District Health Authorities Research Articles

Gonorrhea cluster detection in Manitoba, Canada: Spatial, temporal, and spatio-temporal analysis

In Canada, Gonorrhea infection ranks as the second most prevalent sexually transmitted infection. In 2018, Manitoba reported an incidence rate three times greater than the national average. This study aims to investigate the spatial, temporal, and spatio-temporal patterns of Gonorrhea infection in Manitoba, using individual-level laboratory-confirmed administrative data provided by Manitoba Health from 2000 to 2016. Age and sex patterns indicate that females are affected by infections at younger ages compared to males. Moreover, there is an increase in repeated infections in 2016, accounting for 16% of the total infections. Spatial analysis at the 96 Manitoba regional health authority districts highlights significant positive spatial autocorrelation, demonstrating a clustered distribution of the infection. Northern districts of Manitoba and central Winnipeg were identified as significant clusters. Temporal analysis shows seasonal patterns, with higher infections in late summer and fall. Additionally, spatio-temporal analysis reveals clusters during high-risk periods, with the most likely cluster in the northern districts of Manitoba from January 2006 to June 2014, and a secondary cluster in central Winnipeg from June 2004 to November 2012. This study identifies that Gonorrhea infection transmission in Manitoba has temporal, spatial, and spatio-temporal variations. The findings provide vital insights for public health and Manitoba Health by revealing high-risk clusters and emphasizing the need for focused and localized prevention, control measures, and resource allocation.

Enhancing COVID-19 Vaccine Uptake among Tribal Communities: A Case Study on Program Implementation Experiences from Jharkhand and Chhattisgarh States, India.

Tribal populations in India have health care challenges marked by limited access due to geographical distance, historical isolation, cultural differences, and low social stratification, and that result in weaker health indicators compared to the general population. During the pandemic, Tribal districts consistently reported lower COVID-19 vaccination coverage than non-Tribal districts. We assessed the MOMENTUM Routine Immunization Transformation and Equity (the project) strategy, which aimed to increase access to and uptake of COVID-19 vaccines among Tribal populations in Chhattisgarh and Jharkhand using the reach, effectiveness, adoption, implementation, and maintenance framework. We designed a qualitative explanatory case study and conducted 90 focus group discussions and in-depth interviews with Tribal populations, community-based nongovernmental organizations that worked with district health authorities to implement the interventions, and other stakeholders such as government and community groups. The active involvement of community leaders, targeted counseling, community gatherings, and door-to-door visits appeared to increase vaccine awareness and assuage concerns about its safety and efficacy. Key adaptations such as conducting evening vaccine awareness activities, holding vaccine sessions at flexible times and sites, and modifying messaging for booster doses appeared to encourage vaccine uptake among Tribal populations. While we used project resources to mitigate financial and supply constraints where they arose, sustaining long-term uptake of project interventions appears dependent on continued funding and ongoing political support.

Human resources challenges in the management of diabetes and hypertension in Mozambique.

The major burden of non-communicable diseases (NCDs) globally occurs in low-and middle-income countries, where this trend is expected to increase dramatically over the coming years. The resultant change in demand for health care will imply significant adaptation in how NCD services are provided. This study aimed to explore self-reported training and competencies of healthcare providers, and the barriers they face in NCD services provision. A qualitative design was used to conduct this study. Data was collected through semi-structured interviews with government officials within the Mozambican Ministry of Health, district health authorities, health facility managers, and health providers at urban and rural health facilities of Maputo, in Mozambique. The data was then analyzed under three domains: provider´s capacity building, health system structuring, and policy. A total of 24 interviews of the 26 planed with managers and healthcare providers at national, district, and health facility levels were completed. The domains analyzed enabled the identification and description of three themes. First, the majority of health training courses in Mozambique are oriented towards infectious diseases. Therefore, healthcare workers perceive that they need to consolidate and broaden their NCD-related knowledge or else have access to NCD-related in-service training to improve their capacity to manage patients with NCDs. Second, poor availability of diagnostic equipment, tools, supplies, and related medicines were identified as barriers to appropriate NCD care and management. Finally, insufficient NCD financing reflects the low level of prioritization felt by managers and healthcare providers. There is a gap in human, financial, and material resources to respond to the country's health needs, which is more significant for NCDs as they currently compete against major infectious disease programming, which is better funded by external partners. Healthcare workers at the primary health care level of Mozambique's health system are inadequately skilled to provide NCD care and they lack the diagnostic equipment and tools to adequately provide such care. Any increase in global and national responses to the NCD challenge must include investments in human resources and appropriate equipment.

Realist evaluation of maternity waiting home intervention models in Inhambane, Mozambique: protocol for a comparative embedded case study, the Mozambique-Canada Maternal Health Project

IntroductionThis is a study protocol that tests and refines realist theories regarding the uptake and scale-up of the linked maternity waiting home (hereafter MWH) and facility birth intervention in the...

Situation analysis of the quality of primary health care services in Pakistan.

Primary health care services to promote the mental and physical health of communities include preventive, promotive, curative, general hygiene, and nutritional elements. To assess the quality of service delivery at primary healthcare settings in Punjab, Pakistan. Quantitative surveys were conducted at 106 health facilities: 92 basic health units (BHUs) and 14 rural health centres (RHCs) across Punjab in 2020. Data from the survey were supplemented with information from observations by the researchers and all data were analysed using SPSS version 25. All the 7 district health authorities surveyed had monthly targets for number of normal deliveries and the outpatient department. Systems for safe transportation and storage of medicines were deficient except in 2 districts. Anti-venom and anti-rabies vaccines were either limited or not available at most of the health units visited. Some 14% of clinical equipment examined at the BHUs and RHCs were non-functional, and no BHU had ultrasonic machines to improve the quality of antenatal care. Sterilization of surgical instruments was unsatisfactory at most health units. Several key positions at BHU and RHC were vacant. Most health units did not have fence and their main buildings were in poor condition. Several gaps were identified at the primary healthcare level in Punjab that need to be addressed to improve the quality of service delivery.

When should DIY have a localized healthcare waste management system?

Purpose: The 2018 healthcare waste management crisis catalyzed a critical review of the concerns expressed by the Health Office (dinkes) and healthcare facilities regarding healthcare waste management in the Special Region of Yogyakarta (DIY). Due to this crisis, the Ministry of Health hired Universitas Gadjah Mada (UGM) to look into potential solutions and promote DIY government policy responses. This paper examines the management strategy during crisis times and possible alternative solutions.
 Methods: This paper uses focused group discussions reports involving separate groups of (1) environmental health officials from community health centers, (2) hospitals, (3) environment health officials of district health authorities, and (4) cross-sectoral province officials in the Yogyakarta Special Region. It is part of a project 'A case study of strengthening regional-based medical waste management model', fund from the Environmental Health Directorate, Directorate General of Public Health, Ministry of Health (Project KN 01.03/6.1/0198/2019).
 Result: A simulation of policy options based on health facility managers suggests that a province-based system is the most profitable in the long term for DIY, with several possible options. The national policy roadmap was considered inadequate to respond to DIY's urgent local needs. Furthermore, the series of meetings succeeded in forming an informal forum between health facilities, provincial health offices, and associations of hospital environmental sanitation experts, monitoring medical waste management.
 Conclusion: The 2018 medical waste management crisis led to the formulation of policy response choices tailored to the capacity of DIY. These choices considered the expenditures and legal sanctions faced by healthcare facilities and the economic value of a region-based waste system for local government authorities. This comprehensive approach highlights the importance of local capacity. It needs to shape effective and sustainable medical waste management policies, underscoring the necessity of region-specific strategies in the face of national health crises.

COMMUNITY SUSTAINED MULTIDISCIPLINARY APPROACH IN COVID PANDEMIC MANAGEMENT - A FIELD EXPERIENCE FROM INDIA- A CASE REPORT

COVID pandemic with repeated outbreaks is associated with newer genomic variants and bound to create professional fatigue, which needs a community-based strategy to control the disease. During March 2021, the Tirunelveli district health authority adopted a Community Sustained Multidisciplinary Approach (CSMA) and was hypothesised to be more productive in managing the 2nd wave. It was a community-centric approach with primary prevention, early diagnosis & referral, early treatment and reduction of morbidity and mortality. The strategy included community-friendly lock-down with social security, community sustained micro-containment, women self-help group sustained hamlet level screening and a time-sensitive patient referral with monitoring of oxygen requirement. This study concludes that resource-constrained public health systems need to adopt a community-based approach to contain the pandemic efficiently, as demonstrated in Tirunelveli district through a Community Sustained Multidisciplinary Approach. This unique public health approach had a vital role in the efficient containment of the pandemic.

CO-INFECTION OF DENGUE AND CHIKUNGUNYA VIRUSES: A SEROLOGICAL STUDY IN A TERTIARY CARE HOSPITAL IN WARANGAL, TELANGANA, INDIA

Background: All around India, Dengue and Сhikungunya (CHIK) diseases seem to be rising. Aedes aegypti mosquitoes frequently transmit the CHIK virus and Dengue virus (DENV). Both viruses can spread together in regions where they cocirculate. Objectives: The objective of the current investigation is to determine the seroprevalence of coinfection with Dengue and Сhikungunya. Methods: The present study was conducted at the Virus Research and Diagnostic Laboratory, Kakatiya Medical College, Warangal, Telangana, India, from January to December 2022. The district health authority and the admitted cases provided the samples. The patients had symptoms typical of CHIK and DEN infections, including high fever (>39°C), chills, rashes, joint pain, joint swelling, nausea, and headache, myalgia, and pain behind the eyes. Results: Between January 2022 and December 2022, a total of 4892, 3344, and 2103 hospitalised patients underwent serological testing for the Dengue virus (DENV), the Сhikungunya virus (CHIKV), and both Dengue and Сhikungunya virus for co-infection, respectively. IgM Capture ELISA was used for all tests. 153 (7.8%) of the cases had both Dengue virus (DENV) and Сhikungunya virus IgM positivity. (CHIKV). Dengue virus (DENV) monoinfection, or 703 (14.3%), denotes the presence of Dengue virus. 313 (9.3%) individuals tested positive for the Сhikungunya virus, or mono-infected with the virus (CHIKV). Chikungunya IgM, Dengue IgM, and Co-infection Conclusion: Dengue and Chikungunya virus co-infections are clinically more serious than a single infection. However, in endemic regions, particularly during the monsoon season, clinically suspected cases should be tested for both viruses. To determine the severity and clinical result of co-infection, more thorough investigations are needed to analyse the pathophysiology and complications of co-infection.

Adherence to Infection Control Measures and the Psychological Effects of Quarantine during COVID-19 Pandemic in Dibrugarh District of Assam, India: A Cross-sectional Study

Introduction: Quarantine is an important means of controlling the spread of Coronavirus Disease-2019 (COVID-19) and it is essential to maintain strict adherence to infection control measures during this period. However, long periods of quarantine may be quite challenging by themselves especially in a pandemic of a new infection which might led to emotional, psychological and financial difficulties. Hence, understanding the psychological impact of COVID-19 on the quarantined people and how they have adhered to the infection control measures will help to formulate better prevention strategies. Aim: To assess the infection control measures among the people who were placed in quarantine and to understand its psychological effects during the COVID-19 pandemic in Dibrugarh District of Assam, India. Materials and Methods: This study was a community based cross-sectional study conducted among the people placed in quarantine in Dibrugarh District of Assam and was conducted from April 2020 to March 2021. During the COVID-19 pandemic, quarantine centres were set up in various educational institutions in the urban areas of Dibrugarh District of Assam. There were six such centres under the supervision of district health authorities. Taking three of these centres located at Chabua, Jokai and Lesai under Dibrugarh district, 159 quarantined subjects were enrolled for the study. Centre for Epidemiologic Studies Depression (CES-D) scale was applied for assessment of depressive symptoms and the post-traumatic stress symptoms were assessed using The Impact of Event Scale-Revised (IES-R). The adherence to infection control measures were assessed by using a predesigned, pretested questionnaire prepared for the purpose of the study, which was applied using online Google platform. Of the total 159 responses, 23 were incomplete and finally 136 were analysed. Descriptive analysis was done for the socio-demographic data. To find the association between quarantine and the psychological effects, Chi-square test was applied and p-value <0.05 was considered as significant. Results: Majority of the study subjects, 96 (70.59%) belonged to 10-29 years, 103 (75.74%) were males, and 126 (92.64%) were Hindu. About half of the participants were from urban area 72 (52.94%) and 48 (35.29%) were graduate. Majority of the participants 125 (91.91%) could manage to stay in separate room but arrangement of separate toilet was difficult. Similarly, about one-third 48 (35.29%) did not have a designated family member to look after them. Majority of the participants 135 (99.26%) practiced regular handwashing, wearing of mask 123 (90.44%) and regular disinfection of the items used by them 111 (81.62%). About 47 (34.56%) of the participants had sign and symptoms of post-traumatic stress, out of which females were affected more 14 (42.42%) and younger age group participants in the age range of 10 to 29 years 35 (36.46%) had more posttraumatic stress symptoms than the older adults. About onethird of participants 51 (37.5%) were depressed, 17 out of 33 females (51.52%) were found to be depressed and the younger age group in the age range of 10 to 29 years 42 (43.75%) were found to be more affected. Conclusion: Quarantine is an effective public health measure to control the spread of infection when people practice appropriate infection control measures. However, long periods of quarantine can cause psychological impact on the quarantined people which needs to be properly addressed.

Transfer or tailor? Implementing a technology‐supported intervention for noncommunicable diseases across contexts

Transfer or tailor? Implementing a technology‐supported intervention for noncommunicable diseases across contexts

Realistic Evaluation of the Integrated Electronic Diagnosis Approach (IeDA) for the Management of Childhood Illnesses at Primary Health Facilities in Burkina Faso.

In 2014, Terre des Hommes (Tdh) together with the Ministry of Health (MoH) launched the Integrated electronic Diagnosis Approach (IeDA) intervention in two regions of Burkina Faso consisting of supplying every health centre with a digital algorithm. A realistic evaluation was conducted to understand the implementation process, the mechanisms by which the IeDA intervention lead to change. Data collection took place between January 2016 and October 2017. Direct observation in health centres were conducted. In-depth interviews were conducted with 154 individuals including 92 healthcare workers (HCW) from health centres, 16 officers from district health authorities, 6 members of health centre management committees. In addition, 5 focus groups were organised with carers. The initial coding was based on a preliminary list of codes inspired by the middle-range theory (MRT). Our results showed that the adoption of the electronic protocol depended on a multiplicity of management practices including role distribution, team work, problem solving approach, task monitoring, training, supervision, support and recognition. Such changes lead to reorganising the health team and redistributing roles before and during consultation, and positive atmosphere that included recognition of each team member, organisational commitment and sense of belonging. Conditions for such management changes to be effective included open dialog at all levels of the system, a minimum of resources to cover the support services and supervision and regular discussions focusing on solving problems faced by health centre teams. This project reinforces the point that in a successful diffusion of IeDA, it is necessary to combine the introduction of technology with support and management mechanisms. It also important to highlight that managers' attitude plays a great place in the success of the intervention: open dialog and respect are crucial dimensions. This is aligned with the findings from other studies.

Socio-demographic determinants of cervical cancer screening uptake among women of child-bearing age in Mangochi, Malawi: a facility-based cross-sectional study

BackgroundCervical cancer (CC) is the number one leading cause of death among women in Malawi. However, it is generally viewed as preventable and treatable if diagnosed in an early stage. Despite the burden, Malawi registers low uptake of cervical cancer screening (CCS). This study examined the socio-demographic determinants of CCS uptake among women of child-bearing age (WCBA) in Mangochi district.MethodsA cross-sectional quantitative study was conducted in five health facilities. A total of 482 women between the ages of 18–49 participated and were sampled using a multi-stage sampling method. An interviewer administered structured questionnaire was used to collect data from June to July, 2019. Multivariate logistic regression model was used to identify determinants of CCS uptake among WCBA.ResultsFew respondents (13.1%) had ever done CCS. Compared to respondents in the age-group of 18–24 years, those in the age-groups of 25–35 years and 36–49 years were 2.63 and 3.90 times more likely to undergo CCS (AOR = 2.63, 95% CI 1.30–5.31 and AOR = 3.90, 95% CI 1.62–9.38), respectively. Respondents who practiced Christianity were 2.77 times more likely to undergo CCS than those who practiced Islam (AOR = 2.77, 95% CI 1.23–6.22). Respondents of the Chewa ethnic group were 71% less likely to undergo CCS as compared to those of Yao ethnicity (AOR = 0.29, 95% CI 0.09–0.95). Respondents who lived in semi-urban areas were 2.57 times more likely to go for CCS than those who were village residents (AOR = 2.57, 95% CI 1.19–5.55).ConclusionOur study showed that CCS uptake was low in Mangochi and the results suggested that age, religion, ethnicity and place of residence were determinants of CCS uptake. We recommend that comprehensive health education on CC should specifically target the young women and Muslim women in places where they meet. We call upon the district health authorities to scale up CCS provision in all Antiretroviral Therapy (ART) and outreach clinics to improve CCS uptake among women residing in the villages and those of the Chewa ethnicity. We, further, call upon all CC program implementers to design programs that address the highlighted socio-demographic determinants of CCS uptake among WCBA in the district.

Rethinking district-level governance of malaria in Ghana: A narrative review.

The goal of global malaria programming is to eliminate and eventually eradicate the disease. Achieving this global goal requires eliminating malaria in individual endemic countries. This paper, based on the observations of current and former implementers of malaria programs at district level, examines Ghana's malaria strategy to determine its adequacy for the elimination of malaria in the country, with a focus on the governance of district health systems. The paper argues that Ghana's malaria strategy is medically oriented, focusing predominantly on diagnosis and treatment of the disease. The strategy ignores determinants of malaria that are related to lifestyle and environment. Furthermore, there is limited engagement with other district-level stakeholders, and what engagement does occur is neither systematic nor sustained. Ghana's malaria strategy therefore requires a systematic rethinking to mobilize the participation of communities in district governance for malaria. The paper proposes several possible actions to restructure district governance of malaria. In Ghana, the malaria program should engage with key stakeholders in districts, using a systematic and sustained approach, to strengthen multisectoral action and community participation. This will require new accountability relationships for malaria progress within communities and among District Assemblies, district health authorities, and communities. Malaria programs in other African countries may also need to be similarly redirected towards community health governance for malaria progress. Simultaneously, global health and malaria agencies should redefine malaria as a social problem and collectively adopt a social determinants approach to strengthening national malaria programs. Pursuing the goals of elimination and eventual eradication of malaria without incorporating effective control of mosquito breeding and public health regulation is a fundamentally flawed approach. Progress on malaria requires a paradigm shift, from a medical perspective to a social determinant-informed approach with sustained and systematic engagement of all stakeholders in local communities.

Parental Anxiety of Perceived Disorder and Application of Concoctions on Infant Pulsating Anterior Fontanelle in the Tamale Metropolis, Ghana

The study seeks to unearth parental anxiety of perceived disorder and application of concoctions on infant pulsating anterior fontanelle in the Tamale metropolis, Ghana. Pulsation of the anterior fontanelle though a physiological reality of all infants, causes anxiety on the part of parents for fear of the infant suffering some form of harm as a result. A qualitative study which employed the narrative realities of mothers, delving into mothers’ beliefs on the physiologic functionality of the anterior fontanelle and perceived treatment mode commonly employed by mothers. The study revealed that mothers do not have any scientific reason behind the belief system for the application of concoctions on the pulsating anterior fontanelles of their infants. Consequently, the author recommends that the Ghana Health Service, the Teaching Hospitals, and the Municipal and District Health authorities should embark on serious health education on the essence of the fontanelle and demystify some cultural or traditional belief systems around pulsation of the anterior fontanelle. The application of concoctions on infant pulsating fontanelles is just not based on scientific principles known to the people, but it is perceptively done out of fear of the unknown.

Use of discrete event simulation and genetic algorithms to estimate the necessary resources to respond in a timely manner in the Medical Emergency System in Bogotá.

Bogotá has a Medical Emergency System of public and private ambulances that respond to health incidents. However, its sufficiency in quantity, type and location of the resources demanded is not known. Based on the data from the Medical Emergency System of Bogotá, Colombia, we first sought to characterize the prehospital re- sponse in cardiac arrest and determine with the model which is the least number of resources necessary to respond within eight minutes, taking into account their location, number, and type. A database of incidents reported in administrative records of the district health authority of Bogotá (2014 to 2017) was obtained. Based on this information, a hybrid model based on discrete event simulation and genetic algorithms was designed to establish the amount, type and geographic location of resources according to the frequencies and typology of the events. From the database, Bogotá presented 938 671 ambulances dispatches in the period. 47.4% high priority, 18.9% medium and 33.74% low. 92% of these corresponded to 15 of 43 medical emergency codes. The response times recorded were longer than expected, especially in out-of-hospital cardiac arrest (median 19 minutes). In the proposed model, the best scenario required at least 281 ambulances, medicalized and basic in a 3:1 ratio, respectively, to respond in adequate time. Results suggest the need for an increase in the resources that respond to these incidents to bring these response times to the needs of our population.

District-led malaria surveillance and response as an effective way to manage malaria upsurges following the withdrawal of indoor residual spraying: a case study from Nwoya District, northern Uganda

BackgroundMalaria remains the number one cause of morbidity and mortality in Uganda. In 2009, the United States President’s Malaria Initiative (PMI) funded an indoor residual spraying (IRS) project in 10 mid-northern districts, resulting in marked reductions in malaria prevalence over 5 years, from 62.5 percent to 7.2 percent. When the project ended and IRS withdrawn, malaria prevalence increased exponentially to pre-IRS level of 63 percent in 2016 and was characterized by frequent life-threatening upsurges that were exacerbated by a weak national led malaria surveillance system with delayed and piece meal responses. Malaria Consortium, in collaboration with Nwoya district local government implemented a district led malaria surveillance and response system. This study was conducted to compare the impact of District led and national led surveillance and response systems on overall malaria burden in two sub-counties in Nwoya district, Northern Uganda.MethodsThe assessment was conducted between week 41 of 2018 and week 10 of 2019 in Anaka and Alero sub counties following the shift from the national to district led malaria surveillance and response system. A district multi-sectoral malaria response taskforce team, known as the District Malaria Surveillance and Response Team (DMSRT), was formed by the Nwoya District Health Team (DHT). The DMSRT was trained and equipped with new surveillance tools for early detection of and response to malaria upsurges within the district, and were mandated to develop a costed district specific malaria response plan.ResultsAll (18) targeted health facilities provided weekly malaria reports and continuously updated the malaria normal channel graphs. There was an overall reduction in weekly new malaria cases from 12.9 in week 41 of 2018 to 6.2 cases in week 10 of 2019. Malaria positivity rates (TPR) for Alero and Anaka sub-counties reduced from 76.0 percent and 69.3 percent at week 42 of 2018 to 28 percent and 30.3 percent, respectively at week 10 of 2019.ConclusionsMalaria surveillance and response, with precisely targeted multipronged activities, when led and implemented by local district health authorities is an effective, efficient, and sustainable approach to prevent malaria upsurges and associated morbidity and mortality.

Outbreak Investigation of a Foodborne Illness in Village Bachal Soomro, District Tharparkar, Sindh, Pakistan (December 2020): Retrospective Cohort Study

Background On December 3, 2020, district health authorities reported 15 suspected cases of gastroenteritis, including 4 deaths, from Village Bachal Soomro after a mourning ceremony. Objective Field Epidemiology and Laboratory Training Program (FELTP) fellows investigated the suspected outbreak, with the objective to determine the magnitude of the outbreak and to evaluate associated risk factors. Methods A retrospective cohort study was conducted on December 3, 2020, at Village Bachal Soomro. The complete cohort was traced back, and a pretested structured questionnaire was adopted to obtain demographic, clinical, and risk factor information. A case was defined as “any individual who attended the mourning ceremony at Village Bachal Soomro on December 3, 2020, and presented with any of the following symptoms: diarrhea, abdominal pain/cramps, and drowsiness.” Descriptive analysis followed by multiple logistic regression was performed. Different blood, stool, oropharyngeal swab, drinking water, and milk samples were sent for microbiological and chemical investigation. Results Of 61 participants, 32 (52%) were males and the median age was 23 years (range 1-70 years). The overall attack rate was 72%, while the most affected age group was 10-19 years, with an attack rate of 85%. The majority of cases presented with diarrhea (47/61, 77%), followed by abdominal pain (44/61, 72%), vomiting (43/61, 70%), body ache (29/61, 48%), drowsiness (10/61, 16%), and fever (4/61, 7%). Among all food items, dessert had the highest food-specific attack rate of 90%. Among all risk factors, consumption of dessert (adjusted odds ratio [aOR] 61.3, 95% CI 6.1-613.1), water (aOR 23.9, 95% CI 2.0-276.7), and buffalo milk (aOR 7.9, 95% CI 1.22-51.8) were found to be significantly associated with the attack. Distribution of cases showed a common point source that was probably due to a single pathogen source. Conclusions Dessert was prepared 10-12 hours prior to meal intake, so the outbreak was probably caused by dessert prepared with contaminated milk and water, with enterotoxins of Staphylococcus aureus. Community awareness of personal hygiene, proper storage/preservation of food items, and provision of safe drinking water are suggested.

Are we expecting too much for too long from the vaccinators? A qualitative study on perceived challenges of COVID-19 vaccinators of district Shahdol, India.

There is a paucity of knowledge regarding challenges faced by the coronavirus disease 2019 (COVID-19) vaccinators in resource constraint settings like district Shahdol, Central India. Hence, the present study was planned to explore the perceived challenges of vaccinators regarding COVID-19 vaccination. In October 2021, district health authorities conducted a one-day workshop with the auxiliary nurse midwives, staff nurses, and lady health visitors who work as vaccinators. It had three distinct but mutually connected phases. In the first phase, a free listing exercise was performed to list out their perceived challenges that are prominent and representative of their cultural domain. In the second phase, the pile-sorting exercise with the challenges mentioned in the above step was performed to produce similar data in the form of a matrix, based on a perceived similarity between them by multi-dimensional scaling analysis. In the final phase, the transcripts generated during the discussion on the free listing and pile sorting exercises was used for the thematic analysis to find plausible explanations for the findings. A total of 15 vaccinators took part in the workshop. In the free listing exercise, a total of 14 items were identified as perceived challenges for COVID-19 vaccinators. The three items with the highest Smith's S value were overtime duty, no holidays, and lack of monetary incentive. The analysis of pile-sorting suggested that participants clustered their 14 perceived challenges into five groups; 1) beneficiaries related, 2) vaccination schedule related, 3) lack of facilities at vaccination site, 4) lack of monetary incentive, and 5) issues related to digital data handling. Thematic analysis suggested that their main challenges were overtime duty, no monetary incentive, and lack of toilet, food, and transport facility at the session site. Vaccinators perceive overtime duty and lack of holidays as their top two challenges and expect monetary incentives for this. The study recommends better basic amenities like toilet facility, sustained and effective community engagement, a monetary incentive, and a better ecosystem for digital data handling for the vaccinators.

A Model; Road Map to Achieve Sustainable Development Goals 2030 Realizing Your Potential a Proposed Guidelines for National Health Policy for Integrated Health Care Delivery

The goals that are set for 2030 regarding sustainable Development are a wakeup call to action that reforms should be made to end poverty, protect the planet and ensure health for all and everywhere. The needs to review and reprioritize the use of existing resources in the health sector along with significant addition and allocation of resources for health should be focusing more on primary health care. Pakistan must also adopt a holistic integrated approach that views health, education, and other social sector development as intrinsically interrelated and interwoven.Most of the patients in Pakistan visit two to three general practitioner / family physicians to rule out and to know the exact diagnosis of their ailment. This increases the frequency of visits to the other physicians and decreases follow up and compliance concerning to the treatment provided. Another Important concern is record maintenance as most of the time patient loss their important notes/ reports.
 So to streamline these all patient record as well as provision of safe treatment and referral if any needed in the region he is residing are the main purpose; this will decrease patient load to Private as well as public sector health units and will decrease the unnecessary movement of patients. The Unique Model by Using the latest Technology has evolved by putting the Communication, Coordination in a synchronization pattern and by keeping the health care provider and client in a centralized position. This will integrate all levels of family Physicians; centralize the patient registration Mechanism in Pakistan. This will regulate Screenings & Surveillance of Communicable and Non communicable Diseases thus support the District Health Administration to keep an eagle eye to monitor disease prevalence and incidence.This will work in coordination with Primary secondary and specialized healthcare; Tertiary health care units Public Sector.The efficient and effective Decrease the Chronicity, Resistance and Poor Compliance
 OBJECTIVES: To strengthen the feedback and Reporting System in Pakistan. To Improve Tracking System, Patient’s Health Care, Surveillance, Coordination, Team Facilitation & Integration hence help in policy development
 METHODOLOGY: This will be a unique Web Portal System with customized features The integrated model will be configured and synchronized; based on integrated, self-regulated concept. It’s all sections shall be interconnected and reports will be auto generated after a concrete analysis and Produce comparative results instantly.
 RESULTS: Rapid communication and Instant strategies policies to improve patient’s health care, by improving the surveillance & tracking system in Pakistan
 CONCLUSIONS: The “Integration Model For Pre & Post Epidemic Communication, Strategies will help to Improve Tracking System, Patient’s Health Care, Surveillance, Coordination, Team Facilitation as well as strengthening the feedback and Reporting System In Pakistan”. This will also help the District Health Authority & District Administration for proper and appropriate measures to initiate.

Establishment of Outbreak Thresholds for Hepatitis A in South Africa Using Laboratory Surveillance, 2017–2020

As South Africa transitions from endemic to intermediate endemicity, hepatitis A surveillance needs strengthening to monitor trends in disease incidence and to identify outbreaks. We used passive laboratory-based surveillance data from the National Health Laboratory Services to calculate national hepatitis A incidence and to establish thresholds for outbreaks. Incidence was calculated by age and geographic location. The static threshold used two or three standard deviations (SDs) above the mean hepatitis A incidence in 2017–2019, and a cumulative summation (CuSum2) threshold used three SDs above the mean of the preceding seven months. These thresholds were applied to hepatitis A data for 2020. From 2017 to 2020, the mean incidence of hepatitis A IgM was 4.06/100,000 and ranged from 4.23 to 4.85/100,000 per year. Hepatitis A incidence was highest in the Western Cape province (WCP) (7.00–10.92/100,000 per year). The highest incidence was in the 1–9-year-olds. The incidence of hepatitis A in 2020 exceeded the static threshold in two districts of the WCP: Cape Winelands in January and Overberg district in August. The provincial incidence did not exceed the static and CuSum2 thresholds. District-level analysis using either threshold was sensitive enough to monitor trends and to alert district health authorities, allowing early outbreak responses.