Health Facility Factors Research Articles

Prenatal hepatitis B screening and associated factors in a high prevalence district of Lira, northern Uganda: a community based cross sectional study

BackgroundChronic hepatitis B Virus (HBV) infection affects 80–100 million people in sub-Saharan Africa and accounts for an estimated 650,000 deaths annually. The prevalence of active hepatitis B virus infection among women aged 15–64 in mid-Northern Uganda is about 5%. Lira district is among the high prevalence areas where government embarked on mass HBV screening since 2015 as a gateway for access to prevention, treatment services, and an effective response to the hepatitis B epidemic. The current proportion of pregnant women screened and the factors associated with prenatal HBVscreening in Lira are not known despite the fact that women contribute largely to both vertical and horizontal transmission of HBV. This study aimed at determining the proportion of pregnant women screened for HBV and factors associated with prenatal HBV screening in Lira district.MethodsThis was a community based cross sectional study conducted among 423 pregnant women in the sub counties of Aromo and Agweng in Lira district. Data were collected using open data kit and analysed using STATA version 14. The outcome variable was prenatal HBV screening while predictor variables were community, individual and health facility factors associated with HBV screening. Multivariable logistic regression was used to determine factors associated with prenatal HBV screening.ResultsThirty five women (8.3%) had been screened for HBV during the current pregnancy. Factors associated with prenatal HBV screening in Lira included perceived risk (Adjusted Odds Ratio (AOR) 3.78, 95% CI 1.01–6.14), respondent’s age (AOR = 3.98, 95% CI 1.39–5.09), husband/partner’s education (AOR = 3.34, 95% CI 1.10–5.12) and past failure to access to HBV screening services at government health facilities (AOR = 6.44, 95% CI 2.10–8.02).ConclusionThe level of HBV screening among pregnant women in Lira was low and is mainly associated with perceived risk, age, access to HBV screening services and spousal education level. More effort is needed in creating mass awareness on the need and importance of HBV screening most especially among pregnant women.

Extent of medicines wastage and its contributing factors in public health facilities of south west Shoa Zone, Oromia Regional State, Ethiopia: a cross-sectional survey

Medicine wastage is a longtime problem of public health facilities in Ethiopia. However, evidence on the extent and type of wastage as well as its contributing factors are limited. Therefore, the aim of this study was to determine the extent of medicine wastage and identify its contributing factors in public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia. A cross-sectional survey was conducted in 10 public health facilities (1 hospital and 9 health centres). The value (i.e. the buying price), types and sources of wasted medicines were collected from records of medicines wastage, disposal report, commercial invoices and bin cards. And, the results are summarized using descriptive statistics. In terms of monetary value, the three years (2012/13-2014/15) wastage was estimated to be 500,522.10 (7.5%) Ethiopian Birr (ETB). Of the 144 items (by generic name) wasted, oral rehydration salt 245 osml/l powder (6.3%), metronidazole 250 mg capsule (4.1%), and tetracycline 250 mg capsules (3.2%) were the top three items by value. Anti-infectives (39.1%), medicines used for correcting water, electrolyte and acid-base balance (12.9%) and gastro intestinal acting medicines (10.6%) were also the top three therapeutic classes of medicines with high wastage rate. The main contributing factors identified for medicine wastage are: supplier’s delivery of near expiry date medicines, lack of a system to exchange nearly expired medicines from one facility to another, absence of electronic stock management tools and shortage of pharmacy professionals in the health facilities. In conclusion, the extent of medicine wastage in public health facilities decreased over the three consecutive years. However, the extent of the problem was still very high compared to the national target. A platform that facilitates communication among key supply chain actors should be devised to make informed decision including redistribution of overstocked and near expired products to less stocked and high consumption areas.Keywords: medicines wastage, wastage rate, expired medicines, contributing factors, Ethiopia

Adolescent Sexual Reproductive Health Services in Bindura Urban of Zimbabwe

This study seeks to understand the capacity of adolescent-friendly reproductive health services (AFRHS) in promoting sexual reproductive health (SRP) among adolescents in Bindura Urban of Zimbabwe. The data collection methods used allowed the researcher to get insight on adolescents' experience and the factors associated with their accessing SRH services from AFRHS, the meaning of AFRHS for adolescents, healthcare providers' attitudes towards adolescents seeking SRH services, and community perceptions and readiness to accept AFRHS. The findings showed that both socio-cultural and health facility factors influence utilisation of SRH services. Many of these factors stem from the moral framework encapsulated in socio-cultural norms and values related to the sexual health of adolescents and healthcare providers' poor value clarification. This study provides an empirical understanding of the reasons and factors associated with SRH service utilisation, which goes much deeper than program provision of AFRHS in Zimbabwe.

Factors Associated with Delayed Initiation of Breastfeeding Among Hospital Deliveries: Secondary Analysis of Bangladesh Demographic and Health Survey 2014 (P18-107-19)

ObjectivesThis study investigates the factors associated with delayed initiation of breastfeeding among hospital deliveries in Bangladesh, where only 50% women initiate breastfeeding within the 1st hour of birth and the rate is lower among deliveries at a health facility (38%). Early initiation of breastfeeding is crucial in improving maternal and newborn health outcomes. MethodsWe used data from the 2014 Bangladesh demographic and health survey. A total of 1277 last-born children born at a health facility in the 2 years preceding the survey were included in this analysis. ‘Early’ breastfeeding was defined using WHO recommendations as initiating within 1st hour of birth. Univariate and multivariable logistic regression were performed to determine factors associated with delayed initiation. ResultsAbout three-fifth (n = 785, 62%) of the children born at a health facility delayed initiation of breastfeeding beyond the first hour. After adjusting for potential confounders, delayed initiation was found to be more common among caesarean deliveries (aOR 3.31; 95%CI 2.38–4.61), delivery by medically un-trained personnel (aOR 1.57; 95%CI 1.02–2.42), delay in first postnatal check-up after birth (aOR 1.61; 95%CI 1.17–2.21), and women exposed to media less than once a week (aOR 1.57; 95%CI 1.09–2.26). Women with higher body mass index had an increased likelihood of delaying initiation (aOR 1.05; 95%CI 1.01–1.10). Multiparous women were less likely to delay initiation (aOR 0.72; 95%CI 0.53–0.98). ConclusionsDelayed initiation following caesarean deliveries continues to be a challenge but several other health facility factors and maternal characteristics also contributed to delayed initiation of BF. Interventions to promote early breastfeeding initiation should include strengthening the capacity of healthcare providers to encourage early initiation especially for caesarean deliveries. Funding SourcesEndeavour Postgraduate Scholarship. Supporting Tables, Images and/or Graphs▪

Women\u2019s perspectives on health facility and system levels factors influencing mode of delivery in Tehran: a qualitative study

BackgroundIran has one of the highest national caesarean section rates worldwide. Few studies explored in-depth the health-facility and health-system level factors that affect women’s choices on mode of delivery in Iran. The aim of this study was to explore the health-facility and health-system level factors affecting women’s preferences on mode of delivery in Tehran.MethodsWe conducted a qualitative study using in-depth face-to-face interviews with women between October 2017 and May 2018. Study participants were sampled purposively from a range of health service settings to include women of varying experiences regarding childbirth. Eligibility criteria were Persian-speaking, women with or without childbirth experiences. All interviews were audio-recorded and lasted 30–45 min. After verbatim transcription of the interviews, we created a preliminary thematic framework to analyze the data. A combined inductive (themes emerging from the data) and deductive (key concepts across existing frameworks) approach was used during data analysis.ResultsIn total, 26 in-depth interviews were conducted. Five central themes influencing women’s preferences on mode of delivery emerged from the analysis: (1) health system conditions (important differences between the quality of care provided at private and public hospitals; staff shortages, skills, competency, motivation and also accessibility to staff during the longer time required for a vaginal delivery; policies and protocols on vaginal birth after cesarean, pain relief for vaginal birth, and having companion during labor; (2) standards of care in facilities (physical condition in facilities; physical examinations and procedures; continuous and organized care; ethics); (3) interaction between women and providers (communicating in a supportive manner with women and communication women’s partners/families); (4) preserving women’s dignity (delivering high quality and respectful care); (5) provision of information (education about pregnancy and childbirth including environment in facility, labor processes/procedures, and the risks and benefits of both vaginal delivery and caesarean section).ConclusionsOur study suggests, there are barriers to increasing demand for and satisfaction with vaginal birth, such as women’s perceived sub-optimal quality of care during labor and birth, understaffed facilities that lack standard protocols and have limited physical space, and lack of privacy and dignity. The multifactorial nature of the increase of unnecessary Cesarean section calls for multicomponent interventions to revert this trend. These interventions need to address the health-systems’ and health-facilities’ deficiencies behind women’s preference for Cesarean section.

Low uptake of postnatal care services in northern Tanzania

Background: High maternal and neonatal mortality is still a challenge in Tanzania. Postnatal care services are highly recommended to prevent these deaths; however, uptake of the services is unsatisfactory. Studies on health facility factors related to low use of postnatal care are also limited. Aims: To determine health facility factors that contribute to the low uptake of postnatal care services in 43 primary care facilities of Misungwi District, Tanzania. Methods: A validated checklist with secondary data from health facility records was used in data collection, which took place between April and June 2016. Findings: Findings showed that 40.6% of 2648 women who gave birth at the facilities returned for postnatal care. Inadequate numbers of midwives, medicines, beds and laboratory facilities were found. Conclusions: There is an urgent need to deploy midwives and improve non human resources for better maternal and infant outcomes.

Availability of Lifesaving Maternal and Child Health Commodities and Associated Factors in Public and Private Health Facilities of Addis Ababa, Ethiopia.

Background:Inaccessible, unaffordable, and poor quality care are the key underlying reasons for the high burden of maternal and child morbidity and mortality in low- and middle-income countries.Objective:To assess the availability of lifesaving maternal and child health (MCH) commodities and associated factors in public and private health facilities of Addis Ababa, Ethiopia, 2016.Methods:Institutional-based, descriptive cross-sectional study was carried out in the selected health facilities (29 publics and 6 private) in Addis Ababa. The data were collected through pretested, structured questionnaire, and in-depth interviews. For the quantitative analysis, data were analyzed using SPSS version 20 statistical software, SPSS Inc. Descriptive statistics were used to summarize the variables, and the Spearman correlation test was run to determine the predictors of the outcome variables. For the qualitative data, the data were handled manually and transformed into categories related to the topics and coded on paper individually in order to identify themes and patterns for thematic analysis.Result:The overall availability of the lifesaving MCH commodities in the health facilities was 74.3%. There is a moderate, positive association between the availability of lifesaving MCH commodities with the adequacy of budget (rs = 0.485, P < .001), use of more than 1 selection criteria during selection (rs = 0.407, P = .015), and training given to health facilities on logistics management (rs = 0.490, P = .003).Conclusion:The availability of the lifesaving MCH commodities in the health facilities was within the range of fairly high to high. Adequacy of budget, use of more than 1 selection criteria during selection, and training given on logistics management were the predictors of the availability of the commodities.

FACTORS INFLUENCING ANTENATAL CARE UTILIZATION IN ETHIOPIA: A SYSTEMATIC REVIEW

ABSTRACT BACKGROUND Maternal death is a major public health problem in Ethiopia. Antenatal care (ANC) utilization is believed to promote the uptake of obstetric care services and hence improve maternal health. But ANC coverage is low and reviews on determinants of utilization are lacking in Ethiopia.OBJECTIVE Synthesize evidence on factors influencing ANC utilization in Ethiopia. METHODOLOGY Relevant articles were searched electronically, filtered and quality assessed. Factors were categorized using a conceptual framework adapted from Anderson’s model and bio-behavioural modelling in health care utilization. RESULTS Twenty-five studies were reviewed. Maternal education, place of residence, family income, husband’s approval, media exposure, pregnancy intention and previous bad obstetric history were the major individual factors affecting ANC utilization. The only health service factor was distance of a health facility. Most of the studies lack standardized outcome measures which could differentiate between non-use verses inadequate use of ANC. Only a single study used conceptual framework. Other important individual factors such as women’s autonomy, cultural beliefs, social networks and health facility factors such as quality, waiting time, and service fee were not examined. No study identified consumer satisfaction as a factor affecting ANC use. CONCLUSIONS AND RECOMMENDATIONS Comprehensive data on factors influencing ANC utilization is lacking in Ethiopia. The measurement of ANC utilization should be standardized and factors should be segregated into those influencing initiation verses adequate use of ANC. Programs intended to improve ANC utilization should focus on women’s education; promote planned pregnancy; target the underprivileged and expand their scope to involve partners in ANC provision. KEY WORDS: antenatal care, prenatal care, utilization, maternal health, factors, systematic review, Ethiopia(Ethiopian Journal of Reproductive Health 2018; 10; 3: 25-37)

Utilization of hospital services during delivery among post-natal mothers in Thika urban and Kangundo rural Counties, Kenya

Background: Maternal mortality rate due to pregnancy-related complications in Kenya remains high at 362 per 100,000 live births. Hospital deliveries are low despite government strategies on improving health system and human resources. Home delivery practice is common in many parts of Kenya, especially in the rural areas. Generally, midwifery in home delivery lacks the necessary expertise to identify, resolve or prevent maternal complication, a situation which could raise maternal delivery related morbidity and mortality rates.&#x0D; Objectives: The study aimed to determine the rates of hospital deliveries both in urban and the rural hospital settings and establish the factors that determined the choice for hospital services.&#x0D; Methods: The study population was composed of post-natal mothers attending Maternal Child Health Clinics in an urban hospital setting and a rural hospital setting. The mothers were those who had delivered less than one year earlier. Thika Level 5 Hospital in Kiambu County represented the urban setting while Kangundo Level 4 Hospital represented the rural setting. A total of 400 post-natal mothers in each of the two hospitals were interviewed using a structured questionnaire to collect the relevant data in each hospital. Focus Group Discussions and Key informants interviews were also conducted in each hospital.&#x0D; Results: Client specific factors that were associated with hospital delivery included a steady source of income and occupation (p = 0.028, p = 0.007), ability to pay for hospital expenses and remedies (p = 0.000, p = 0.00), accessibility and short distance from the health facility (p= 0.001, p = 0.029), and client having a positive experience from a previous delivery and hope for a better services in the hospital (p = 0.000, p = 0.000) respectively. Health facility factors were lack of privacy (p = 0.000) manner in which the mother was handled by the health care worker (p = 0.0901) and the expected care (p =0.017).&#x0D; Conclusion: The study concludes that mothers fail to utilize the health facility for delivery due to service related factors such as long distance from the hospital, negative attitude of health workers, lack of privacy and poor quality of care, an improvement of which will make them deliver in hospitals and not at home.

Spinning plates: livelihood mobility, household responsibility and anti-retroviral treatment in an urban Zambian community during the HPTN 071 (PopART) study.

IntroductionQualitative data are lacking on the impact of mobility among people living with HIV (PLHIV) and their decision‐making around anti‐retroviral treatment (ART). We describe challenges of juggling household responsibility, livelihood mobility and HIV management for six PLHIV in urban Zambia.MethodsSix PLHIV (three men and three women, aged 21 to 44) were recruited from different geographic zones in one urban community drawn from a qualitative cohort in a social science component of a cluster‐randomized trial (HPTN071 PopART). Participants were on ART (n = 2), not on ART (n = 2) and had started and stopped ART (n = 2). At least two in‐depth interviews and participant observations, and three drop‐in household visits with each were carried out between February and August 2017. Themed and comparative analysis was conducted.ResultsThe six participants relied on the informal economy to meet basic household needs. Routine livelihood mobility, either within the community and to a nearby town centre, or further afield for longer periods of time, was essential to get by. Although aware of ART benefits, only one of the six participants managed to successfully access and sustain treatment. The other five struggled to find time to access ART alongside other priorities, routine mobility and when daily routines were more chaotic. Difficulty in accessing ART was exacerbated by local health facility factors (congestion, a culture of reprimanding PLHIV who miss appointments, sporadic rationed drug supply), stigma and more limited social capital.ConclusionsUsing a time‐space framework illustrated how household responsibility, livelihood mobility and HIV management every day were like spinning plates, each liable to topple and demanding constant attention. If universal lifelong ART is to be delivered, the current service model needs to adjust the limited time that some PLHIV have to access ART because of household responsibilities and the need to earn a living moving around, often away from home. Practical strategies that could facilitate ART access in the context of livelihood mobility include challenging the practice of reprimand, improving drug supply, having ART services more widely distributed, mapped and available at night and weekends, and an effective centralized client health information system.

Knowledge, practice and associated factors of infection prevention among healthcare workers in Debre Markos referral hospital, Northwest Ethiopia

BackgroundHealthcare-associated infections are a major global public health agenda. Health care workers are front line of protecting themselves and clients from infection. This study examined the knowledge and practice of healthcare workers on infection prevention and its associated factors among health professionals working at Debre Markos Referral Hospital.MethodsA Hospital-based cross-sectional study was conducted with a structured pre-tested questionnaire among 150 participants. The healthcare workers were selected through systematic random sampling technique. Multivariate logistic regressions were computed to identify associated factors of knowledge and practice of infection prevention and variables with a p-value < 0.05 were considered statistically significant.ResultsMore than two thirds (84.7%) of healthcare workers were found to be knowledgeable but only 86 (57.3%) of respondents demonstrated a good practice on infection prevention. Older age, lengthy work experience and higher educational status were significantly associated with both knowledge and practice of infection prevention. In-service training, availability of infection prevention supplies and adherence to infection prevention guidelines was also associated with the practice of infection prevention.ConclusionsThe finding of this study revealed a good knowledge of infection prevention on the majority of participants with relatively minimal practice rate. Sociodemographic factors and health facility factors were associated with knowledge and practice of infection prevention. Hospitals and other concerned stakeholders should ensure constant availability of guidelines and the provision of training to health providers. Moreover, developing professionals’ educational level, introducing infection prevention standard of practice and continuous mentorship was recommended.

Adverse selection and supply-side factors in the enrollment in community-based health insurance in Northwest Ethiopia: A mixed methodology.

Since 2010, the Ethiopian government introduced different measures to implement community-based health insurance (CBHI) schemes to improve access to health service and reduce the catastrophic effect of health care costs. The aim of this study was to examine the determinants of enrollment in CBHI in Northwest Ethiopia. In this study, we utilized a mix of quantitative (multivariate logistic regression applied to population survey linked with health facility survey) and qualitative (focus group discussion and in-depth interview) methods to better understand the factors that affect CBHI enrollment. The study revealed important factors, such as household, informal association, and health facility, as barriers to CBHI enrollment. Age and educational status, self-rated health status, perceived quality of health services, knowledge, and information (awareness) about CBHI were among the characteristics of individual household head, affecting enrollment. Household size and participation in an informal association, such as local credit associations, were also positively associated with CBHI enrollment. Additionally, health facility factors like unavailability of laboratory tests were the main factor that hinders CBHI enrollment. This study showed a possibility of adverse selection in CBHI enrollment. Additionally, perceived quality of health services, knowledge, and information (awareness) are positively associated with CBHI enrollment. Therefore, policy interventions to mitigate adverse selection as well as provision of social marketing activities are crucial to increase enrollment in CBHI. Furthermore, policy interventions that enhance the capacity of health facilities and schemes to provide the promised services are necessary.

Challenges faced in rural hospitals: the experiences of nurse managers in Uganda.

The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda. The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff. This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study. Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: 'Numbers do matter'; 'I cannot access them when I need them at work'; 'Challenges in dealing with negative attitudes'; and 'Questioning own ability to manage health services'. Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff. Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development. It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development.

What influences where they seek care? Caregivers' preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment.

Access to and utilisation of quality healthcare promotes positive child health outcomes. However, to be optimally utilised, the healthcare system needs to be responsive to the expectations of the population it serves. Health systems in many sub-Saharan African countries, including Malawi, have historically focused on promoting access to health services by the rural poor. However, in the context of increasing urbanisation and consequent proliferation of urban slums, promoting health of children under five years of age in these settings is a public health imperative. We conducted a discrete choice experiment to determine the relative importance of health facility factors in seeking healthcare for childhood illnesses in urban slums of Malawi. Caregivers of children under five years of age were presented with choice cards that depicted two hypothetical health facilities using six health facility attributes: availability of medicines and supplies, thoroughness of physical examination of the child, attitude of health workers, cost, distance, and waiting time. Caregivers were asked to indicate the health facility they would prefer to use. A mixed logit model was used to estimate the relative importance of and willingness to pay (WTP) for health facility attributes. Attributes with greatest influence on choice were: availability of medicines and supplies (β = 0.842, p<0.001) and thorough examination of the child (β = 0.479, p <0.001) with WTP of MK3698.32 ($11) (95% CI: $8–$13) and MK2049.13 ($6) (95% CI: $3–$9) respectively. Respondents were willing to pay 1.8 and 2.4 times more for medicine availability over thorough examination and positive attitude of health workers respectively. Therefore, strengthening health service delivery system through investment in sustained availability of essential medicines and supplies, sufficient and competent health workforce with positive attitude and clinical discipline to undertake thorough examination, and reductions in waiting times have the potential to improve child healthcare utilization in the urban slums.

Antiretroviral therapy clinic attendance among children aged 0-14 years in Kahama district, Tanzania: a cross-sectional study

Background: Efforts made to scale up care and treatment for HIV in Tanzania have started to pay off. The number of people living with HIV (PLHIV) who are on antiretroviral therapy (ART) has massively increased owing to an increase in investment made. However, this is not reflected in all populations, especially children living with HIV. This study, therefore, aims to determine the magnitude and factors associated with ART uptake among children living with HIV in Kahama district, Tanzania. Methods: This cross-sectional study was conducted among pairs of children aged 0-14 years and their caregivers. A total of 423 randomly selected caregivers of HIV-positive children were interviewed using a structured questionnaire. The outcome variable was ART uptake while independent variables constituted of socio-demographic, health facility, and systemic factors. Results : A total of 132 (31%) of all caregivers reported to have missed at least one clinic visit for their children during a period of three months before the survey. Of them, one in four missed at least two clinics. Caregivers cited factors such as lack of transport fare and distance to the health facility as barriers to attend the planned clinics. After adjusting for the important confounders and other covariates, factors associated with ART uptake were being divorced/widowed (AOR= 0.57, 95% CI; 0.33-0.97) and having primary education or more (AOR 0.30, 95% CI 0.11-0, 82). Conclusion: One in every three HIV-positive children miss their scheduled routine ART clinics in Kahama, Shinyanga. Tailored interventions should target caregivers of such children who are divorced or widowed and those with low or no education while addressing distance and transportation challenges in this and other areas with similar contexts.

The status of vaccine availability and associated factors in Tshwane government clinics.

Vaccines have greatly contributed to the control of vaccine-preventable diseases and to human development. Efforts by many countries to introduce new vaccines are a significant move towards achieving the sustainable development goal for health. However, effective vaccine supply chains that ensure an uninterrupted supply of vaccines are pivotal to attaining universal access to life-saving vaccines and sustainable development. The introduction of new vaccines puts a strain on supply chains; South Africa (SA) is no exception, as there are indications of vaccine stock-outs in clinics. To establish the status of vaccine availability and associated factors in government health facilities of Tshwane Health District in Gauteng Province, SA. A cross-sectional study was conducted in a sample of randomly selected government clinics in the Tshwane health district of Gauteng Province. Data were collected using a structured measurement instrument in participating clinics. Data were analysed using Excel-based software (Microsoft, USA). A total of 31 clinics participated. In the preceding 12 months, clinics had experienced vaccine stock-outs, especially of the three newer vaccines: pneumococcal conjugate vaccine, rotavirus and Pentaxim. These were also out of stock for a long duration; for over 2 weeks in a majority of clinics. The causes of vaccine stock-outs were: poor management of stock, district depot out of stock, unreliable deliveries, lack of pharmacy assistants and limited fridge capacity. Further burdening the situation is the ineffective emergency-ordering system. Significant shortages of vaccines, which are essential drugs, occur in Tshwane government clinics. Vaccine supply chain issues and vaccine shortages should be treated as a priority at all levels of the healthcare system; therefore, a similar study should be conducted at national level. It is recommended that the vaccine supply chain should be restructured and overhauled with the use of advances in technology and could be linked with current initiatives such as MomConnect.

Quality of Case Management for Pneumonia and Diarrhea Among Children Seen at Health Facilities in Southern Malawi.

Pneumonia and diarrhea are leading causes of child deaths in Malawi. Guidelines to manage childhood illnesses in resource-poor settings exist, but studies have reported low health-care worker (HCW) adherence to guidelines. We conducted a health facility survey from January to March 2015 to assess HCW management of pneumonia and diarrhea in children < 5 years of age in southern Malawi, and to determine factors associated with case management quality. Descriptive statistics and multivariable logistic regression models examined patient, HCW, and health facility factors associated with recommended pneumonia and diarrhea management, using Malawi's national guidelines as the gold standard. Of 694 surveyed children 2-59 months of age at 95 health facilities, 132 (19.0%) met survey criteria for pneumonia; HCWs gave recommended antibiotic treatment to 90 (68.2%). Of 723 children < 5 years of age, 222 (30.7%) had uncomplicated diarrhea; HCWs provided recommended treatment to 94 (42.3%). In multivariable analyses, caregivers' spontaneous report of children's symptoms was associated with recommended treatment of both pneumonia (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.2-6.8, P = 0.023) and diarrhea (OR: 24.2, 95% CI: 6.0-97.0, P < 0001). Malaria diagnosis was negatively associated with recommended treatment (OR for pneumonia: 0.5, 95% CI: 0.2-1.0, P = 0.046; OR for diarrhea: 0.3, 95% CI: 0.1-0.6, P = 0.003). To improve quality of care, children should be assessed systematically, even when malaria is suspected. Renewed efforts to invigorate such a systematic approach, including HCW training, regular follow-up supervision, and monitoring HCW performance, are needed in Malawi.

The magnitude and factors related to facility-based maternal mortality in Mozambique

Facility-based maternal mortality remains an important public health problem in Mozambique. A number of factors associated with health system functioning can be described behind the occurrence of these deaths. This paper aimed to evaluate the magnitude of the health facility-based maternal mortality, its geographical distribution and to assess the health facility factors implicated in the occurrence of these deaths. A secondary analysis was done on data from the survey on maternal health needs performed by the Ministry of Health of Mozambique in 2008. During the study period 2.198 maternal deaths occurred out of 312.537 deliveries. According to the applied model the availability of Maternal and Child Health (MCH) nurses performing Emergency Obstetric Care functions was related to the reduction of facility-based maternal mortality by 40%. No significant effects were observed for the availability of medical doctors, surgical technicians and critical delivery room equipment.Impact statementIs largely known that the availability of skilled attendants assisting every delivery and providing Emergency Obstetric Care services during the pregnancy, labor and Childbirth is key for maternal mortality reduction.This study add the differentiation on the impact of different cadres of health services providers working on maternal and child health services on the facility based maternal mortality. In this setting the study proven the high impact of the midlevel skilled maternal and child health nurses on the reduction of maternal mortality. Another important add from this study is the use of facility based maternal mortality data to inform the management process of maternal healthcare services.The findings from this study have potential to impact on the decision of staffing prioritization in setting like the study setting. The findings support the policy choice to improve the availability of maternal and child health nurses.

Factors influencing medical students' motivation to practise in rural areas in low-income and middle-income countries: a systematic review

ObjectivesThere is a shortage of doctors working in rural areas all over the world, especially in low-income and middle-income countries. The choice to practise medicine in a rural area is...

Factors Associated with Contraceptive Use among Women of Reproductive Age in Rural Districts of Burkina Faso.

Given the current low contraceptive use and corresponding high levels of unwanted pregnancies leading to induced abortions and poor maternal health outcomes among rural populations, a detailed understanding of the factors that limit contraceptive use is essential. Our study investigated household and health facility factors that influence contraceptive use decisions among rural women in rural Burkina Faso. We collected data on fertile non-pregnant women in 24 rural districts in 2014. Of 8,657 women, 1,098 used a modern contraceptive. Women having a living son, a child younger than one year, and household wealth were more likely to use modern contraceptives. Women in polygamous marriages and women living at least 5 kilometers from a health facility were less likely to use contraception. We conclude that modern contraceptive use remains weak, hence, programs aiming to encourage contraceptive use must address barriers at both the health facility and the household level.