Health Facilities In Cities Research Articles

Maternal health in cities: analysis of institutional maternal mortality and health system bottlenecks in Kampala City Uganda, 2016-2021

Background Recent estimates have shown a stagnation in maternal mortality reduction globally. Levels and trends in maternal mortality in urban settings in Africa are of interest due to health system challenges posed by rapid urbanisation. Given the high percentage of births occurring in city health facilities, tracking the institutional maternal mortality ratio (IMMR) can reveal key performance issues. We described the trends in IMMR between 2016 and 2021, and the causes and characteristics of maternal deaths in Kampala, Uganda. Methods This retrospective study utilised routine data from all facilities in Kampala that provided childbirth services from 2016 to 2021. Three key variables were used: number of deliveries, live births, and maternal deaths. Additionally, from medical records in three purposively selected hospitals, we extracted information on characteristics of women recorded as maternal deaths and their causes for the period 2016-2021 from death notification and review forms. We conducted descriptive analysis and assessed time trends in IMMR. Results For the six-year period, the Kampala-level IMMR was 189/100,000 deliveries (194/100,000 livebirths). The IMMR declined from 213 (2016) to 109/100,000 deliveries in 2019 (p=0.04) and then increased to 258 in 2021 (p=0.12). A review of 358 maternal death records showed that 65% of deaths were women referred from other health facilities, and 47% lived in the surrounding district (Wakiso). Obstetric haemorrhage (44%) and hypertensive disorders in pregnancy (28%) were the most commonly recorded causes of death. Health system factors such as lack of blood and other supplies contributed to 65% of the deaths reviewed. Conclusions IMMR in Kampala increased from 2019-2021. Health infrastructure changes and maternal health initiatives potentially accounted for the observed trend by affecting data quality. Referral and facility readiness were underlying reasons for maternal deaths. Addressing bottlenecks in emergency referral processes may contribute to mortality reduction. Further research should determine the relative contribution of key influences on mortality levels and examine the dynamics between women’s care-seeking pathways and service delivery arrangements for emergency obstetric care in urban settings.

Risk Factor Analysis of Drug-Resistant Tuberculosis in Tuberculosis Patients at Level II Health Facilities in Depok City

Based on Global Tuberculosis Report In 2022, Indonesia will be among the 10 countries contributing to the highest incidence of drug-resistant tuberculosis each year. There are 12,794 cases of drug-resistant tuberculosis in Indonesia with 7,884 cases starting treatment. The number of drug-resistant tuberculosis cases involves a variety of risk factors. This study aims to analyze the risk factors associated with drug-resistant tuberculosis. The research method is observational analytic design case control study. The research samples were patients with drug-resistant tuberculosis and drug-sensitive tuberculosis in Depok City Health Facilities for the period March 2022–May 2023. Data were collected using questionnaires and SITB (Tuberculosis Information System). Bivariate analysis using Chi Square, while multiple logistic regression multivariate analysis. The results of the study of 73 cases and 73 controls showed that the majority were aged 18 - 65 years, 89% of cases and 62% of controls, male gender was the most dominant, 64.4% of cases and 52% of controls, most of the respondents did not work 68.5 % of cases and 53.4% ​​of controls, most of them had low income, 82.8% of cases and 62% of controls. Most of the case group had a high level of education, namely 58.5%. Meanwhile, most of the control group had low education, 50.7%. Bivariately, risk factors associated with drug-resistant tuberculosis are HIV, history of previous treatment, adherence to taking medication and the role of drug swallowing supervisor (PMO). Based on multivariate analysis, the dominant variable associated with the incidence of drug-resistant tuberculosis is history of previous treatment (OR6.021 with CI 2.055-18.721) meaning that patients with a history of previous treatment have a 6 times risk of developing drug-resistant tuberculosis compared to patients without a history of previous treatment.

Post-abortion contraceptive utilization and associated factors among women who attended abortion services: A health facility cross-sectional study.

Background: Post-abortion contraceptive utilization prevents unintended pregnancies, reduces the number of abortions, and lowers the morbidity and mortality related to obstetric complications. It plays a central role in improving maternal health and reducing child mortality. However, many women are suffering from unintended pregnancy and its complications after abortion care. Hence, the main objective of this study was to determine the magnitude of post-abortion contraceptive utilization and its associated factors in Bahir Dar City. Methods: Health-facility-based cross-sectional study was conducted in Bahir Dar city health facilities from April 1 to May 30, 2018. A systematic random sampling technique was used to select 354 eligible study participants. A pre-tested semi-structured questionnaire was used to collect the data. Data entry was done using Epi Data version 3.7 software and analyzed by SPSS v23 software. Descriptive statistics were done based on the nature of the data. A simple logistic regression model was used to identify the association and strength of exploratory variables and the outcome variables. Associations were announced at a 95% confidence interval and p-value <0.05 with adjusted odds ratio. Model fitness was checked by the Hosmer-Lemeshow goodness of fit test for logistic regression. Results: In this study, 348 aborted participants were involved with a mean age of 24.37 (±5.73) years. About 40% of the participants were not currently married and 12.9% were unable to read and write. The magnitude of post-abortion contraceptive utilization was 65.8%. The number of alive children (adjusted odds ratio: 7.0, 95% confidence interval: 1.54, 31.95), lower income (adjusted odds ratio: 0.14, 95% confidence interval: 0.03, 0.60), and (adjusted odds ratio: 0.11, 95% confidence interval: 0.02, 0.46), primary school education (adjusted odds ratio: 0.18, 95% confidence interval: 0.03, 0.97), and currently unemployed (adjusted odds ratio: 0.23, 95% confidence interval: 0.06, 0.85) were significantly associated with the post-abortion contraceptive utilization. Conclusion: The level of post-abortion contraceptive utilization is low as per the national plan. The number of alive children, lower income, lower education, and currently unemployed were the identified factors affecting post-abortion contraceptive utilization. Therefore, a collaborative effort is needed among stakeholders to increase the utilization and avoid factors that prevent the utilization of post-abortion contraceptive utilization.

Delay in Healthcare-Seeking Behavior and its Associated Factors among Tuberculosis Patients Attending TB Clinic in Hawassa City Health Facilities in Sidamma Region, Hawassa Ethiopia, 2022

Tuberculosis (TB) is a major public health concern throughout the world, particularly in low- and middle-income countries. Patient delay in seeking TB care is one impediment to sustainable development goals. There is limited data on patient delays seeking health care in the study area.

Depression, anxiety and their associated factors among patients with tuberculosis attending in Gondar city health facilities, North West Ethiopia

IntroductionDepression and anxiety are the most prevalent mental disorders in the general population and are expected to be the number one global burden of disease by the year 2030. They are also common comorbid conditions for patients with tuberculosis.ObjectiveThis study aimed to assess the prevalence of symptoms of depression, and anxiety and their associated factors among patients with tuberculosis attending Gondar city health facilities.MethodsAn institution-based cross-sectional study was conducted from September 01 to 30/2020. A census sampling technique was employed to select 390 patients. A structured interviewer-administered questionnaire was used to collect data, and a standardized hospital anxiety and depression scale was used to measure the symptoms of anxiety and depression. Data were entered in Epi-Info version 7 and analyzed using SPSS version 23. Binary and multivariable logistic regressions were computed to identify factors associated with the symptoms of depression and anxiety. P-value < 0.05 and adjusted odds ratios were used to declare the significance and strength of the association.ResultsThe overall prevalence of symptoms of depression and anxiety were found to be 35.8% with 95% CI (34.6, 36.6). Perceived stigma and duration of illness > 12 months were associated positively ([AOR = 3.60; 95% CI (2.74, 4.43)], and [AOR = 3.19; 95% CI (2.17, 4.19)]) for both depression and anxiety respectively. Separate analyses revealed that the prevalence of symptoms of depression was 55.9% (95% CI (51.0%, 60.3%) and was significantly associated with duration of illness 4–6 months and > 12 months (AOR = 1.21; 95% CI (1.17, 2.73)] and [AOR = 2.36; 95% CI (2.16, 3.79)], comorbid chronic disease (AOR = 0.12; 95% CI (0.08, 0.91)] and perceived stigma [AOR = 0. The prevalence of anxiety symptoms was 39.5 percent, with 95% confidence intervals of 34.6% and 44.6%, and it was significantly associated with comorbid chronic disease [AOR = 2.53; 95% CI (1.96, 6.32)] and perceived stigma [AOR = 3.31; 95% CI (1.22, 7.74)].ConclusionThe prevalence of symptoms of depression and anxiety was high. Duration of illness, comorbid chronic disease, and perceived stigma were significantly associated with symptoms of depression. Comorbid chronic disease and perceived stigma were significantly associated with symptoms of anxiety.

Determinants of adherence to anti-TB treatment and associated factors among adult TB patients in Gondar city administration, Northwest, Ethiopia: based on health belief model perspective

BackgroundAdherence is crucial in treating Tuberculosis to achieve the required treatment success rate. However, due to the longer treatment duration, adherence to Tuberculosis treatment is the most challenging factor affecting Tuberculosis control. Furthermore, although several studies have reported the determinants of Tuberculosis treatment adherence, few of them have used Health Belief Model (HBM) as the guiding principle to determine the individual perception of health-related decisions as much or more than medical concerns with Tuberculosis treatment adherence. Therefore, this study aims to assess adherence to anti-Tuberculosis treatment and associated factors among adult Tuberculosis patients in Gondar city, Northwest Ethiopia, in 2020.MethodsInstitution-based cross-sectional study was conducted among Tuberculosis patients following anti-Tuberculosis treatment in Gondar city health facilities from February 20 to March 26, 2020. A total of 265 Tuberculosis patients were selected by systematic random sampling techniques that include patients who were on treatment follow up for ≥ 1 month and whose age is ≥ 18 years. Data were collected by trained data collectors using interviewer administer and structured questionnaires. EPI DATA version 4.2 was used for data entry and SPSS version 24 for analysis. The logistic regression model was used to indicate the association between independent variables with adherence to anti Tuberculosis treatment.ResultsThe overall rate of adherence to anti-Tuberculosis treatment was 90.6% within the last 4 weeks and 96.6% within the last 4 days. Multivariable analysis revealed that having treatment supporter [AOR = 3.51, 95% CI (1.15, 10.75)], difficulties in taking TB drugs regularly [AOR = 0.07, 95% CI (0.01, 0.31)], perceived benefit [AOR = 3.45, 95% CI (1.07, 11.08)] and perceived self-efficacy [AOR = 0.22, 95% CI (0.07, 0.63)] were independently associated with adherence to anti-Tuberculosis treatment.ConclusionThe treatment adherence rate of the patients was low in the last month before the data survey. Treatment supporters, difficulties in taking anti Tuberculosis drugs regularly, perceived benefit, and perceived self-efficacy were identified as affecting adherence to anti-TB treatment.

Breastfeeding and breastmilk substitute use and feeding motivations among mothers in Bandung City, Indonesia.

Suboptimal breastfeeding is common in Indonesia, with only half of infants 0–5 months of age exclusively breastfed and feeding of breastmilk substitutes (BMS) highly prevalent among infants and toddlers. Various factors influence these feeding practices, including social norms, limited health system support and BMS manufacturer marketing practices. This cross‐sectional survey aimed to identify the prevalence of breastfeeding and BMS feeding among children aged 0–35 months, explore socio‐demographic characteristics and motivating factors associated with these feeding behaviours and identify the prevalence of mothers' exposure to BMS promotions. Indonesian mothers of children <3 years of age (n = 595) were interviewed in Bandung City health facilities using structured questionnaires. Although all children were ever breastfed, half of children across all age groups received BMS in the previous day. Maternal employment outside the home and insufficient breastmilk production were associated with BMS use. The most important motivational factors for feeding BMS were perceived benefits for growth, intelligence and immunity. Despite Indonesian legislation restricting some BMS marketing, 93% of mothers reported observing a BMS promotion outside the health system, with television, social media and newspapers as the most common sources. Half of mothers (43%) reported observing a BMS promotion within the health system, and half (46%) reported receiving recommendations from health workers to use BMS. Such high prevalence of BMS marketing may be influencing caregivers' feeding choices; stronger national legislation and implementation of laws are needed to ensure mothers' ability to make feeding choices free from manufacturer influence.

Magnitudes of post-abortion family planning utilization and associated factors among women who seek abortion service in Bahir Dar Town health facilities, Northwest Ethiopia, facility-based cross-sectional study.

Globally an estimated 55.9 million abortions occur each year. The majority of abortions occur due to unintended pregnancies, which is a result of the non-use of family planning methods. World health organization recommends all clients to utilize modern contraceptive methods after any abortion procedure. However, post-abortion family planning utilization is still low in Ethiopia including the study area. Therefore, this study was expected to determine the utilization of post-abortion family planning and associated factors in Bahir Dar city health facilities in Northwest Ethiopia. Institution based cross-sectional study was conducted among 408 women from March 1 to April 30, 2019. Data were collected through face-to-face interview using a structured and pre-tested questionnaire. Systematic random sampling was used to select the study participants. Data were cleaned, coded, and entered into epi data and exported to SPSS for further analysis. Both bivariable and multivariable logistic regression were employed. Those variables that had a p-value of less than 0.2 during the bivariate analysis were retained for the multivariable analysis. P-value and confidence interval were used to measure the level of significance on multi-variable analysis and those variables whose P-value, less than 0.05 was considered as statistically significant. The finding of this study showed that the magnitude of post-abortion family planning (PAFP) utilization was 61% with 95% CI (55, 65). Secondary education level(AOR, 4.58; 95% CI (1.96, 10.69)), certificate and above education level (AOR, 3.06; 95% CI (1.32, 7.08)), Manual Vacuum Aspiration(MVA) (AOR, 7.05; 95% CI (2.94, 16.90)), both medication and Manual Vacuum Aspiration (AOR, 5.34; 95% CI (2.56, 11.13)) and received Post Abortion Family Planning (PAFP) counseling (AOR, 5.99; 95% CI (3.23, 11.18)) were significantly associated with PAFP utilization. Post-abortion family planning utilization in Bahir Dar health facilities was low compared with the national figure. Secondary and above educational level, respondents who were managed by Manual Vacuum Aspiration (MVA), both Manual Vacuum Aspiration (MVA) and medication and receiving Post Abortion Family Planning (PAFP) counseling were predictors of post-abortion family planning service utilization.

PENGELOMPOKAN KABUPATEN-KOTA DALAM PRODUKSI DAGING TERNAK DI JAWA TENGAH TAHUN 2016 -2018 MENGGUNAKAN METODE MULTIDIMENSIONAL SCALING

Animal husbandry is very important for the development of the welfare of the people of Central Java.the geographical conditions, Central Java is a suitable place to do livestock activities.Because of the increasing needs of livestock meat on the market, empowerment of livestock can be used as a livelihood to improve the economy of Central Java Comunity. This research is aimed at mapping the production of livestock meat in cities in Central Java both rural and urban areas. This study aimed to map existing health facilities in cities in West Java. The results of the analysis conducted by using Multidimensional Scaling analysis shows how grouping the cities in Central Java by its production of livestock meat. From the mapping of the cities there are three groups that have similarities among its members but different from the other groups.Each group formed have similar characteristics of a number of production of livestock meat.

Maternal satisfaction among vaginal and cesarean section delivery care services in Bahir Dar city health facilities, Northwest Ethiopia: a facility-based comparative cross-sectional study

BackgroundMothers’ delivery care satisfaction is one of the indicators to monitor the quality of health care provision. However, there is only limited information in this regard in Ethiopia, particularly in the study area. Therefore, the study aimed to determine the level of maternal satisfaction and the determinants among vaginal and cesarean section delivery care in Bahir Dar city health facilities.MethodsFacility-based comparative cross-sectional study was conducted from April to May 2018. Using systematic random sampling, a total of 896 recently delivered mothers were interviewed. The collected data were entered into the Epi-Data soft and then exported to SPSS Version 20.0 for analysis. Descriptive statistics were computed and Logistic regression model was used to identify the association between explanatory and outcome variables. Adjusted Odds Ratio with 95% CI was used to measure the strength of the association between these variables. The model fitness was checked using Hosmer and Lemeshow goodness of fit (P > 0.05). A p-value < 0.2 at bivariate analysis was considered for variables to be candidates for multivariable logistic regression analysis. Variables with a p-value of < 0.05 at multivariate analysis were considered as statistically significant predictors of mothers’ satisfaction.ResultsA total of 894 recently delivered mothers participated in the study yielded a response of 99.8%. 448 (50.1%) mothers delivered vaginally whereas 446 (25.8%) via cesarean section. The overall mean age of respondents was 26.60 (± 4.88) years. The total maternal delivery care service satisfaction level was 61.4%. More mothers were satisfied with vaginal delivery care, 65.6% (95% CI: 56.97, 74.22%) than cesarean section, 57.2% (95% CI: 48.19, 66.2%). Maternal education, residence, current delivery care planned, maternal HIV status, the gender of health care provider and gave birth in a private health facility were significantly associated with vaginal delivery care satisfaction. Whereas, maternal education, residence, current delivery care planned, antenatal care attended, gender of health care provider was significantly associated with cesarean section delivery care satisfaction.ConclusionsThe overall maternal delivery care service satisfaction level was low as, per the national standard, and there is a great discrepancy in maternal satisfaction level between vaginal and cesarean section delivery care services.

Utilization and outcomes of cervical cancer screening services in Harare City, 2012\u20132016: a secondary data analysis

BackgroundVisual inspection with acetic acid and cervicography (VIAC) is a method used to screen for cervical cancer. VIAC can be used as part of a “see and treat” strategy. Nine Harare city council health facilities offer VIAC free of charge with the aim of reducing morbidity and mortality from cervical cancer. Between 2014 and 2016, the number of women utilising VIAC dropped by 35%. We analysed records of clients who utilise VIAC at Harare city health facilities to characterise women accessing VIAC and their outcomes to make recommendations for improving the services.MethodsWe conducted a descriptive cross-sectional study using data collected for the Harare city VIAC program. We analysed all records of clients who utilised VIAC services at nine Harare city health facilities from 1 May 2012 to 31 December 2016.ResultsWe analysed 46,217 records, the median age of the clients was 34 years [Q1 = 27: Q3 = 42]. Of the 46,217 clients screened, 3001 (6.5%) were VIAC positive, and 512 (1.1%) had suspicious of cancer lesions. The prevalence of VIAC positive ranged from 58 to 74 per 1000-screened clients over the 5 years. The prevalence of suspected cancer ranged from 9 to 14 per 1000-screened clients, and there was a general decrease in the prevalence between 2012 and 2016. Of the 3513 clients with VIAC positive or had suspicious of cancer lesions, 2090 (74.1%) did not receive treatment at the site where the screening took place.ConclusionThe majority of women who are accessing VIAC services in Harare are middle-aged, multiparous and married women. There is a treatment gap at most of the VIAC centres such that clients are referred to other centres for management. The objective of “see and treat” is not being realised.

Spatial distribuition of tooth loss in a population of adults

ABSTRACT Introduction: Although there has been an improvement in the oral health status of the population, tooth loss still aggravates the oral health of adults and is a matter of great relevance to dentistry. Aim: To determine the spatial distribution of tooth loss in adults and correlate this with the Social Exclusion Index and proximity to public dental services. Material and Method: This ecological study was based on epidemiological data of adults from Piracicaba municipality and from the Piracicaba Research and Planning Institute (IPPLAP). Data on dental evaluations were extracted from the Piracicaba epidemiological survey, which was a cross-sectional study with probabilistic sampling of 248 adults aged 20-64 years, representative of adults living in Piracicaba, Brazil. Oral examinations of the DMFT index were in accordance with the World Health Organization codes and criteria and were performed by a single examiner calibrated for this purpose. Data on social exclusion and the municipal health units that have dental services were extracted from IPPLAP. Georeferencing was performed of census tracts selected by draw, and the city health facilities that have dental services. For Spearman correlation analysis (p &lt;0.05), we used the mean value of teeth lost per district, the Social Exclusion Index (IEX), and proximity to public dental service categorized according to radius: &lt;500m, between 500-1000m, and &gt;1000m the census tract. Result: There was a correlation between tooth loss and higher IEX, and r=−0.51 (p=0.01), but no correlation with proximity to public dental services (p=0.42). Conclusion: Tooth loss in adults was distributed according to social exclusion, however, it was unrelated to proximity to the public dental services.

Burden of congenital inguinal hernia and hydrocele in northern and southern Nigeria: an opportunity for awareness creation.

Nigeria, with a population of >150 million people in which half of the population are children encounters challenges in paediatric surgery practice in rural areas. There are paediatric surgeons in Nigeria, but majority practice in tertiary health facilities in cities. The poor rural dwellers have little or no access to such highly trained specialists. Hence, children with congenital and acquired paediatric surgical pathologies including anterior abdominal wall defects not only grow up with these diseases to adulthood, they are also exposed to various health hazards posed by unqualified personnel. Therefore, we are evaluating the burden of congenital inguinal hernia/hydrocele in northern and southern Nigeria for awareness creation and the way forward. Data obtained from organised free hernia missions to the rural populace from northern and southern Nigeria by the West African Collage of Surgeons in 2010 and Kano State Government in 2013 was analysed. A total of 811 patients aged from 3 months (0.25 years) to 35 years was screened and found to have congenital hernia and/or hydrocele from the two centres. 171 (21.1%) were successfully operated, while the remaining 640 (78.9%) could not benefit from a surgical procedure during the missions. There were n = 46 (26.9%) patients with various forms of genital mutilations/and or surgical mismanagements among the operated patients. The burden of congenital anterior abdominal wall defects among Nigerian children is high. A little effort could bring succor and create awareness among this group of people.