accountability (5%) and efficiency (3.9%) in the health system. Most of the existing DHIs in SEA region address challenges related to availability of services and lack of information, while they fall short in addressing challenges related to quality of services, efficiency, and accountability. Acknowledging the inter-linkages across the health system challenges, this gap identification may well guide future investments and planning in DHIs.

Optimizing health system volume flexibility: key determinants and strategies during the COVID-19 crisis.

The need to match highly variable demand for healthcare services with existing capacity has been a significant health system challenge experienced by the COVID-19 pandemic. Despite mounting research on various COVID-19 responses in the recent literature, there has not been a structured review examining key determinants of health system volume flexibility. The focus of the present research is to review recent literature based on a conceptual framework developed based on the volume flexibility literature on COVID-19. The review also provides a meaningful way to guide practice and future research in the area. A literature review was performed guided by the theoretical frameworks developed in the previous volume of flexibility literature. Selected research papers were reviewed and analyzed to identify key determinants of health system volume flexibility. Seven determinants of health system volume flexibility under three domains (demand management, capacity management, and performance) included demand management strategies, integration, capacity management strategies, workforce management, technology, quality of disease outcomes, and health system knowledge. The research provides both health systems researchers as well as practitioners with a foundational conceptual framework and knowledge related to health system volume flexibility. In addition, this research identifies future research areas to expand knowledge relevant to health system volume flexibility.

Early Predictive Value of Laboratory Inflammatory Markers in Evaluating Both Lung Involvement and Progression in Hospitalized Patients With COVID-19

Background The new coronavirus known as SARS-CoV-2, first discovered in Wuhan, China, in December 2019, rapidly spread over the globe. It has created many challenges for the world's health and treatment systems. Due to the outspread of this virus and the limited treatment facilities, one of the important issues is the early diagnosis of patients who may continue to suffer from a severe type of disease. This study aims to determine the relationship between hospitalized COVID-19 patients' computed tomography (CT) scan results and laboratory results such as neutrophil-to-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). Methods We created this retrospective study to investigate the relationship between the CT scan results of COVID-19 patients and laboratory results such as NLR and PLR ratios. We randomly sampled individuals whose hospitalization records from Shahada Kargar Hospital in Yazd in 2021 showed a positive COVID-19 test diagnosis. Results During this investigation, 17% of patients were hospitalized in the intensive care unit, and around 7% of patients passed away. These prognostic values have had a significant relationship with the mean NLR and (P = 0.004). In addition, this NLR laboratory index indicated a considerable positive correlation coefficient with the CT scan score (P = 0.014). Conclusions Our results reflect the significant predictive ability of NLR and PLR ratios regarding the prognosis of hospitalized patients with COVID-19. Imaging findings use the CT scan score as an indicator to predict the amount of NLR. In this way, the results of preliminary laboratory tests and imaging can determine the affected patient's progress to a large extent.

Educational and Resource Needs of Pelvic Health Physiotherapists: Context Matters.

Evidence on health system challenges mostly relate to high-income countries. Lack of context-specific knowledge, educational opportunities, and access to resources among pelvic health care providers could be barriers to effective implementation of pelvic health services in South Africa. The aim of this study was to determine the patient and therapist profile, and the educational and resource needs of pelvic health physiotherapists in South Africa. Ninety-five pelvic health physiotherapists, recruited over 6 months, participated in a cross-sectional study during 2022-2023. Participants completed a REDCap survey covering the stipulated domains. Frequencies, percentages, and Chi-squared tests were used for data analysis. The majority were employed in the private sector (n = 72; 75.8%) and had undergraduate training in pelvic health (n = 86; 89.5%); mostly in pre- and postnatal care (n = 69; 72.6%). Urinary incontinence was the most frequently seen condition (n = 81; 85.3%). Conditions were seen very seldom (n = 46; 48.4%) and most participants treated < 5 patients per month (n = 75; 78.9%), did not have patient educational material available (n = 58; 61.1%), preferred hard-copy formats (63.8%, n = 60), whereas 94.7% (n = 90) felt that there is a lack of patient resources. Participants (n = 66; 69.5%) indicated a need for educational opportunities for clinicians. This study highlights the contextualising of educational and resource needs in mid- to low-income countries, such as South Africa, which might be contrary to common beliefs and practices.

A Network to Interlink All the Medical Institutions in a Province

Developing a network to integrate all medical institutions within a province represents a critical advancement in healthcare delivery, aiming to enhance patient care and streamline operations across diverse healthcare settings. This initiative focuses on establishing an Electronic Health Record (EHR) interoperability framework, which facilitates the seamless exchange of patient information among providers, ensuring comprehensive access to medical records. By fostering integrated care, the network seeks to address prevalent challenges in public health systems and improve overall health outcomes for the population.[2] One of the key objectives of this integrated network is to promote patient-centered care, placing patients at the core of their healthcare experience. By modernizing service delivery and engaging patients in their health management, the network aims to create a more responsive healthcare environment that respects and prioritizes individual needs.[3][4] Additionally, workforce development and training are essential components of this initiative, addressing the capacity of healthcare systems to meet future demands and challenges effectively. Despite its promising objectives, the integration of medical institutions faces notable challenges, including funding constraints, policy barriers, and issues related to trust and collaboration among stakeholders. Fragmented funding streams and existing reimbursement structures often hinder coordinated efforts necessary for effective integrated care. Moreover, cultural competence and communication gaps can impede the success of collaboration among diverse healthcare teams. Addressing these challenges is paramount for realizing the full potential of an integrated healthcare network and improving patient outcomes across the province. As healthcare continues to evolve, the establishment of such integrated networks represents a pivotal step toward achieving a cohesive and efficient healthcare system. By leveraging technology, enhancing communication, and fostering collaboration among medical institutions, this initiative aims to optimize healthcare delivery and ensure that all patients receive comprehensive, quality care.

Relational coordination and team‐based care: Change initiative overload and other challenges in a learning health system

Relational coordination and team‐based care: Change initiative overload and other challenges in a learning health system

Understanding reasons for delay in diagnosis of leprosy in Pakistan: A qualitative study.

Recent epidemiological data shows significant rates of grade 2 disability at point-of-diagnosis among new leprosy cases in Pakistan. This indicates a feature of extensive diagnostic delay; the disability burden appears unmoving and disproportionate to the falling leprosy incidence rates. Therefore, this study was required to understand reasons for delay in diagnosis and treatment of leprosy. A qualitative design of 7 semi-structured interviews was employed to reveal perceptions and understandings of various leprosy stakeholders in Pakistan, termed "leprosy experts". Subsequent inductive analysis was used to identify themes and subthemes concerned with delay in the diagnosis and treatment of leprosy. Leprosy experts identified three main areas, or domains, to which delay can be attributed: 1. Awareness and beliefs about leprosy, within the general population, 2. Knowledge and clinical experience of leprosy, among healthcare professionals, 3. Leprosy control program infrastructure, allocation of resources and institutional funding. These domains were each viewed as consequent to the larger theme of 'low-endemicity'. Strong correlations between diagnostic delay and socioeconomic status, gender, geography and health system challenges, were also mentioned, and which intersected the three major themes. Reasons for diagnostic delay are evident in all tiers of the healthcare hierarchy in Pakistan. Thus, an approach at multiple levels is justified, to improve the general awareness of leprosy, education of healthcare professionals, and organizational structuring. Additionally, cultural features relevant to different communities in Pakistan which might be different from other care access frameworks demonstrated a need for further study into the health beliefs of Pakistani patients in a wide range of communities.

The Role of Social Integration in Chronic Disease Prevalences Among the Internal Migrant Populations in China: Evidence from a National Survey.

Background: China has the world's largest internal migrant population, yet chronic disease prevalence among this group remains largely overlooked. The integration of the internal migrant population into the local society may affect their noncommunicable disease prevalences and become a challenge for the public health system. This study aimed to explore the association between the social integration of China's internal migrant population and the prevalences of chronic diseases, including hypertension and diabetes. Methods: This study used data from the 2017 China Migration Dynamic Survey. Social integration status was assessed using an 8-item Likert scale and categorized into four quartiles, with higher points indicating higher levels of social integration. Multivariate logistic regression was conducted to examine the association between social integration level and the prevalences of hypertension, diabetes and combined chronic diseases. Disaggregated analysis was performed to explore the potential effect modification by age, sex, income, and migration duration. Results: A medium level of social integration was associated with lower prevalences of chronic diseases, while the lowest and highest levels of social integration were both associated with enhanced prevalence. Further disaggregation demonstrated the relationship between social integration and chronic disease prevalences were modified by various factors, including age, sex, income, and migration duration. Conclusions: This study demonstrated that both the lowest and highest levels of social integration can significantly affect chronic disease outcomes of China's internal migrants. These findings emphasize the necessity to formulate tailored public health policies to effectively prevent and manage chronic diseases among the internal migrant population in China.

Transformando práticas em modelo: caminhos para uma Rede de Atenção à Saúde da População em Situação de Rua

Abstract The Homeless Population (HP) has grown exponentially in the last decade, causing different challenges for the Brazilian Unified Health System, especially during the COVID-19 pandemic. A cross-sectional, descriptive, and exploratory study, with triangulated quantitative and qualitative methods, was conducted from 2020 to 2022, exploring care practices geared to the HP in Belo Horizonte. The quantitative stage adopted official datasets from the health and social assistance secretariats, and 48 semi-structured interviews and four focus groups were conducted in the qualitative stage, totaling 86 participants. The results point to the need for implementing a polyarchic and multidisciplinary Healthcare Network (RAS-PSR) with intersectoral support, guided care territorialization and longitudinality integrated with information systems to address the complex approach and based on the logic of the expanded clinic. Updating HP records in health systems and qualifying services is needed to achieve RAS-PSR efficacy. Understanding the dynamics of actions developed or broadened by the municipality and lessons learned locally can assist the development of effective social care and health policies that can be upscaled to the national level.

Impact of the COVID-19 pandemic on mHealth adoption: Identification of the main barriers through an international comparative analysis.

The COVID-19 pandemic greatly challenged health systems worldwide. The adoption and application of mHealth technology emerged as a critical response. However, the permanent implementation and use of such technology faces several barriers, which vary by each country's innovation level and specific health policies. This study provides a detailed analysis of the transformations in mHealth service implementation within the context of the COVID-19 pandemic. The study analyses the changes to mHealth service implementation during the COVID-19 pandemic. It seeks to identify the main uses of technology in mHealth, to assess their level of adoption, and to address any barriers found. It also aims to compare different countries to understand how factors such as geographical location and public health policies affect mHealth status worldwide. The survey tool was a revised version of the World Health Organization (WHO) 2015 Global Survey on eHealth, which had been updated to reflect the latest advances and policy priorities. The 2022 Survey on Digital Health in the WHO European Region was conducted by the WHO between April and October 2022 to gather information from the Member States of that region. This study shows that across the countries analysed, significant variations occurred in mHealth service adoption during the pandemic. Teleconsultation, access to patient information, and appointment reminders were the most implemented services, highlighting the importance of remote care during health crises. Regional differences were identified regarding barriers such as privacy and security and patient digital literacy, underscoring the need to address such shortcomings. These conclusions have important implications for stakeholders in the digital health sector and emphasise the need for collaboration to address the identified challenges.

Assessing the impact of the COVID-19 pandemic on uptake and experiences of gestational diabetes mellitus screening in Ontario: A parallel convergent mixed-methods study.

Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy that leads to adverse outcomes for both infants and pregnant people. Early detection and treatment can mitigate these negative outcomes. The COVID-19 pandemic strained healthcare and laboratory services, including GDM screening programs. Adapted GDM screening guidelines were introduced in many jurisdictions. This study examined changes in uptake, modality, and experiences of GDM screening in Ontario, Canada during the COVID-19 pandemic. This convergent mixed-method study involved a population-based retrospective cohort analysis of Ontario-based health administrative data to describe and compare gestational diabetes screening rates among 85,228 individuals with live, in-hospital births between January 1-March 31 before (2019) and during the COVID-19 pandemic (2021 and 2022). Descriptive analyses were conducted for GDM screening pathways aligning with usual and pandemic-adapted screening guidance. Qualitative descriptive interviews were conducted about experiences and decision-making of GDM screening with 43 Ontario residents who gave birth between May 2020 and December 2021. Data were integrated during the design and interpretation phases. There were small but significant increases in GDM screening during the pandemic; likelihood of screening completion using any modality increased in 2021 and 2022 compared to 2019. Testing modality shifted; the alternate screening strategies introduced during COVID-19 were adopted by clinicians. Interview participants perceived GDM screening to be important and obligatory but accompanied by a degree of stress about potential COVID-19 exposure. Despite health system challenges experienced in Ontario during the COVID-19 pandemic, GDM screening rates increased in the study population, demonstrating the success of adapted GDM screening guidelines. Decisions about screening modalities were driven by clinician expertise, and interview participants were satisfied to provide informed consent to these recommendations.

What will it take? Perspectives from five low- and middle-income countries on opportunities and challenges of introducing new maternal vaccines.

New vaccines for pregnant women have recently been introduced in some high-income countries to protect infants in early life. Implementing maternal immunisation (MI) successfully in low- and middle-income countries will require planning and adaptations to immunisation and maternal health programs. To inform cost of MI delivery studies, we gathered perspectives from key stakeholders in five countries (Bangladesh, Ghana, Kenya, Mozambique, and Nepal) regarding health system requirements, opportunities, and challenges to introducing new maternal vaccines into routine health programs. We convened national stakeholders for country workshops to deliberate potential delivery strategies, opportunities, and constraints for implementing new MI interventions. Divided into thematic areas, participants discussed health system adaptations needed to establish or strengthen an MI platform. Stakeholders felt that existing programs that administer vaccines to pregnant women, primarily tetanus-containing vaccines, provide a proven path for the delivery of additional maternal vaccines. Maternal health and immunisation program integration was perceived strongest at the health care provision level and weakest at the national level. Concerted coordination at the national level was identified as critical to the success of introducing new interventions. Stakeholders perceived that most health workforce providing immunisation and antenatal care services undergo similar training and have transferrable skills, however developing operational guidelines with clear roles and responsibilities was deemed critical for ownership and accountability. Human resource constraints were cited as a challenge for some countries. The importance of raising awareness of disease burden and new MI interventions was also highlighted across countries. Sustainable financing was a recurring challenge cited, especially with transitions from Gavi support. The workshops enabled country stakeholders to deliberate needs to support the introduction of new maternal vaccines. While circumstances and needs differed, stakeholders across countries were optimistic about the capability of their health systems to integrate new maternal vaccines.

The phenomenon of electronic betting games: socioeconomic and health impacts - an integrative literature review

Introduction: The phenomenon of bets referred to as electronic gambling in Brazil, following precarious regulation of the activity through a federal normative act has impacted the economic, social, and health realities of the Brazilian population. Objective: This study aims to identify the factors associated with gambling in the context of the scientific literature between 2014 and 2024, as well as its implications for the economy and public health. Method: An integrative literature review was conducted, based on research using databases accessible through Scielo, PubMed, Scopus, and BVS search engines. Results: Articles addressing the economic and public health impacts of gambling, particularly addiction and its social consequences, were analyzed. The study includes an examination of the effects of gambling on vulnerable communities and offers policy recommendations. Conclusion: The findings indicate that while gambling generates revenue, it exacerbates inequalities and creates new challenges for public health systems.

Experiences of patient delay among lung cancer patients in South China

BackgroundLung cancer is a commonly diagnosed cancer and the leading cause of cancer-related mortality worldwide. Cancer delay pose significant challenges for health systems globally, with patient delay being a primary factor contributing to late diagnoses, ultimately resulting in adverse outcomes and reduced survival rates. However, the underlying reasons for patient delay are not well understood, and there is a scarcity of studies that specifically examine the experiences related to patient delay among lung cancer patients. Therefore, this study aims to explore the experiences of lung cancer patients and identify potential strategies to mitigate their delays in seeking care.MethodsThe interview framework was developed based on the Theory of Planned Behavior. Face-to-face semi-structured interviews were conducted with participants. Data analysis was performed using Colaizzi’s phenomenological analysis method.ResultsA total of 30 lung cancer patients participated in the interviews, which lasted between 26 and 42 min (with an average duration of 33 min). The duration of patient delay varied from 90 to 213 days. Four themes were identified: (1) reasons for patient delay, (2) health-seeking triggers, (3) perception of patient delay, and (4) potential solutions.ConclusionLung cancer patients exhibited varying degrees of patient delay attributed to factors such as ignoring or dismissing symptoms, lack of family support, poor access to health services, and the COVID-19 pandemic. Promoting disease knowledge, optimizing resources and implementing technology-based solutions may serve as effective measures to address these issues.

Virtual Primary Care for People With Opioid Use Disorder: Scoping Review of Current Strategies, Benefits, and Challenges.

There is a pressing need to understand the implications of the rapid adoption of virtual primary care for people with opioid use disorder. Potential impacts, including disruptions to opiate agonist therapies, and the prospect of improved service accessibility remain underexplored. This scoping review synthesized current literature on virtual primary care for people with opioid use disorder with a specific focus on benefits, challenges, and strategies. We followed the Joanna Briggs Institute methodological approach for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist for reporting our findings. We conducted searches in MEDLINE, Web of Science, CINAHL Complete, and Embase using our developed search strategy with no date restrictions. We incorporated all study types that included the 3 concepts (ie, virtual care, primary care, and people with opioid use disorder). We excluded research on minors, asynchronous virtual modalities, and care not provided in a primary care setting. We used Covidence to screen and extract data, pulling information on study characteristics, health system features, patient outcomes, and challenges and benefits of virtual primary care. We conducted inductive content analysis and calculated descriptive statistics. We appraised the quality of the studies using the Quality Assessment With Diverse Studies tool and categorized the findings using the Consolidated Framework for Implementation Research. Our search identified 1474 studies. We removed 36.36% (536/1474) of these as duplicates, leaving 938 studies for title and abstract screening. After a double review process, we retained 3% (28/938) of the studies for extraction. Only 14% (4/28) of the studies were conducted before the COVID-19 pandemic, and most (15/28, 54%) used quantitative methodologies. We summarized objectives and results, finding that most studies (18/28, 64%) described virtual primary care delivered via phone rather than video and that many studies (16/28, 57%) reported changes in appointment modality. Through content analysis, we identified that policies and regulations could either facilitate (11/28, 39%) or impede (7/28, 25%) the provision of care virtually. In addition, clinicians' perceptions of patient stability (5/28, 18%) and the heightened risks associated with virtual care (10/28, 36%) can serve as a barrier to offering virtual services. For people with opioid use disorder, increased health care accessibility was a noteworthy benefit (13/28, 46%) to the adoption of virtual visits, whereas issues regarding access to technology and digital literacy stood out as the most prominent challenge (12/28, 43%). The available studies highlight the potential for enhancing accessibility and continuous access to care for people with opioid use disorder using virtual modalities. Future research and policies must focus on bridging gaps to ensure that virtual primary care does not exacerbate or entrench health inequities.

Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study.

Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements. This study aims to identify opportunities for DHIs from clients' and health care professionals' perspectives to address health system challenges and improve CVD care. This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis. Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange. The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care.

PD85 Are Current Payment Models For Integrated Care Promoting The Uptake of Medical Device Innovations?

IntroductionIntegrated care (IC) is a patient-centered approach to the provision of health care that overcomes the fragmentation in the delivery of services that often occurs in older people with multiple comorbidities. Medical device innovations could help tackle this and other challenges of health systems when facing the adoption of high quality IC. Nevertheless, this should be accompanied by the right innovation funding scheme to encourage adoption.MethodsA systematic search strategy to identify payment models for IC was performed in PubMed for the period from 2014 to 2023 using the International Foundation for Integrated Care Knowledge Tree tool. This was complemented with both a gray literature search in Google and a benchmark of payment models for innovative medicines. A scoping review was then performed identifying the following information: payment scheme; advantages and disadvantages for IC; inclusion of innovation; type of IC program or initiative described (sectors and providers); population (therapeutic area); country; and whether the information was conceptual or empirical.ResultsAccording to the literature reviewed, five payment schemes used in IC were identified. However, they were rarely used in isolation; more often a mix of payment schemes was used. Based on conceptual and empirical articles, the combination of bundled payment, shared savings, and pay for performance (based on the quality of care delivered) seemed to be the most comprehensive payment scheme. However, references to inclusion of innovation were not mentioned even in this mixed system. Payment systems for innovative medicines were benchmarked for medical devices.ConclusionsA mixed system of bundled payment, shared savings, and pay for performance appears to be the most complete payment model for IC, since it counteracts the limitations of individual funding schemes. No evidence was found on how to incentivize medical device innovation in the context of IC delivery. However, inspiration from current payment schemes for innovative medicines can provide a starting point for innovative medical device schemes.

Mixed-methods study assessing the accuracy of verbal autopsy and sociocultural determinants of infant mortality in Gujarat, India.

Accurate determination of infant mortality causes and understanding sociocultural factors influencing care-seeking behaviors are crucial for targeted interventions in resource-limited settings. This mixed-methods study aimed to assess the accuracy of verbal autopsy (VA) in ascertaining infant death causes and explore sociocultural determinants of infant mortality in Gujarat, India. It was a mixed-method study with a retrospective cohort component for which data from 661 infant records were extracted from the main health office's database, with a subset of 328 infant deaths selected for verbal autopsy analysis. Delivery characteristics, care-seeking behaviors, access to healthcare, and risk factors were evaluated. Bivariate and multivariate analyses were conducted to identify factors associated with infant mortality. VA diagnostic accuracy was assessed using sensitivity, specificity, predictive values, and receiver operating characteristic curve analysis, with death certificates as the reference standard. Qualitative methods, including in-depth interviews, and focus group discussions were used to explore the sociocultural influences, health system challenges, and stakeholder experiences related to infant deaths and VA implementation. Findings were integrated through triangulation. Institutional deliveries were 583/661 (88%), and the skilled birth attendance was 397/661 (60%). Care-seeking from health facilities was low at 264/661 (40%), with a mean time of 12 hours. Home deaths accounted for 328/661 (49.6%) cases. Low birth weight (aOR 1.81, 95% CI 1.3-2.4, P = 0.002), home delivery (aOR 1.72, 95% CI 1.1-2.8, P = 0.01), early complementary feeding (aOR 1.48, 95% CI 1.1-2.0, P = 0.01), and acute malnutrition (aOR 1.91, 95% CI 1.3-2.6, P = 0.001) were independent risk factors for mortality. Verbal autopsy showed high specificity (87%) but variable sensitivity (70%) in determining causes of death. Qualitative findings revealed barriers to timely care (lack of danger sign recognition, financial constraints, traditional healer reliance), cultural beliefs impacting care practices, gender discrimination, health system constraints (staff shortages, diagnostic limitations), and challenges with VA implementation (recall bias, desire for feedback). Enhancing antenatal care, skilled birth attendance, optimal breastfeeding, complementary feeding practices, addressing acute malnutrition, overcoming sociocultural barriers through community engagement, health system strengthening, and culturally sensitive interventions could potentially reduce infant mortality rates. While a verbal autopsy is practical for the cause of death determination in resource-limited settings, its effectiveness relies on addressing the identified challenges through policy measures focused on community participation, health system improvements, and culturally appropriate strategies.

Perceived drivers of the Ebola virus disease outbreak in Mubende and Kassanda districts, Uganda: a qualitative study

IntroductionDuring the most recent Ebola virus disease (EVD) outbreak in Uganda, a cluster of community deaths with epidemiological linkages to the first reported case were identified to have occurred in...

Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia.

Digital health innovations have emerged globally as a transformative force for addressing health system challenges, particularly in resource-constrained settings. The COVID-19 pandemic underscored the critical importance of these innovations for enhancing public health. In South and Southeast Asia, a region known for its cultural diversity and complex health care landscape, digital health innovations present a dynamic interplay of challenges and opportunities. We advocate for ongoing research built into system development and an evidence-based strategy focusing on designing and scaling national digital health infrastructures combined with a vibrant ecosystem or "marketplace" of local experiments generating shared experience about what works in which settings. As the global digital health revolution unfolds, the perspectives drawn from South and Southeast Asia-including the importance of local partnerships-may provide valuable insights for shaping future strategies and informing similar initiatives in low- and middle-income countries, contributing to effective digital health strategies across diverse global health contexts.