Health Care Level Research Articles

Beyond the margins: antenatal health and healthcare behaviours among homeless women in Kolkata Municipal Corporation, India.

Despite high childbearing rates among homeless women in India, the antenatal health and healthcare behaviours among such population remain poorly understood. To address this research gap, a mixed-methods approach was employed in the present study, involving interviews with a sample of 400 women aged 15-49 years, utilising time and location sampling techniques. Additionally, a purposeful sample of 52 women from the same age group participated in in-depth interviews. The respondents exhibited rampant socio-economic backwardness, including chronic homelessness (36%), no formal education (54%), engagement in rag picking (31%), and low income levels. About 56% of the women reported poor self-rated health (SRH), notably higher among those aged 35 and above and those living alone (68%). Poor SRH was also prevalent among the ever married (61%), ragpickers (61%), beggars (62%), chronic homeless individuals (62%), tobacco (60%) and alcohol consumers (61%), and those with chronic diseases (61%). Common health issues included depression or anxiety (56%) and iron deficiency anaemia (35%). The level of unmet healthcare needs was 41%, with significant variation across diseases. Lack of reproductive health rights and awareness, socio-cultural beliefs, stigma, socio-economic poverty, poor quality of public healthcare services, irregularity in charity-run healthcare, and time constraints hindered antenatal care visits. The study underscores the urgent need for population-centric programmes and policies aimed at promoting reproductive health to achieve Sustainable Development Goal 3 of 'Good health and wellbeing' by 2030.

P043 PREACH IMPLEMENTATION PROJECT A SOCIO-ECOLOGICAL FRAMEWORK FOR HYPERTENSION IN PAKISTAN

Background: Worldwide hypertension prevalence is projected to reach 1.56 billion by 2025, affecting 29% of the global population according to the WHO1. It contributes to 7.5 million deaths, 3.7% of total disability-adjusted life years (DALYs) and is responsible for causing stroke in 54% of hypertensives2,3. Pakistan has a prevalence of 43% hypertension with merely 12.5% of controlled hypertensives4,5. There is a pressing need for a national level intervention through uniform clinical approaches for optimum hypertension prevention, treatment and control6, 7. Through PREACH project, we prioritize primary care physicians as first-line responders and are training them on standardized hypertension guidelines to alleviate the burden from tertiary care hospitals. To detect new onset hypertension the project also incorporates early surveillance and community level screenings. Objectives: • To build capacity of practitioners on standardized guidelines endorsed by health ministry, PCS (Pakistan Cardiac Society) & PHL (Pakistan Hypertension League) • To raise community awareness, to screen and develop self-referral pathways to specialty care • To develop a robust national hypertension registry • To include hypertension in essential primary healthcare packages Methodology: Hypertension guidelines are developed. Accredited national certified workforce of more than 14,000 general practitioners (GPs) will be built through guidelines trainings via train the trainer model. Impact assessment studies will be done to assess training effectiveness and implementation at clinics. Community mobilization and awareness campaigns will be run to identify and direct self-referral pathway to an accredited GP. Development of national hypertension registry as a centralized system for data collection to report actual disease burden. Ministry of health will be advocated to prioritize hypertension management via multi-sectoral collaboration i.e. medical societies, academic, non-profit and private-sector for incorporations into annual development programs. Results \Conclusion: We aim to create an impact in the lives of 4.3 million beneficiaries (anti-hypertensive naïve hypertensive patients of Pakistan) by increasing self-referral of hypertensive cases to specialists through PREACH implementation project at all healthcare service delivery levels.

Assessing and Comparing Musculoskeletal Knowledge and Red Flag Identification Skills: A Cross-Sectional Study of Physical Therapists and Primary Care Physicians

Background: Musculoskeletal disorders are one of the most common health issues often managed at the level of primary health care. Enabling physical therapists to be first-contact practitioner for patients with musculoskeletal disorders could improve patient access, expedite management, enhance outcomes and reduce costs. However, this role requires a high level of musculoskeletal knowledge and the ability to detect red flags. Objectives: To assess and compare the musculoskeletal knowledge and abilities to identify red flags between physical therapists and primary care physicians (PCPs). Methods: A cross-sectional study was undertaken using an electronic survey assessed participants’ musculoskeletal knowledge and ability to identify red flags. Study participants included physical therapist and PCPs practicing at Ministry of Health hospitals and/or primary care centers in Riyadh, Saudi Arabia. Results: A total of 60 physical therapists and 76 PCPs participated. Good knowledge levels (total score ≥ 75%) were found for 7% of physical therapists compared to 18% of PCPs, and moderate knowledge levels (total score 60-75%) were found in 70% of physical therapists compared to 62% of PCP participants (P=.003). Conclusion: Physical therapists and PCPs demonstrated an overall moderate level of musculoskeletal knowledge and the ability to identify red flags. The results suggest that with further education on red flags identification, physical therapists in Saudi Arabia could potentially act as first-contact practitioners for patients with musculoskeletal conditions.

Early Detection of Infectious Diseases among the Refugees of UNHCR in South Tangerang, Banten; the Problems and Strategies to Prevent the Disease's Transmission

The previous study at Puskesmas Pisangan, Ciputat had reported that among 23.8 % patient of the UNHCR was infected by malaria Plasmodium vivax, and one patient with bacterial urinary infection. However, the result can not represent the actual case of the disease, because of the lack number of participant to visit the Puskesmas since the Covid-19 pandemic which had been contributing to decrease number of the patients. The study purposed to improve data and information about parasitic infection, and to design strategy in early detection and prevention to the disease. Design of the study was approached in cross-sectional with a total sampling method of the UNHCR out patients visiting the Puskesmas Pisangan and Cirendeu.We collected specimen of feces, urine, and blood, and performed blood diff-count, rapid diagnostic, microscopic, dipstick, and bacterial culture. The study revealed some parasitic and bacterial infections as defined: five cases (17.24%) of malaria, which is suspected as imported cases; Enterobacteriacea family as non-specific bacteria of negative gram in urine; also Entamoeba coli in stool. This finding was confirmed 17.24% of leucocytosis in blood diffcount and 24.14 % in urinalysis. By nationality, Sudanese was detected the most prevalent 10.34% of parasitic infections, followed by Somalia (6.9%), Yaman (3.45%), and Afghanistan (3.45%) respectively. While mosquitoes and poor living conditions were also contributed as the major potential risk of transmission to the diseases. In conclusion, early detection, health screening, vaccination, access to primary, and upgraded levels of healthcare are important for diseases control and management to prevent transmission.

How enabling factors determine unmet healthcare needs? A panel data approach for countries

Health service need refers to the essential care required to achieve optimal health outcomes within resource constraints. When necessary services to address identified health issues are not received, unmet needs arise. This research focuses on the determinants of unmet healthcare needs across the 34 countries within the European region from 2011 to 2019, focusing on Andersen's Behavioral Model's enabling factors. We employed a static and robust panel regression model using Stata 14.0 software. Key determinants analyzed include GDP per capita, urbanization rate, and physicians per capita. Findings reveal that lower GDP per capita and lower urbanization rates are significantly correlated with higher levels of unmet healthcare needs, highlighting income level and geographical accessibility as critical factors. Additionally, a higher number of physicians per capita is associated with reduced unmet healthcare needs, indicating the importance of healthcare resources in addressing healthcare access gaps. These findings underscore the importance of targeted healthcare policies that address income level, improve healthcare accessibility, and enhance healthcare resource allocation to reduce unmet healthcare needs effectively. These findings equip policymakers and administrators with empirically grounded insights to comprehend the factors contributing to unmet healthcare needs and to develop policies aimed at addressing this challenge.

Neonatal screening for critical congenital heart diseases in Peru: an urgent call

Congenital heart diseases are the most common congenital malformations worldwide and represent one of the leading causes of neonatal death, in addition to the significant use of human and financial resources by health systems. The purpose of this document is to support the implementation of neonatal screening for critical congenital heart diseases using pulse oximetry according to the different geographical altitudes of Peru. This technology is widely used worldwide and has high sensitivity, specificity, and cost-effectiveness. At many latitudes, it has led to better survival in this group of patients and in the neonatal population in general since its use in the early detection of sepsis, pneumonia, and other conditions that affect the oxygenation of the newborn. Neonatal screening for critical congenital heart disease is applicable at all levels of healthcare at a national level, and its implementation must be a priority to improve neonatal health.

Treatment engagement in comorbid alcohol use disorder and alcohol-related liver disease: A qualitative exploration of barriers and facilitators with service users.

Effective interventions to improve patient outcomes in comorbid alcohol use disorder (AUD) and alcohol-related liver disease (ARLD) remain a clinical unmet need. While the choice of abstinence is the cornerstone for the prevention of disease progression and mortality, evidence suggests a suboptimal engagement with treatment supporting recovery. This qualitative investigation aims to understand barriers and facilitators to treatment as experienced by this clinical population by applying a multidimensional adherence model proposed by the World Health Organization. Twenty-four participants with comorbid AUD and ARLD were recruited from an inpatient clinical setting. Data for this study were collected through semistructured, in-depth interviews. Deductive analysis was organized by the Framework method, and theory-driven themes were identified according to the multidimensional adherence model. This included factors across the social and economic, patient, condition, treatment, and healthcare system levels. The findings in this study indicate systematic challenges in maintaining continuity between primary, secondary, and community care. Aspects related to social and economic context, treatment, and healthcare systems were found to hinder engagement. Identified facilitators to engagement included the participatory role of family, shared lived experience of addiction/recovery, and therapeutic alliance with healthcare providers. The understanding of these barriers and facilitators from a service user's perspective can bridge the treatment gap for this clinical population. This can provide an opportunity for the implementation of effective interventions and inform the development of policies promoting accessible care. Government and public health bodies have fundamental roles in shifting treatment paradigms in comorbid AUDand ARLD.

The importance of continuing medical education on cardiopulmonary resuscitation of health care professionals at the level of primary health care – experience of the Health Center of Osijek-Baranja County

The importance of continuing medical education on cardiopulmonary resuscitation of health care professionals at the level of primary health care – experience of the Health Center of Osijek-Baranja County

Navigating complex care pathways-healthcare workers' perspectives on health system barriers for children with tuberculous meningitis in Cape Town, South Africa.

Tuberculous meningitis (TBM) occurs when tuberculosis (TB) bacilli disseminate and seed into the meninges, triggering a severe inflammatory response that often leads to brain infarction. It is the most severe and debilitating form of childhood TB with high mortality, and children who survive TBM often suffer lifelong physical and neuro-disability resulting in emotional, social, and economic burdens for families. In the early stages the symptoms may be non-specific and so the diagnosis is often made late when the patient already has significant brain injury. To facilitate earlier diagnosis, it is important to understand how patients are evaluated. This study aimed to chart health systems for paediatric TBM care at both primary healthcare (PHC) and hospital level in Cape Town, South Africa. We conducted fourteen in-depth interviews and eight days of semi-structured observations of patient flow across eight healthcare facilities. We found that children with TBM navigate multiple levels of care categorised into pre-admission and primary care, hospital admission and inpatient care, and post-discharge follow-up care. Healthcare workers identified the following health system barriers along the TBM care pathway for children: limited post-training and mentorship opportunities to manage TBM, overburdened facilities, time constraints, lack of recognition of TBM symptoms, delays in referral between PHC and hospital, lack of standardized diagnostic algorithms, limited diagnostic tests and a lack of child-friendly, easy-to-administer treatment. Regular and compulsory training on TB and TBM in children, including continuous mentoring and support to healthcare workers working in child health and TB services in high TB-burden settings, can facilitate early recognition of symptoms and rapid referral for diagnosis. Algorithms outlining referral criteria for patients with possible TBM at both PHC facilities and district level hospitals can guide healthcare providers and facilitate timely referral between different levels of healthcare services. An integrated data system and alert functions could flag multiple healthcare visits and improve communication between different healthcare facilities during diagnosis and treatment. Children and families affected by TBM are an especially vulnerable sub-population requiring high priority attention and support.

Evaluative analysis of collection, storage, and transmission of statistical data on tuberculosis at district and central levels of health care in the Republic of Tajikistan

Aim. To assess the effectiveness of collection, storage and transfer of statistical information on tuberculosis in the districts of Rasht region.Material and methods. The material for the planned study was data on registered cases of tuberculosis for 2022 according to the National Tuberculosis Register “OpenMRS”, the Unified Health Management Information Network “DHIS2” and the initial data of primary documentation of the anti-tuberculosis service in five districts of the Rasht region (Rasht, Tajikabad, Sangvor, Nurabad, Lakhsh).Results. The studies conducted revealed a significant discrepancy in the official statistical information on tuberculosis in the unified health management information system “DHIS2”, in the national tuberculosis data register “OpenMRS” and in the primary documentation of the anti-tuberculosis service: Form No. 036, Reporting Form 8, Patient Registration Journal - TB-03 and TB-03U, Quarterly Report Form - TB-07 and TB-07U in all five districts of Rasht region.Conclusion. Frequent criticism of the specialists responsible for providing official statistics on tuberculosis for their inconsistency with WHO data, data from the unified health management information system “DHIS2”, data from the national registry “OpenMRS” and data from the primary documentation of the anti-tuberculosis service is justified. One of the ways to bring official statistical data into line with the real epidemiological situation of tuberculosis is to carry out systematic routine monitoring and evaluation of the quality of collection, storage and transmission of statistical information on tuberculosis from the district level to the central level, to organise continuous training of specialists responsible for this component, to minimise paperwork and to prioritise the digitalisation of this process.

The effect of kangaroo mother care on weight gain pattern in low birth weight premature babies at a tertiary care hospital

Abstract Background: Premature infants are at high risk of death. They need specialized incubatory care which is very costly and requires skilled workforce and specialized equipment. Kangaroo mother care (KMC) does the same job with no cost and does not require set-up as for incubatory care. It can prevent mortality and morbidity and also promotes bonding between mother and child. Objective: The objective of the study was to study the effect of KMC on weight gain pattern in low birth weight premature babies compared to incubatory care. Materials and Methods: A nonrandomized experimental study was carried out among 200 premature infants. They were divided into two groups of 100 each. Randomization was not done. One group was given KMC. The second group was given incubatory care. The weight of babies in both groups was measured with a digital weighing machine. Both groups were followed till the 9th day with a follow-up frequency of days – 1, 3, 5, 7, and 9. On each follow-up day, weight was recorded. Results: Both groups were comparable for gender, birth weight, and gestational age. In the KMC group, there was significant weight gain on day 2 compared to day 1 and on day 7 compared to day 6. But weight gain on day 3 compared to day 2 and on day 9 compared to day 8 was not significant. In the non-KMC group, there was significant weight gain on day 3 compared to day 2 and on day 9 compared to day 8. From 2nd day to 9th day, each day weight gain in the KMC group was higher compared to the non-KMC group. Conclusion: We conclude that the KMC significantly improved weight gain on a daily basis. The KMC also improved the weight gain compared to that of the non-KMC group. Hence, we recommend to create awareness among the community at all health-care levels and among health-care professionals on the benefits of KMC/the importance of KMC.

Understanding factors affecting the acceptance of post-abortion contraception: A comprehensive analysis

To assess the proportion of post-abortion contraceptive acceptance and the determinant factors in the utilization of contraception. It is a prospective observational study done on 468 women who presented for abortion care in a tertiary care centre. Data were collected using a pre-structured questionnaire, counselled for contraceptive usage. The family planning method accepted was noted and followed up after one month. Data were analysed using descriptive statistics and expressed in the form of frequency and percentages. In the present study, the magnitude of acceptance of post-abortion contraception was 73.08%. Most women were in the age group 21-30 years (62.82%), the majority belonged to lower socioeconomic status (43.16%), 78.62% were homemakers. Age of the women, education status, and history of the previous usage of contraception showed a positive association with acceptance of post-abortion contraception. The most accepted method was tubectomy (24.35%) followed by barrier contraception (20.51%). During follow-up after 1 month, 69.24% were willing to continue the same method and 5.1% opted for a change in the contraceptive method. The common determinant factors for not opting for post-abortion contraception were due to religious belief, partner opposition, fear of side effects of contraceptive methods and willingness to concieve again shortly. The proportion of post-abortion family planning utilization is good but could be improved. Education before and especially at the time of abortion strongly influenced the usage of family planning services especially in rural areas where the accessibility is comparatively low. Family planning counseling during the time of abortion plays an important role in accepting post-abortion family planning services. At all levels of health care, family planning counseling and services should be provided to those who come for abortion to reduce maternal morbidity and mortality.

Functional neurological disorder in Europe: regional differences in education and health policy.

Functional neurological disorder (FND) is a common cause of neurological disability. Despite recent advances in pathophysiological understanding and treatments, application of this knowledge to clinical practice is variable and limited. Our aim was to provide an expert overview of the state of affairs of FND practice across Europe, focusing on education and training, access to specialized care, reimbursement and disability policies, and academic and patient-led representation of people with FND. We conducted a survey across Europe, featuring one expert per country. We asked experts to compare training and services for people with FND to those provided to people with multiple sclerosis (MS). Responses from 25 countries revealed that only five included FND as a mandatory part of neurological training, while teaching about MS was uniformly included. FND was part of final neurology examinations in 3/17 countries, unlike MS that was included in all 17. Seventeen countries reported neurologists with an interest in FND but the estimated mean ratio of FND-interested neurologists to MS neurologists was 1:20. FND coding varied, with psychiatric coding for FND impacting treatment access and disability benefits in the majority of countries. Twenty countries reported services refusing to see FND patients. Eight countries reported an FND special interest group or network; 11 reported patient-led organizations. FND is largely a marginal topic within European neurology training and there is limited access to specialized care and disability benefits for people with FND across Europe. We discuss how this issue can be addressed at an academic, healthcare and patient organization level.

Shared patient information and trust: a qualitative study of a national eHealth system

BackgroundIn Norway, as in other countries, national eHealth systems, such as the Summary Care Record (SCR), have been implemented to improve the collaboration around patients by sharing patient information between health professionals across healthcare institutions and administrative levels. Although widely implemented across the health and care services in Norway, evaluations of the SCR indicate less use than expected. There is a need for analysis that lays out the visions and expectations of the SCR and contrasts these with detailed observations of use in everyday health professional work. This study adds to the eHealth research field by exploring this reality.MethodThis paper has a qualitative design with an ethnographic approach, including participant observation, qualitative interviews, and a document review. Qualitative individual interviews with 22 health professionals and six weeks of participant observation were conducted, and eight documents were reviewed. The field notes and the interview-transcriptions were analyzed following a stepwise-deductive induction analysis.ResultsThe document review identified the expectations and visions of the SCR, including an underlying assumption of trust in shared patient information. However, this assumption is implicit and not recognized as a crucial element for success in the documents. In our observation and interview data, we found that health professionals do not necessarily trust information in the SCR. In fact, several procedures and routines to assess the trustworthiness of SCR information were identified that complicate and disturb the expected use. In our analysis, two main themes characterize the health professionals' handling of the SCR: adapting to workflow and dealing with uncertainty.ConclusionOur study illustrates that unconditional trust in shared patient information is an implicit assumption in SCR policy documents, but in their everyday work health professionals do not necessarily unconditionally trust shared patient information. Rather, sharing patient information through technology, such as the SCR, requires of health professionals to critically assess the digital information. The information in the SCR, as all sources of information presented to health professionals, becomes an item for their constant trust-work. Our study is of value to policymakers, health information systems developers, and the field of practice both nationally and internationally.

Evaluation of a specialist nurse-led structured self-management training for peer supporters with type 2 diabetes mellitus with or without comorbid hypertension in Slovenia

BackgroundThe training of peer supporters is critical because the success of the entire peer support intervention depends on the knowledge and experience that peer supporters can share with other patients. The objective of this study was to evaluate the pilot implementation of a specialist nurse-led self-management training programme for peer supporters with type 2 diabetes mellitus (T2DM) with or without comorbid hypertension (HTN) at the primary healthcare level in Slovenia, in terms of feasibility, acceptability, and effectiveness.MethodsA prospective pre-post interventional pilot study was conducted in two Community Health Centres (CHC) in Slovenia from May 2021 to August 2022. Purposive sampling was employed to recruit approximately 40 eligible volunteers to become trained peer supporters. A specialist nurse-led structured training lasting 15 h over a 2-month period was delivered, comprising four group and two individual sessions. The comprehensive curriculum was based on interactive verbal and visual learning experience, utilising the Diabetes Conversation Maps™. Data were collected from medical records, by clinical measurements, and using questionnaires on sociodemographic and clinical data, the Theoretical Framework of Acceptability, knowledge of T2DM and HTN, and the Appraisal of Diabetes Scale, and evaluation forms.ResultsOf the 36 participants, 31 became trained peer supporters (retention rate of 86.1%). Among them, 21 (67.7%) were women, with a mean age of 63.9 years (SD 8.9). The training was evaluated as satisfactory and highly acceptable. There was a significant improvement in knowledge of T2DM (p < 0.001) and HTN (p = 0.024) among peer supporters compared to baseline. Six months post-training, there was no significant improvement in the quality of life (p = 0.066), but there was a significant decrease in body mass index (BMI) (p = 0.020) from 30.4 (SD 6.2) at baseline to 29.8 (SD 6.2).ConclusionThe pilot implementation of a specialist nurse-led self-management training for peer supporters was found to be feasible, acceptable, and effective (in the study group). It led to improvements in knowledge, maintained disease control, and promoted positive self-management behaviours among peer supporters, as evidenced by a decrease in their BMI over six months. The study emphasises the need for effective recruitment, training, and retention strategies.Trial registrationThe research is part of the international research project SCUBY: Scale up diabetes and hypertension care for vulnerable people in Cambodia, Slovenia and Belgium, which is registered in ISRCTN registry (https://www.isrctn.com/ISRCTN41932064).

Evaluation of an electricity-independent method for IS2404 Loop-mediated isothermal amplification (LAMP) diagnosis of Buruli ulcer in resource-limited settings.

Buruli ulcer (BU) caused by Mycobacterium ulcerans (MU) is a devastating necrotic skin disease. PCR, recommended for confirmation of BU by WHO, requires an adequately equipped laboratory, therefore often delaying timely diagnosis and treatment of BU patients in remote settings. Loop-mediated isothermal amplification (LAMP) is a PCR-based protocol for isothermal amplification of DNA that has been suggested for diagnosis of BU in low-resource settings. This is an exploratory diagnostic test evaluation study, with an embedded qualitative sub-study. Its aims are two-fold: First, to evaluate a simple rapid syringe-based DNA extraction method (SM) in comparison with a more elaborate conventional DNA extraction method (CM), followed by a LAMP assay targeting IS2404 for the detection of MU, either using a commercially available pocket warmer (pw) or a heat block (hb) for incubation. Second, to complement this by exploring the diagnostic workflow for BU at a community-based health centre in an endemic area in rural Ghana as an example of a potential target setting, using interviews with researchers and health care workers (HCWs). Diagnostic test evaluation results are discussed in relation to the requirements of a target product profile (TPP) for BU diagnosis and the target setting. A protocol using SM for DNA extraction followed by IS2404 PCR (IS2404 PCRSM) was able to identify MU DNA in 73 out of 83 BU clinical specimens submitted for diagnosis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of IS2404 PCRSM were 90.12%, 100%, 100% and 65.21% respectively, as compared to the reference standard IS2404 PCR in combination with a standard extraction protocol for mycobacterial DNA. Evaluation of the LAMP assay on 64 SM DNA extracts showed a sensitivity, specificity, PPV and NPV of 83.6%, 100%, 100% and 50%, respectively, using either pocket warmer (pwLAMPSM) or heat block (hbLAMPSM) for incubation of the reaction, as compared to the same reference standard. The limit of detection of pwLAMPSM was found to be 30 copies of the IS2404 target. Interview findings explored barriers to BU diagnosis and treatment, including perceptions of the disease, costs, and availability of transport. Participants confirmed that a diagnosis at the PoC, in addition to screening based on clinical criteria, would be advantageous in order to prevent delays and loss to follow-up. The high diagnostic and analytic accuracy of the pwLAMP, evaluated by us in combination with a syringe-based DNA extraction method, supports its potential use for the rapid detection of MU in suspected BU samples at the community or primary health care level without reliable electricity supply. Further optimization needs include a lysis buffer, evaluation directly at the PoC and/or other sites, assessing staff training requirements and quality control.

Assessing ventilation through ambient carbon dioxide concentrations across multiple healthcare levels in Ghana.

Infection prevention and control (IPC) measures safeguard primary healthcare systems, especially as the infectious disease landscape evolves due to climate and environmental change, increased global mobility, and vaccine hesitancy and inequity, which can introduce unexpected pathogens. This study explores the importance of an "always-on," low-cost IPC approach, focusing on the role of natural ventilation in health facilities, particularly in low-resource settings. Ambient carbon dioxide (CO2) levels are increasingly used as a measure of ventilation effectiveness allowing for spot checks and targeted ventilation improvements. Data were collected through purposive sampling in Northern Ghana over a three-month period. Levels of CO2 ppm (parts per million) were measured by a handheld device in various healthcare settings, including Community-Based Health Planning and Services (CHPS) facilities, municipal and teaching hospitals, and community settings to assess ventilation effectiveness. Analyses compared CO2 readings in community and hospital settings as well as in those settings with and without natural ventilation. A total of 40 facilities were evaluated in this study; 90% were healthcare facilities and 75% had natural ventilation (with an open window, door or wall). Facilities that relied on natural ventilation were mostly community health centers (60% vs 0%) and more commonly had patients present (83% vs 40%) compared with facilities without natural ventilation. Facilities with natural ventilation had significantly lower CO2 concentrations (CO2 ppm: 663 vs 1378, p = 0.0043) and were more likely to meet international thresholds of CO2 < 800 ppm (87% vs 10%, p = <0.0001) and CO2 < 1000 ppm (97% vs 20%, p = <0.0001). The adjusted odds ratio of low CO2 in the natural facilities compared with non-natural were: odds ratios, OR (95% CI): 21.7 (1.89, 247) for CO2 < 800 ppm, and 16.8 (1.55, 183) for CO2 < 1000 ppm. Natural ventilation in these facilities was consistently significantly associated with higher likelihood of low CO2 concentrations. Improved ventilation represents one cost-effective layer of IPC. This study highlights the continuing role natural ventilation can play in health facility design in community health care clinics. Most health facilities met standard CO2 thresholds, particularly in community health facilities. Further research is needed to optimize the use of natural ventilation. The use of a handheld devices to track a simple metric, CO2 levels, could improve appreciation of ventilation among healthcare workers and public health professionals and allow for them to target improvements. This study highlights potential lessons in the built environment of community primary health facilities as a blueprint for low-cost, integrated multi-layer IPC measures to mitigate respiratory illness and anticipate future outbreaks.

Multilevel determinants of antiretroviral therapy initiation and retention in the test-and-treat era of Nepal: a qualitative study

BackgroundThe transition to the “test-and-treat” policy in Nepal in 2017, coupled with the rapid initiation of antiretroviral therapy (ART) in 2020, necessitates an in-depth understanding of factors influencing ART initiation and retention. This study investigates these factors from the perspectives of healthcare providers, families/communities, and people living with HIV (PLHIV).MethodsEmploying a qualitative design, in-depth interviews were conducted with 24 ART clients and 26 healthcare providers across different provinces of Nepal. A comprehensive interview guide facilitated the exploration of experiences and perceptions. Interviews were transcribed verbatim, and thematic analysis was applied to distill key insights. Guided by a socio-ecological model, interviews were analyzed to identify the barriers and facilitators to ART initiation and continuation at the individual, family/community, and health system levels.ResultsFacilitators and barriers were identified at three levels. Individual-level facilitators included fear of death, perceived health benefits, knowledge about HIV/ART, confidentiality, and financial support. Barriers encompassed concerns about lifelong medication, side effects, denial of HIV status, fear of disclosure, and financial constraints. At the family/community level, support from family and community health workers facilitated ART adherence, while social stigma and discrimination posed barriers. The health system’s role was dual; the provision of free treatment, a client tracking system and a robust drug supply chain were facilitators, whereas logistical challenges and service accessibility during the COVID-19 pandemic were notable barriers.ConclusionsThis study highlights the various factors that influence ART initiation and retention in Nepal during the test-and-treat era. Tailored interventions should focus on increasing awareness about HIV and ART, strengthening healthcare systems, ensuring availability of medications, and providing accessible treatment during service disruptions. Furthermore, these interventions should encourage supportive environments at the individual, community, and healthcare system levels. Taking this holistic approach is essential for effectively implementing ART and achieving long-term health outcomes in light of changing public health policies.

A low-cost approach to upskilling tutors in frontline health care worker production value chain.

Nigeria, like many countries, struggles with a shortage of healthcare professionals including frontline healthcare providers at the primary healthcare (PHC) level. While the country is pitched towards producing more healthcare professionals, the existing infrastructure to produce them is inadequate. Producing healthcare professional with the required skills to deliver quality services is impeded by several factors including the use of outdated curricula for their training, low application of technology in teaching, and weak tutor capacity that is worsened by the paucity and high cost of opportunities for tutor continuing professional development. To address these issues, the Health Workforce Management Activity (HWM), an initiative of the United States Agency for International Development (USAID), in 2023 designed and implemented a low-cost programme called TutorConnect that offered low-cost continuing professional development to tutors. TutorConnect is a Zoom-based monthly training programme that is facilitated by subject matter experts. The programme offered topics spanning effective learning, enhanced instructional design, and improved student engagement in the 14 months of its operation with over 700 tutors from more than 10 states in Nigeria that benefited from it. Utilising WhatsApp for additional support and peer-to-peer learning was crucial to providing more hands-on support, and institution-specific solutions. This low-cost approach to build competencies enabled access to continuing professional development by tutors, limiting effects of location and finances as barriers to continuing professional development. Developing the teaching capacity of tutors is pivotal to enhancing the quality of frontline healthcare worker training.

Exploring Death Anxiety Among Older Adults: An Integrative Review of Associated Factors and Interventions.

With the aging of the population and the substantial surge of individuals above the age of 60, psychological concerns particular to this population have come to hold more weight on the healthcare and social levels. One of the concerns of older adults, which can significantly influence their psychological well-being, is the fear of inevitable mortality or death anxiety. This integrative review tackles the subject of death anxiety among older adults by providing a comprehensive synthesis of the factors associated with death anxiety and the effective interventions to mitigate it. A systematic screening of relevant articles was conducted using the PRISMA guidelines. Content and thematic analysis of 46 selected articles were performed, from which five key themes emerged: demographic factors, psychological and psychosocial factors, spiritual and religious factors, death reminders, and effective interventions. The review contributes to the field of thanatology and offers clinical insights into the care of older adults.