Facility Attendance Research Articles

Impact of a Medical Fitness Model on Incident Major Adverse Cardiovascular Events: A Prospective Cohort Study of 11 000 Members.

Cardiovascular disease remains the leading cause of disease burden and death in the world. The medical fitness model may be an alternative public health strategy to address cardiovascular risk factors with medical integrated programming. We performed a retrospective cohort study between January 1, 2005, and December 31, 2015. Adults (aged ≥18 years) who did not have a prior major adverse cardiovascular event were included. Controls were assigned a pseudo-index date at random on the basis of the frequency distribution of start dates in the medical fitness facility group. Multivariate Cox proportional hazards regression models were adjusted for age, sex, socioeconomic status, comorbidities, and year of index date. We stratified the medical fitness facility group into low-frequency attenders (≤1 weekly visit) and regular-frequency attenders (>1 weekly visit). Our primary outcome was a hospitalization for nonfatal myocardial infarction and stroke, heart failure, or cardiovascular death. We included 11 319 medical fitness facility members and 507 400 controls in our study. Compared with controls, members had a lower hazard risk of a major adverse cardiovascular event-plus (hazard ratio [HR], 0.88 [95% CI, 0.81-0.96]). Higher weekly attendance was associated with a lower hazard risk of a major adverse cardiovascular event-plus compared with controls, but the effect was not significant for lower weekly attendance (low-frequency attenders: HR, 0.94 [95% CI, 0.85-1.04]; regular-frequency attenders: HR, 0.77 [95% CI, 0.67-0.89]). Medical fitness facility membership and attendance at least once per week may lower the risk of a major adverse cardiovascular event-plus. The medical fitness model should be considered as a public health intervention, especially for individuals at risk for cardiovascular disease.

Peritoneal Dialysis in High-Risk Occupations.

Renal Replacement Therapy (RRT), involving two modalities of dialysis, namely haemodialysis (HD) and/or peritoneal dialysis (PD) remain the mainstay of therapy for patients with End Stage Renal Disease (ESRD) worldwide. The goals of renal replacement therapy are multi-pronged. They are not only limited to ensuring patient survival, but also improving patient overall well-being and quality of life. The relationship between employment and quality of life are often closely linked. Peritoneal dialysis provides patients with greater flexibility, independence and control over their treatment. This is particularly advantageous to the working ESKD patients. On the other hand, HD sessions can often interfere with work schedules due to HD facility attendance and the duration of each session. This case report highlights PD and its impact on improved quality of life by specifically supporting the case patient ‘s ability to maintain employment as a commercial truck driver. In addition, it edifies both ESRD patients and clinicians, particularly in developing countries, on the advantages of PD. These advantages extend beyond the physiological preservation of residual renal function and patient survival, but also embody the improvement of the overall well-being and quality of patients’ lives by broadening the employment horizon of patients in even high-risk occupations such as commercial truck driving.

Testing an insurance-based monetary incentive program for exercise: RCT design and rationale

Participation in regular physical activity (PA) has numerous health benefits; however, as few as 10% of U.S. adults meet guidelines when device-based assessments of PA are used. The present paper presents the design and rationale for an RCT examining the efficacy of an exercise incentive program currently offered by at least three major US insurance companies, in which participants must attend a YMCA fitness facility at least 50 times within 6 months to receive an incentive. In a factorial design, incentive amount ($200, $100, $0) is crossed with a comparison of the standard gain-framed incentive program and a loss-framed incentive condition in which participants are told their membership fee is being held and will be returned or forfeited depending on their fitness facility attendance. Participants (N = 330) are randomized to gain-framed $100 incentive (n = 55), gain-framed $200 incentive (n = 55), loss-framed $100 incentive (n = 55), loss-framed $200 incentive (n = 55), or control (n = 110). Each participant is enrolled in the same condition for two consecutive 6-month periods for a total of 12 months per participant. The primary outcome is number of visits to the fitness facility over each 6-month period, verified by objective swipe-card data. Secondary outcomes include total moderate-to-vigorous PA (MVPA) over 7-day periods assessed at 3-month intervals through accelerometers (Actigraph wGT3x-BT) and self-report. Habit formation and anticipated regret are putative mediators and household income is a putative moderator of the incentive-based programs. A payer-perspective, within-trial cost-utility analysis will quantify the incremental costs per (a) quality-adjusted life year gained, (b) YMCA attendance, and (c) change in MVPA.

Impacts of unconditional cash transfers on health care utilisation in informal sector households in Togo.

Most Togolese population earns their income from informal sector, and they are very often exposed to health outcomes. Cash transfers impact healthcare utilization by improving household's social capital, socio-economic status, lifestyle choice, and physical health. The aim of this paper was to analyse the impact of unconditional cash transfers on health care utilisation in informal sector households. We used the propensity-score method to compare health care utilisation by households that received cash transfers from nonbeneficiary households and simulated a potential confounder to assess the robustness of the impacts of the estimated treatment (i.e., cash transfer). Data were obtained from a national survey that covered 1405 households. The results show that women benefited the most from cash transfers (73.1%). Our estimates indicate that health care utilisation increased by 28.3% among workers in the informal sectors who benefited from unconditional cash transfers compared to nonbeneficiaries. The greatest impact was found on agriculture households with an increase by 31.3% in the health care utilisation. In general, cash transfer beneficiaries are more likely to use public health centres; there was an increase in public health facility attendance of 21.3%. Cash transfers are a valuable social protection instrument that improve health care utilisation of populations in the informal sector. Policymakers could use cash transfer as the infusion of income and/or assets that may impact health outcomes. Cash transfers are an opportunity to alleviate barriers of access to health care by older people. Future research must examine impact of cash transfer on health of vulnerable groups such as older people, children, and people with disabilities.

Factors associated with men’s health facility attendance as clients and caregivers in Malawi: a community-representative survey

IntroductionMen have higher rates of morbidity and mortality across nearly all top ten causes of mortality worldwide. Much of this disparity is attributed to men’s lower utilization of routine health services; however, little is known about men’s general healthcare utilization in sub-Saharan Africa.MethodsWe analyze the responses of 1,116 men in a community-representative survey of men drawn from a multi-staged sample of residents of 36 villages in Malawi to identify factors associated with men’s facility attendance in the last 12 months, either for men’s own health (client visit) or to support the health care of someone else (caregiver visit). We conducted single-variable tests of association and multivariable logistic regression with random effects to account for clustering at the village level.ResultsMedian age of participants was 34, 74% were married, and 82% attended a health facility in the last year (63% as client, 47% as caregiver). Neither gender norm beliefs nor socioeconomic factors were independently associated with attending a client visit. Only problems with quality of health services (adjusted odds ratio [aOR] 0.294, 95% confidence interval [CI] 0.10—0.823) and good health (aOR 0.668, 95% CI 0.462–0.967) were independently associated with client visit attendance. Stronger beliefs in gender norms were associated with caregiver visits (beliefs about acceptability of violence [aOR = 0.661, 95% CI 0.488–0.896], male sexual dominance [aOR = 0.703, 95% CI 0.505–0.978], and traditional women’s roles [aOR = 0.718, 95% CI 0.533–0.966]). Older age (aOR 0.542, 95% CI 0.401–0.731) and being married (aOR 2.380, 95% CI 1.196–4.737) were also independently associated with caregiver visits.ConclusionQuality of services offered at local health facilities and men’s health status were the only variables associated with client facility visits among men, while harmful gender norms, not being married, and being younger were negatively associated with caregiver visits.

Keratoconus management at public sector facilities in KwaZulu-Natal, South Africa: Practitioner perspectives

Background: Keratoconus (KC) is a non-inflammatory, self-limiting corneal ectasia that causes reduced visual acuity and if left undiagnosed and/or untreated may lead to visual impairment. Optometrists remain the first point of contact for affected patients, making appropriate timeous care essential.Aim: To investigate keratoconus management in the public sector in KwaZulu-Natal, South Africa.Setting: Public sector eye care facilities in KwaZulu-Natal, South Africa.Methods: In a quantitative, cross-sectional study, a questionnaire was distributed to optometrists employed by the Department of Health in KwaZulu-Natal (DoH-KZN). Data on practitioner demographic profile and clinical competence, facility attendance statistics, resources available and KC clinical protocols were collected.Results: The response rate was 36 (71%). The optometrists’ mean age was 30.19 ± 4.53 years, and 80% of them had work experience of less than 10 years. The majority of the health facilities (63.9%) reported a monthly attendance of 51–300 patients, and, of these, 72% of the respondents reported seeing only between 1 and 10 keratoconic patients. A lack of equipment and/or fitting of contact lenses being disallowed by the DoH-KZN were cited by the majority (61%) as the reason for routinely referring KC patients to optometrists in private practice.Conclusion: This study highlights a deficiency in the minimum standard of optometric care for KC in the public sector in KZN, primarily because of a lack of equipment and resources. It is recommended that the management of KC at all levels of the public health system be reviewed to improve the quality of service for keratoconic patients.

Lessons Learned from Programmatic Gains in HIV Service Delivery During the COVID-19 Pandemic - 41 PEPFAR-Supported Countries, 2020.

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supports country programs in identifying persons living with HIV infection (PLHIV), providing life-saving treatment, and reducing the spread of HIV in countries around the world (1,2). CDC used Monitoring, Evaluation, and Reporting (MER) data* to assess the extent to which COVID-19 mitigation strategies affected HIV service delivery across the HIV care continuum† globally during the first year of the COVID-19 pandemic. Indicators included the number of reported HIV-positive test results, the number of PLHIV who were receiving antiretroviral therapy (ART), and the rates of HIV viral load suppression. Percent change in performance was assessed between countries during the first 3 months of 2020, before COVID-19 mitigation efforts began (January-March 2020), and the last 3 months of the calendar year (October-December 2020). Data were reviewed for all 41 countries to assess total and country-level percent change for each indicator. Then, qualitative data were reviewed among countries in the upper quartile to assess specific strategies that contributed to programmatic gains. Overall, positive percent change was observed in PEPFAR-supported countries in HIV treatment (5%) and viral load suppression (2%) during 2020. Countries reporting the highest gains across the HIV care continuum during 2020 attributed successes to reducing or streamlining facility attendance through strategies such as enhancing index testing (offering of testing to the biologic children and partners of PLHIV)§ and community- and home-based testing; treatment delivery approaches; and improvements in data use through monitoring activities, systems, and data quality checks. Countries that reported program improvements during the first year of the COVID-19 pandemic offer important information about how lifesaving HIV treatment might be provided during a global public health crisis.

Promoting male participation in maternal healthcare in the Jaman North District in Ghana: Strategies and implementation challenges.

Promoting male participation in maternal healthcare is essential for improved maternal health outcomes. This study explored existing strategies to promote male participation in maternal healthcare and assessed their implementation challenges within healthcare facilities in the Jaman North District in Ghana. A qualitative approach was implemented in April 2020. Interviews were administered to a stratified purposive sample of 18 respondents comprising six midwives and 12 male partners of postnatal mothers. All interviews were audio-recorded, transcribed, and manually analysed using thematic analysis. The findings revealed early service, male partner invitation, male partner incentivisation, public sensitization, and male informed education, as strategies to promote male participation in the district. The implementation of these strategies has been constrained by socio-cultural and health system factors, namely, perception of pregnancy as non-illness, perceived experiences gained by women during previous births, cultural stereotypes, unconducive environment of healthcare facilities, inappropriate timing of facility attendance and unexpected costs associated with male participation. Promoting male participation, therefore, requires dedicated policy attention to the existing socio-cultural and health system constraints. The Ghana Health Service and other stakeholders should consider both community-level and targeted sensitization on the benefits of male participation in maternal healthcare and a general improvement in maternal healthcare infrastructure.

Non-communicable disease care and management in two sites of the Cape Town Metro during the first wave of COVID-19: A rapid appraisal.

BackgroundNon-communicable diseases (NCDs), including type-2 diabetes and hypertension, have been associated with increased morbidity and mortality rates because of coronavirus disease 2019 (COVID-19). Maintaining quality care for these conditions is important but data on the impact of COVID-19 on NCD care in South Africa are sparse.AimThis study aimed to assess the impact of COVID-19 on facility and community-based NCD care and management during the first COVID-19 wave.SettingTwo public health sector primary care sites in the Cape Town Metro, including a Community Orientated Primary Care (COPC) learning site.MethodsA rapid appraisal with convergent mixed-methods design, including semi-structured interviews with facility and community health workers (CHWs) (n = 20) and patients living with NCDs (n = 8), was used. Interviews were conducted in English and Afrikaans by qualified interviewers. Transcripts were analysed by thematic content analysis. Quantitative data of health facility attendance, chronic dispensing unit (CDU) prescriptions and routine diabetes control were sourced from the Provincial Health Data Centre and analysed descriptively.ResultsQualitative analysis revealed three themes: disruption (cancellation of services, fear of infection, stress and anxiety), service reorganisation (communication, home delivery of medication, CHW scope of work, risk stratification and change management) and outcomes (workload and morale, stigma, appreciation and impact on NCD control). There was a drop in primary care attendance and an increase in CDU prescriptions and uncontrolled diabetes.ConclusionThis study described the service disruption together with rapid reorganisation and change management at primary care level during the first COVID-19 wave. The changes were strengthened by the COPC foundation in one of the study sites. The impact of COVID-19 on primary-level NCD care and management requires more investigation.

The MOVE Frankston study: 24-Month follow-up of a randomized controlled trial of incentives and support to increase leisure center usage and physical activity

Recreational physical activity (PA) facilities have the potential to deliver health benefits for surrounding communities, however little is known about the impact of marketing strategies to encourage their use. This study aimed to assess the effectiveness of two low intensity interventions aimed at promoting usage of a new multipurpose recreation facility. A community-based randomized controlled trial with a 24-month follow up period was conducted with 1320 inactive adult residents of the City of Frankston, Victoria, Australia. Participants were randomized to a control, intervention 1 (information and attendance incentive) or intervention 2 (information, attendance incentives, personalized support) group. Primary outcomes were recreation facility attendance, purchase of facility membership and PA participation. Eight hundred and fifty-four (65%) participants completed 24-months follow up. Provision of incentives with personalized support was associated with greater attendance at the facility, as well as higher rates of membership. Those receiving incentives without additional support reported increases in stage of readiness to attend the facility. The interventions did not contribute to higher levels of PA, however those who became regular users of the facility were more likely to improve PA and meet the target of ≥150 min per week. Increased frequency and duration of promotion led to more regular attendance at the recreation facility, while those who attended regularly showed significant increases in PA. Incorporating recreation facilities within broader PA strategies, by engaging community members in a way that promotes more regular use of recreation facilities, will contribute to improvements in PA at a population level.

Influence of Conditional Cash Transfers on the Uptake of Maternal and Child Health Services in Nigeria: Insights From a Mixed-Methods Study.

Background: Increasing access to maternal and child health (MCH) services is crucial to achieving universal health coverage (UHC) among pregnant women and children under-five (CU5). The Nigerian government between 2012 and 2015 implemented an innovative MCH programme to reduce maternal and CU5 mortality by reducing financial barriers of access to essential health services. The study explores how the implementation of a financial incentive through conditional cash transfer (CCT) influenced the uptake of MCH services in the programme.Methods: The study used a descriptive exploratory approach in Anambra state, southeast Nigeria. Data was collected through qualitative [in-depth interviews (IDIs), focus group discussions (FGDs)] and quantitative (service utilization data pre- and post-programme) methods. Twenty-six IDIs were conducted with respondents who were purposively selected to include frontline health workers (n = 13), National and State policymakers and programme managers (n = 13). A total of sixteen FGDs were conducted with service users and their family members, village health workers, and ward development committee members from four rural communities. We drew majorly upon Skinner's reinforcement theory which focuses on human behavior in our interpretation of the influence of CCT in the uptake of MCH services. Manual content analysis was used in data analysis to pull together core themes running through the entire data set.Results: The CCTs contributed to increasing facility attendance and utilization of MCH services by reducing the financial barrier to accessing healthcare among pregnant women. However, there were unintended consequences of CCT which included a reduction in birth spacing intervals, and a reduction of trust in the health system when the CCT was suddenly withdrawn by the government.Conclusion: CCT improved the utilization of MCH, but the sudden withdrawal of the CCT led to the opposite effect because people were discouraged due to lack of trust in government to keep using the MCH services. Understanding the intended and unintended outcomes of CCT will help to build sustainable structures in policy designs to mitigate sudden programme withdrawal and its subsequent effects on target beneficiaries and the health system at large.

COVID-19 and physical activity

Physical Activity (PA) is bodily movement that involves energy output from the muscles and is associated with numerous health benefits. However, with the emergence of the COVID-19 pandemic on March 11, 2020, stay-at-home orders and public health measures led to a decreased trend in PA levels throughout the Canadian population. As restrictions began to ease in British Columbia (BC), gym and recreation facilities re-opened on May 19, 2020, under new public health safety protocols. This study explored whether gym and/or recreational facility attendance among regular users was impacted by public health safety or financial factors during COVID-19.

Incidence and predictors of 30-day hospital readmissions for liver cirrhosis: insights from the United States National Readmissions Database.

BackgroundCirrhosis is associated with substantial inpatient morbidity and mortality. This study aimed to determine the trends in 30-day hospital readmission rates among patients with cirrhosis and identify factors associated with these readmissions.MethodsWe conducted a retrospective analysis of data retrieved from the Nationwide Readmissions Database to determine trends in 30-day readmission for patients discharged with a diagnosis of cirrhosis in 2010 through 2014. Multivariate logistic regression analysis was used to identify predictors of readmission.ResultsAmong 303,346 patients identified from the database, the 30-day readmission rate for patients with a discharge diagnosis of cirrhosis was 31.4% (n=95,298). The trends in the readmission rates remained steady during the study period. On multivariate analysis, female sex, age 45 years or older, esophagogastroduodenoscopy (EGD) during admission, and disposition to a short-term care facility or skilled nursing facility protected against readmissions. In contrast, coverage by Medicaid insurance, admission during a weekend, nonalcoholic cause of cirrhosis, and history of hepatic encephalopathy and ascites were associated with readmission.ConclusionsWe found an exceptionally high 30-day readmission rate in patients with cirrhosis, although it remained stable during the study period. This study identified some modifiable factors such as disposition to a short-term care facility or skilled nursing facility and patients’ attendance of alcohol rehabilitation facilities that could decrease the likelihood of readmission and could inform local and national healthcare policymakers.

A systematic review and meta-analysis of the effectiveness of maternity waiting homes in low- and middle-income countries.

Maternity waiting homes (MWHs) in low- and middle-income countries (LMICs) provide women with accommodation close to a health facility to enable timely access to skilled care at birth. We examined whether MWH use and availability compared with non-use/unavailability were associated with facility birth, birth with a skilled health professional, attendance at postnatal visit(s) and/or improved maternal and newborn health, in LMICs. We included (non-)randomized controlled, interrupted time series, controlled before-after, cohort and case-control studies published since 1990. Thirteen databases were searched with no language restrictions. Included studies (1991-2020) were assessed as either moderate (n = 9) or weak (n = 10) on individual quality using the Effective Public Health Practice Project tool. Quality was most frequently compromised by selection bias, confounding and blinding. Only moderate quality studies were analyzed; no studies examining maternal morbidity/mortality met this criterion. MWH users had less relative risk (RR) of perinatal mortality [RR 0.65, 95% confidence intervals (CIs): 0.48, 0.87] (3 studies) and low birthweight (RR 0.34, 95% CI: 0.20, 0.59) (2 studies) compared with non-users. There were no significant differences between MWH use and non-use for stillbirth (RR 0.75, 95% CI: 0.47, 1.18) (3 studies) or neonatal mortality (RR 0.51, 95% CI: 0.25, 1.02) (2 studies). Single study results demonstrated higher adjusted odds ratios (aOR) for facility birth (aOR 5.8, 95% CI: 2.6, 13.0) and attendance at all recommended postnatal visits within 6 weeks of birth (aOR 1.99, 95% CI: 1.30, 3.07) for MWH users vs. non-users. The presence vs. absence of an MWH was associated with a 19% increase in facility birth (aOR 1.19, 95% CI: 1.10, 1.29). The presence vs. absence of a hospital-affiliated MWH predicted a 47% lower perinatal mortality rate (P < 0.01), but at a healthcare centre-level a 13 higher perinatal mortality rate (P < 0.01). Currently, there remains a lack of robust evidence supporting MWH effectiveness. We outline a six-point strategy for strengthening the evidence base.

Determinants of Attendance at the University Hospital Center-National Odontostomatology Center of Bamako CHU-CNOS

Introduction: According to the World Health Organization (WHO), the determinants of health facility attendance are "personal, social, economic and environmental factors that determine the state of health of individuals or populations". The objective of this study was to study the determinants of attendance at CHU-CNOS. Methodology: The study took place within the CHU-CNOS. This was an analytical cross-sectional study that took place over a period of 6 months (July to December 2020). Patients who received treatment at CHU-CNOS constituted the study population. All patients who received treatment at the CHU-CNOS and who agreed to participate in the study were included in this study.The sample size was n = 420 patients. The questionnaire survey and the questionnaire were respectively the technique and the data collection tool. The questionnaire was administered face to face to patients to collect data. Data entry and analysis were performed on EPI INFO 2000 version 7 and SPSS software version IBM SPSS Statistics 2, respectively. Results: More than half of those surveyed was 52.1% female. The sex ration was 0.92. Bride and groom represented 66% of the study population. Of the people surveyed, 35.7% were not in school. Civil servants made up 21.9% of respondents. The majority of respondents (90.2%) found that the costs of care at the CHU-CNOS were affordable. The average cost of care was 3,965 FCFA with a standard deviation of 1,245 FCFA (3,965 ± 1245 FCFA). The 30.4% of those surveyed said that the costs of prescribed drugs were high. The average cost of prescribed drugs was 6,635 ± 1,400 FCFA. The satisfaction rate of the people surveyed was 80.7%.. Among the unsatisfied patients surveyed, 63% had the waiting time in front of the office as a reason for dissatisfaction and 18.5% felt that the reception was poor.There was a statistically significant relationship to satisfaction with the following variables: level of listening to the patient by the practitioner (p &lt;0.001)

Factors Associated with Men's Health Facility Attendance as Clients and Caregivers in Malawi: A Community-Representative Survey

Factors Associated with Men's Health Facility Attendance as Clients and Caregivers in Malawi: A Community-Representative Survey

Effects of SARS-CoV-2 (COVID-19) Pandemic on Primary Health Care Service Delivery and Data Management in Nigeria, July 2020

Primary health care, the foundation of healthcare systems around the world, recognized for its ability to deliver efficient, equitable, high-quality, patient-centered care. As with the rest of the world, Nigeria is currently dealing with COVID-19 pandemic. On February 27, 2020, the first case of COVID-19 in Nigeria was reported. As of July 31 2020, there were over Forty Thousand cases and 900 deaths. We assessed the effects of SARS-CoV-2 on primary health care service delivery and data management in Nigeria A desk review (secondary data analysis) of health data submitted monthly (January 2020 – May 2020 reporting period) on National Health Management Information System hosted on the national instance of the District Health Information System was conducted. Other procedures include: Selection of primary healthcare performance indicators, download of data from District Health Information System, data cleaning and analysis There was no significant impact on the completeness of the report for the month of March, April and May 2020 which dropped from 83.2% in February, 2020 to 82.7%, 82.7% and 82.4% in March, April and May, 2020 respectively. Amidst the increasing number of COVID-19 cases in the FCT despite the total lockdown proclaimed by the government, other PHC indicators had also been on the decline. Since the first confirmed COVID-19 case in Lagos, PHC indicators had been on the decline. In Ogun state, Total facility attendance declined significantly in the month of March and April when the lockdown was implemented. Although fixed sessions for routine immunization increased, antenatal attendance declined and Penta dropout rate increased over the period of the lockdown. Access to healthcare is a fundamental human right, but the strain that the COVID 19 pandemic has placed on Nigerian citizens especially in areas where restrictive measures were met has in turn, affected many people’s access to healthcare.Funding Statement: The author(s) received no specific funding for this work.Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: Not required.

Addressing challenges in routine health data reporting in Burkina Faso through Bayesian spatiotemporal prediction of weekly clinical malaria incidence

Sub-Saharan African (SSA) countries’ health systems are often vulnerable to unplanned situations that can hinder their effectiveness in terms of data completeness and disease control. For instance, in Burkina Faso following a workers' strike, comprehensive data on several diseases were unavailable for a long period in 2019. Weather, seasonal-malaria-chemoprevention (SMC), free healthcare, and other contextual data, which are purported to influence malarial disease, provide opportunities to fit models to describe the clinical malaria data and predict the disease spread. Bayesian spatiotemporal modeling was applied to weekly malaria surveillance data from Burkina Faso (2011–2018) while considering the effects of weather, health programs and contextual factors. Then, a prediction was used to deal with weekly missing data for the entire year of 2019, and SMC and free healthcare effects were quantified. Our proposed model accurately predicted weekly clinical malaria incidence (correlation coefficient, r = 0.90). The distribution of clinical malaria incidence was heterogeneous across the country. Overall, national predicted clinical malaria incidence in 2019 (605 per 1000 [95% CrI: 360–990]) increased by 24.7% compared with the year 2015. SMC and the interaction between free healthcare and health facility attendance were associated with a reduction in clinical malaria incidence. Our modeling approach could be a useful tool for strengthening health systems’ resilience by addressing data completeness and could support SSA countries in developing appropriate targets and indicators to facilitate the subnational control effort.

A PRESCRIPTION FOR WELLNESS: EXERCISE REFERRALS FOR PATIENTS AT A FEDERALLY QUALIFIED HEALTH CENTER

Physical activity improves quality of life and prevents or delays chronic disease, but most adults in the United States are inactive. Consultation and planning with a health care provider, specifically with an exercise “prescription,” may increase physical activity, but utilization patterns and success of such programs are not well understood. This study assessed the initial 6 months of an exercise prescription program at a large, federally-qualified health center during 2018 whereby adult patients were referred via prescription to personalized health coaching by a fitness advisor. A census of all adults (n=512) who received an exercise prescription was combined with attendance data from the on-site exercise facility to classify patients as never attended, 1 to 3 visits, and ≥4 visits. Ordinal logistic regression was used to examine patient characteristics from the electronic health record that influenced exercise facility attendance. Only 30.2% of adults (mean age 44.7 years (SD 14.4)) completed ≥1 visit and 21.7% completed ≥4 visits. We identified no significant utilization differences by sex, race/ethnicity, body mass index, diabetes, hypertension, or coronary artery disease, but adults aged ≥60 years had almost twice the odds of ≥4 visits (OR=1.97; 95% CI: 1.18, 3.33; p=0.01) compared to younger patients. Many adult patients did not participate in the exercise prescription program, but older adults were more likely to participate. Exercise prescription programs with personalized health coaching may be useful for older adult patients receiving care at a federally-qualified health center. Future work will examine if or how exercise prescriptions impact chronic disease self-management.

Providing mothers with mobile phone message reminders increases childhood immunization and vitamin A supplementation coverage in Côte d'Ivoire: A randomized controlled trial.

We conducted a randomized controlled trial to assess the effect of providing mothers with mobile voice or text (SMS) reminder messages on health facility attendance at five infant immunization and vitamin A supplementation (VAS) visits. The study was conducted at 29 health facilities in Korhogo district. Mothers were randomized to receive a voice or text reminder message two days prior to each scheduled visit and two additional reminders for missed doses (n=798; intervention group), or no phone reminder messages (n=798; control group). Infants in the intervention group were 2.85 (95% CI: 1.85-4.37), 2.80 (95% CI: 1.88-4.17), 2.68 (95% CI: 1.84-3.91), and 4.52 (95% CI: 2.84-7.20) times more likely to receive pentavalent 1-3 and MMR/yellow fever doses, respectively, and 5.67 (95% CI: 3.48-9.23) times more likely to receive VAS, as compared to the control group. In the reminder group, 58.3% of infants completed all five visits, compared to 35.7% in the control group (P<0.001). Providing mothers mobile phone message reminders is a potentially effective strategy for improving immunization and VAS coverage in Cote d’Ivoire.