Health Posts Research Articles

Determinants of successful transition from adolescent to adult HIV treatment in Zambia: a facility-level based comparative study

Background: Successful transition from adolescent to adult care has not been extensively evaluated, in Zambia. The study aimed to assess the relationship between facility-based socio-demographic traits and successful transition to adult HIV care, in Zambia. Methods: A retrospective descriptive cross-sectional analysis of 7275 patient files from 718 PEPFAR sponsored facilities. Data was extracted from the National Electronic Health Record (EHR) system and imported into STATA SE v-16 for analysis. Descriptive statistics were calculated on socio-demographic features and facility-level performance. Logistic regression was used to analyse the association between level of facility and successful transition to adult care, comparing third level facilities to lower-level facilities. Chi-square was employed to evaluate the association between socio-demographic traits and effective transition outcomes at a significance level of 0.05. Results: 43.2% had successfully transitioned to adult care. Health posts performed the best, with 57.3% of patients successfully transitioning to adult care. The study found that health post type, private ownership, rural location, and province were significant factors in successful transition. Adolescents in lower-level facilities had a 59.9% success rate compared to those in third-level facilities. Conclusions: The study stresses the importance of health system structure and posits that successful transition depends on many factors, not simply adolescent traits.

Missed opportunities of method information index plus (MII+) counseling among current modern contraceptive users. multi-level analysis from the Ethiopian PMA 2021 data set

IntroductionIn Ethiopia, there is a decrease in percentage of women who receive method information index counseling service from 39% (95%CI: 33%, 44%) in 2015 to 12% in 2019 (95% CI: 10%, 14%) nationally, and less than 40% of these services provided are high quality. Therefore, the aim of this study was to identify modern contraceptive users-related factors at individual level and community level associated with missed opportunities of method information index plus counseling.MethodsThis study used the datasets from the 2019 Performance Monitoring for Action Ethiopia Survey, which comprised a total of 8,365 households (98.9%) and 7,988 women (98.8%). The data analysis was done with Stata version 14. Using multilevel mixed effect logistics regression, both individual and community-level factors were found to be associated with missed opportunities of method information index plus counseling. a P-value of less than 0.05 was used to declare statistical significance. The association was presented using an adjusted odds ratio with a 95% confidence interval.ResultsThe study shows that the prevalence of missed opportunity MII + family planning counseling among current modern contraceptive users was 81% (79.15, 82.66) and factors significantly associated with missed opportunities of method information index plus counselling are educational status, low level of media exposure, religion, receiving the service in health centers and health posts, never heard of any other methods, number of children at first contraceptive use and region.ConclusionsIn Ethiopia 81% of women had a missed opportunities of MII + counseling service. In order to address this, we recommend policy makers to focus on training of health care workers and pharmacists about MII + counseling, and establishing ways to improve access to media exposure.

Evaluation of the feasibility, acceptability, and impact of Group Antenatal Care at the health post level on continuation in antenatal care and facility based delivery in Ethiopia using a cluster randomized stepped-wedge design: Study protocol

Background Adequate antenatal care (ANC) and facility-based delivery are linked to improved maternal and neonatal outcomes. Adequate antenatal care attendance and facility birth rates are increasing in Ethiopia but remain well below national goals and global recommendations. Group ANC (G-ANC), when implemented at higher level facilities, is associated with improved quality and experience of ANC, and increased ANC retention and facility-based delivery. The objectives of the study are to assess the feasibility, acceptability, and impact of G-ANC implemented at lower-level facilities (health posts) on ANC continuation and facility-based delivery. Methods G-ANC will first be piloted in five purposively selected health posts. The study will then use a stepped-wedge design in 36 health posts under six health centers, with randomization of the order of the start of the intervention done at the health center level (clusters). The design will include three time periods: first is a six-month control period with no G-ANC implementation, followed by another six months period where G-ANC will be introduced in half (n=18) of the study health posts, then final six months where G-ANC will be implemented in the remaining 18 health posts. Quantitative and qualitative data collection approaches will be used. The study has “pause and reflect” points designed to iterate on the intervention before rolling out to the next set of sites. Qualitative research will be conducted using in-depth interviews with pregnant women, health care workers, facility managers, and regional health managers. 770 women will be enrolled across all phases. Conclusions The study will inform decision makers locally and globally on whether G-ANC is a feasible service delivery model at the health post level. Effectiveness of G-ANC at increasing ANC retention and facility-based delivery will be reported, as well as its acceptability to pregnant women and Health Extension Workers. Registration NCT05054491, ClinicalTrials.gov (September 23rd 2021).

Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment.

Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that "there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level," seconded by the Botswana National eLearning strategy (2020), which states that "there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating." The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. DERR1-10.2196/52411.

Posyandu Cadres' Contributions to Elderly Health Improvement

Background: This study investigates the role of community health workers in promoting elderly health through integrated health posts. Specific Background: A qualitative descriptive approach is used to examine the significance of these workers in ensuring regular attendance of the elderly at health services. Knowledge Gap: While previous studies have focused on health post activities, they often overlook the specific strategies employed by community health workers. Aims: The study aims to clarify the contributions of community health workers in facilitating elderly health programs. Results: Findings indicate that these workers adapt activities, such as health consultations and educational sessions, to enhance elderly participation and health outcomes. Novelty: The research provides new insights into innovative service delivery by community health workers amid logistical challenges. Implications: The results highlight the need for ongoing support and training for community health workers, advocating for structured programs to enhance elderly engagement and well-being, with potential applications in similar contexts to improve elderly healthcare. Highlights : Community health workers play a crucial role in facilitating elderly health services. Adaptation of activities enhances elderly engagement and health outcomes. Continuous support and training for health workers are essential for effective program implementation. Keywords: community health workers, elderly health, qualitative study, health post, participation

Digital Solutions for Efficient Posyandu Services

Abstract: The advancement of digital technology emphasizes the importance of management information systems in enhancing efficiency in health care. General Background: Integrated Health Posts (Posyandu) are crucial facilities at the village level, focusing on preventive health efforts. Specific Background: In Ganggang Panjang Village, queuing issues and manual data processing hinder Posyandu cadres, leading to inefficiencies. Knowledge Gap: Existing literature lacks tailored solutions for the unique challenges faced by Posyandu in rural areas. Aims: This study aims to design a digital-based Posyandu service system to streamline data collection, recording, and reporting. Results: Using Agile Web Development, the proposed system is browser-accessible, significantly improving operational efficiency through a functional website developed in PHP and JavaScript. Novelty: This research introduces a comprehensive digital solution tailored to rural health providers’ needs. Implications: The findings highlight the potential for digital solutions to enhance health service delivery in rural communities, contributing to improved health outcomes. Highlights: Efficiency Improvement: The digital system streamlines data collection and reporting for Posyandu, reducing manual processing time. Accessibility: The system is designed to be accessible via various browsers, enhancing usability for cadre members. Tailored Solutions: This research addresses the specific challenges faced by rural health providers, promoting effective health service delivery. Keywords: Posyandu, Health Care, Agile Development, Community Health, Information System

Machine learning and natural language processing to assess the emotional impact of influencers' mental health content on Instagram.

This study aims to examine, through artificial intelligence, specifically machine learning, the emotional impact generated by disclosures about mental health on social media. In contrast to previous research, which primarily focused on identifying psychopathologies, our study investigates the emotional response to mental health-related content on Instagram, particularly content created by influencers/celebrities. This platform, especially favored by the youth, is the stage where these influencers exert significant social impact, and where their analysis holds strong relevance. Analyzing mental health with machine learning techniques on Instagram is unprecedented, as all existing research has primarily focused on Twitter. This research involves creating a new corpus labelled with responses to mental health posts made by influencers/celebrities on Instagram, categorized by emotions such as love/admiration, anger/contempt/mockery, gratitude, identification/empathy, and sadness. The study is complemented by modelling a set of machine learning algorithms to efficiently detect the emotions arising when faced with these mental health disclosures on Instagram, using the previous corpus. Results have shown that machine learning algorithms can effectively detect such emotional responses. Traditional techniques, such as Random Forest, showed decent performance with low computational loads (around 50%), while deep learning and Bidirectional Encoder Representation from Transformers (BERT) algorithms achieved very good results. In particular, the BERT models reached accuracy levels between 86-90%, and the deep learning model achieved 72% accuracy. These results are satisfactory, considering that predicting emotions, especially in social networks, is challenging due to factors such as the subjectivity of emotion interpretation, the variability of emotions between individuals, and the interpretation of emotions in different cultures and communities. This cross-cutting research between mental health and artificial intelligence allows us to understand the emotional impact generated by mental health content on social networks, especially content generated by influential celebrities among young people. The application of machine learning allows us to understand the emotional reactions of society to messages related to mental health, which is highly innovative and socially relevant given the importance of the phenomenon in societies. In fact, the proposed algorithms' high accuracy (86-90%) in social contexts like mental health, where detecting negative emotions is crucial, presents a promising research avenue. Achieving such levels of accuracy is highly valuable due to the significant implications of false positives or false negatives in this social context.

Creation of an Emergency Care Capacity Assessment Tool for Facilities in Austere Environments.

Facilities in austere environments may consider emergency care beyond their scope. Often patients with high-acuity conditions have no other choice than to present to these facilities. The disconnect between the intent of health systems planners and the reality faced by providers manifests as facilities unable to manage such cases.The Indian Health Service, with a range of stakeholders, developed an emergency care delivery assessment tool for facilities in austere environments, designed to identify deficiencies in facility readiness for emergency care delivery across four areas: 1. Procedural2. Human resources3. Non-pharmacologic material resources4. Pharmacologic material resources. The tool's underlying architecture is a resource matrix similar to hospital-based tools, using the "Facility" component of the WHO Emergency Care Systems Framework as the Y-axis and undifferentiated presentations taught by the WHO basic emergency care course, advanced trauma life support, and advanced life support in obstetrics as the X-axis. The tool was piloted at a remote frontier clinic. We found 48 deficiencies: 7 procedural, 1 human resources, 31 non-pharmacologic materials, and 9 pharmacologic materials. We aggregated deficiencies by facility function to assess the capacity to perform each. We also aggregated deficiencies by clinical presentation to identify targets for educational interventions. We successfully created a novel emergency care capacity assessment tool for use in austere environments using materials with broad international consensus. The successful pilot found deficiencies across all 4 areas. This tool may be useful in many other remote domestic facilities and rural health posts in low- and middle-income countries.

Analysis of stunting in East Java, Indonesia using random forest and geographically weighted random forest regression

Stunting is one of the problems that the world focuses on today to be resolved immediately. World Health Organization (WHO) stipulates that a country’s public health problems are said to be chronic if the stunting prevalence rate reaches more than 20%.The prevalence rate of stunting in Indonesia in 2021 reached 24.4%. This study aims to analyze factors that correlate with the prevalence of stunting in East Java Province using machine learning methods: Random Forest Regression (RFR) and Geographically Weighted Random Forest (GWRF) methods. The results of this research are the factors that correlate with the prevalence of stunting based on the RFR method, namely the number of babies who get early breastfeeding initiation, the number of malnourished toddlers, and the number of active integrated health posts. The RFR method results in RMSE values of 3.014, MAPE 11.69%, and R2 0.8168. The factors that correlate with the prevalence of stunting based on the GWRF method are divided into six groups according to the similarity of factors that correlate with stunting in the regency/city. The GWRF method gives better results than the RFR indicated by the resulting RMSE values of 1.023, MAPE 4.45%, and R2 0.9788.

Effectiveness of a Mobile Phone Messaging-Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial.

Ethiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging-based message framing for maternal and newborn health. This research aims to examine the effectiveness of mobile phone messaging-based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. A 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone-based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. Recruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. This trial was carried out to understand how mobile phone-based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Pan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49. DERR1-10.2196/52395.

Relationships between Family Support, Gender, and Education on Quality of Life in Elderly in Jambi: Multi-Level Analysis

Background: The elderly pain rate in 2021 is 22.48%, this shows that around one in five elderly people in Indonesia have experienced illness in the past month. 3 factors affect predisposing factors, including knowledge and attitudes, supporting factors, and reinforcing factors. This study aims to determine the relationship between family support, gender, and education to the quality of life of the elderly in Jambi.Subjects and Method: This was a cross-sectional study conducted in Jambi, Indonesia, from March to April 2024. A total of 200 elderly participants were selected using fixed disease sampling. The independent variables were gender, education, family support, and Integrated Health Posts for the elderly. The dependent variable is quality of life. Data were collected using questionnaires and analyzed using multiple linear regression.Results: Quality of life in old age improved with strong family support (b= 0.46; 95% CI= 0.19 to 0.74; p = 0.001) and ≥high school education (b=4.99; 95%CI = 2.89 to 7.09; p <0.0010). The quality of life of the elderly decreased or decreased in women compared to men (b= 2.94; 95% CI= -5.22 to -0.66; p= 0.011). There was a strong contextual influence of Integrated Health Posts for the elderly on the quality of life of the elderly (ICC= 31.15%).Conclusion: The quality of life of the elderly improves with strong family support and ≥high school education. The quality of life of the elderly decreases or is lower in women than men. There is a strong contextual influence of Integrated Health Posts for the elderly on the quality of life of the elderly.

Predictors of time to recovery from uncomplicated severe acute malnutrition among children in eastern Ethiopia.

Managing severe acute malnutrition (SAM) involves an outpatient therapeutic program (OTP), targeting more than 80% of SAM children where the quality of primary healthcare remains poor. Treatment success and recovery from SAM remain poor and could be affected by many factors, where such evidence is limited in East Hararghe. This study assessed the predictors of time to recovery from SAM in eastern Ethiopia. A retrospective cohort study was conducted on 402 records of SAM children under 5 years of age enrolled on OTP at 12 health posts retrieved from 2020 to 2021. We used the Kaplan-Meir estimate along with the p-value of the log-rank test and the survival curve to compare the time to recovery across categories. A multivariable Cox proportional hazard model was fitted to identify predictors of time to recovery from SAM. A p-value below 0.05 was used to declare statistical significance. A total of 402 records were reviewed, and the cure rate from SAM was 89.6% [95% confidence interval (CI), 87-93]. Moreover, a death rate of 0.7%, a default rate of 9.5%, and a non-responder rate of 0.2% were obtained with a median length of stay of 7 weeks. The median time to recovery was significantly shorter for children from shorter distances from OTP sites with edema, amoxicillin, (p < 0.05). Edema at admission [adjusted hazard ratio (AHR) = 1.74; 95% CI: 1.33-2.29], without diarrhea (AHR = 1.51; 95% CI: 1.18-1.94), taking amoxicillin (AHR = 1.55; 95% CI: 1.19-2.02), shorter travel time to the OTP site (AHR = 1.44; 95% CI: 1.13-1.85), breastfeeding (AHR = 1.60; 95% CI: 1.27-2.02), adequacy of ready-to-use therapeutic food (RUTF) (AHR = 1.22; 95% CI: 0.90-1.65), and new admission (AHR = 1.62; 95% CI: 0.84-3.10) were important predictors of recovery from SAM. Recovery from SAM was found to be acceptable in comparison with the Sphere Standards and is predicted by edema, diarrhea, distance from the OTP site, amoxicillin, and RUTF adequacy. These allow for focused interventions that address the identified factors for better recovery from SAM.

Husband's involvement in utilization of maternal health services by their spouse in district Rohtak, Haryana.

Husband and wife as a couple are fully responsible for their current and future. In our society, the husband is mostly responsible for making the decision regarding any expenses. In India, there is a need to reduce the maternal mortality rate, and Husband's involvement in antenatal care could be a key to success as it will enable them to support their partner in adequate preparation for birth and to utilize emergency obstetric care early if complications arise. To find out about male involvement in the utilization of maternal healthcare services by their spouse and various factors affecting male involvement in the utilization of maternal healthcare services. This study was conducted in urban and rural field practice areas attached to the Department of Community Medicine, PGIMS, Rohtak. The study included 400 couples where 200 each were recruited from rural and urban areas. Out of 17 subcenters under CHC Chiri eight, subcenters were selected randomly by lottery method. A line list of these couples was prepared at each subcenter using ANC and birth register. Couples were enrolled from this line list till a sample size of 25 was reached at each of these eight subcenters. In this way, a total of 200 couples were enrolled from rural areas in which women delivered and availed maternal health services in the last 6 months. In urban areas, an equal number of couples were enrolled from each of these three urban health posts till the sample size of 200 was reached in an urban area. The majority of the husbands (73%) reported that they participated in their wives' utilization of maternal health services. Twenty-seven percent did not participate in their wives' utilization of maternal health services. It also showed that 71.0% of the husbands did not know about the investigations that needed to be performed during a woman's pregnancy. Only 29% were aware of it. On analysis, it was observed that 73% of the husbands had good participation in their spouses' maternal and child health (MCH) care, while the rest had poor participation (27%). It also showed that as the education level of the participants' husbands increased, their participation in their spouses' MCH care increased, with the highest being observed among graduates (91.3%) and the lowest among those with primary schooling level education (66.7%) which were statistically significant.

Effect of a simplified approach on recovery of children 6-59 months with wasting in Ethiopia: A noninferiority, cluster randomized controlled trial.

Worldwide, nearly 45 million children under the age of 5 years were affected by wasting in 2022. Ethiopia has been challenged by disasters increasing the caseload of children with wasting. This study aimed to determine the effect of a simplified approach on recovery of children with acute malnutrition as compared with the standard protocol. A cluster randomized, controlled, noninferiority trial was carried out in three regions of Ethiopia from December 4, 2021, to July 30, 2022. A total of 58 clusters (health posts) were randomized into intervention and control groups. Children with SAMin the intervention groups received two sachets of Ready-to-Use Therapeutic Food (RUTF),whereas children in the control groups received RUTF based on their body weight. Children with moderate acute malnutrition (MAM)received one sachet of RUTF and one sachet of Ready-to-Use Supplementary Food (RUSF)daily in the intervention and control groups, respectively. Per protocol (PP) andintention-to-treatanalysis were used to compare recovery at a noninferiority margin of 15%. Data were collected from 55 health posts and 1032 children. In the PP analysis, the recovery rate of children with wasting amongthe simplified group (97.8%) was noninferior to the standard protocol group (97.7%), p = 0.399. The RUTF cost per treatment of child with SAM was 56.55 USD for the standard versus 42.78 USD for the simplified approach. The simplified approach is noninferior to the standard protocol in terms of recovery and has a lower cost of RUTF. Further study is recommended to assess the effectiveness of the simplified approach in emergency contexts.

Measuring and Comparing Service Delivery Time in Government and Outsourced Health Posts Affiliated with Tehran University of Medical Sciences

Background: The duration of healthcare services has a significant impact on the quality of care and patient's satisfaction. Having information on service delivery time in both government and outsourced Health Posts (HPs) can contribute to evidence-based policymaking and better resource management. Therefore, this study aims to estimate and compare service delivery time in government and outsourced HPs. Methods: This descriptive-analytical cross-sectional study was conducted in six affiliated HPs under Tehran University of Medical Sciences in 2019–2020. Data were collected through a census using a stopwatch and a time recording form during one working week. The average duration of each service (in minutes) was obtained. The results were reported using descriptive statistics and were analyzed using SPSS24 software and multivariate analysis of variance (ANOVA). Results: The total mean of duration of services provided in government HPs (777.6 minutes) was greater than that in outsourced HPs (788.5 minutes). Among the 10 services provided, the average duration of services for adolescents (20.4±4.5 minutes), young adults (20.5±5.6 minutes), middle-aged adults (26.1±10.4 minutes), and elderly individuals (24.3±13.6 minutes) in government HPs was significantly longer than in outsourced HPs (p&lt;0.05). Additionally, the average duration of health education services (23.1±10.5 minutes) and health ambassador training (36.1±13.7 minutes) in private HPs was significantly longer than in government HPs (p&lt;0.05). Conclusion: In outsourced HPs, it is important to focus on creating a balance between the number of visits and the staff available for services which target adolescents, young adults, middle-aged adults, and elderly individuals. In government HPs, emphasis should be placed on increasing the time allocated for educational and promotional health services. By considering the importance of service delivery time and the observed differences in findings of this study, it is crucial to prioritize the duration of service delivery as an important performance measure when comparing government and outsourced HPs.

Mewujudkan Generasi Bebas Polio: Program Sub PIN Polio Di Puskesmas Mojolangu Kota Malang

The eradication of polio has become a global priority. Through the synchronized Sub-PIN Polio immunization program, the aim is to enhance human welfare and achieve a polio-free generation. The target is to reach 95% immunization coverage in the Mojolangu Health Center, Malang City. Immunization activities in the Mojolangu Health Center's area cover several schools, integrated health posts (Posyandu), and early childhood education centers (Pos PAUD), targeting children aged 0-7 years. The first round took place from January 15th to 20th, 2024. The immunization coverage has reached the target, with 95.3% of children vaccinated. This synchronized immunization effort aligns with the vision of a polio-free generation and sustainable community health achievement.

Malaria prevalence and use of control measures in an area with persistent transmission in Senegal.

In Senegal, the widespread use of vector control measures has resulted in a significant reduction in the malaria burden and led the country to consider the possibility of elimination. Given this shift and changing context, it is important to characterize the malaria burden across all age groups to guide decision-making on programmatic interventions to interrupt transmission and ultimately eradicate the disease. In Senegal, there is a lack of information on malaria prevalence among certain populations, particularly among adolescents and adults. This study sought to assess the magnitude of malaria infections in all age groups, as well as malaria associated factors in an area of persistent transmission in Senegal. A cross-sectional household survey was conducted in four health posts (Khossanto, Mamakhona, Diakhaling and Sambrambougou), of the health district of Saraya, in November 2021, among individuals over 6 months of age. Households were selected using multistage sampling. Consented participants were screened for malaria parasites by microscopic examination of blood smears, and hemoglobin levels were measured using the Hemocue HB 301TM analyzer. Socio-demographic information of the participants, household heads, household assets, and information on ownership and use of preventive measures were collected using a structured questionnaire. Weighted generalized mixed effects logistic regression model was used to identify factors associated with microscopically confirmed malaria infection. A total of 1759 participants were enrolled in the study. Overall, about 21% of participants were classified as having Plasmodium infection; children aged 5-10 years old (26.6%), adolescents aged 10-19 years old (24.7%), and children under five years of age (20.5%) had higher rates of infection compared to adults (13.5%). Plasmodium falciparum accounted for 99.2% of the malaria infections, and most infections (69%) were asymptomatic. Around one-third of study participants had anemia (hemoglobin level <11.0 g/dl), with under five children bearing the highest burden (67.3%). Multivariate analysis showed that the odds of having a malaria infection were around 2 times higher among participants in Khossanto compared to Diakhaling (aOR = 1.84, 95% CI:1.06-3.20). Participants aged 5-9 years were more likely to have malaria infection compared to under five children (aOR = 1.40, 95% CI:1.02-1.91). Factors associated with anemia were P. falciparum infection (aOR = 1.36, p = 0.027), females (aOR = 2.16, p = 0.000), under-five age group (aOR = 13.01, p = 0.000). Malaria burden was considerable among adolescents and under ten children living in an area of persistent transmission, with adolescents more commonly presenting as asymptomatic. Interventions tailored to this specific group of the population are needed to better control the disease and reduce its burden.

Facilitators and barriers to supply-side maternal, newborn, and child health service availability in DRC: a systematic review and narrative synthesis

Background This study is a systematic review of barriers and facilitators of supply-side maternal, newborn, and child health (MNCH) service availability in the Democratic Republic of the Congo (DRC). Given gaps in understanding of the factors affecting supply-side service availability, authors reviewed the literature to describe the DRC’s landscape and inform future research and programming. # Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, authors searched two databases and grey literature, using the Quality Assessment with Diverse Studies tool to assess quality. Authors identified key themes and used a narrative approach to analyze extracted data. # Results The search identified 2160 articles, with 26 meeting the inclusion criteria. Authors grouped them according to the following key themes: facility readiness, human resources for health (HRH), geography and transportation, conflict, financing, and governance. MNCH service availability was hindered by lack of supplies, logistical challenges, weak infrastructure, unmet staffing needs, HRH turnover, poor HRH distribution, career and payment obstacles, long distances to facilities and poor transportation, system strain and disruption due to conflict, low government expenditure, high out of pocket costs, fragmented stakeholders, and low government prioritization. Authors found facilitating factors in each key theme, including parallel supply chains and buffer stocks, proactive staffing policies, motivated HRH, novel transportation methods, health posts, concentrations of stakeholders in conflict zones, universal health coverage policies, provider payment reforms, stakeholder coordination, and horizontal integration efforts. # Conclusions The DRC faces substantial supply-side barriers to MNCH service availability. Progress towards the Sustainable Development Goals and better MNCH outcomes requires additional work to build on existing facilitators and investments in service availability. Additional research on demand-side factors and quality of care could inform these efforts.

Optimizing Knowledge of Clean and Healthy Living Behavior among Santri in Az Zahro Islamic Boarding School through Public Health Podcast Media

Optimizing Knowledge of Clean and Healthy Living Behavior among Santri in Az Zahro Islamic Boarding School through Public Health Podcast Media

Perspectives on the Performance of the Ethiopian Vaccine Supply Chain and Logistics System after the Last Mile Delivery Initiative: A Phenomenological Study.

Uninterrupted availability of vaccines requires a robust vaccine supply chain and logistics system (VSCLS). With special focus on remote and underserved settings, we assessed the reach and bottlenecks of the Ethiopian VSCLS after the initiation of the last mile transition. We explored the perspectives of key stakeholders using a qualitative phenomenological study. More than 300 in-depth interviews and 22 focus group discussions were conducted. The study was sequentially implemented over two phases to understand the bottlenecks at national and regional (Phase I) and lower (Phase II) levels. After the transition, the Ethiopian Pharmaceutical Supply Service started supplying vaccines directly to health facilities, bypassing intermediaries. The transition reduced supply hiccups and enabled the health sector to focus on its core activities. However, in remote areas, achievements were modest, and health facilities have been receiving supplies indirectly through district health offices. By design, health posts collect vaccines from health centers, causing demotivation of health extension workers and frequent closure of health posts. Challenges of the VSCLS include artificial shortage due to ill forecasting and failure to request needs on time, lack of functional refrigerators secondary to scarcity of skilled technicians and spare parts, and absence of dependable backup power at health centers. Vaccine wastages owing to poor forecasts, negligence, and cold chain problems are common. The VSCLS has not yet sustainably embraced digital logistics solutions. The system is overstrained by frequent outbreak responses and introduction of new vaccines. We concluded that the transition has improved the VSCLS, but the reach remains suboptimal in remote areas.