Fragile Health Research Articles

Antimicrobial resistance in Democratic Republic of Congo: the way forward

Antimicrobial resistance in Democratic Republic of Congo: the way forward

Fear of falls is associated with fear of COVID-19 in older adults

BACKGROUND: Individuals with a perception of their fragile health can potentiate the fear of COVID-19. AIM: We investigated the relationship between perceived functional capacity and fear of falls with fear of COVID-19 in older adults. METHOD: Thirty older adults (60-75 years) participated in this study. We applied two questionnaires to assess functional capacity: the Independence in Activities of Daily Living and the Instrumental Activities of Daily Living Scale. We also administered two questionnaires for fear of falling: the Activities-Specific Balance Confidence Scale and Falls Efficacy Scale International. Finally, we used the Fear of COVID-19 Scale. RESULTS: The results showed a significant correlation between fear of COVID-19 and the ABC Scale (r = -0.548, p = 0.002) and FES-I (r = 0.466; p = 0.009). Multiple linear regression analysis showed that the ABS Scale was the only predictor of fear of COVID-19 (p = 0.004). CONCLUSION: Fear of COVID-19 was related to a worsening perception of functional balance and fear of falls in older adults, suggesting a greater vulnerability for those more afraid of falls.

An Emerging Health Crisis in Turkey and Syria after the Earthquake Disaster on 6 February 2023: Risk Factors, Prevention and Management of Infectious Diseases

On 6 February 2023, Turkey and Syria were hit by two major earthquakes that caused extremely heavy structural damage to buildings and infrastructure in one of the most densely populated areas of Anatolia. The authors visited the devastated area shortly after the earthquakes in the frame of search and rescue and scientific missions in order to check whether the newly formed conditions have the potential to further affect public health. Based on the collected disaster-related field data, it is revealed that risk factors associated with and favoring emergence of infectious diseases are present in the affected residential areas from the first hours of the emergency state. The coexistence and synergy of many collapsed health facilities, cold winter conditions, destruction of lifeline infrastructures, overcrowding in emergency shelters, poor sanitation and adverse socio-economic conditions along with evolving crises and disasters (conflicts, pandemic and epidemics) may further aggravate the already fragile public health situation and cause considerable delays in the recovery process. Efficient disease surveillance at local and regional levels is a crucial requirement for early warning and protection against emerging infectious diseases in the earthquake-affected areas among other proposed measures for prevention and management of infectious diseases.

Analysis of human resources for health in Afghanistan.

Despite large-scale investment in health service delivery outsourcing, few studies have examined human resources for health (HRH) in Afghanistan. To review the HRH situation of outsourced healthcare services in Afghanistan and evaluate nongovernment organization (NGO) investments in the health workforce. Two questionnaires were used for data collection. One gathered information about the characteristics of HRH in 2020 and the other collected budgetary data for 2017-2020 to analyse budget allocation and expenditure by NGOs on the health workforce. A total of 25 262 (65% male, 35% female) individuals were employed by NGOs in 31 provinces of Afghanistan. There was a critical shortage of personnel and a prevalence of gender imbalance across all provinces. Healthcare workers were mostly aged 26 to 30 years. Services were mostly provided by local NGOs and their scopes were not limited to outsourced projects. More than 75% of the budget of NGOs was allocated to the health workforce in 2017-2020, and more than 70% of allocations was spent on staff salaries, followed by other health workforce expenditure. Less than 5% was spent on capacity building. There is a gross shortage and large gender imbalance in the Afghanistan health workforce. It is essential to maintain and increase current financial and technical investments to ensure sustainability and enhance the fragile health system in Afghanistan.

Burnout among healthcare workers during public health emergencies in sub-Saharan Africa: Contributing factors, effects, and prevention measures

Countries in sub-Saharan Africa (SSA) are expected to experience more public health emergencies (PHEs) in the near future. The fragile health systems emanating from poor health governance, inadequate health infrastructure, shortage of healthcare workers (HCWs), inadequate essential medicines and technology, and limited funding will make responses to these outbreaks slow and ineffective as seen with the COVID-19 pandemic. The workload for HCWs will grow due to these PHEs, which will increase the likelihood that they may experience burnout. This narrative review loosely followed the guidelines provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement. Google Scholar, PubMed, and ScienceDirect databases were used to retrieve relevant articles. Two reviewers assessed the titles and abstracts of all identified articles and extracted the data independently and compared their results thereafter. The causes of burnout among HCWs, its impact on patients, HCWs, and healthcare institutions, as well as preventive steps that should be taken to safeguard HCWs from burnout, are all covered in this article.

COVID-19 & Problematics of Global Health Security

COVID-19 illustrates our fragile and precarious global health security. Global health governance has failed miserably to ensure health security. This study examines the problematics of health security. The findings reveal that the problem lies in the conception of health security. A narrow understanding of the term "security" has been used to define and implement health security at the national and global levels, based on the Westphalian legacy of protecting countries against external public health threats through many emergency measures. Nationalistic and sovereign norms constantly stand in the way of collaboration among states. The problem is primarily interpretation, acceptability, and implementation of the concept. This study recommends that health security be redefined from a human security paradigm. As a second step, revamp the global health governance regime through de-politicization of WHO, constructing a pandemic treaty and making 'health security a priority.

The Pandemic Puzzle—Reviewing the Existing Pieces, Searching for the Missing Ones

The research carried out on socioeconomic implication models of (re)emerging infectious diseases triggering pandemics has shown us that these largely depended on infection transmission, conditioned by the type of pathogen and the human host. Also, these depended on certain external factors, such as the phenomenon of globalization, pollution, fragile health systems, modification of human behaviors, expansion of human habitat near the outbreaks, favorable vectors involved in the transmission and development of new pandemics and last but not least of wars or civil revolts. The present research attempts to provide some responses to the following questions: 1. What have been the most recent and important emerging infectious disease pandemics and what were the risk factors? 2. What was the socioeconomic impact generated by these pandemics and what important lessons did we learn/identify? 3. What measures and/or directions must be implemented/addressed to prevent/possibly stop a future wave of infections or a new pandemic? The answers to these questions are substantiated by different indicators (transmission potential and pathogen severity) through which we focused to offer some suggestions/directions regarding the way in which these pandemics could be anticipated or prevent, indicators that otherwise are already used by public authorities in the development and exploration of intervention strategies. However, through the elaboration and staged presentation of how these pandemics acted as well as the socioeconomic implications and human reactions, this research could be useful in leading to the development of new, effective ways to prevent the transmission of (re)emerging infectious diseases.

Potentials and challenges of using co-design in health services research in low- and middle-income countries

Co-design with people having poor access to health services and fragile health systems in low- and middle-income countries can be momentous in bringing service users and other stakeholders together to improve the delivery and utilisation of health services. There is ample of evidence from high-income countries regarding how co-design can translate available evidence into developing acceptable, feasible, and adaptable health solutions in different settings. However, there is limited literature on co-design in health research in the context of low- and middle-income countries. Therefore, it is crucial to understand how knowledge about collaborative working can be translated into policy and practice in the context of low- and middle-income countries. Thus, this paper discusses the concept of co-design, co-production, and co-creation in health and the potentiality and challenges of using co-design in health services research in low- and middle-income countries. Despite the challenges, the co-design research has considerable potential to encourage the meaningful engagement of service users and other stakeholders in developing, implementing, and evaluating real-world solutions in low- and middle-income countries. It is essential to balance power dynamics in a co-design process through mutual recognition and respect, participant diversity, and reciprocity and flexibility in sharing. The inclusive and collaborative approach to working is complex due to existing rigid hierarchical structures, socio-cultural beliefs, political interference and working practices. However, this could be minimised by developing transparent terms of reference that reflect the value and benefits of equal partnership in particular co-design work.

All-cause mortality of hospitalised patients with suspected COVID-19 in Sierra Leone: a prospective cohort study

ObjectivesTo study the mortality of patients with COVID-19 in Sierra Leone, to explore the factors associated with mortality during the COVID-19 pandemic and to highlight the complexities of treating patients...

Burnout due to COVID-19 pandemic in frontline healthcare workers from low- and middle-income countries: A systematic review

IntroductionThe coronavirus pandemic was declared one of the deadliest pandemics in the world’s history, surpassing even the 1918 flu pandemic in some countries. The speed with which the virus spread around the world did not leave the slightest chance to prepare even for protected health systems of developed countries, let alone countries with fragile health systems, experiencing a large number of problems at work even at regular times. Although burnout is included in the ICD-11 classification only as a syndrome caused by occupational stress and not a disease, unrecognized and unaddressed, it has the capacity to transform into a wide range of mental disorders, including depressive and anxiety disorders. This poses a threat to healthcare workers and patients, so it is very important to understand the scale of the problem and the factors that can play protective and triggering roles.ObjectivesOur objective was to evaluate point-prevalence of burnout syndrome among healthcare workers from LMIC during the COVID-19 pandemic.MethodsWe conducted a systematic search in Ovid MEDLINE, Embase and PsycInfo, as well as a manual search in PubMed, Google Scholar and Grey Literature to select studies describing burnout prevalence in healthcare workers from low-and middle-income countries during the pandemic. We used a wide range of subject headings as well as main keywords, such as “mental health”, “burnout”, “coronavirus”, “health personnel”, “depression”, “anxiety”, “developing countries” and their synonyms study design search had no limitations and included cohort, case-control, cross-sectional and randomized controlled studies. All identified studies were screened and a final sample of relevant studies was used for data extraction and quality appraisal.ResultsData was extracted from 15 studies and included 21,007 individuals from eight countries. The proportion of female healthcare workers in our sample was 69% and the overall mean age of participants was 34.3 (2.3). Burnout prevalence varied from 3.62% to 90.1%. Gender, age, workload-related factors and institutional support were mentioned among the most important aspects influencing the burnout level. Clinical heterogeneity was a major drawback of our study as cut-off points for overall burnout and burnout sub-scales were inconsistent even among studies using the same inventory.ConclusionsIt is of critical importance to adopt a wide range of burnout preventive measures for healthcare workers, in particular, easy access to mental health support services, proper organization of human force and more comprehensive educational training in emergency situations. Furthermore, it is suggested, that researchers use a more precise and evidence-based approach to the use of measurement tools in order to increase the reliability of their work and recommendations.Disclosure of InterestNone Declared

Mental Health and Psychosocial Support in Response to Onset of the COVID-19 Pandemic: Findings from Action Against Hunger’s Emotional and Stress Management Intervention in Ivory Coast, Liberia, and Sierra Leone

IntroductionIn 2020, as in the rest of the world, the COVID-19 pandemic spread in Africa and transformed people’s lives. Adding to the already existing burden of fragile health care systems, especially in low-resource settings, the pandemic response highlighted the need to address the health and well-being of populations in innovative ways. While research findings reported critical impacts on populations’ mental health, few studies assessed this progression within African countries. At the onset of the COVID-19 pandemic, Action Against Hunger (ACF), developed and delivered a brief Emotional and Stress Management Intervention (ESMI) to reduce symptoms of emotional distress and increase perceived social support through problem solving techniques and relaxation exercises among adults and youth living in vulnerable communities experiencing a relatively high prevalence of COVID-19 in urban and rural areas in Sierra Leone, Liberia and Ivory Coast.ObjectivesThe primary aim of this study is to evaluate whether individuals who received ESMI experienced changes in psychological distress and social support following the intervention and the association between change in psychological distress and change in social support for each country.MethodsThis study consisted of secondary analysis of data collected via routine monitoring of activities by ACF for their ESMI programs implemented in community-based centers and health facilities from May to December 2020. Service delivery mechanisms were adapted to each context and setting (i.e., face to face vs. remote, health facilities vs. home visits, etc.). The main outcomes were psychological distress and social support measured with culturally relevant visual analogue scales. All analyses were performed separately for each country.ResultsIn total, 1,412 adults and youth (11-17 years old) benefitted from the intervention across all countries and 1,350 were assessed at follow-up. As a result, changes for psychological support and social support with mean scores difference at baseline and follow up were significantly different in all countries. Correlations between changes in distress and changes in social support varied by country, and ranged from negative in Liberia, (r = -.88, p = 0.001), to positive in Ivory Coast (r = .55, p = 0.001), and null in Sierra Leone (r = -.07, p = 0.11). Across countries, the most commonly reported presenting problems were fear of infection, stigma, and socio-economic difficulties, with coping strategies differing by country.ConclusionsAt the onset of a pandemic crisis, low-intensity psychosocial support activities hold potential for reducing psychological distress and improving social support among adults and youth from vulnerable communities in the context of the COVID-19 pandemic.Disclosure of InterestNone Declared

COVID-19 and the Indian healthcare scenario

Background: The Indian economy and health system has been shaken to the core by the sudden strike of the COVID-19 pandemic. The already fragile and underequipped public health system reeled under the pressure of escalating cases of infection and demand for hospitalization of critical and emergency cases of COVID. Although the private healthcare sector worked in sync with the public counterpart and provided adequate support for case management, the former is not expected to play the primary role when it comes to a public health crisis like COVID-19. The study attempts to explore the pattern of utilization of the existing health system by Indian households in the event of general illness, which is expected to throw some light on the mechanism for devising an optimal public-private mix for management of COVID or similar public health threats in future. Methods: The study was exploratory and based on secondary data. It employs unit level data from NFHS-4 (2015-16) besides published reports and documents. Results: Health insurance coverage is low among households belonging to the lowest wealth quintile. Inequalities in access to quality health care coupled with spiraling health costs due to COVID and falling incomes continue to push such vulnerable households into poverty and debt. Conclusions: Public expenditure on health should be increased with a shift in focus from curative to preventive care.

Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer

BackgroundThe incidence of colorectal cancer increases with aging. Curative-intent surgery based on a minimally invasive concept is expected to bring survival benefits to elderly patients (aged over 80 years) with colorectal cancer who are frequently with fragile health status and advanced tumors. The study explored survival outcomes in this patient population who received robotic or laparoscopic surgery and aimed to identify an optimal surgical option for those patients.MethodsWe retrieved the clinical materials and follow-up data on elderly patients with colorectal carcinoma who received robotic or laparoscopic surgery in our institution. The pathological and surgical outcomes were compared to examine the efficacy and safety of the two approaches. The DFS (disease-free survival) and OS (overall survival) results at 3 years after surgery were assessed to explore the survival benefits.ResultsA total of 111 patients were screened for the study, including 55 in the robotic group and 56 in the laparoscopic group. The demographic details were generally similar between the two groups. No statistically significant difference in the number of removed lymph nodes was observed between the two approaches, with a median of 15 versus 14 (P = 0.053). The intraoperative blood loss was significantly reduced by robotic technique when compared to the laparoscopic approach, with a mean of 76.9 ml versus 161.6 ml (P = 0.025). There were no significant differences in operation time, conversion, postoperative complications and recovery, and long-term outcomes between the two groups.ConclusionRobotic surgery was prized for elderly patients with colorectal cancer who developed anemia and/or hematological conditions.

Value of Verbal Autopsy in a Fragile Setting: Reported versus Estimated Community Deaths Associated with COVID-19, Banadir, Somalia.

Accurate mortality data associated with infectious diseases such as coronavirus disease 2019 (COVID-19) are often unavailable in countries with fragile health systems such as Somalia. We compared officially reported COVID-19 deaths in Somalia with COVID-19 deaths estimated using verbal autopsy. We interviewed relatives of deceased persons to collect information on symptoms, cause, and place of death. We compared these data with officially reported data and estimated the positive and negative predictive values of verbal autopsy. We identified 530 deaths during March-October 2020. We classified 176 (33.2%) as probable COVID-19 deaths. Most deaths (78.5%; 416/530) occurred at home and 144 (34.6%) of these were attributed to COVID-19. The positive predictive value of verbal autopsy was lower for home deaths (22.3%; 95% CI: 15.7-30.1%) than for hospital deaths (32.3%; 95% CI: 16.7-51.4%). The negative predictive value was higher: 97.8% (95% CI: 95.0-99.3%) for home deaths and 98.4% (95% CI: 91.5-100%) for hospital deaths. Conclusions Verbal autopsy has acceptable predictive value to estimate COVID-19 deaths where disease prevalence is high and can provide data on the COVID-19 burden in countries with low testing and weak mortality surveillance where home deaths may be missed.

Task-shifting and family planning continuation: contraceptive trajectories of women who received their method at a community-based event in Kinshasa, DRC

While community-based interventions are a proven high-impact strategy to increase contraceptive uptake in low-income countries, their capacity to support women’s contraceptive choices (including continued use, switching and discontinuation) in the long run remains insufficiently discussed. This cohort study follows 883 women 3 and 6 months after they received a modern method during community campaigns organized in Kinshasa (D.R. Congo), to analyze their contraceptive trajectories and the factors associated with ever discontinuing contraceptive use in the first 6 months following a campaign. In the community-based distribution (CBD) model currently institutionalized in DRC, campaign clients are not provided with additional doses or support, besides baseline counseling, to (dis-)continue using the method they received, but must rely on Family Planning resources within the existing local health system. Almost a third (28.9%) of all women discontinued modern contraception during the study period, with much higher discontinuation rates for short-acting methods (38.7% for pills and up to 68.9% for DMPA-SC). Variables previously associated with high discontinuation (marital status, fertility intentions and side-effects) led to higher odds of “ever discontinuing”. However, these variables became non-significant when controlling for resupply issues. Women’s self-reported reasons for discontinuation confirmed the multivariate regression results. Detailed sub-analysis of resupply issues for pills, injectables and Cyclebeads pointed to the role of cost, unreliable campaign schedules and weak integration of community-based strategies into the formal health system. Extremely low rates of implants removal suggest similar access to FP services issues. The study highlights the need to identify CBD strategies best suited to support women’s choices and preferences towards successful contraceptive trajectories in fragile health systems.

The impact of energy shortages on health and healthcare in Europe.

The impact of energy shortages on health and healthcare in Europe.

E-government, political system and COVID-19 in Africa: lessons for future disruptive shocks

PurposeThis study aims to explore the role of mobile tracing applications as part of e-government services in combating the COVID-19 pandemic effects in Africa by analyzing the moderating role of sustainable development. This study also investigated the role of the political and economic systems in mitigating the negative consequences of COVID-19 and how e-government interacts in this relationship.Design/methodology/approachThis study included the COVID-19 performance index for 94 countries belonging to different regions, including 20 African countries. Multiple linear regression was used for data analysis via Stata software. The study was conducted from the start of the pandemic to March 13, 2021.FindingsThe results show that less economically and technologically developed countries with generally authoritarian political systems, including African countries, could limit the spread of the pandemic better than some democratic, economically and technologically developed countries in the first wave of the pandemic. The promotion of sustainable development goals moderates the relationship between mobile tracing applications as part of the e-government service and the fight against COVID-19.Originality/valueThis study provides insight into the role of mobile application technology as an e-governance service in mitigating the negative consequences of the COVID-19 pandemic in a context characterized by economic limitations, fragile public health infrastructure and relatively high political instability, especially in Africa. The findings shed light on some of the difficulties African countries may face in incorporating technology into their development projects.

Health and wellbeing of older people in LMICs: a call for research-informed decision making

An estimated 80% of the world's older people (defined as those aged ≥60 years) will live in low-income or middle-income countries (LMICs) by 2030.1 Ageing well requires addressing the complex financial, health, and social care needs of older people. But, despite economic growth and investment in health, LMICs continue to struggle with fragile and under-resourced health and social care systems to support older people.2 Such issues can be particularly problematic in rural areas, from which younger people often leave to find economic opportunities, leading to a loss of labour and depletion of carers for older people, and worsening unmet needs for social care.

COVID‐19 vaccine wastage: A challenge to achieving herd immunity in Nigeria

AbstractThe emergence of the COVID‐19 pandemic has overburdened many health‐care systems in the world, particularly in Nigeria and other African countries with fragile public health system. Since the emergence of the pandemic, Nigeria has been struggling to restore the impact on its health‐care system as the country keeps recording a growing number of cases and deaths. Vaccination has been the most efficient strategy towards curbing the COVID‐19 pandemic, particularly in countries like Nigeria where preventive measures were poorly strategised or implemented. The country was able to secure some doses of the COVID‐19 vaccine through donations, but concerns have been raised as up to 1 million doses of the vaccine were wasted due to delays in importations and poor cold chain management system. This wastage can pose a challenge to achieving COVID‐19 herd immunity in Nigeria. The causative factors of the vaccine wastage in Nigeria must therefore be tackled in order to effectively curb the COVID‐19 outbreak and consequently achieve herd immunity through massive vaccination. The government in collaboration with World Health Organisation and Africa Centre for Disease Control should facilitate and fast track the safe delivery of the vaccines to Nigeria. Misconceptions about COVID‐19 and its vaccine should be tackled to encourage the vaccine acceptance. The challenges faced by the vaccine supply chain system should be properly addressed by providing adequate funding and security, improved power supply, good vaccine infrastructure and improved vaccine data management in order to facilitate the safe and timely distribution of adequate vaccines across the country.

Beyond patient delay, navigating structural health system barriers to timely care and treatment in a high burden TB setting in Papua New Guinea

ABSTRACT Tuberculosis (TB) is a major public health issue in Papua New Guinea, with incidence rates particularly high in the South Fly District of Western Province. We present three case studies, along with additional vignettes, that were derived from interviews and focus groups carried out between July 2019 and July 2020 of people living in rural areas of the remote South Fly District depicting their challenges accessing timely TB diagnosis and care; most services within the district are only offered offshore on Daru Island. The findings detail that rather than ‘patient delay’ attributed to poor health seeking behaviours and inadequate knowledge of TB symptoms, many people were actively trying to navigate structural barriers hindering access to and utilisation of limited local TB services. The findings highlight a fragile and fragmented health system, a lack of attention given to primary health services, and undue financial burdens placed on people living in rural and remote areas associated with costly transportation to access functioning health services. We conclude that a person-centred and effective decentralised model of TB care as outlined in health policies is imperative for equitable access to essential health care services in Papua New Guinea.