Facilities In Study Area Research Articles

The Impact of COVID-19 on Supplies of Routine Childhood Immunization in Oromia Regional State, Ethiopia: A Mixed Method Study.

Globally, national immunization programs are at risk of disruption due to severe health system constraints caused by the ongoing Corona Virus Disease 2019 (COVID-19) pandemic. To assess the impact of COVID-19 on the availability of supplies of routine childhood immunization in the Oromia Regional State in Ethiopia. A health facility-based mixed-methods of study design was conducted. Both quantitative and qualitative data were collected using pre-tested questionnaires and key informant interview question guides, respectively. Descriptive statistics such as frequencies, means, and standard deviations were performed. Binary logistic regression analysis was employed to assess the associations between the COVID-19 pandemic and the availability of vaccine-related supplies at health facilities in study area. The qualitative data were analyzed using a thematic content analysis approach. Of the total 448 study participants, 214 (47.8%) reported that COVID-19 has disrupted childhood vaccines availability. A significant proportion of participants agreed with the disruption of BCG (62.1%), OPV (48%), IPV (40.4%), and PENTA (36.9%) vaccine availabilities. These findings were also supported with key informant interviews. Fear of not maintaining physical distance (71.4%) followed by government lockdown (68.1%) and inadequate supply by local providers/suppliers (62.4%) were the most frequently reported likely causes for the observed disruptions. A large proportion of participants (87.7% and 81.7%) reported disruptions in the supply of face masks and hand gloves, respectively. As to the binary logistic regression analysis, the study participants from hospitals were 1.72 (1.01, 2.68; 95% CI) times more likely to report the impacts of COVID-19. Corona Virus Disease -19 significantly disrupted the availability of supplies of childhood immunization in the Oromia region. The most disrupted vaccines and related supplies were BCG, OPV, IPV, PENTA, facemasks, and hand gloves. An effective vaccine supply management is crucial to prevent disruptions during pandemics such as COVID-19.

Rural-urban differences in utilization of antenatal and delivery services in Ebonyi State, Nigeria.

The high maternal death burden in developing countries when compared to the developed could be attributed to differences in use of antenatal and skilled delivery care. To assess the differences in utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria. A cross-sectional comparative study design was used. Two stage (cluster) sampling technique was used to select 660 women in 4 of 13 local government areas in the state. The respondents were women who were permanent residents of communities and have delivered in last one year. Outcome measure was good utilization of antenatal and delivery services and was assessed by proportion of respondents who obtained antenatal and delivery from a skilled provider and also made at least four antenatal visits. The mean age of respondents was urban, 29.6 ± 6.2 and rural, 28.6 ± 5.1 years. Majority in urban, 51.8% utilized tertiary health facility for antenatal care while in rural, 77.9% used primary health centers (P < 0.001). Comparable proportions in urban, (77.3%) and rural, (79.1%) had good use of antenatal and delivery services (P = 0.572). Predictors of good use of antenatal and delivery services in urban included having one child (AOR = 4.8; 95%C1: 1.4--17.0), having attained tertiary education, (AOR = 2.6; 95%C1: 1.2--5.5), being in low socioeconomic class, (AOR = 0.4; 95%C1: 0.2--0.7), and having good knowledge of danger signs, (AOR = 2.6; 95%C1: 1.3--5.4). In rural, predictors included having one child, (AOR = 2.8; 95%C1:1.1--7.1), being unmarried, (AOR = 0.3; 95%C1: 0.1--0.9), and having good knowledge of danger signs (AOR = 3.7; 95%C1: 1.8--7.5). Utilization of antenatal and delivery services in health facilities in study area was high but there is room for improvement. There is need to plan specific interventions aimed at improving utilization of maternal health services by some groups like urban poor and unmarried mothers, especially teenagers. Emphasis should also be placed on improving community understanding of danger signs of pregnancy.

Impact of family DOTS on tuberculosis treatment outcomes and associated factors in tribal and hard to reach areas in the state of Chhattisgarh: an implementation research

Background: Tuberculosis (TB) remains a worldwide healthcare problem and it is one of the major public health concerns in India including Chhattisgarh state. National tuberculosis elimination program (NTEP) has adopted direct observed treatment (DOTS) strategy for elimination of TB. Due to inaccessibility and difficult to reach areas in the tribal areas, monitoring of treatment adherence and treatment completion remains a challenge leading to poor treatment outcomes among TB cases. This implementation research was aimed to assess the impact of family DOTS on the TB treatment outcomes in a tribal district of Chhattisgarh.Methods: A prospective cohort study of all new smear positive sputum, new smear negative sputum and extra-pulmonary TB patients who were newly diagnosed and registered for treatment under the revised national tuberculosis control programme (RNTCP) in hard to reach district was implemented between November 2016 to January 2018. They were followed till the completion of the treatment.Results: Total 305 tuberculosis new patients (218 intervention and 87 in comparison blocks) were registered for treatment at health facilities in study area. The treatment success rate in the comparison group was better (72.41%) compared to the intervention group (68.35%). Similar results have been observed in terms of non-adherence to treatment and death rate. Sputum conversion rate was observed to have 94% in intervention group in comparison to 95% comparison group.Conclusions: Family DOTS may not be effective unless there is involvement from the RNTCP by regular monitoring and follow up.

Prescribing patterns and associated factors of antibiotic prescription in primary health care facilities of Kumbo East and Kumbo West Health Districts, North West Cameroon.

BackgroundInappropriate use of antibiotics is a global public health challenge and has been associated with antibiotic resistance. WHO reports show that efforts to promote rational antibiotic use in developing countries are poor. With the growing number of infections with antibiotic resistant bacteria, rational drug use becomes imperative and studies that promote rational drug use are highly necessary. Considering this, we investigated prescribing patterns and predictors of antibiotic prescription in primary health care facilities in Kumbo East (KE) and Kumbo West (KW) health districts in North West Cameroon, to contribute data which could influence policy on antibiotic use.Methods and findingsA cross sectional retrospective study was conducted from April 2014 to April 2015 in 26 randomly selected primary care facilities. Questionnaires were administered to 59 antibiotic prescribers to determine factors that predict antibiotic prescribing. Data on antibiotic prescription were collected by review of consultation registers. Prescription rates and demographics, prescriber and institution factors were analyzed using ANOVA. The best predictor of prescription was determined using multiple linear regression analysis.ResultsA total of 30,096 prescriptions were reviewed. Overall antibiotic prescription rate was 36.71%, with a mean of 1.14 antibiotics prescribed per patient. Amoxicillin was the most prescribed (29.9%). The most prevalent indications for prescribing were respiratory tract infections (21.27%). All antibiotics prescribed were broad-spectrum. Antibiotics were prescribed for patients with malaria and also in situations where diagnosis was uncertain. Prescribing by generic name was 98.36% while 99.87% was from Essential Drug List. Use of laboratory results, patient turnout and Performance Based Financing (PBF) were significantly associated with antibiotic prescribing rates (p < 0.05). PBF moderated prescribing.ConclusionThere was misuse of antibiotics in primary care facilities in study area. We recommend all primary care health facilities in study area to be included in the PBF scheme and that prescribing should only be done by physicians as the have adequate training.

English

The provision of healthcare generates waste which can be detrimental to health and the environment. Management of healthcare waste is still a challenge in developing countries as practices, capacities and policies on waste disposal are grossly inadequate and require intensification. With the growing trend of biomedical services in Kumbo Cameroon, the medical waste management practices in this area was investigated to generate data that could guide policy in planning for an effective and sustainable waste management program. A qualitative cross sectional study was conducted in 30 of the 52 health facilities in study area. Participating facilities were selected by convenience sampling and personnel by random sampling. Data was collected using questionnaires, interviews and direct field observations and results analyzed using SPSS V 17.0. P-values &lt;0.05 were considered significant. Participants aware of the existence of a national policy guide on waste management were mostly administrators (66.7%). Only 2 (6.6%) health facilities had a copy of this document. None of the participating facilities kept records of their medical waste management practices. All participants were aware of the health risk of healthcare waste. Use of PPE varied among participants and was highest among employed waste handlers (EWH) (100%) and laboratory technicians (100%) while the lowest (69%) was among pharmacy attendants. Gloves were the most commonly used PPE. Most of the EWH (55.6%) used examination gloves which was inappropriate. Not all participants segregated or disinfected waste. Waste bins were not colour-coded and all facilities had appropriate safety boxes for sharps. In 86.7% of health facilities, waste disposal was by burning in pits located within 400 m away from the facility. These pits were not protected from scavengers. Only 4 facilities had incinerators and all did not meet the required standards, as none was equipped with a scrubber. Even after segregation at the point of generation, wastes were mixed at the point of final disposal. Waste management practices in study site did not meet standard practices. There is an urgent need for proper medical waste management in Kumbo East and Kumbo West to minimise threats to human health and the environment. Regular supervision and enforcement of policy on medical waste management is paramount. Key words: Medical waste, medical waste management, disposal, Kumbo

Environmental and Urban Land Use Analysis by GIS in AL-Shaab of Baghdad as a Case Study

AL-Shaab municipality faces many problems in the distribution of services)health centers, police stations, kindergartens and local markets( since these services are sometime concentrated in some of its regions and nonexistent in others. Moreover, distribution systems of these services do not adhere to planning criteria that are made consistent with population concentration and population growth, urban expansion and other resident’s needs. The subject of this study is environmental and urban land use analysis for AL-Shaab municipality in Baghdad city. The main purpose is knowing the strong and poor regions of distribution facilities in study area depending on a planning standard and trying to find out a planning solution for poor regions to comply the municipality with a planning standard. The researchers of this work selected AL-Shaab municipality for this work, being one of the important parts in Baghdad city, because its location, its high density of population, large area of the city, faces large problems in its urban planning and residential areas should depend on planning standard to show the weak regions in AL-Shaab municipality. In this work, kindergarten, primary schools, intermediate and secondary schools, green zones, religious facilities, local markets, police centers, health centers and garages were studied. The results showed that there are a weakness distribution of kindergartens, police centers, local markets and health centers in the municipality, especially in 348 and 346 neighborhoods and a some weakness in other of facilities distribution in the other neighborhoods centers.

Catching the missing million: experiences in enhancing TB & DR-TB detection by providing upfront Xpert MTB/RIF testing for people living with HIV in India.

BackgroundA critical challenge in providing TB care to People Living with HIV (PLHIV) is establishing an accurate bacteriological diagnosis. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents results from PLHIV taking part in a large demonstration study across India wherein upfront Xpert MTB/RIF testing was offered to all presumptive PTB cases in public health facilities.MethodThe study covered a population of 8.8 million across 18 sub-district level tuberculosis units (TU), with one Xpert MTB/RIF platform established at each TU. All HIV-infected patients suspected of TB (both TB and Drug Resistant TB (DR-TB)) accessing public health facilities in study area were prospectively enrolled and provided upfront Xpert MTB/RIF testing.Result2,787 HIV-infected presumptive pulmonary TB cases were enrolled and 867 (31.1%, 95% Confidence Interval (CI) 29.4‒32.8) HIV-infected TB cases were diagnosed under the study. Overall 27.6% (CI 25.9–29.3) of HIV-infected presumptive PTB cases were positive by Xpert MTB/RIF, compared with 12.9% (CI 11.6–14.1) who had positive sputum smears. Upfront Xpert MTB/RIF testing of presumptive PTB and DR-TB cases resulted in diagnosis of 73 (9.5%, CI 7.6‒11.8) and 16 (11.2%, CI 6.7‒17.1) rifampicin resistance cases, respectively. Positive predictive value (PPV) for rifampicin resistance detection was high 97.7% (CI 89.3‒99.8), with no significant difference with or without prior history of TB treatment.ConclusionThe study results strongly demonstrate limitations of using smear microscopy for TB diagnosis in PLHIV, leading to low TB and DR-TB detection which can potentially lead to either delayed or sub-optimal TB treatment. Our findings demonstrate the usefulness and feasibility of addressing this diagnostic gap with upfront of Xpert MTB/RIF testing, leading to overall strengthening of care and support package for PLHIV.

Utilization of Integrated Management of Childhood Illnesses for Child health in Western Kenya

Implementation of integrated management of childhood illness (IMCI) in comprehensive and holistic, forms bench mark for fifth birth day celebration for child health, free from Malaria, Pneumonia, Diarrhea, Measles and Malnutrition, which was to be achieved through quality Basic and Post-basic IMCI training, willingness of community uptake and perception, and modifying environmental factors to promote MDG 4, vision 2030 in Western Kenya. Cross-sectional design was explored to establish how above determinants influence IMCI. Mixed methods of data collection, procedure was adopted, in quantitative data, structured questionnaire was used, 235 respondents derived by Fishers formulae as sample size, while qualitative data, Focused Group Discussion (FGD) guides and Key informants interviews (KII) were used by forming groups of 8 to 12 discussants. Observations and transect mapping done in partnership with key stakeholders for quality checks from 4 facilities studied. Study population was well mothers attending / presenting their children below five years in level 1 and 2 facilities in study area, besides stakeholders attached to IMCI. Demographical data were also collected. Showed only 14% of under five child health care covers IMCI program contrary to WHO standard of above 68%, (95% CI 0.9 to 5.5%). Evidence seen from limited number of service providers trained in IMCI concepts, low Community uptake and perception and limited efforts to improve environmental factors for child survival at household level. Similar to results from studies identified noteworthy number of children still affected by Malaria, Pneumonia, Malnutrition, diarrhea and Measles.

Enhancing TB case detection: experience in offering upfront Xpert MTB/RIF testing to pediatric presumptive TB and DR TB cases for early rapid diagnosis of drug sensitive and drug resistant TB.

BackgroundDiagnosis of pulmonary tuberculosis (PTB) in children is challenging due to difficulties in obtaining good quality sputum specimens as well as the paucibacillary nature of disease. Globally a large proportion of pediatric tuberculosis (TB) cases are diagnosed based only on clinical findings. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents the results from pediatric groups taking part in a large demonstration study wherein Xpert MTB/RIF testing replaced smear microscopy for all presumptive PTB cases in public health facilities across India.MethodsThe study covered a population of 8.8 million across 18 programmatic sub-district level tuberculosis units (TU), with one Xpert MTB/RIF platform established at each study TU. Pediatric presumptive PTB cases (both TB and Drug Resistant TB (DR-TB)) accessing any public health facilities in study area were prospectively enrolled and tested on Xpert MTB/RIF following a standardized diagnostic algorithm.Results4,600 pediatric presumptive pulmonary TB cases were enrolled. 590 (12.8%, CI 11.8–13.8) pediatric PTB were diagnosed. Overall 10.4% (CI 9.5–11.2) of presumptive PTB cases had positive results by Xpert MTB/RIF, compared with 4.8% (CI 4.2–5.4) who had smear-positive results. Upfront Xpert MTB/RIF testing of presumptive PTB and presumptive DR-TB cases resulted in diagnosis of 79 and 12 rifampicin resistance cases, respectively. Positive predictive value (PPV) for rifampicin resistance detection was high (98%, CI 90.1–99.9), with no statistically significant variation with respect to past history of treatment.ConclusionUpfront access to Xpert MTB/RIF testing in pediatric presumptive PTB cases was associated with a two-fold increase in bacteriologically-confirmed PTB, and increased detection of rifampicin-resistant TB cases under routine operational conditions across India. These results suggest that routine Xpert MTB/RIF testing is a promising solution to present-day challenges in the diagnosis of PTB in pediatric patients.