Goal Of Coverage Research Articles

Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies

AbstractDeeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan's healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the health system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency are crucial. This article aims to address Bhutan's evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on the dual objective of improving health outcomes and promoting financial sustainability by leveraging health taxes, whereas the second option emphasizes reinforcing a systematic health technology assessment (HTA) in the Bhutanese health system. First, drawing lessons from global experiences, the policy brief recommends leveraging health taxes to reduce societal and healthcare costs and enhance financial sustainability in the health sector. Considering Bhutan's high prevalence of tobacco and alcohol consumption, and taking opportunity from the ongoing Goods and Services Tax (GST) reform, continued advocacy on health taxes is essential, and soft earmarking the health taxes may be considered to finance a broader array of public health programmes, particularly focusing on the promotion of healthy lifestyle, health screening and outreach public health activities. Second, the integration of HTA into policymaking and decision‐making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA governance structure under the Ministry of Health (MoH) and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision‐making and resource optimization. HTA evidence should inform the revision of health service standards, clinical guidelines development, procurement decisions and healthcare priorities. These policy options can assist the country in improving financial sustainability, enhancing effective resource allocation and utilization and improving healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.

CT-guided online adaptive stereotactic body radiotherapy for pancreas ductal adenocarcinoma: Dosimetric and initial clinical experience

Purpose/ObjectivesRetrospective analysis suggests that dose escalation to a biologically effective dose of more than 70 Gy may improve overall survival in patients with pancreatic ductal adenocarcinoma (PDAC), but such treatments in practice are limited by proximity of organs at risk (OARs). We hypothesized that CT-guided online adaptive radiotherapy (OART) can account for interfraction movement of OARs and allow for safe delivery of ablative doses. Materials/MethodsThis is a single institution retrospective analysis of patients with PDAC treated with OART on the Ethos platform (Varian Medical Systems, a Siemens Healthineers Company, Palo Alto). All patients were treated to 40 Gy in 5 fractions. PTV overlapping with a 5 mm planning risk volume expansion on the stomach, duodenum and bowel received 25 Gy. Initial treatment plans were created conventionally. For each fraction, PTV and OAR volumes were recontoured with AI assistance after initial cone beam CT (CBCT). The adapted plan was calculated, underwent QA, and then compared to the scheduled plan. A second CBCT was obtained prior to delivery of the selected plan. Total treatment time (first CBCT to end of radiation delivery) and active physician time (first to second CBCT) were recorded. PTV_4000 V95 %, PTV_2500 V9 5%, and D0.03 cc to stomach, duodenum and bowel were reported for scheduled (S) and adapted (A) plans. CTCAEv5.0 toxicities were recorded. Statistical analysis was performed using a two-sided T test and α of 0.05. Results21 patients with unresectable or locally-recurrent PDAC were analyzed, with a total of 105 fractions. Average total time was 29 min and 16 s (16:36–49:40) and average active physician time was 19:41 min (9:25–39:34). All fractions were treated with adapted plans. 97 % of adapted plans met PTV_4000 V95.0 % >95.0 % coverage goal and 100 % of adapted plans met OAR dose constraints. Median follow up was 6.6 months. Only 1 patient experienced acute grade 3+ toxicity directly attributable to radiation. Only 1 patient experienced late grade 3+ toxicity directly attributable to radiation. ConclusionsDaily CT-based OART was associated with significantly reduced dose OARs while achieving superior PTV coverage. Given the relatively quick total treatment time, radiation delivery was generally well tolerated and easily incorporated into the clinic workflow. Our initial clinical experience demonstrates OART allows for safe dose escalation in the treatment of PDAC.

Estimating the out-of-pocket health expenditure in patients under 5years with severe malnutrition in Afghanistan in 2023: Findings from a cross-sectional study.

This study, of significant importance to healthcare professionals, policymakers, researchers, and organizations involved in child healthcare and malnutrition in Afghanistan, aimed to estimate the out-of-pocket expenditure (OOPE) in patients under 5 years old with severe malnutrition in a children's hospital in Herat Province, Afghanistan. This study employed a meticulously designed cross-sectional descriptive-analytical approach with practical results. The research population consisted of families with malnourished children under 5 who were referred to Herat Children's Hospital. Data was collected using a comprehensive standard World Health Organization questionnaire to gather demographic information from children in Herat. A carefully selected convenience sampling method was used, with 300 referring patients participating in face-to-face interviews with the supervisors of these children. After obtaining personal consent and coordinating with health officials, interviews were conducted with the caregivers of children under 5 who suffered from severe malnutrition. The data was then analyzed using robust descriptive statistics, quantitative variables, mean and standard deviation, frequency, and relative frequency. Multiple regression analysis was used to determine the factors that most influenced direct payments from patients' pockets, ensuring the reliability and validity of the findings. The results showed that OOPE in both households with seven and less than seven people and more than seven people was 68%. The findings indicated that among the residents of Herat referred to the studied hospital, these people spent 54% of the treatment costs directly out of pocket. In contrast, people in the rural areas of Herat pay 69% of the treatment costs to receive medical services straight out of pocket. The critical point is that 93% of the families have incurred catastrophic expenses to treat their children suffering from severe malnutrition. The research revealed that the patient's location and the education level of the head of the household were the most significant factors affecting out-of-pocket payments by patients. Increasing OOPE in rural Afghanistan poses a significant obstacle to equitable healthcare services and access to appropriate medicines. To support the goal of universal healthcare coverage, geographic imbalances, and broad health financing options must be addressed. Strengthening insurance coverage and more government assistance can significantly reduce these patients' out-of-pocket payments.

Influence of nursing services and facilities on the satisfaction level of BPJS Patients in the inpatient ward of Wajo health Center

Overview: The research conducted at the Wajo Health Center in Baubau City in 2023 aims to evaluate the impact of nursing services and facilities on the satisfaction of BPJS patients. Using an analytical cross-sectional approach, this study involved 42 patients selected through accidental sampling. Primary data were collected through survey questionnaires, while secondary data were obtained from the health center's medical records. Body of Knowledge: This study evaluates the influence of nursing services and health facilities on BPJS patient satisfaction as a key indicator of the effectiveness of the National Health Insurance. The research highlights the importance of improving service quality and health infrastructure to achieve equitable health coverage in line with the WHO's Universal Health Coverage goals. Methods: The study employed an analytical cross-sectional design at the Wajo Health Center in Baubau City from May to June 2023. Out of a population of 55 patients, 42 were selected via accidental sampling. Primary data were gathered through questionnaires and analyzed using univariate, bivariate, and Chi-Square statistical methods. Ethical considerations were maintained by ensuring informed consent, anonymity, and data confidentiality. Results: The majority of respondents were female (81%), predominantly aged 20-29 years (54.8%), and had a high school education (57.1%). Most were housewives (66.7%). There was a high level of satisfaction with nursing care (71.4%) and health facilities (81%). Bivariate analysis showed a significant relationship between satisfaction with nursing services (X² = 10.438, p = 0.005) and health facilities (X² = 12.101, p = 0.003) and BPJS patient satisfaction. Recommendation: It is recommended to enhance service quality through regular training for medical personnel to improve interpersonal and clinical skills. Periodic evaluations of health infrastructure are necessary to ensure reliability. Continuous support from management is required for ongoing improvements, ensuring that health service standards meet BPJS patient expectations.

Neighbourhood effect and inequality in access to essential health services among mother–child paired samples: a decomposition analysis of data from 58 low- and middle-income countries

IntroductionNeighbourhood effect on health outcomes is well established, but little is known about its effect on access to essential health services (EHS). Therefore, this study aimed to assess the contributing factors to access to EHS in slum versus non-slum settings.MethodologyThe most recent data from 58 Demographic and Health Surveys (DHS) conducted between 2011 and 2018 were used, including a total of 157,000 pairs of currently married women aged 15–49 and their children aged 12–23 months. We used meta-analysis techniques to examine the inequality gaps in suboptimal access to EHS between mother-children pairs living in slums and non-slums. Blinder-Oaxaca decomposition technique was used to identify the factors contributing to the inequality gaps in each low- and middle-income country (LMIC) included.ResultThe percentage of mother–child pairs living in slums ranged from 0.5% in Egypt to 63.7% in Congo. Meta-analysis of proportions for the pooled sample revealed that 31.2% [27.1, 35.5] of slum residents and 20.0% [15.3, 25.2] among non-slum residents had suboptimal access to EHS. We observed significant pro-slum inequalities in suboptimal access to EHS in 28 of the 52 LMICs with sufficient data. Of the 34 African countries included, 16 showed statistically significant pro-slum inequality in suboptimal access to EHS, with the highest in Egypt and Mali (2.64 [0.84–4.44] and 1.76 [1.65, 1.87] respectively). Findings from the decomposition analysis showed that, on average, household wealth, neighbourhood education level, access to media, and neighbourhood-level illiteracy contributed mostly to slum & non-slum inequality gaps in suboptimal access to EHS.ConclusionThe study showed evidence of inequality in access to EHS due to neighbourhood effects in 26 LMICs. This evidence suggests that increased focus on the urban poor might be a important for increasing access to EHS and achieving the universal health coverage (UHC) goals.

Advocacy, experience sharing and action planning toward raising additional financing for primary health care: spending more and spending better towards universal health coverage.

Reallocation of funding to respond the covid-19 pandemic, against a backdrop of longstanding underfunded health systems and high out of pocket expenditures for health, affected access to health services for households, especially those without social protection. These highlighted the urgency in curbing the impact of disruptions on progress towards Universal Health Coverage (UHC) goals. Strategic investments in Primary Health Care (PHC) can help spur the necessary momentum. Under the collaborative platform of the Harmonization for Health in Africa's Health Financing Technical Working Group; UNICEF Regional Office for East and Southern Africa and WHO Regional Office for Africa convened the first PHC financing forum for 21 countries across the Eastern and Southern Africa Region. The three-day forum engaged key health and financing decision makers in constructive dialogue to identify practical actions and policy changes needed to accelerate delivery of UHC through improvements in PHC financing mechanisms and arrangements. The forum was attended by over 130 senior policy makers and technicians from governments, United Nations agencies and nonstate actors drawn from within country, regional and affiliating headquarter institutions. The Regional Forum engaged participants in meaningful, and constructive discussions. Five themes emerged (1) regular measurement and monitoring of PHC services and spending (2) increasing investments in PHC (3) enhancing efficiency, effectiveness, and equity of PHC spending, (4) ensuring an enabling environment to invest more and better in PHC, and (5) better partnerships for the realization of commitments. An outcome statement summarizing the main recommendations of the meeting was approved at the end of the forum, and action plans were developed by 14 government delegations to improve PHC financing within country-specific context and priorities. The aims of this meeting in augmenting the political will created through the Africa Leadership Meeting (ALM), by catalyzing technical direction for increased momentum for improved health financing across all African countries was achieved. Peer exchanges offered practical approaches countries can take to improve health financing in ways that are suited to regional context providing a channel for incremental improvements to health outcomes in the countries.

Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach

The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12–35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers’ occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.

Dosimetric and NTCP analyses for selecting parotid gland cancer patients for proton therapy.

To perform a dosimetric and a normal tissue complication probability (NTCP) comparison between intensity modulated proton therapy and photon volumetric modulated arc therapy in a cohort of patients with parotid gland cancers in a post-operative or radical setting. From May 2011 to September 2021, 37 parotid gland cancers patients treated at two institutions were eligible. Inclusion criteria were as follows: patients aged ⩾ 18 years, diagnosis of parotid gland cancers candidate for postoperative radiotherapy or definitive radiotherapy, presence of written informed consent for the use of anonymous data for research purposes. Organs at risk (OARs) were retrospectively contoured. Target coverage goal was defined as D95 > 98%. Six NTCP models were selected. NTCP profiles were calculated for each patient using an internally-developed Python script in RayStation TPS. Average differences in NTCP between photon and proton plans were tested for significance with a two-sided Wilcoxon signed-rank test. Seventy-four plans were generated. A lower Dmean to the majority of organs at risk (inner ear, cochlea, oral cavity, pharyngeal constrictor muscles, contralateral parotid and submandibular gland) was obtained with intensity modulated proton therapy vs volumetric modulated arc therapy with statistical significance (p < .05). Ten (27%) patients had a difference in NTCP (photon vs proton plans) greater than 10% for hearing loss and tinnitus: among them, seven qualified for both endpoints, two patients for hearing loss only, and one for tinnitus. In the current study, nearly one-third of patients resulted eligible for proton therapy and they were the most likely to benefit in terms of prevention of hearing loss and tinnitus.

Media and Natural Disasters: Organising Storytelling in the Age of Climate Change

Starting on 2 November 2023, some territories in the Region of Tuscany in Italy were hit by exceptionally intense meteorological and calamitous events. The Region of Tuscany’s government was immediately at the forefront of relief, assisting the population, and aiding restoration. On 3 November, a national state of emergency was declared due to flooding. Journalistic communication is an essential aspect of disaster mitigation, preparedness, response and recovery. In terms of protecting people and reducing damage, journalists and the media have an important role to play. This article reports an Italian case study analysing the behaviour of local media in cases of natural disaster. Nine focus groups were conducted with local journalists covering the flood emergency. The results highlight the role of social and institutional mediation, rather than mere dissemination, played by the local press in emergency situations, a central element in the construction of a community bond, precisely in moments of insecurity and disorientation. The narration of a disaster from the inside seems to have allowed the emergence and representation of hitherto unknown social realities in Tuscany. The goal of the news coverage was widened, making it possible to respond better to the diverse interests of the reading public and to satisfy in a short time and exhaustively the information needs of individual communities in difficulty.

Trends and projections of age-appropriate vaccination coverage in 41 low- and middle- income countries in Asia and Sub-Saharan Africa, 2000-2030.

Routine immunization programs have focused on increasing vaccination coverage, which is equally important for decreasing vaccine-preventable diseases (VPDs), particularly in low- and lower-middle-income countries (LMICs). We estimated the trends and projections of age-appropriate vaccination coverage at the regional and national levels, as well as place of residence and wealth index in LMICs. In total, 174 nationally representative household surveys from 2000 to 2020 from 41 LMICs were included in this study. Bayesian hierarchical regression models were used to estimate trends and projections of age-appropriate vaccination. The trend in coverage of age-appropriate Bacillus Calmette-Guérin (BCG), third dose of diphtheria, tetanus, and pertussis (DTP3), third dose of polio (polio3), and measles-containing vaccine (MCV) increased rapidly from 2000 to 2020 in LMICs. Findings indicate substantial increases at the regional and national levels, and by area of residence and socioeconomic status between 2000 and 2030. The largest rise was observed in East Africa, followed by South and Southeast Asia. However, out of the 41 countries, only 10 countries are estimated to achieve 90% coverage of the BCG vaccine by 2030, five of DTP3, three of polio3, and none of MCV. Additionally, by 2030, wider pro-urban and -rich inequalities are expected in several African countries. Significant progress in age-appropriate vaccination coverage has been made in LMICs from 2000 to 2020. Despite this, projections show many countries will not meet the 2030 coverage goals, with persistent urban-rural and socioeconomic disparities. Therefore, LMICs must prioritize underperforming areas and reduce inequalities through stronger health systems and increased community engagement to ensure high coverage and equitable vaccine access.

Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study

BackgroundKenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)),...

Elderly care facility location in the face of the climate crisis: A case study in Canada

The climate crisis poses a dual threat to the environment and human health, with older adults being particularly vulnerable. This study aims to establish a network of elderly care facilities designed to respond to climate-induced disasters—an essential element in creating resilient cities that address the challenges of elderly care within the context of the climate crisis. First, we formulate an equation grounded in expert opinions to estimate demand in each region based on factors such as the elderly population, average age, frailty, and proximity to healthcare service nodes. We then introduce an Integrated Coverage and Distance Facility Location problem (ICDFL), a novel approach tailored to address the unique needs of seniors during disasters while considering governmental budget constraints. The ICDFL, therefore, simultaneously pursues two key objectives: (i) maximizing coverage while respecting a maximum allowable coverage radius, and (ii) minimizing overall travel distance. The first objective ensures the resilience of elderly health, guiding healthcare policymakers, while the second considers transportation and service costs faced by government agencies. To address dual-objective optimization, we utilize the epsilon-constrained optimization technique, which enables precise management of both coverage and distance goals through an iterative problem-solving approach. We apply the proposed model to a real-world case study in southern Ontario, Canada, to validate its effectiveness. This is an important aspect of the study, as Canada’s warming trend is happening twice as fast as the rest of the world and its elderly population is expanding at an alarming rate. The results of our model provide guidance to policy makers and healthcare planners in improving emergency preparedness, thus creating a sustainable community for our growing elderly population and improving the well-being of older people during climate-induced disasters.

THE CONSEQUENCES OF RECEIVING SOCIAL INSURANCE ONCE IN VIETNAM

Objective: Social insurance policies have played a crucial role as a cornerstone in the social security system, contributing positively to social stability and the realization of goals for a prosperous, strong, fair, democratic, and civilized society. The current legal framework on social insurance in Vietnam stipulates provisions to ensure the rights of workers in all cases, including regulations regarding one-time social insurance cases. Although the significance of receiving one-time social insurance aligns with the legal provisions for each case, the lack of understanding among workers regarding the significance of social insurance policies or their deliberate acceptance of one-time social insurance can have unpredictable consequences for society, the social insurance system, and the workers themselves... The study builds on the situation of receiving social insurance in Vietnam and makes a case study of consequences for once workers receive social insurance suggesting solutions to mitigate the situation. Method: The study is based on a method to collect secondary data on the status of social insurance once received in Vietnam through data channels. This data is presented and analyzed by the descriptive statistical method (mainly in the form of tables and charts) that will see the situation for receiving social insurance once in Vietnam over time. In order to conduct the research, the method applied in this article is a qualitative method including: The systematic approach to the research materials, legal regulations related to the research; The integrated analysis method is used to analyze and synthesize the situation of receiving social insurance once in Vietnam; The objective methodology is used by the author to argue, the views of the individual, along with the combination of perspectives of other studies of nature to make a broad consensus about a particular problem. Results: The results of the study show that although social insurance policies were established to protect workers from income risk, they can lead a stable future life. Rules on one-off social insurance regimes can help resolve many special cases of workers. However, research shows that the number of people who choose to receive social insurance in Vietnam in the period of 2014-2023 has increased greatly. The increase of the number of people who receive social insurance once means the increase in the number of people leaving the system, making it difficult to achieve the goal of universal social insurance coverage in the spirit of resolution No. 28-NQ/TW of the XII Central Committee. Actual data suggest that on average 1 new person is entering social insurance, there is 1 old person leaving the system. The number of people withdrawn the following year was always higher than the previous year with an average annual increase of about 10%. The proportion of workers that have returned from social insurance benefits to continue their low participation in social insurance. In the period of 2016-2022, the country had more than 4.8 million workers requesting and resolving social insurance once. After receiving social insurance coverage once, approximately 1.3 million people returned to continue the social insurance penetration. Thus, the proportion of workers who have been remarried to social insurance benefits is 26%, and the remaining 74% of those who have received social insurance benefits once, corresponding to about 3.5 million who do not return to social insurance contributions, meaning that they are not guaranteed short-term benefits in the process of continuing labor such as sickness, maternity, occupational accidents, unemployment and long-term retirement. Conclusion: Receiving one-time social insurance benefits of workers will have some consequences for the social insurance system, for Society and Workers in the current context of Vietnam population aging trends lead to the number of people who do not have a monthly pension in Vietnam accounting for a large proportion of approximately 10 million people, this shows that the lack of sustainability of the Social Security system in general creates pressure for the community and the workers themselves will not be protected from the immediate benefits and long-term social insurance system.

Effective Cataract Surgical Coverage in Four Large Districts in Telangana, India – Results from Rapid Assessment of Visual Impairment Study

ABSTRACT Purpose To report cataract surgical coverage (CSC) and effective Cataract Surgical Coverage (eCSC) from four districts in Telangana, India. Methods Individuals aged ≥40 years were recruited from Adilabad, Mahbubnagar, Warangal and Khammam districts using two stage cluster sampling methodology. All participants had detailed eye examinations including visual acuity assessment using a standard Snellen chart at a distance of six meters, anterior segment examination and fundus imaging by trained professionals. CSC and eCSC were calculated for persons using a 6/12 visual acuity cut-off. Results Of 12,150 individuals enumerated from four districts 11,238 (92.5%) were examined. The mean (standard deviation) age of the participants was 54.1 (±11.2) years (range: 40 to 102 years) and 54.6% (n = 6137) were women. Overall, the CSC (%) was 54.2%. It ranged from a highest of 59% in Khammam followed by 57.5% in Adilabad, 51.7% in Warangal, and a least of 49.7% in Mahbubnagar district. Overall, the eCSC (%) was 39.9%. It ranged from a highest of 46.1% in Adilabad followed by 43.2% in Khammam, 36.2% in Warangal district and a least of 35.8% in the Mahbubnagar district. Conclusions CSC and eCSC varied across the districts. A significant gap between CSC and eCSC is noted suggestive of challenges with quality of services. District-wise planning of cataract surgical services with a focus on quality care is recommended to improve coverage and contribute towards achieving the goal of universal eye health coverage in the Telangana State in India

The micro-dimensions of health policy design: evidence from a comparative analysis

Policy design studies typically focus on broad policy goals and the types of tools that governments use to realize them. There is however limited scholarly understanding of how these goals and tools are operationalized “on-the-ground.” In this paper, we apply Capano and Howlett’s 2024 Framework on the Micro-Dimensions of Policy Design to understand how universal health coverage goals in the United States, Singapore, and Thailand are operationalized. The framework unpacks the “nuts and bolts” of policy design particularly the specification of policy targets and tools. A comparative analysis of three programs (Obamacare in the US, Medisave in Singapore, and Universal Coverage Scheme in Thailand) demonstrates how similar high-level policy goals are pursued through different tools and settings. Studying these micro dimensions provides insights into the actual operational ways in which high-level objectives are translated into impacts at the ground level. From an applied point of view, a comparative focus on the dimensions of the micro level of policy design is useful for generating evidence and informing health policy debates about what works or does not work on-the-ground.

IJCM_262A: Digital Health Boon or Bane: From Community Health Worker’s Perspective in an Aspirational District

Background: Digital health technologies are pivotal for achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3. This study investigates Community Health Workers (CHWs) perspectives on digital health platforms in an aspirational district in India, aligning with the World Health Organization’s emphasis on fostering an enabling environment for digital health adoption. Objectives: To assess CHWs’ current practices and knowledge of digital health applications/platforms and to understand their perceptions regarding the need and use of digital health platforms in the public health system. Methodology: A mixed-methods approach was utilized, involving 95 CHWs in quantitative surveys and 30 CHWs in qualitative interviews and focus group discussions. The study was conducted in Muzaffarpur, Bihar, India’s most populated aspirational district, using stratified random sampling and purposive sampling methods. Results: Findings reveal varied app usage patterns among CHWs, with challenges like non-functional government-provided devices. Qualitative insights highlight the importance of peer support and training quality alongside concerns about device accessibility and app rationalization. Despite government provision of smartphones, CHWs face obstacles in utilizing digital health tools effectively. Conclusion: This research illuminates the availability and utilization of digital health applications among CHWs, emphasizing the need to address challenges and tailor digital tools to enhance healthcare delivery in aspirational districts.

"My Health, My Right:" There Is More to It than Meets the Eye.

The WHO's World Health Day 2024 slogan, "My health, my right," has been unpacked through the lens of an evolving social epidemiological understanding. The operative part of the theme merely reiterates international positions that have been established for a long and is unable to adequately incorporate advances in the understanding of the central role that structural determinants play in the production of ill-health. Given the urgency of addressing Sustainable Development Goal and Universal Health Coverage goals, the reduction of health inequities through the promotion of social justice is as much a governance imperative as moral.

Coverage Goal Selector for Combining Multiple Criteria in Search-Based Unit Test Generation

Coverage Goal Selector for Combining Multiple Criteria in Search-Based Unit Test Generation

Mixed methods to evaluate knowledge, attitudes and practices (KAP) towards rabies in central and remote communities of Moramanga district, Madagascar.

Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.53 per 100 person-years, 95% CI: 0.31-0.85) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09-0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (89.5%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33-3.26) and living in central area (OR = 1.91, CI = 1.22-3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98-7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14-4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination.

Knowledge and Practices of Women Attending Postnatal Consultations on Vaccination Against COVID-19 in the Health District of Sakal in 2022 (Senegal)

Introduction: The COVID-19 pandemic remains a public health problem despite the lulls between waves. Achieving the goal of broad vaccination coverage is of paramount importance, particularly for populations at risk of severe forms of COVID-19. Hence the interest in studying vaccination among women attending post-natal consultations in the Sakal Health District. Methodology: A cross-sectional, descriptive and analytical study was conducted from 28 June to 27 October 2022. The study population consisted of women who had given birth and/or come for a postnatal consultation in the Sakal health district. Data were analysed using R 4.2 software. Results: The mean age of the women surveyed was 26.56±6 years, with extremes of 17 to 43 years. The median age was 25 years. The age groups most represented were [20-30], with a proportion of 50.6%. More than 80% of these women were uneducated (30.4%) or had no more than primary education (51.4%). A further 17% had completed secondary education, and only 1.2% had completed higher education. A quarter of these women had an income generating activity (15.2%). Almost ¾ of respondents had a television at home (70.2%) and a telephone (73.1%). Of those who had a phone, more than half (65.1%) had a smartphone, almost all of which had access to social networks (96.3%). The types of social network whose use was significantly associated with vaccination against COVID-19 were: WhatsApp (p=0.004), Facebook (p=0.008), TikTok (p=0.021) and YouTube (p=0.015). YouTube was the source of information with a statistically significant association with vaccination against COVID-19 (p=0.015). The next three elements, i.e. knowledge of previous COVID-19 infection (p=0.01), knowledge of someone who had been infected with the disease (p=0.042) and knowledge of available COVID-19 vaccines (p&lt;0.001) were significantly linked to vaccination against COVID-19. Women who were aware of the available COVID-19 vaccines were 8.33 times more likely to be vaccinated. All the women surveyed were married, 25.7% of whom had been vaccinated, and those whose spouses had been vaccinated were 7.3 times more likely to be vaccinated in turn (p&lt;0.001). Conclusion: The results of this study demonstrate the need to raise awareness of COVID-19 vaccination among pregnant women, with the full involvement of the spouse. Priority should be given to raising awareness of the seriousness of COVID-19 in pregnant women, the benefits of being vaccinated and, of course, reassurance about the safety of the available COVID-19 vaccines.