District Health Research Articles

Analysis of oxidative status, inflammatory cytokines, and Ascaris lumbricoides infection in women at a health district in Bamenda, Northwest, Cameroon

BackgroundClinical outcomes of ascariasis, one of the most common parasitic infections, are remarkably variable ranging from asymptomatic infection to death. Ascariasis can pair absorption of fats, vitamin A, iodine, and lactose digestion and destroys the villi, with significant consequences in pregnancy outcomes, leading to growth retardation, and cognitive impairment, decreased work capacity, and adverse pregnancy outcomes. One of the crucial factors driving the clinical outcomes of ascariasis is the immune response and associated oxidative stress. This study therefore examined the prevalence of ascariasis and associated immune response dysfunction by measuring four inflammatory cytokines alongside with the oxidant and antioxidant biomarkers in women of reproductive age in a health center in Cameroon.ResultsThree-hundred and fifty-five women (pregnant and non-pregnant) were examined for the parasite. Because some participants did not donate blood and due to low volume of blood available, only 127 individuals (62 non-pregnant women and 65 pregnant women) were included for analysis of oxidative biomarkers, and 90 samples were used for the evaluation of inflammatory biomarkers (40 non-pregnant and 50 pregnant). The prevalence of Ascaris lumbricoides was of 13.23%. Ascariasis was associated with high levels in inflammatory cytokines (IL-1β, IL-12, IL-10, and TNF-α) and oxidative markers (TOS, OSI, MDA, and CAT) in both pregnant and non-pregnant women, while high level of NO was only seen in pregnant women. A significant relation was observed between some cytokines and oxidant markers: IL-10 and OSI and IL-12 and NO and between IL-1β and MDA in pregnant women, while in non-pregnant, significant relation was found between Il-10 and NO as well as IL-1β and OSI and NO. Principal component analysis (PCA) underlined a pro-inflammatory cytokine signature (with strongest contributions from IL-1β, IL-10, TNF-α). PCA also highlighted an oxidative stress with strongest contributions from TOS, OSI, SOD, NO, and CAT in pregnant and from OSI, TOS, NO, CAT, and TAC in non-pregnant.ConclusionThese findings demonstrate elevated cytokines (IL-1β, IL-12, IL-10, and TNF-α) and high oxidative stress imbalance, adding further evidence for the role of a pro-inflammatory cytokine signature of oxidative stress in women with A. lumbricoides.

Grace Under Pressure: a mixed methods impact assessment of a verbatim theatre intervention to improve healthcare workplace culture

BackgroundHealthcare workplace mistreatment has been documented globally. Poor workplace behaviour, ranging from incivility to bullying and harassment, is common in healthcare, and contributes significantly to adverse events in healthcare, poor mental health among healthcare workers, and to attrition in the healthcare workforce, particularly in junior years. Poor workplace behaviour is often normalised, and is difficult to address. Verbatim theatre, a form of research informed theatre in which plays are created from informants’ exact words only, is particularly suited to facilitating workplace culture change by raising awareness about issues that are difficult to discuss. The objective of this study was to assess the impact of the verbatim theatre play ‘Grace Under Pressure’ on workplace culture in NSW hospitals.MethodsThe intervention was conducted in 13 hospitals from 8 Local Health Districts (LHDs) in NSW, Australia, in October and November 2019, with aggregated impact across all sites measured by a bespoke survey (‘Pam McLean Centre (PMC) survey’) at the conclusion of the intervention. This study was conducted in 3 Local Health Districts (one urban, one regional, one remote), with data collection conducted in November–December 2019 and December 2020. The study design was a mixed methods assessment of the play’s impact using (1) validated baseline measures of psychosocial risk, analysed descriptively, (2) overall findings from the PMC survey above, analysed descriptively, (3) interviews conducted within a month of the intervention, analysed thematically and (4) interviews conducted one year later, analysed thematically.ResultsHalf (51.5%) of the respondents (n = 149) to the baseline survey had scores indicating high risk of job strain and depressive symptoms. Of 478 respondents to the PMC survey (response rate 57%), 93% found the play important, 92% recommended others see the play, 89% considered that it stimulated thinking about workplace behaviour, and 85% that it made discussing these issues easier. Thematic analysis of interviews within one month (n = 21) showed that the play raised awareness about poor workplace behaviour and motivated behaviour change. Interviews conducted one year later (n = 6) attributed improved workplace culture to the intervention due to improved awareness, discussion and capacity to respond to challenging issues.ConclusionsVerbatim theatre is effective in raising awareness about difficult workplace behaviour in ways that motivate behaviour change, and hence can be effective in catalysing real improvements in healthcare workplace culture. Creative approaches are recommended for addressing similarly complex challenges in healthcare workforce retention.

Implementing Quality Improvement Initiatives to Improve the Use of Adolescent- and Youth-Friendly Health Services in Zou, Benin.

In Benin, the unmet need for family planning services is especially high for adolescent girls and youth aged 15-24 years. The Challenge Initiative (TCI) supported the health system to assess and improve the quality of adolescent and youth sexual reproductive health services and enhance contraceptive uptake in 65 service delivery points (SDPs) of the Zou department. Between June 2019 and March 2021, TCI supported the health districts in Zou to train an assessment team to complete 3 cycles of quality assessments (QAs) using a QA checklist adapted to the local context. Based on assessment scores, the SDPs were categorized into poor, moderate, or good to excellent quality. The SDP managers developed remedial action plans after each cycle and for each SDP and followed up with supportive supervision. The first QA cycle showed that 52% of assessed SDPs achieved a good to excellent classification; by the second QA cycle, this reached 74%. However, the quality of adolescent- and youth-friendly health services regressed during the third QA cycle (during COVID-19 pandemic disruptions), when only 40% of SDPs achieved the good to excellent category. Between the first and second QA cycles, contraceptive uptake for adolescents and youth improved in the SDPs that had good or excellent quality of services, compared to the ones that were of lower quality (established significance level of 5% with a P value of .031). Further assessments could deepen our understanding of the internal and external factors that can affect service quality. The findings reinforce the importance of investing in quality improvement strategies to maximize the use of sexual and reproductive health services among adolescents and youth. They also underscore the need for a contextual and nuanced approach to ensure enduring results.

First Level of Health Care: The Autonomous Role of Nurses

Introduction: Although nursing autonomy is advancing with national legislation towards a competency-based approach, a positivist vision centered on biomedical aspects persists, limiting comprehensive care. Despite training and experience, role conflicts and oppression by the medical team persist, impeding freedom of decision and leading to job dissatisfaction.Objective: To analyze the professional autonomy of nurses in type A, B and C health centers at the first level of care in Health District 09D04 - Febres Cordero.Method: Qualitative, descriptive, and dialectical approach, based on the perceptions of nursing professionals about their autonomy in Health District 09D04.Results: The perception of autonomy in the first level of health care is limited, under pressure and subject to demanding schedules. There are restrictions imposed by parameters and regulations, although benefits such as quality care and educational responsibility are recognized. Legal limitations, lack of support and restrictions affecting nurses' autonomy are also identified.Conclusions: To empower nurses, a series of measures are required at both the practical and educational levels. These include the implementation of laws that support their autonomy, ongoing training, the promotion of a favorable work environment, and the strengthening of their educational background with a focus on leadership and solution-finding skills.

Perception of dental surgeons on multidisciplinary teamwork and preceptorship during the COVID-19 pandemic.

The objective of this work was to verify the perception of dental surgeons (DC) about their professional practice in the family health strategy (ESF), considering aspects related to multidisciplinary action, teamwork and preceptorship during the COVID-19 pandemic. 07 CDs from the Basic Health Units of a Health District (DS) in Recife participated, in the years 2020 to 2021. This was a qualitative study, using a semi-structured interview guide and sociodemographic questionnaire. The data were treated using Bardin's content analysis. The majority of CDs are women (71%), aged between 40 and 50 years old (57%), with more than 20 years of training (57%) and with good professional qualifications, including specialization in the field of activity and a master's degree. Three categories emerged from the qualitative analysis: Daily life before and after the Covid-19 pandemic and comprehensive care; Multidisciplinary teamwork and Influence of the exercise of Preceptorship on the Work Process of the CD in the ESF that recognize dentistry in the ESF is based on teamwork and multidisciplinary action to guarantee comprehensiveness, the pandemic changed the daily routine of services and fragmented care.

Predictors, motives, sources and patterns of nonmedical use of prescription drugs among youths in Buea, Southwest region of Cameroon: A mixed method analysis

BackgroundThe non-medical use of prescription drugs (NMUPD) is an emerging phenomenon of serious public health concern among young people globally. This study seeks to determine the predictors, motives, sources, patterns of use of NMUPD among youths in the Buea Health District of the South west region. Materials and MethodsA mixed-method community-based, cross-sectional study conducted from May to June 2018, enrolled participants aged 15 - 29 years from schools and community. A pretested semi-structured questionnaire was used to capture data and focus group discussions and key informant interviews were conducted. Quantitative and qualitative analyses were performed with SPSS version 24 and ATLAS.ti version 7 respectively. Logic regression analysis were carried at 5 % significance level. ResultsThe study enrolled 464 participants (median age of 21 years, IQR: 18 – 23.8 years) into the quantitative study, 63 % were females. Forty-nine participants were enrolled for the qualitative study. A total of 90 (19.6 %; CI: 15.9 – 23.3 %) participants accepted they have used prescriptions medications in the last 12 months for non-medical purposes. Opioids (74.4 %) particularly tramadol (60.1 %) were the most common drugs used. Male gender (p = 0.001), the age group 20–24-year, smoking (p = 0.043) and use of illicit substances (p < 0.001) were independent predictors of NMUPD. Prominent motivations were:- curiosity (31.1 %) and enhancement of work performance (30 %). Unregistered pharmacies and private health facilities were the main sources of these drugs which are acquired mainly without prescription. ConclusionMale gender, young adults, smoking and use of illicit substances were independent predictors of NMUPD. Motives were hinged to enhancement of performance in various domains of social life. Opioids, particularly tramadol was the predominant drug used, acquired without prescription from unregistered pharmacies. Findings of this study provide baseline evidence that could guide policies on drug prevention, treatment and harm reduction interventions.

Evaluating automated machine learning platforms for use in healthcare.

To describe development and application of a checklist of criteria for selecting an automated machine learning (Auto ML) platform for use in creating clinical ML models. Evaluation criteria for selecting an Auto ML platform suited to ML needs of a local health district were developed in 3 steps: (1) identification of key requirements, (2) a market scan, and (3) an assessment process with desired outcomes. The final checklist comprising 21 functional and 6 non-functional criteria was applied to vendor submissions in selecting a platform for creating a ML heparin dosing model as a use case. A team of clinicians, data scientists, and key stakeholders developed a checklist which can be adapted to ML needs of healthcare organizations, the use case providing a relevant example. An evaluative checklist was developed for selecting Auto ML platforms which requires validation in larger multi-site studies.

Long-Lasting Insecticidal Net Ownership and Use in Mogode Health District, Cameroon.

Cameroon is a malaria-endemic country. Many control strategies including long-lasting insecticidal nets (LLIN) have been proposed to reduce the burden of malaria. The World Health Organization aims to achieve at least 80% of people sleeping under a LLIN. This study assessed the ownership and use of LLNs in the Mogode Health District (MHD). A community-based cross-sectional study was conducted in MHD in September 2021. Data on ownership and LLINs use were collected using structured questionnaires following the Roll Back Malaria guidelines. Univariate and multivariate analyses were performed to assess the determinants of ownership and failure to LLIN use. A total of 332 households were included from eight health areas. The proportion of households with at least one LLIN was 72.0% (238). However, 232 (70.0%) reported having used LLIN (sleeping under LLIN the previous night). Household heads with higher education were six times more likely to have owned LLINs than those with no education (adjusted odds ratio (AOR)=6.8; confidence interval (CI) 1.5, 31.0, p< 0.05). Additionally, household heads between the ages of 36-50 were 4.2 times (AOR= 4.2, CI 1.3-13.8, p< 0.05) likely to fail to use LLINs in households. However, households where heads had secondary education (AOR= 0.2, CI 0.1-0.6, p< 0.05), were negatively associated with failure to use LLINs. Ownership and use of LLINs in MHD remain challenging. Therefore, this finding will contribute to improving recommendations and updating strategies such as targeted messages aimed at raising awareness of malaria during mass LLIN distribution campaigns.

Students’ Experiences with Interprofessional Service-Learning Global Health Education Pilot Program in Ghana

Interprofessional service-learning programs can help to break down the education and training silos between public health and health care in the United States. This paper describes the development and implementation of one such program between the University of Massachusetts, Amherst, School of Public Health and Health Sciences, Bay Path University Physician Assistant Program, and the Wa-West Health District in Ghana. The program brought together Master of Public Health students and Physician Assistant students to complete an applied practicum and training experience in a low-resource community that faces significant health care and public health delivery challenges. In 2017 and 2018, nine students participated in the two-year pilot program, UMass Amherst Interprofessional Integrated Service Learning and Community-Based Participatory Collaboration. Students completed projects designed by Ghanaian health officials over two summers in direct collaboration with the communities. Findings from the evaluation of the pilot program revealed that though the students faced some challenges with the program, such as language barriers, transportation issues due to poor roads, and difficulty scheduling meetings while completing their projects in Ghana, the majority described their experience as positive and were satisfied. Some expressed the idea that their experiences were something that they could incorporate into their current and future practices. In addition, they reported that interprofessional communications and collaborations were effective. Recommendations are offered to address the program’s challenges for its continuation and formalization.

Factors Associated with Hemoglobinemia After 12 Months of Lucky Iron Fich (LIF) Use in Women of Reproductive Age (FAR, 15-49 years) in the Tambacounda Health District in 2020 (Senegal)

Factors Associated with Hemoglobinemia After 12 Months of Lucky Iron Fich (LIF) Use in Women of Reproductive Age (FAR, 15-49 years) in the Tambacounda Health District in 2020 (Senegal)

Evaluation of Obstacles to Low Coverage of Routine Vitamin A Supplementation in 2021 in the Guédiawaye Health District in Dakar, Senegal

Introduction: Micronutrient deficiencies, particularly the most serious deficiencies of iron, vitamin A and iodine, are a major public health problem in developing countries. Vitamin A deficiency is one of the most common nutritional deficiencies and one of the most serious, as it greatly increases the risk of death and predisposes to numerous infectious diseases. Routine vitamin A supplementation in children aged between 6 and 59 months is the strategy used in Senegal to combat micronutrient deficiencies. The aim of this study is therefore to assess the obstacles to the low coverage of routine vitamin A supplementation (VAS) in the Guédiawaye district of Dakar in 2022. Methodology: This is a descriptive and analytical cross-sectional study using a quantitative and qualitative method. The cluster sampling method was chosen for the quantitative study. The study population consisted of all mothers/caregivers of children aged 06 to 59 months, providers, and community stakeholders. Results: The practice of supplementation was statistically related to the level of education of those surveyed (p=0.00), communication by health workers (p=0.001) and community stakeholders (P=0.003). Knowledge of the benefits on child growth (p=0.003), the fight against blindness (0.017), the strengthening of the immune system (p=0.001) and the fight against infections (p=0.002) are statistically linked to the practice of VAS. Non-supplementation with vitamin A was 2.3 times higher among children aged over 24 months (p= 0.016); 3.1 times higher among uneducated women (P=0.001) and 3 times higher (0.001) among women who had received no information about VAS. The qualitative results show that a number of reasons were given, including lack of familiarity with the schedule, forgetting to keep appointments at different times, stopping the vaccination cycle and household chores. Conclusion: the obstacles to vitamin A supplementation in Guédiawaye are mainly linked to a lack of knowledge about vitamin A and the non-existence of a proper VAS communication strategy. Hence the need to step up communication with the public.

COVID-19 lockdowns affected birthing outcomes in a regional New South Wales Health District.

The 400 000 residents of the Illawarra Shoalhaven Local Health District (ISLHD) experienced two distinct lockdowns aimed at mitigating the transmission of severe acute respiratory syndrome coronavirus 2 infection. Analysing effects of these lockdowns on maternal and neonatal outcomes presents a valuable opportunity to assess the impact of pandemic-level restrictions on maternal and neonatal outcomes. Evaluate the impacts of restrictions from two lockdown periods on maternal, birthing, and neonatal outcomes within a regional local health district. The study included 22 166 women who gave birth within ISLHD between 2017 and 2022. Groups included for analysis: Control Group - mothers pregnant before the pandemic (conception before 3 April 2019); Exposure Group 1 - mothers pregnant during the first lockdown (conception date 22 January 2020 to 5 May 2020); and Exposure Group 2 - mothers pregnant during the second lockdown (conception date 30 April 2021 to 13 Sep 2021). Odds of adverse birthing outcomes including non-reassuring fetal status (odds ratio (OR) 1.34; 95% CI 1.14-1.56 and OR 1.20; 95% CI 1.03-1.40), and postpartum haemorrhage (OR 2.04; 95% CI 1.73-2.41 and OR 1.74; 95% CI 1.48-2.05) were substantially increased in Exposure Groups 1 and 2, respectively. Gestational diabetes, gestational hypertension, low birth weight and admission to neonatal intensive care rates improved. Pregnant women exposed to pandemic restrictions within ISLHD had decreased odds of adverse antenatal and neonatal outcomes, but increased odds of poor peripartum outcomes.

Efficacy of an aloe vera, chamomile, and thyme cosmetic cream for the prophylaxis and treatment of mild dermatitis induced by radiation therapy in breast cancer patients (the Alantel study)

ObjectivesRadiation-induced dermatitis (RD) is one of the most common toxicities in radiation therapy (RT) patients. Corticosteroids, immunosuppressants, and natural products (NPs) have been used as treatment. The objective was to evaluate the efficacy of a NPs-based cream (Alantel®) to reduce the incidence of RD in women with breast cancer undergoing RT treatment. DesignWe conducted a controlled, randomized, double-blind clinical trial. SettingRadiation Oncology Unit of the Reina Sofía Hospital and 5 Primary Care centers of the Cordoba and Guadalquivir Health District (Spain). InterventionsPatients assigned to the experimental group (GTA) were treated with Alantel, while those in the control group (GTE) were treated with a moisturizer and emollient cream. Main outcome measuresThe primary outcome variable was the incidence of RD. RD-free time, duration of RD, quality of life, and product safety were also assessed. ResultsSeventy patients were included in the study, 35 in the GTA and 35 in the GTE. The incidence of RD was lower in the GTA (71.4%) than in the GTE (91.4%) after 4 weeks of follow-up (RR = 0.78; NNT = 5; p < 0.031). The Skindex-29 questionnaire showed differences in the statement: “My skin condition makes it hard to work or do hobbies” (17.1% in the GTE vs. 2.9% in GTA; p = 0.024). ConclusionsThe higher efficacy of Alantel® compared to the control cream in reducing the incidence of RD in women with breast cancer has been demonstrated.

IJCM_331A: Helping beyond the Helpline – Experience from a Unique Model for Mental Health Care among Frontline workers during COVID – 19 Pandemic in Andhra Pradesh

Background: Psychological issues among Health Care Workers (HCWs) in COVID-19 stem from the fact that normal people are being exposed to extraordinary situations. Facing this critical situation, it is essential to ensure that these personnel are identified early and offered appropriate intervention. Hence, AIIMS Mangalagiri partnering with UNICEF started a project to reach out to all frontline workers in the state of Andhra Pradesh. Objectives: To set up a Psycho-Social Counselling (PSC) system for healthcare &amp; other front-line workers in the state of Andhra Pradesh to handle stress due to COVID–19 To conduct capacity-building programs for health care &amp; other front-line workers to prevent psycho-social conditions arising due to COVID–19 Methodology: A simple Mental Health Screening Questionnaire (MHSQ) was developed and validated in the local language. After getting prior approvals, a Google form link of the MHSQ was sent via email, SMS, and WhatsApp to every frontline worker in the state. Consenting participants with scores above 6 were contacted personally by the psychologists for further detailed evaluation. A helpline number for counseling was publicized and psychologists conducted sessions on mental health awareness and coping strategies in various institutes across the state. Results: About 8,217 respondents attempted the MHSQ out of which detailed mental health evaluation (GAD-7, PHQ-9, CAGE, AUDIT, and PSQI) was done for 392 respondents. The most common issues identified were Anxiety (45%), Insomnia (42%), Depression (12%), and Substance Abuse (2%). Also, as a part of the mental health capacity-building campaign around 4,500 healthcare workers like nurses, Anganwadi teachers, and ANMs were trained offline across the state, along with the District Mental Health team. Conclusion: Mental health can have a significant impact on the competence of frontline workers. In addition to existing interventions available, confidential mental health intervention and service provision are the need of the hour.

Diet and well-being of 1st year Medical Interns during hospital placement

Hospital placement is essential training for medical interns, involving shift work and high-pressure environments. This can increase physiological and psychological stress, which may be mediated by metabolites of microbial digestion(1). Nutrients of interest include those accessible to microbial digestion and associated with altered signalling within the microbiota-gut-brain axis (MGBA)(1). Fibre is fermented by gut microbes to produce short-chain fatty acids(2) and is associated with improved psychological outcomes(3). Tryptophan, a precursor to gut-derived serotonin(2), has been negatively associated with anxiety(4). Processed foods contain food additives, excess sugars, and saturated fats that may disrupt gut homeostasis(1) and impact psychological well-being(4). Lastly, total energy intake may determine the level of substrate available for microbial fermentation(2). Therefore, this research explores how microbiota-accessible food components interact with physical and psychological well-being in a cohort of medical interns undertaking their first-year of hospital placement. Participants were healthy medical interns, during first-year hospital placement (n = 21) from the Hunter New England Local Health District, NSW, Australia. Participants completed diet and wellbeing surveys at baseline and every 2 months over a 10-month period. 24-hour diet diaries were self-recorded from participants using a mobile application (Easy Diet Diary) and analysed using AusNut and the NOVA classification system of ultra-processed foods (ULP). Wellbeing surveys include depression, anxiety, stress scale (DASS), and PROMIS survey for mental (M), physical (P), and sleep well-being. Current data represents an ‘in-progress’ of the longitudinal data collection. This study utilised Spearman correlation and Tukey’s post hoc test for mixed methods analysis. From baseline to timepoint 3 (T3, 4 months) daily energy intake was consistent with cohort estimated energy requirements (EER). However, consumption ranged from 37% to 167% of EER, indicating a large variation of intakes. Energy consumed from ULP ranged from 30% to 34% (p = 0.6875). Baseline tryptophan intake (x¯ = 1139mg) was within the suggested target, whilst fibre intake (x¯ = 23g) was below the recommended intake. Neither saw significant changes from baseline to T3. Fibre intake was positively correlated with mental and physical well-being at baseline (x¯ = 23.1g, M: r = 0.474, p = 0.04, P: r = 0.608, p = 0.007), and timepoint 2 (x¯ = 31.5g, M: r = 0.647,p = 0.026, P: r = 0.780, p = 0.004) but not at T3. In addition, baseline consumption of sugar (x¯ = 18g) and poly-unsaturated fats (x¯ = 15g) were both negatively correlated with mental and physical well-being. Overall, no significant dietary changes were evident from baseline to mid-year collection in a first-year medical intern cohort during hospital placements. Fibre was significantly associated with mental and physical well-being, building on current understanding of fibre’s role in the MGBA. Planned metabolite analysis will explore the mechanisms of proposed microbiome-accessible nutrients alongside diet, well-being, and microbiota data. Findings from this study will identify how diet-microbiome interactions change under stress, with wider positive implications on intense workplace environments with the aim to preserve individual wellbeing.

Relational Coordination at the Primary-Secondary Care Interface: Insights from a Cross-Sectional Survey in the South Tyrolean Healthcare System.

Understanding the dynamics of teamwork and communication among healthcare professionals is crucial in the face of evolving healthcare challenges. This study assessed relational coordination among healthcare professionals in the South Tyrolean healthcare system in Italy, focusing on communication and teamwork dynamics in a cross-sectional survey. Using the validated Relational Coordination Survey (RCS) instrument and 525 completed online responses, the questionnaire aimed to understand the implications of different levels of relational coordination ratings by general practitioners, hospital physicians, nurses, and administrative personnel (response rate 26%). The demographics of the participants revealed a predominance of female professionals (64%), with an average age of 50 and 18 years of service. The resulting RCS scores varied significantly across professional groups, with nurses reporting the highest within-group scores, indicating moderate coordination, and administrators reporting the lowest scores, reflecting areas of weak coordination. Between-group relational coordination was generally perceived as weak across professional groups, with the least weakness observed between general practitioners and nurses. German or Italian language and health district affiliation emerged as significant factors influencing relational coordination ratings, highlighting the need for differentiated understanding and strategies in multilingual and diverse regional settings. Assessments of interdisciplinary feedback and referral practices highlight the variation in teamwork and communication weaknesses and underscore the need for targeted interventions to improve relational coordination. This study provides insights into the complexity of relational dynamics in health care settings. This suggests that improving relational coordination through tailored strategies could significantly improve team effectiveness, quality of patient care, and overall system efficiency.

Cost-effectiveness of severe acute malnutrition treatment delivered by community health workers in the district of Mayahi, Niger

BackgroundA non-randomized controlled trial, conducted from June 2018 to March 2019 in two rural communes in the health district of Mayahi in Niger, showed that including community health workers (CHWs) in the treatment of severe acute malnutrition (SAM) resulted in a better recovery rate (77.2% vs. 72.1%) compared with the standard treatment provided solely at the health centers. The present study aims to assess the cost and cost-effectiveness of the CHWs led treatment of uncomplicated SAM in children 6–59 months compared to the standard national protocol.MethodsTo account for all relevant costs, the cost analysis included activity-based costing and bottom-up approaches from a societal perspective and on a within-trial time horizon. The cost-effectiveness analysis was conducted through a decision analysis network built with OpenMarkov and evaluated under two approaches: (1) with recovery rate and cost per child admitted for treatment as measures of effectiveness and cost, respectively; and (2) assessing the total number of children recovered and the total cost incurred. In addition, a multivariate probabilistic sensitivity analysis was carried out to evaluate the effect of uncertainty around the base case input data.ResultsFor the base case data, the average cost per child recovered was 116.52 USD in the standard treatment and 107.22 USD in the CHWs-led treatment. Based on the first approach, the CHWs-led treatment was more cost-effective than the standard treatment with an average cost per child admitted for treatment of 82.81 USD vs. 84.01 USD. Based on the second approach, the incremental cost-effectiveness ratio of the transition from the standard to the CHWs-led treatment amounted to 98.01 USD per additional SAM case recovered.ConclusionsIn the district of Mayahi in Niger, the CHWs-led SAM treatment was found to be cost-effective when compared to the standard protocol and provided additional advantages such as the reduction of costs for households.Trial registration: ISRCTN with ID 31143316. https://doi.org/10.1186/ISRCTN31143316

An ecological analysis of socio-economic determinants associated with paediatric vaccination coverage in the Campania Region: A population-based study, years 2003–2017

IntroductionVaccines are the most cost-effective and straightforward intervention against severe infectious diseases. However, in Europe and in Italy, paediatric vaccination coverage for certain vaccines remains suboptimal, with considerable regional differences in Italy. Vaccine coverage varies significantly due to socio-economic and organisational factors. Aim of this study was to assess the influence of the Deprivation Index, the density of General Practitioners and General Paediatricians per inhabitants on the coverage of both mandatory and non-mandatory paediatric vaccinations across local health authorities and health districts in the Campania Region for birth cohorts from 2001 to 2015. Materials and methodsPopulation-based, ecological time series analysis focusing on the Campania Region, most populous region in the south of Italy. Vaccination coverage data were extracted from the regional immunization database, whilst information on the Deprivation Index and number of primary care doctors and primary care paediatricians per local health district were extracted from public health records. Univariate descriptive statistics were employed to describe study characteristics, as appropriate, whilst and mixed-effect linear regression models were employed to assess the associations between variables of interest and vaccination coverage. ResultsOverall vaccination coverage has generally increased, except for the MMR vaccine, which showed coverage fluctuations. An increase in the Deprivation Index, indicative of less favourable socio-economic conditions, was associated with decreased vaccination coverage in the 24-month age group for some mandatory vaccines (DTaP: Coef −0.97, 95% CI −1.77 | −0.17; Poliomyelitis: Coef −0.98, 95% CI −1.78 | −0.17; Hepatitis B: Coef −0.90, 95% CI −1.71 | −0.10). Moreover, areas with a greater density of General Paediatricians per inhabitants saw increased coverage for Haemophilus influenzae type b in the 6-year age group (Coef 9.78, 95% CI 1.00 | 18.56). ConclusionsIt is necessary to target public health policies to address vaccination inequalities. These efforts should include expanding vaccination campaigns, enhancing catch-up programs, and increase resource allocation in primary care settings to facilitate the role of General Practitioners and Paediatricians in fostering awareness and adherence.

A study protocol for live and deceased donor uterus transplantation as a treatment for women with uterine factor infertility.

Uterus transplantation (UTx) is an emerging treatment option for women with uterine factor infertility (UFI) or the absence of a functional uterus. This is the study protocol for the first human UTx clinical trial in Australia. This protocol outlines the approved training program used to plan, diagnose, screen, and treat patients who may be eligible for UTx using living and deceased donors. This multi-site clinical research study includes three tertiary hospital sites within New South Wales (NSW), Australia - Prince of Wales, Royal Hospital for Women and Westmead Hospitals. Our UTx protocol is based on that used by our collaborative partner, the inaugural UTx team in Gothenburg, Sweden. The Swedish UTx team provides ongoing preceptorship for the Australian UTx team. Ethics approval for six UTx procedures using living or deceased donors (Western Sydney Local Health District Human Research Ethics Committee: 2019/ETH138038) was granted in 2020. Results from surgeries and live births will be published. Data will be prospectively entered into the registry of the International Society of Uterus Transplantation (ISUTx), a sub-section of The Transplantation Society (TTS). ACTRN12622000917730. A multidisciplinary research team has been formed between three tertiary hospitals in Sydney - The Royal Hospital for Women, Prince of Wales and Westmead Hospitals; and with the Swedish UTx, University of Gothenburg. The Swedish team pioneered animal and human UTx studies since 1998, including publishing the first live birth after UTx. (1) This Australian trial commenced in January 2023. Uterus transplantation gives women with UFI the opportunity to be gestational and genetic mothers. It is a complex procedure for both the donor and recipient, with medical and surgical risks. An extensive multidisciplinary approach is required to optimise patient safety and graft outcomes. This protocol outlines our Australian UTx team strategy for screening, recruitment, surgical approach, and clinical management of UTx recipients and donors.

Intense malarial transmission during the dry season in irrigated rice-growing areas: a case study in Sakassou, Côte d'Ivoire.

The health district of Sakassou is one of the 83 health districts in Côte d'Ivoire, located in a zone with very high malarial transmission rates, with an incidence rate of ≥40% Therefore, to guide vector control methods more effectively, it was crucial to have a good understanding of the vectors in the area. This study aimed to determine the level of malarial transmission during the dry season in Sakassou, Côte d'Ivoire. Female Anopheles mosquitoes were sampled using human landing catches (HLCs) and pyrethrum spraying catches (PSCs). The larvae were collected using the 'dipping' method. A total of 10,875 adult female mosquitoes of Anopheles gambiae were collected. The PCR analysis revealed that all individuals were Anopheles coluzzii. The geographical distribution of potential breeding sites of Anopheles showed the presence of An. coluzzii in all the wetlands of the city of Sakassou. During the dry season, the human-biting rate of An. coluzzii was 139.1 bites/person/night. An exophagic trend was displayed by an adult female of An. coluzzii. The entomological inoculation rate during the dry season was 1.49 infectious bites/person/night. This study demonstrated that An. coluzzii was the main vector of malarial transmission in Sakassou, and the intensity of transmission remains high throughout the dry season.