Health Facilities For Treatment Research Articles

Does health insurance status influence healthcare-seeking behavior in rural communities? evidence from rural Ghana

IntroductionNational health insurance programs are considered important mechanisms for ensuring equity in access to and utilization of healthcare services by removing financial barriers associated with seeking treatment in healthcare facilities. Although studies on health insurance schemes in many low-and-middle-income countries (LMICs) have demonstrated a significant relationship between health insurance status and healthcare-seeking behavior, data on the influence of this health financing policy on the decision to seek formal healthcare among rural inhabitants remains limited. Underpinned by the Andersen-Newman behavioral model of healthcare use, this study examined the influence of health insurance status on healthcare-seeking behavior among rural dwellers in Ghana. MethodsA community-based cross-sectional study was conducted among 460 rural residents in Ghana from 8th September to 5th December 2022. Chi-square tests were used to study the significance level and association between healthcare-seeking behavior and selected independent variables. A multiple logistic regression model was fitted to test the association between health insurance status and healthcare-seeking behavior, introducing other selected explanatory variables as controls. ResultsThe mean age of the respondents was 29.6 ± 6.8 years. A little above half (53.1 %) disclosed having insurance, whereas 46.1 % stated they were without coverage. Regarding healthcare-seeking behavior, the most commonly chosen treatment source was traditional healers (37.2 %), followed by the public healthcare system (28.3 %) and self-treatment (18.2 %). The private healthcare system was the least preferred, with only 16.3 % opting for it. While the bivariate analysis demonstrated a significant relationship between health insurance status and healthcare-seeking behavior (p-0.001), the logistic regression model results showed that health insurance status was not an independent predictor of healthcare-seeking behavior (p = 0.069). ConclusionIt could, therefore, not be concluded that the respondents with health insurance coverage were more likely than the uninsured to use formal healthcare providers as their most frequent source of treatment during illness. This study provides vital information for policymakers aiming at increasing access to and utilization of facility-based formal care in rural and remote settings.

Comparison of factors associated with seasonal influenza and COVID-19 booster vaccination coverage among healthcare personnel working at acute care hospitals during 2021–2022 influenza season, National Healthcare Safety Network, United States

The simultaneous circulation of seasonal influenza virus and SARS-CoV-2 variants will likely pose unique challenges to public health during the future influenza seasons. Persons who are undergoing treatment in healthcare facilities may be particularly at risk. It is important for healthcare personnel to protect themselves and patients by receiving vaccines. The purpose of this study is to assess coverage of the seasonal influenza vaccine and COVID-19 monovalent booster among healthcare personnel working at acute care hospitals in the United States during the 2021–22 influenza season and to examine the demographic and facility characteristics associated with coverage. A total of 3260 acute care hospitals with over 7 million healthcare personnel reported vaccination data to National Healthcare Safety Network (NHSN) during the 2021–22 influenza season. Two separate negative binomial mixed models were developed to explore the factors associated with seasonal influenza coverage and COVID-19 monovalent booster coverage. At the end of the 2021–2022 influenza season, the overall pooled mean seasonal influenza coverage was 80.3%, and the pooled mean COVID-19 booster coverage was 39.5%. Several demographic and facility-level factors, such as employee type, facility ownership, and geographic region, were significantly associated with vaccination against influenza and COVID-19 among healthcare personnel working in acute care hospitals. Our findings highlight the need to increase the uptake of vaccination among healthcare personnel, particularly non-employees, those working in for-profit and non-medical school-affiliated facilities, and those residing in the South.

Risk Prediction of Emergency Department Visits in Patients With Lung Cancer Using Machine Learning: Retrospective Observational Study.

Patients with lung cancer are among the most frequent visitors to emergency departments due to cancer-related problems, and the prognosis for those who seek emergency care is dismal. Given that patients with lung cancer frequently visit health care facilities for treatment or follow-up, the ability to predict emergency department visits based on clinical information gleaned from their routine visits would enhance hospital resource utilization and patient outcomes. This study proposed a machine learning-based prediction model to identify risk factors for emergency department visits by patients with lung cancer. This was a retrospective observational study of patients with lung cancer diagnosed at Seoul National University Bundang Hospital, a tertiary general hospital in South Korea, between January 2010 and December 2017. The primary outcome was an emergency department visit within 30 days of an outpatient visit. This study developed a machine learning-based prediction model using a common data model. In addition, the importance of features that influenced the decision-making of the model output was analyzed to identify significant clinical factors. The model with the best performance demonstrated an area under the receiver operating characteristic curve of 0.73 in its ability to predict the attendance of patients with lung cancer in emergency departments. The frequency of recent visits to the emergency department and several laboratory test results that are typically collected during cancer treatment follow-up visits were revealed as influencing factors for the model output. This study developed a machine learning-based risk prediction model using a common data model and identified influencing factors for emergency department visits by patients with lung cancer. The predictive model contributes to the efficiency of resource utilization and health care service quality by facilitating the identification and early intervention of high-risk patients. This study demonstrated the possibility of collaborative research among different institutions using the common data model for precision medicine in lung cancer.

Prevalence, contributing factors, and economic implications of strokes among older adults: a study of North-East India

Stroke is a significant cause of mortality and disability in India, with its economic impact on the rise. This study aims to investigate the prevalence and factors associated with stroke among the elderly population in seven north-eastern states of India and its economic consequences. Data from the initial phase of the Longitudinal Ageing Study in India (2017–2018) were utilized, and bivariate and multivariate analyses were done. Stroke prevalence (1.53%) was notable among both genders, with approximately 1% in females and 2.3% in males. Individuals with low physical activity, higher socio-economic status, and unemployment faced a higher risk of stroke. Females exhibited a 60% lower likelihood [AOR 0.40; (CI 0.250–0.627)] of stroke compared to males and hypertension was a significant risk factor. Stroke patients incur up to INR 50,000 of financial burden, with a considerable proportion facing disability in comprehension and speech. The economic burden of stroke-related hospitalization was significantly high, emphasizing the need for government-funded health insurance to cover stroke-related medications and reducing out-of-pocket expenses for patients seeking treatment in healthcare facilities. The study highlights the urgency for better schemes to address the growing threat of strokes in the north-eastern parts of India for comprehensively tackling this public health challenge.

A Cross-sectional Study on Factors Influencing Health Services Utilisation for under-Five Morbidities in South Bengaluru

Background: World Health Organization (WHO) estimates that seeking prompt and appropriate healthcare could reduce child deaths by nearly 30%. In this background, the present study was conducted to 1. assess the health services utilization for diarrhoea and ARI (acute respiratory infections) among under-5 children in South Bengaluru, 2. determine the factors influencing mothers for utilization of health services.
 Methods: Authors conducted a cross-sectional study in 10 randomly selected wards of South Bengaluru from July, 2019 to January, 2020 using multistage sampling. 432 mothers with under-5 children were interviewed regarding morbidities of their children in the previous one month and the health services they utilised, using a semi-structured questionnaire derived from multiple indicator cluster survey (MICS) by UNICEF. Data were analysed using SPSS 21.0 for descriptive statistics and logistic regression.
 Results: 95 of the participants had illnesses in the past one month; but, only 41 had used health facilities for treatment, mainly in the private sector (68.3%). The reasons for non-utilization of healthcare services were negligence (36.9%), long waiting time at the center (22.4%), financial constraints (20.4%) and mothers’ jobs (9.6%). The most significant factors influencing the health services utilisation were: literacy status of the mother (predisposing factor), low socio-economic status/ BPL (below poverty line) families (enabling factor), and severity of symptoms (need factor).
 Conclusion: Utilisation of healthcare services for under-five morbidities in the studied population was inadequate. The influencing factors have to be addressed on a priority basis to fulfil the goal of universal health coverage.

Vulnerability of the Katana Health Zone in the Democratic Republic of the Congo: A Resilience Strategy to Malaria Treatment in Healthcare Facilities from 2014 to 2018

Vulnerability of the Katana Health Zone in the Democratic Republic of the Congo: A Resilience Strategy to Malaria Treatment in Healthcare Facilities from 2014 to 2018

PATHWAY TO CARE AMONG CLIENTS ATTENDING AT PSYCHIATRIC OUT PATIENT DEPARTMENT OF A TEACHING HOSPITAL, BHARATPUR

Background: Mental illnesses cause significant suffering around the world. A limited number of people with psychiatric problems seek treatment in healthcare facilities when their condition is severe only. Treatment by faith healers and unqualified medical practitioners is frequent which lead to the delay in proper treatment. The objective of the study was to identify the pathway to care among clients attending at Psychiatric Outpatient Department of Chitwan Medical College, Teaching Hospital, Bharatpur. Methods: Descriptive cross-sectional design was used and 166 clients attending at psychiatric OPD of Chitwan Medical College, Teaching Hospital were selected by using non-probability, consecutive sampling technique. Data were collected from 11th August 2019 to 6th September 2019 through face to face interview method using structured interview schedule. Collected data were further analyzed in SPSS version 23 using descriptive and inferential statistics Results: The finding of the study revealed that 54.2% of clients first visited faith healer for initial treatment and only 16.9% visited psychiatrist directly for the treatment. Similarly, 53.6% of clients visited other personnel than psychiatrist due to their cultural belief and 59.6% of the clients had adequate level of awareness towards mental illness. Significant association was found between status of pathway to care and client’s sex, ethnic group and occupation. Conclusions: It is concluded that mental illness clients first approached faith healer for their initial treatment due to their cultural belief. It is important that traditional healers and other treatment providers must be aware of and recognize the mental illnesses in order to treat mental patients early and refer to psychiatrist.

Structural and human resourcing of rehabilitation care in health care facilities of Transcarpathian region as the basis of rehabilitation component of the regional health care system

In Ukraine, reforming rehabilitation in the field of health care at the national level requires the adaptation of health care facilities to the implementation of rehabilitation component of regional health care systems. The aim of the study was to analyse the resource provision (network and staffing) of health care institutions of Transcarpathian region in the field of rehabilitation, as the basis for transformation into a full-fledged rehabilitation system in accordance with the current reform of rehabilitation care in Ukraine. Materials and methods. The following methods were used in the research process: statistical, structural and logical analysis, generalization, graphic. Materials included published information from the industry statistical reporting of health care facilities in Transcarpathian region for 2011–2020: indicators of the availability of structural units, bedspace and staffing. Research results and their discussion. Over the period of the study, an absolute reduction in the number of beds for rehabilitation therapy, a decrease in the total number of rehabilitation departments (rooms) by 50%, therapeutic physical training rooms for adults - by 13.3%, and physiotherapy rooms - by 77.3% were established in the region. The sharpest reductions in the number of physiotherapy rooms in Transcarpathian region were observed in 2013 (by 42.6%) and 2018 (by 44.6%). The number of full-time positions of physiotherapists and exercise therapy doctors has fluctuated over the past 10 years and by 2020 has decreased by 13.0% and 41.4%, respectively, and exercise therapy nurses by 41.5%. Since 2021, doctors of physical and rehabilitation medicine have appeared in the official statistics of health care institutions of the region. Conclusions. The conducted study demonstrated a significant reduction in the network and staffing of rehabilitation treatment in health care facilities of Transcarpathian region during 2009-2020. However, the saved resources are available for use in order to create an effective system of rehabilitation care for the population of the region in accordance with WHO recommendations, current regulations and requirements of the National Health Service of Ukraine.

Monitoring hand hygiene with commercial gas sensors: A pattern recognition approach

Insufficient hand hygiene compliance of Health care workers is a widespread problem in medicine leading to several preventable infections each year. Hence, World Health Organization (WHO) presumes, that up to 1 in 10 patients acquires a Health care associated infection (HCAI) while receiving treatment in health care facilities. Apart from hand hygiene adherence and compliance, a correct hand disinfection technique regarding the amount of hand rub and exposure time is crucial for hand hygiene efficacy. Since alcohol-based hand rub is prevalent in the medical sector, the present study presents a new method for anonymous, electronic hand hygiene monitoring with commercial Ethanol gas sensors. In contrast to previous attempts of electronic monitoring, which mostly merely count the amount of hand hygiene actions, the present approach exploits different algorithms of Machine Learning to assess and categorize the hand disinfection technique into correct and incorrect. To demonstrate functionality of the mentioned approach, labeled hand disinfection data was collected in a pilot study over the period of one year with two different sensor setups. In detail, on the one hand a commercial portable gas sensor tag is used, which can be directly attached to the surgical gown. On the other hand, the performance of several commercial gas sensors is investigated, which are stationarily mounted next to the hand rub dispenser station. The present study follows three subgoals: Firstly, suitability of the stationary vs. portable setup shall be assessed. Secondly, the adequacy of different commercial gas sensor types is evaluated and thirdly the performance of possible algorithms for time series classification of the given sensor response is investigated, i.e. Support Vector Machines (SVM) as well as different Deep Learning algorithms, such as Multilayer Perceptron (MLP), Fully Convolutional Neural Networks (FCN) and a Bidirectional Long-Short-Term Memory network (Bi-LSTM). It could be found that the stationary setup is significantly superior compared to the portable setup. For most of the sensors within this stationary setup an accuracy score between 85% and 87% could be obtained for classification of correctly and incorrectly performed hand disinfections.

Costs and barriers faced by households seeking malaria treatment in the Upper River Region, The Gambia

BackgroundMalaria transmission in The Gambia decreased substantially over the last 20 years thanks to the scale-up of control interventions. However, malaria prevalence is still relatively high in eastern Gambia and represents both a health and a financial burden for households. This study aims to quantify the out-of-pocket costs and productivity losses of seeking malaria treatment at household level.MethodsA household survey was carried out through in-person interviews. Respondents were asked about malaria prevention methods, their treatment-seeking behaviour, and any costs incurred for transport, services, food, and/or overnight stays. A bottom-up costing approach was used to calculate the unit cost of treatment and a tobit regression approach to investigate cost drivers.ResultsThe survey included 864 respondents, mainly subsistence farmers. Most respondents (87%) considered malaria to be a problem affecting their ability to perform their regular duties. Respondents preferred going to a health facility for treatment. The primary reason for not going was related to costs; 70% of respondents incurred costs for seeking health care, with a median of £3.62 (IQR: £1.73 to £6.10). The primary driver of cost was living in one of the villages that are off the main road and/or far from health facilities. 66% reported productivity loss of 5 working days on average during a malaria episode of them or their child.ConclusionsAlthough malaria prevalence is decreasing and treatment is provided free of charge, households seeking treatment are confronted with out-of-pocket expenditures and lost working days; particularly in remote villages.

Drug used pattern by self-medication among the RT-PCR positive health workers in Dhaka city

Background: To date there is no effective treatment against COVID-19. Self-medication played one of the major modes of treatment among general population as well as the health workers during this pandemic. Studying the pattern of self-medication among the health care workers (HCWs) may indicate their knowledge and skills towards rational use of medicines. The aim of the study was to assess the pattern self-medication among the COVID-19 affected HCWs.Methods: This cross-sectional survey assessed the pattern of drug used by self-medication among the health workers who were RT-PCR positive in context to Bangladesh.Results: A total of 267 HCWs data were collected. Most of the HCWs were in middle age group between 31-40 years with the mean age of 32.2±5.2. Doctors (83.9%) enrolled five times more than the nurses (16.1%). Most of the HCWs (60.3%) commenced medications just after appearance of symptoms and 27.0% went for the RT-PCR testing. Only 3.7% went to health care facilities for treatment. More than sixty percent of the respondents took medication by themselves just after start the symptoms, 19 (33.7%) took advised from the specialists and attended at health facilities 2.6%. Most of the patients (42.7%) used azithromycin as antimicrobial agent. Paracetamol was the most used drug among the participants (78.65%) followed by antihistamines (67.79%). Average number of drugs used by patients 3.1% and percentage of antibiotics per patients 42.6%.Conclusions: The prescribing practice of antibiotics shows deviation from the standard recommendation. Awareness regarding essentials drug list should be needed.

Identify the Disaster Nursing Training and Education Needs for Nurses in Taif City, Saudi Arabia.

IntroductionNursing is considered the healthcare profession with the most members. Emergency nurses constitute the first line of treatment in healthcare facilities when catastrophic events bring disaster victims in need of medical attention. Therefore, these nurses must be well educated and trained efficiently to be able to deal with disastrous situations properly. This study aimed to distinguish the most important elements of education and training for preparing emergency nurses to face disasters in the Kingdom of Saudi Arabia (KSA), specifically, the city of Taif.MethodsThis study employed a tool to measure nurses’ most important training and education needs that was created by the authors based on a literature review and was approved by an expert panel in disaster nursing. Questionnaires were distributed to emergency nurses in four hospitals run by the Ministry of Health in Taif city. Survey responses were received from 210 participants, and the data were analyzed using a principal component analysis (PCA). A one-way ANOVA was used to determine the differences between groups according to their experiences.ResultsThe following three factors were extracted from the data after redundant items were loaded and excluded: incident management systems (IMSs), disaster triage, and disaster drills. Nurses with less than three years of experience have a significant need to learn about these elements in order to be able to cope with disasters.ConclusionUnderstanding different types of disasters and how to deal with these catastrophic events is crucial. Significant differences existed between ED nurses in their understanding of the basic elements of disaster management based on their level of experience in an ED. Therefore, disaster education must be included in nursing curricula, and more training courses, mock drills, and simulations must be conducted in hospitals for nurses, especially nurses with less experience, so they can learn to manage their responsibilities during disasters.

Trends of inequalities in care seeking behavior for under-five children with suspected pneumonia in Ethiopia: evidence from Ethiopia demographic and health surveys (2005\u20132016)

BackgroundPneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia.MethodsUsing cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance.ResultsThe percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years.ConclusionsHealth care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).

Economic Benefit in Treatment of Unintentional Childhood Injuries by Implementation of Child-To-Child Approach.

Background:Childhood injury has been recognized as a major threat to child survival and health, as well as economic burden, which includes the cost to government and out-of-pocket expenses (OOPE) to families. Child-To-Child Approach is an innovative technique to reduce childhood injuries and expenses on their treatment.Objectives:To assess economic benefit in the treatment of unintentional childhood injuries, including OOPE by families, by the implementation of the child-To-Child approach.Materials and Methods:The present study is part of a quasi-experimental before-and-after intervention study conducted in the rural area of Delhi for the prevention of childhood injuries through intervention by the child-To-Child approach. Cost of injury treatment, including travel and accommodation expenses, and wage loss were noted. The projected gain in the total cost and out-of-pocket expenditure on injury treatment throughout 20 years of childhood and adolescence were calculated.Results:Both incidences of injuries and total expenditure for treatment of injuries had decreased during the postintervention period in the intervention group, against a rise in the control group. The proportion of OOPE for availing private health care facilities for treatment of injuries, which was more than one-fourth of total expenses, also had decreased in the intervention group during the postintervention period. On economic analysis, it is projected that there will be enormous gain in cost by the implementation of child-To-Child approach in the study area in 20 years, along with saving of OOPE of the families.Conclusion:Child-To-Child approach is effective in preventing childhood injuries and reducing the cost of treatment of injuries.

One-arm safety intervention study on community case management of chest indrawing pneumonia in children in Nigeria – a study protocol

ABSTRACT Current recommendations within integrated community case management (iCCM) programmes advise community health workers (CHWs) to refer cases of chest indrawing pneumonia to health facilities for treatment, but many children die due to delays or non-compliance with referral advice. Recent revision of World Health Organization (WHO) pneumonia guidelines and integrated management of childhood illness chart booklet recommend oral amoxicillin for treatment of lower chest indrawing (LCI) pneumonia on an outpatient basis. However, these guidelines did not recommend its use by CHWs as part of iCCM, due to insufficient evidence regarding safety. We present a protocol for a one-arm safety intervention study aimed at increasing access to treatment of pneumonia by training CHWs, locally referred to as Community Oriented Resource Persons (CORPs) in Nigeria. The primary objective was to assess if CORPs could safely and appropriately manage LCI pneumonia in 2–59 month old children, and refer children with danger signs. The primary outcomes were the proportion of children 2–59 months with LCI pneumonia who were managed appropriately by CORPs and the clinical treatment failure within 6 days of LCI pneumonia. Secondary outcomes included proportion of children with LCI followed up by CORPs on day 3; caregiver adherence to treatment for chest indrawing, acceptability and satisfaction of both CORP and caregivers on the mode of treatment, including caregiver adherence to treatment; and clinical relapse of pneumonia between day 7 to 14 among children whose signs of pneumonia disappeared by day 6. Approximately 308 children 2–59 months of age with LCI pneumonia would be needed for this safety intervention study.

First Presentation of Breast Cancer in Patients Presenting to Health Care Facilities of Bahawalpur

Background: There is an increased incidence of breast tumors worldwide. It is the second leading cause of death and disability related to cancer among females. High case fatality rates seen in resource-limited countries is due to a lack of awareness of the screening in the general population and inadequate facilities for early detection and poor access to health care facilities for treatment. Objective: The objective of our study was to determine the frequencies of different types and stage breast cancer at first presentation of the patients to a health care facility. Study Design: Descriptive Cross-Sectional Study. Settings: Study was conducted in two Government hospitals, Bahawal Victoria and Civil Hospital of Bahawalpur Pakistan. Duration: Six months (Jan 1, to June 30, 2019). Methodology: Total of 95 patients presented with breast cancer to the respective hospitals. After taking informed verbal consent from the patients the questions regarding their personal biodata were asked from them. Examination and surgical details were taken from their medical chart records. The data was analyzed with SPSS. Results: The mean age of the parents was 49.5(+11.6 SD) years. TNM staging of the patients showed that most of the patients were already in stage III (49.4%) of breast cancer. Infiltrative ductal carcinoma was the most frequently occurring cancer,66 (69.4%). Conclusion: Education about breast cancer awareness to female population could be helpful in early detection of cancer.

Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol

BackgroundIn many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs. Integrated community case management (iCCM) is an integrated approach addressing disease and malnutrition through use of community health volunteers (CHVs) in children under-5 years. Evidence on the potential impact and practical experiences on integrating community-based management of acute malnutrition as part of an iCCM package is not well documented. In this study, we aim to investigate the effectiveness and cost effectiveness of integrating management of acute malnutrition into iCCM.MethodsThis is a two arm parallel groups, non-inferiority cluster randomized community trial (CRT) employing mixed methods approach (both qualitative and quantitative approaches). Baseline and end line data will be collected from eligible (malnourished) mother/caregiver-child dyads. Ten community units (CUs) with a cluster size of 24 study subjects will be randomized to either an intervention (5 CUs) and a control arm (5 CUs). CHV in the control arm, will only screening and refer MAM/SAM cases to the nearby health facility for treatment by healthcare professionals. In the intervention arm, however; CHVs will be trained both to screen/diagnose and also treat moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) without complication. A paired-matching design where each control group will be matched with intervention group with similar characteristics will be matched to ensure balance between the two groups with respect to baseline characteristics. Qualitative data will be collected using key informant and in-depth interviews (KIIs) and focused group discussions (FGDs) to capture the views and experiences of stakeholders.DiscussionOur proposed intervention is based on an innovative approach of integrating and simplifying SAM and MAM management through CHWs bring the services closer to the community. The trial has received ethical approval from the Ethics Committee of AMREF Health Africa - Ethical and Scientific Review Committee (AMREF- ESRC), Nairobi, Kenya. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, and presented to local and international conferences.Trial registrationPACTR201811870943127; Pre-results. 26 November 2018.

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

BackgroundThe Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery.MethodsFormative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed.ResultsA theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others.ConclusionThis study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.

Can Mobile Integrated Health Care Paramedics Safely Conduct Medical Clearance of Behavioral Health Patients in a Pilot Project? A Report of the First 1000 Consecutive Encounters

Background: Mental health patients wait lengthy periods in emergency departments for disposition. This delay is secondary to the process of medical clearance and then placement in an appropriate psychiatric specialty center. ACEP clinical policy questions the necessity of laboratory investigation for medical clearance and favors history and physical exam to determine safe disposition to mental health facilities. This manuscript explores if specially trained paramedics can effectively employ triage algorithms to determine proper disposition of patients suffering an acute mental health crisis in a 9-1-1 system. Methods: Six paramedics working for AMR in Stanislaus County, California underwent 180 hours of specialized training to become Mobile Integrated Healthcare Paramedics (MIHPs). Their training detailed the use of two algorithms designed to identify patients that require evaluation in an emergency department versus those that can be triaged directly to a licensed mental health facility. Patients aged 18–59 with a suspected mental health crisis who are encountered via the 9-1-1 system, law enforcement or who walk in to the mental health facility for treatment were eligible. All patients in the study were evaluated with the well person algorithm (WPA). Those that passed the WPA were evaluated using the mental health clearance algorithm (MCHA). MIHPs directed patients to either the ED or the mental health facility based upon the evaluation results of the WPA and MHCA. Results: 1006 patients were evaluated between September 2015 and December 2017. 404 patients failed one or more components of the WPA or MHCA. 326 patients passed both the WPA and the MHCA, but were ultimately transported to a local emergency department, most often because of lack of available psychiatric beds in the community. 276 patients were transported directly to a psychiatric facility. Of these, 10 returned to the emergency department within 6 hours, but none of the 10 were admitted for a previously unidentified medical or traumatic condition. Conclusion: Specially trained paramedics can effectively employ triage algorithms to screen and select patients experiencing an acute mental health crisis for transport directly to psychiatric treatment facilities.

Local knowledge and practices towards malaria in an irrigated farming community in Ghana

BackgroundAlthough malaria is endemic across Ghana, the risk is generally elevated for residents living in and around stagnant water bodies such as dams and irrigated farming projects. What knowledge do these at-risk populations have about the aetiology and symptoms of malaria? What are their coping strategies? And what interventions are needed to help improve the health outcomes of people living in high-risk malaria communities?MethodsThis study addressed these research questions with primary data, comprising both qualitative interviews and quantitative surveys, collected in Asutsuare—a rural irrigated farming community located in the Greater Accra Region of Ghana.ResultsResults from the fieldwork showed that awareness of malaria as a major health concern in the community was universal. Respondents also displayed a high knowledge of some common clinical symptoms of malaria. Yet, only 3% out of the total survey respondents of 337 indicated they immediately visit a health facility for treatment whenever they suspected malaria. The overwhelming majority (about 97%) indicated they only visit a healthcare facility for treatment if they felt the suspected malaria illness was severe and/or other treatment options had failed.ConclusionMalaria testing training for drug dispensing personnel as well as the provision of malaria testing kits in drug dispensing stores are necessary to facilitate early malaria screening and timely diagnosis particularly in rural endemic areas.