Early Care Research Articles

Delays in seeking abortion and its determinants among reproductive-age women based on the Ethiopian Demographic and health survey

IntroductionDelaying in seeking abortion services causes adverse public health outcomes, which increases maternal mortality rates due to complications from abortion. However, evidence shows that there are limited factors associated with delayed abortion. Therefore, the study aims to determine the magnitude and identify factors associated with delayed seeking abortion among reproductive-aged women in Ethiopia. MethodsSecondary cross-sectional data analysis was conducted on the Ethiopian Demographical and Health Survey dataset. A total weighted sample of 2198 reproductive-aged women was considered in this study. All data processing and statistical analyses were performed using R-software version 4.2.3. Multilevel binary logistic regression analysis was used to identify a significant predictor for delays in seeking abortion. An adjusted odds ratio with a 95 % confidence interval was used to measure a statistical association. ResultThe prevalence of delays in seeking abortion among women in Ethiopia was 32 %. Educational status (AOR = 0.63; 95 % CI: 0.37–0.78), marital status (AOR = 2.12; 95 % CI: 1.38–3.74), wealth index (AOR = 0.54; 95 % CI: 0.41–0.75), frequency of listening a radio (AOR = 0.61; 95 % CI: 0.45–0.75), live births (AOR = 0.43; 95 % CI: 0.25–0.72), pregnancy wanted status (AOR = 0.59; 95 % CI: 0.4–0.79), contraceptive use (AOR = 0.46; 95 % CI: 0.34–0.69), and place of residence (AOR = 2.31; 95 % CI: 1.67–3.19) were statistically significantly variables associated with delays in seeking abortion. ConclusionsDelayed seeking abortion remains high in Ethiopia. The study is vital for policymakers, healthcare providers, and advocates to improve training on the importance of early abortion care, develop targeted interventions for better accessibility to abortion services, expand health education programs to raise awareness about reproductive rights and empower women with information for informed reproductive health decisions. Health education programs, specifically targeting uneducated women, poorer women, rural resident women, and women who do not use contraceptives, would decrease delays in accessing abortion services.

Beyond babysitting: an analysis of the quality of childcare service in Ethiopia

ABSTRACT Empirical evidence underscores the importance of investing in early childhood care to ensure its quality. This study examined the quality of child care in day-care centers in Bahir Dar and Gondar cities, Amhara region, Ethiopia, employing an embedded mixed-methods approach. Utilizing descriptive and inferential statistics, including t-tests, regression analysis, and thematic analysis, the research assessed both distal quality – encompassing environmental and staffing conditions – and proximal quality – focusing on caregiver–child interactions. The findings revealed significant deficiencies in distal quality, including inadequate space, activities, and staff qualifications. Proximal quality was also found to be lacking, with government centers exhibiting higher levels of harshness in caregiver interactions compared to private centers. Key factors influencing interaction quality were staff education, experience, and child-to-worker ratios. Despite existing regulatory standards, their enforcement was found to be inadequate. The study recommends that policymakers enhance and enforce regulations, improve staff training and invest in professional development. Further research should explore regulatory enforcement challenges and assess the long-term impacts of training improvements on care quality.

Who Cares? Women entrepreneurs and the transition to the Canada-wide Early Learning and Child Care Agreement in Nova Scotia

The Canada-wide Early Learning and Child Care Agreements signed in 2021/2022 represent an unprecedented investment into child care across Canada, supporting the expansion of care spaces, reductions in parent fees, and increased wages for care workers. In the province of Nova Scotia, however, the new funding model faced considerable pushback from women entrepreneurs in the care field, who felt overlooked and bullied by the provincial government amidst the policy rollout. This paper evaluates the experiences of child care owners in Nova Scotia during the transition to the new funding agreement through a series of interviews with entrepreneurs. The paper posits that the consultation and communications between the province and care owners reified gendered power relations, particularly through the devaluation and exploitation of women's care work. Interviewees report feeling treated as “glorified babysitters” and experiencing significant mental health strains as a result of the policy negotiation with the province.

Empowered, Strained, or Stable: Teachers’ Experiences of Occupational Well-Being During the Two-Year Pre-Primary Education Trial in Finland

ABSTRACT Research Findings: This study investigated early childhood education and care (ECEC) teachers’ experiences of occupational well-being during a two-year pre-primary education trial in Finland. Profile groups of the trial experimental group teachers (n = 376) were identified. We also examined whether the identified profiles differed with respect to different ECEC classroom and teacher professional characteristics. Through latent profile analysis, three profile groups of occupational well-being were identified among the ECEC teachers: empowered (n = 34), strained (n = 138), and stable teachers (n = 200). In the majority of the pre-primary groups of empowered teachers, children represented the same age group, whereas the age distribution varied more among the pre-primary groups of strained and stable teachers. Empowered teachers reported having more instructed activity sessions and distributing responsibility more among the personnel teams. Strained teachers reported having more individual responsibility for instructing group activities. Practice or Policy: Attention to ECEC teachers’ occupational well-being should be paid in dynamic and changing circumstances of their work careers, such as the Finnish two-year pre-primary education trial. Nationally unitary and appropriate classroom resources should be guaranteed to support ECEC teachers’ well-being both in trials and in their everyday work.

Implementing an early-life nutrition intervention through primary healthcare: staff perspectives

BackgroundNutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff’s experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions.MethodsThree group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC.ResultsThree main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN’s implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access.ConclusionThe findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization.Trial registrationThe main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967. (Registration date: 19-06-2022).

High prevalence of alcohol use disorder & psychiatric comorbidity among coal mine workers: Observations from a cross-sectional study in West Bengal.

Background & objectives Tobacco (30%), alcohol (21.4%) and cannabis (3%) are the three most commonly abused substances in India. Tobacco and alcohol abuse have higher prevalence rates among different occupational groups as compared to that in general population in the country. Both tobacco and alcohol lead to significant occupational harm in terms of absenteeism, injuries, sickness and lost productivity. This study estimated the patterns of substance use and associated common psychiatric comorbidity in a sample of coal mine workers. Methods Coal mine workers at the age of 18 yr or above engaged in mining activities (skilled/semi-skilled/unskilled) were recruited from the Raniganj - Asansol coal mining areas of Eastern Coalfields Limited (ECL). Participants were screened to identify patterns of substance use and other common mental health problems. All participants were administered ASSIST (The Alcohol, Smoking and Substance Involvement Screening Test); GENACIS (Gender, Alcohol and Culture: An International Study) modified questionnaire; and Hospital Anxiety and Depression Scale (HADS) for primary screening for anxiety and depression. Results Out of 202 participants 69 per cent (n=140) were found with either 'hazardous and harmful' (moderate risk); or 'dependent' (high risk) patterns of use of either tobacco or alcohol or cannabis or of more than one substance. Only 31 per cent (n=62) were 'low-risk' for all substances. Almost 65 per cent (n=132) and 49 per cent (n=99) participants out of the whole sample (n=202) belonged to 'hazardous and harmful' (moderate risk) and 'dependent' (high risk) pattern of tobacco and alcohol consumption, respectively. About 28.8 per cent (n=38) and 23.7 per cent (n=31) of all participants had anxiety and depression, respectively. Combined moderate to high use of both alcohol and tobacco use was significantly associated with the risk of having anxiety [adjusted odds ratio (AOR)=4.896, P<0.015] and depression (AOR=5.335, P<0.012). Interpretation & conclusions Alcohol and tobacco are major substance abuse problems among coal mine workers. This population requires early community and primary care based brief intervention as well as additional community-based pharmacotherapy for substance dependence problems as well as intervention for common mental health issues.

Management of Patients With Cardiac Arrest Requiring Interfacility Transport: A Scientific Statement From the American Heart Association.

People who experience out-of-hospital cardiac arrest often require care at a regional center for continued treatment after resuscitation, but many do not initially present to the hospital where they will be admitted. For patients who require interfacility transport after cardiac arrest, the decision to transfer between centers is complex and often based on individual clinical characteristics, resources at the presenting hospital, and available transport resources. Once the decision has been made to transfer a patient after cardiac arrest, there is little direct guidance on how best to provide interfacility transport. Accepting centers depend on transferring emergency departments and emergency medical services professionals to make important and nuanced decisions about postresuscitation care that may determine the efficacy of future treatments. The consequences of early care are greater when transport delays occur, which is common in rural areas or due to inclement weather. Challenges of providing interfacility transfer services for patients who have experienced cardiac arrest include varying expertise of clinicians, differing resources available to them, and nonstandardized communication between transferring and receiving centers. Although many aspects of care are insufficiently studied to determine implications for specific out-of-hospital treatment on outcomes, a general approach of maintaining otherwise recommended postresuscitation care during interfacility transfer is reasonable. This includes close attention to airway, vascular access, ventilator management, sedation, cardiopulmonary monitoring, antiarrhythmic treatments, blood pressure control, temperature control, and metabolic management. Patient stability for transfer, equity and inclusion, and communication also must be considered. Many of these aspects can be delivered by protocol-driven care.

Teacher-related factors associated with teacher–child interaction quality in preschool education

Quality teacher–child interaction is considered one of the primary mechanisms through which educational experience fosters the development of children’s competencies. Teachers’ self-efficacy and beliefs about developmentally appropriate practices influence the quality of classroom interaction. However, the findings are mixed, and more research must be done within the preschool teacher population. The present study investigated teacher-related factors influencing teacher–child interaction quality with preschool children. Two rating scales and one observation measure were used to survey and observe 55 preschool teachers in preschool centres of Arba Minch town, Ethiopia. Statistically significant positive correlations were found between teacher factors (i.e., teacher belief, self-efficacy, teaching experience) and teacher–child interaction quality (emotional support, classroom organization, and instructional support). Teacher belief significantly predicted teachers’ emotional support and classroom organization, while teaching experience significantly predicted instructional support. The findings of this study have implications for concerned bodies striving to achieve the 2030 sustainable development goals aimed at increasing the supply of qualified teachers to ensure all girls and boys have access to quality early childhood development and care so that they are ready for primary education, especially in the least developed countries.

Factors associated with cervical cancer screening among women of reproductive age in Ghana

BackgroundCervical cancer remains a leading cause of cancer-related deaths among women in Ghana and other Sub-Sahara African (SSA) countries. Despite the importance of early diagnosis for timely treatment and death prevention, cervical cancer screening among women in developing countries remain very low. Nonetheless, there is a paucity of research examining the factors associated with screening uptake among women of reproductive age in Ghana. Thus, this study fills the scholarly void and contributes to the existing literature by examining the determinants of cervical cancer screening in Ghana.MethodsUtilizing data from the 2022 Ghana Demographic and Health Survey (GDHS) (N = 15,014 women), and by employing logistic regression models for a cross-sectional analysis, this study evaluated the factors associated with cervical cancer screening in Ghana.ResultsWomen with tertiary educational attainment (OR = 4.140; 95%CI: 2.960 5.789; p < 0.001), from the richer (OR = 1.968; p < 0.001) and richest households (OR = 2.492; p < 0.001), the married/living with partner (OR = 1.773; 95%CI:1.372 2.290; p < 0.001), the widowed/divorced/separated (OR = 1.888; 95%CI:1.320 2.701; p < 0.001), owners of valid health insurance card (OR = 1.356; 95%CI:1.086 1.693; p < 0.01), visitation to health facility in the past 12 months (OR = 1.312; 95%CI: 1.082 1.590; p < 0.001), those who watched television at least once in a week (OR = 1.395; 95%CI: 1.055 1.846; p < 0.001), as well as those who listened to radio at least once in a week (OR = 1.509; 95%CI: 1.228 1.853; p < 0.001), were all significantly more associated with cervical cancer screening in the study context. Also, ethnicity, religion, and the region of residence significantly predicted cervical cancer screening in the study context.ConclusionCervical cancer screening in Ghana can be improved by addressing socioeconomic and geographical disparities in the country’s healthcare system. To ensure early detection, timely treatment or care and prevention of cervical cancer-related deaths in the country, there must be coordinated efforts by the government of Ghana to improve healthcare access and surveillance systems for cervical cancer cases, particularly, in geographically disadvantage areas.

Early Palliative Care Improves Patient and Caregiver Quality of Life.

Patients receiving early palliative care experience improved quality of life, may live longer, and may have earlier referrals to hospice. Caregivers with loved ones receiving early palliative care experience improved communic.

Scaling up healthy eating in early childhood education and care: evaluation of the Appetite to Play capacity-building intervention.

The purpose of this study was to examine the dissemination of the healthy eating component of Appetite to Play at scale using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The Appetite to Play capacity-building intervention is a set of evidence-informed implementation strategies aimed at enhancing the adoption of recommended practices for promoting healthy eating and active play in early years settings. The evaluation was pragmatic, employing both quantitative (surveys) and qualitative (interviews) data collection. The Appetite to Play intervention was delivered through in-person community-based workshops, virtual workshops, asynchronous e-learning and online resources. We received completed surveys from 1670 in-person workshop participants (96 % female), and twenty-three (all female) survey respondents also participated in a telephone interview. Approximately two-thirds of all participant groups were certified early childhood educators. Results indicated that Appetite to Play had high reach (25 867 individual website visits, 195 workshops delivered), effectiveness (significant increases in care provider's knowledge, confidence (P < 0·05) and high post-intervention intention to implement), adoption (11 % of educators in BC trained) and implementation (good alignment with implementation strategies and current practices), with a significant maintenance plan to support the intervention's future success. An evidence-based capacity-building intervention with an emphasis on training and provision of practical online resources can improve early years providers' knowledge, confidence and intention to implement recommended practices that promote healthy eating. Further research is needed to determine the impact on child-level outcomes and how parents can be supported in contributing to positive food environments.

유보통합을 위한 유치원⋅어린이집 교사 자격 통합 방안 연구: 싱가포르 사례를 중심으로

Objectives This study aims to explore strategies for the integration of kindergarten and childcare teacher qualifications proposed by the Yoon Suk-yeol government by examining the current qualification criteria for kindergarten and childcare teachers in South Korea and reviewing the standards for early childhood educator certification in Singapore. Methods Data for this study were obtained from the official websites of South Korea's Ministry of Education, Ministry of Health and Welfare, and Singapore's Early Childhood and Development Agency (ECDA), and the content was reviewed and feedback was provided by a researcher specializing in early childhood education and care policies and a professor of early childhood education. Results As results of the study, first, there were differences between Kindergarten teacher level 2 and Childcare teacher level 2 in Korea in terms of credits earned and practice period in acquiring certification. Second, Singapore has various types of qualifications, and accordingly, there were differences in the ages of infants and toddlers who could be in charge and the institutions where they could work. Conclusions This research, centered on the Singaporean case, offers a fresh perspective on the amalgamation of qualifications related to kindergarten and childcare center teachers in South Korea. Its significance lies in its pragmatic and well-reasoned contribution to the formulation of integration strategies.

STUDY OF SUPPRESSION OF HIV VIRAL LOAD AMONG PEOPLE RECEIVING ANTIRETROVIRAL THERAPY IN PALEMBANG CITY

Background: Suppression of viral load is a targeted strategy for the prevention of HIV transmission. Viral load (VL) testing can be done at all health centres in Palembang City with free services. Purpose: This study aims to evaluate VL suppression and factors associated with VL suppression. Methods: The study design of this research was a cross-sectional study with data analysis using the Chi-square and binomial logistic regression tests. The population in this study was all HIV patients who accessed health services for VL testing. Data sources were obtained from the HIV/AIDS Information System (SIHA) for the period 2023 - June 2024. Results: The majority of PLHIV cases were male (1072 people) (83%) and unmarried (802 people) (62.1%). The transmission group was male-sexual males, 54.88%, with an average age of 36.62 years. The results of multivariate analysis showed that there were three variables associated with viral load levels, namely age with a p-value &lt;0.03, AOR = 1.59 (95% CI: 1.04-2.43), ARV adherence with a p-value &lt; 0.00, AOR = 1.76 (95% CI: 1.18-2.61), and clinical stage with a p-value &lt; 0.04 AOR = 1.02 (95% CI: 1.02-2.07). Conclusion: Adherence to ART therapy, prevention of opportunistic infections, and early detection of clinical stage are predictors of successful viral load suppression. The role and responsibility of the community and the active participation of health workers in early detection, treatment and care are needed.

Juveniles of a biparental cichlid fish compensate lack of parental protection by improved shoaling performance

Parental brood care greatly affects offspring’s fitness, but the specific effects of care on the collective behaviour of independent offspring are less well understood. It has been suggested that the loss of care induces increased sibling cooperation to compensate parental contributions. However, the empirical evidence is ambiguous. Here, we examined how the loss of early parental care affects the collective behaviour, i.e. shoaling performance of independent juveniles in a genetically heterogeneous lab-population of the biparental cichlid fish Pelvicachromis pulcher. Applying a split-clutch design, we reared in- and outbred offspring with or without parents. In the experiment, we examined shoal density (inter-individual distance) in relation to body size of the shoaling fish. Dense shoaling reduces predation risk and small fish may benefit strongest because they are particularly vulnerable to predation by gape-limited predators. Juveniles reared without parents formed denser shoals and they adjusted shoaling behaviour depending on own body size compared to juveniles reared with parents; especially smaller fish formed dense shoals. Inbreeding did not significantly affect shoaling performance. This indicates that juveniles compensate missing parental care by adjusting their shoaling behaviour depending on own vulnerability. Our study contributes to the understanding of the co-evolution of brood care and sibling cooperation.

Improving global and math-specific teacher–toddler interactions through an intervention for early childcare teachers: The role of activity settings

This study is part of the ‘EarlyMath’ project, in which two teacher trainings, identical in terms of method and scope, but different in terms of focus and content, were developed to enhance global and math-specific teacher–toddler interactions in early childhood education and care (ECEC). We aimed to answer two questions: (1) Do teacher trainings improve global and math-specific interactions and (2) does this improvement differ in distinct activity settings (free play vs. structured activity)? Teachers from 95 toddler classrooms were randomly assigned to three groups: math-focused intervention (MIG), general intervention (GIG), and control (CG). The training was structured through nine modules emphasizing practical aspects, which included video analyses and role-plays. The results showed that the teacher training improved math-specific interactions in the MIG during free play, but not during structured activities. Global interaction quality did not significantly improve in either intervention group compared to the control group. This study highlights the potential of teacher training to enhance interactions in ECEC by emphasizing the specific role of activity settings.

Navigating chronic uncertainty: a theory synthesis for nursing communication in life-limiting illness

BackgroundDespite the proven benefits of early palliative care, patient communication regarding these services remains elusive. Therefore, this paper aims to (a) provide a focused literature review on nurse palliative care communication addressing chronic uncertainty in life-limiting illness (LLI), (b) define the Reconceptualization of Uncertainty in illness Theory and Problematic Integration Theory within a nursing Unitary Caring Science philosophical worldview and, (c) synthesize these theories and literature review into a unique theoretical framework for early palliative care communication in acute care nursing.MethodTurner’s theory synthesis methodology was combined with a PRISMA-style literature review. The literature search was conducted in July 2023 and updated in May 2024 using EBSCOhost, Pubmed, and PsychINFO databases. A second literature search was undertaken to identify applicable uncertainty theories in chronic or LLIs.ResultsThis theory synthesis highlights the interconnectedness of all facets of uncertainty for those living with severe LLI (personal factors, types of uncertainty, and the nursing communicatory process) and conceptualizes uncertainty communication as a series of events happening simultaneously, not simply a cause-and-effect process.DiscussionThe framework resulting from this synthesis encourages nurses’ holistic understanding of the complex nature of uncertainty in LLI, highlights the integral communicatory role nurses have in their patients’ health and wellness, and promotes further nursing-specific communication research. Future research on enabling nurse-initiated early palliative care communication and narrative communication techniques will support patients’ values and dignity throughout more than a single hospital stay but their entire disease trajectory.

Educators’ responses to children’s grieving: exploring emotional configurations in flexibly scheduled early childhood education and care

ABSTRACT The study explores emotional configurations that emerge from educators’ responses to children’s grieving in flexibly scheduled early childhood education and care (ECEC) in Finland. We analysed observational data of children who were under three years old and their educators, focusing on the interrelationships between the children’s grief, the educators’ sense-making, and their practices. The exploration yielded three emotional configurations that address different ways in which educators make sense of and orient themselves to children’s grief. While the educators usually recognized grief and responded with compassion, some situations prompted sensemaking that questioned grief and the primacy of comforting over other concurrent activities. Based on the findings, it is important to further discuss children’s grief in ECEC and develop practices that would serve grieving young children even better.

Understanding how community-dwelling persons with early dementia perceive health and community services: Informing the dementia strategy of Newfoundland and Labrador, Canada.

With an increased aging population, the number of individuals with dementia is expected to rise. The onset of dementia marks the start of negotiating access to a wide range of health and social services to find practical and emotional supports to deal with the management of changes and subsequent challenges that individual with dementia face. The toll of dementia goes beyond the health care system, affecting families and caregivers' quality of life. This places more pressure on family caregivers and health care institutions to provide services for affected individuals. It is important to understand the service needs of this population to enable them to live at home longer, contribute to society and maintain a positive quality of life. To increase understanding of how persons living at home with early dementia and their caregivers/significant others currently perceive and interact with health and community-based services and service providers. A qualitative descriptive approach was used to explore the experiences of individuals with early dementia and care providers with health and community-based services using semi-structured interviews and content analysis. Participants included 16 individuals 50years and older with mild/early dementia living at home, 22 informal caregivers of individuals with mild/early dementia, and 5 key community informants (community health nurses and social workers). Four thematic categories of barriers and two thematic categories of facilitators for access to and uptake of supportive services were identified. Five strategies to inform the development of an action plan to enhance access to, and uptake of, supportive services were determined. Early recognition of dementia through education and publicity enhanced public awareness, attention, and social inclusion with dementia-friendly neighborhoods and facilities need to be considered to achieve effective dementia-related services. Inclusion and recognition of the wishes of persons with dementia is key.

Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer

Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care. To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non-small cell lung cancer (NSCLC). Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers. Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits. Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48. By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P < .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions. The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery. ClinicalTrials.gov Identifier: NCT03375489.

Analysis of care-seeking pathways and factors influencing early and appropriate care-seeking for malaria patients in the Republic of Guinea: a cross-sectional study

BackgroundMalaria is a major public health issue in Guinea and care-seeking behaviour is dominated by self-medication and delayed access to appropriate care. However early and appropriate care-seeking are essential to control and reduce complicate forms and mortality, particularly for the most vulnerable. This study was conducted to analyse the diagnostic pathway, and the factors associated with early and appropriate care-seeking for malaria patients in the Republic of Guinea.MethodsA cross-sectional study was carried out between December 2022 to March 2023 in nine health districts within health facilities and at community level. The study population was confirmed malaria patients with RDT or microscopy. Kroeger’s conceptual framework was used to design the questionnaire. Conventional recourse was defined as using a healthcare facility or community services, early and appropriate care-seeking was defined as within 24 h of symptom onset in a conventional recourse, and care pathway as the sequence of recourses followed by each patient. Sankey alluvial plots were used to represent patients' diagnostic pathways, and logistic regression to identify factors associated with early and appropriate care-seeking.ResultsA total of 3300 malaria patients were studied, of which 1632 (49.45%) were female and 1132 (34.30%) were under 5 years of age, with a median age of 23 months. At the time of the survey, 1337 (40.52%), 1423 (43.12%), and 437 (13.85%) of patients were respectively in their first, second and third recourse. A total of 2002 (60.67%) patients had sought care from a conventional recourse as a first line. Of all patients, 1757 (53.25%) had sought care within 24 h, while 28.55% had sought early and appropriate care. In the initial stages of treatment, self-medication was the most common approach, used by 1214 (37.30%). Patients from the health districts of Boffa (Lower Guinea, coastal region) OR = 0.48 95% CI 0.33–0.70, Dabola (Upper Guinea, savanna region) OR = 0.43 95% CI 0.30–0.63 and Labe (Middle Guinea, mountain region) OR = 0.63 CI 95% 0.43–0.91 (p < 0.05) were more likely to delay appropriate care-seeking, when compared to those in Dixinn, (Conakry). However, the under 5-year-old group OR = 1.55 95% CI 1.30–1.85 (p < 0.001) and the availability of a stable monthly household income OR = 4.98 95% CI 3.03, 8.27 (p < 0.001) were positively associated with early and appropriate care seeking.ConclusionA low rate of early and appropriate care-seeking was observed. Patients sought care through multiple means, often resulting in a delay in adequate management. The results show the need to deploy strategies adapted to the needs of communities.