Health Service Factors Research Articles

Spatial association of socioeconomic and health service factors with antibiotic self-medication in Thailand.

Antibiotic Self-Medication (ASM) is a major contributing factor to Antimicrobial Resistance (AMR) that can lead to both mortality and long-term hospitalizations. High provincial ASM proportions associated with mortality due to AMR have been observed in Thailand but there is a lack of studies on geographic factors contributing to ASM. The present study aimed to quantify the distribution of ASM in Thailand and its correlated factors. Socioeconomic and health services factors were included in the spatial analysis. Moran's I was performed to identify global autocorrelation with the significance level set at p=0.05 and spatial regression were applied to identify the factors associated with ASM, the proportion of which is predominant in the north-eastern, central and eastern regions with Phitsanulok Province reporting the highest proportion of Thailand's 77 provinces. Autocorrelation between Night-Time Light (NTL) and the proportion of ASM was observed to be statistically significant at p=0.030. The Spatial Lag Model (SLM) and the Spatial Error Model (SEM) were used with the latter providing both the lowest R2 and Akaike Information Criterion (AIC). It was demonstrated that the proportion of alcohol consumption significantly increased the proportion of ASM. The annual number of outpatient department visits and the average NTL decreased the proportion of ASM by 1.5% and 0.4%, respectively. Average monthly household expenditures also decreased the ASM proportion. Policies to control alcohol consumption while promoting healthcare visits are essential strategies to mitigate the burden of AMR in Thailand.

PEMANFAATAN DANA ALOKASI KHUSUS NON FISIK TERHADAP PENCAPAIAN KINERJA SPM KESEHATAN

Background: The successful implementation of health sector activities needs to be supported by non-physical Special Allocation Funds (DAK). Non-physical DAK for health is a fund to improve access and quality of health services in the region. Several service targets in North Musi Rawas Regency show that they have not yet reached 100%. This research aims to analyze the use of non-physical DAK on the achievement of health SPM performance at the North Musi Rawas District Health Service. Method: Qualitative research design with a descriptive approach. The research was carried out at 8 Community Health Centers and the North Musi Rawas District Health Service. Information collection was carried out from March to April 2024. Information was collected by in-depth interviews and document review. Result : The research results show that the majority of health workers do not have sufficient competence because they have never attended training. Health workers do not yet have clear duties and functions. All Community Health Centers have a budget for the diabetes mellitus program, but the elderly program budget is only available for 3 Community Health Centers. The available facilities and infrastructure are not yet complete. Health workers do not yet know the policies related to the Diabetes Mellitus (DM) program and the elderly. Program reporting is still manual. Health services for DM sufferers and the elderly have been carried out well. The SPM achievement of DM health services has met the target of 100%, but elderly services have not met the target. The total budget absorption coverage for DM services is 100%, while for the elderly it does not reach 100%. Conclusion : Health service factors, SPM services and non-physical DAK absorption are still not up to standard. Keywords: SPM, Utilization, Funds, Non-Physical DAK, Performance

Risk Factors of Standalone and Coexisting Forms of Undernutrition Among Children in Sub-Saharan Africa: A Study Using Data from 26 Country-Based Demographic and Health Surveys.

Undernutrition in low- and middle-income countries (LMICs) remains a leading public health challenge. It accounts for one-third of the under-five mortality rate in sub-Saharan Africa (SSA). This study applied the composite index of anthropometric failure (CIAF) to assess the prevalence of various standalone and coexisting forms of undernutrition and identify associated risk factors. Nationally representative demographic health survey (DHS) data from 26 SSA countries were used. A multilevel multinomial logistic regression analysis was conducted considering the hierarchical nature of DHS data and more than two categories of outcome variable. Four models were fitted and the model with the highest log-likelihood and lowest deviance was chosen as the best-fitted model. The adjusted relative risk ratio (aRRR) with its corresponding 95% confidence interval (CI) was presented as a measure of the effect. The overall prevalence of undernutrition among under-five children in SSA was 34.59% (95% CI: 34.35-34.82). Additionally, 20.49% (95% CI: 20.30-20.69) and 14.09% (95% CI: 13.92-14.26) of under-five children had standalone and coexisting undernutrition, respectively. The mother's educational level and household wealth status were the most significant shared drivers for standalone and coexisting undernutrition. On the other hand, child and health service factors were differentiating factors between standalone and coexisting undernutrition. Age of the child, sex of the child, type of birth, birth weight, adherence to age-appropriate feeding, antenatal care visit (ANC), place of delivery, and maternal educational status were the most significant determinants of various undernutrition forms in 0-23-month-old children. For 24-59-month-old children, age of the child, sex of the child, type of birth, household wealth status, and maternal education were identified as the main determinants of different forms of undernutrition. Our analysis revealed that distal factors were shared risk factors among standalone and coexisting forms of undernutrition. However, proximal and intermediate factors varied in the type and strength of the association between standalone and coexisting undernutrition. This implies that holistic and category-specific strategies are needed to significantly reduce undernutrition among under-five children in SSA.

Progress in research of incidence of co-infection of HIV and Mycobacterium tuberculosis and influencing factors

The co-infection of HIV and Mycobacterium tuberculosis (MTB) poses a severe challenge for the prevention and control of infectious disease, resulting in poor clinical outcomes of the patients and risk for wide spread. As steady progress in global health, the co-infection of HIV/MTB has been basically controlled, and the new cases are generally declining. However, its incidence remained high in resource-limited areas. The incidence of the co-infection of HIV/MTB is associated with the interaction among individual, social, health service, and natural factors. Comprehensive measures are needed to reduce this disease burden. This paper summarized the epidemiological characteristics of the co-infection of HIV/MTB and influencing factors both at home and abroad to provide evidence for the identifications of high-risk populations and areas and development of targeted prevention measures for the purpose of reduce the incidence of co-infection of HIV/MTB.

Adherence to Pulmonary Tuberculosis Medication and Associated Factors Among Adults: A Cross-Sectional Study in the Metinaro and Becora Sub-Districts, Dili, Timor-Leste.

Timor Leste is one of the top countries in Asia with a high incidence rate of pulmonary tuberculosis (TB). The success of TB treatment necessitated a more profound comprehension of adherence as a multifaceted behavioral issue, along with identifying the barriers that hinder and the factors that promote patient adherence. This study aimed to assess the rate of pulmonary TB medication adherence and identify its predictors among adults in Metinaro and Becora, Dili, Timor-Leste. A descriptive analytical cross-sectional study was conducted, and new patients with pulmonary TB aged 18 years and above were selected using a proportional sampling method. Quantitative data were collected from 398 patients with pulmonary tuberculosis. The medication adherence results were as follows: 73.6% low adherence, 18.3% moderate adherence, and only 8.1% high adherence. The study identified significant predictors of medication adherence, such as health service factors (OR = 14.024, 95% CI: 5.42-35.54, p = 0.001). Patients who perceived a high quality in the health service were 14 times more likely to exhibit higher medication adherence. Regarding individual behaviors, patients who consumed alcohol or occasionally engaged in physical exercise were significantly less likely to exhibit higher medication adherence (OR = 0.17, 95% CI: 0.091-0.312, p = 0.001). Similarly, patients experiencing high levels of stigma were less likely to achieve strong adherence (OR = 0.146, 95% CI: 0.058-0.326, p = 0.001).Both health service quality and individual factors, such as lifestyle behaviors and social stigma, were statistically significant predictors ofTB medication adherence. Enhancing the healthcare infrastructure, implementing multisectoral strategies for behavior change, and reducing stigma are crucial. Additionally, mobile health technologies, like SMS reminders and telehealth, might support real-time adherence improvements.

Health services delivery factors affecting HIV retesting among pregnant women at 34weeks gestation in Saboba District, Northern region, Ghana.

Vertical transmission of HIV is a major global public health issue, particularly due to maternal HIV acquisition during pregnancy, challenges in enrolling pregnant women living with HIV into antiretroviral therapy programmes, and loss to follow-up. The factors influencing HIV retesting in pregnant women with an initial HIV-negative results are understudied. The study examined health service delivery factors affecting HIV retesting among pregnant women. A cross-sectional study was conducted in six health facilities in the Saboba District in 2023. Pregnant women who initially tested HIV-negative and were attending antenatal clinics at 34weeks gestation or later were randomly selected. Data was analyzed using Stata version 15.0. Logistic regression was used to examined the health service factors affecting HIV retesting at a 0.05 significant level. Out of 445 pregnant women initially HIV-negative, only 21.1% were retested at 34weeks gestation. Pregnant women receiving antenatal care at health centers were less likely to be retested [aOR = 0.34; CI: 0.14-0.84], while those who spent less time during ANC were more likely to retest [aOR = 2.58; CI: 1.33-5.01]. Improvement in HIV retesting requires reproductive health units to develop strategies to enhance coverage and reduce waiting times at health centers could encourage more pregnant women to retest for HIV.

Barriers to modern contraceptive utilization in Ethiopia.

Contraception is a critical service for women to control their reproductive health, allowing them to determine the number and spacing of their children prevent unintended pregnancies, reduce the risk of morbidity and mortality from associated with childbirth, and reduce the likelihood of abortions. Despite its benefits, the utilization of modern contraceptive methods remains low in certain regions of Ethiopia, Particularly in Afar and Somali, which are also experiencing high fertility rates. However, there is a substantial gap in understanding the sociocultural barriers that hinder the adoption of modern contraception in these regions. This study aims to explore these barriers to contraceptive use among women of reproductive age in Afar and Somali regions, providing qualitative insights that are essential for designing effective strategies to improve contraceptive service utilization. Asequential mixed method approach was employed, including scoping review and qualitative interviews. Scoping review focused on qualitative or mixed-methods studies conducted in Ethiopia and published between 2013 and 2023 in English, Selecting 14 articles Additionally, qualitative data were collected from Afar and Somali regions through In-depth interviews with women aged 15-49 who are married or in consensual union, and key informant interviews with health extension workers and contraception providers at health center. A total of 20 in-depth interviews and 07 key informants were conducted. Thematic analysis was used to analyze the data. The integrated findings from the scoping review and qualitative study reveal various barriers and determinants influencing contraceptive use among women in Ethiopia. Barriers includes religious or cultural beliefs, myths and misconceptions, fear of side effects, lack of knowledge and misinformation, negative attitude towards contraceptives, partner opposition, socio-cultural factors, fear of being judged by family and friends, and lack of communication between husband and wife, husband altitude, distance from health facility, availability of service and different contraceptive choice, separate room for family planning services, and cost of contraceptive method and transportation. The scoping review corroborates these findings, emphasizing on the role of socio-demographic, economic, cultural, religious, health service, and knowledge-related factors. Higher education, urban residence, higher income, mass media exposure, spousal communication, family size, and access to quality health services were associated with increased utilization, while lack of awareness, misconceptions, myths, side effects, fear of infertility, partner opposition, social stigma, and cultural norms decreased utilization. The study recommended promoting contraceptive use, challenging socio-cultural norms through Social Behavioural Communication and Counselling (SBCC), engaging partners and community members, and improving the quality of care.

Rising trend of dentist-prescribed antibiotics in Brazil: 2011-2021.

To describe the trends in antibiotic prescribing by dental practitioners and to investigate the relationship between these trends and some factors of public oral health services in Minas Gerais (MG), Brazil. This was a time-series analysis of antibiotics prescribed by dental practitioners between January 2011 and December 2021. The outcome variables were number of defined daily doses (DDD) and DDD/1000 population/year in a sample of cities in MG. Covariates were public oral healthcare factors, such as coverage, estimates of dental procedures, and frequency of dental pain. Linear time-series regression models were used to examine trends and the influence of covariates on antibiotic prescribing. Overall, the number of prescriptions increased by 334.69% between 2011 and 2021, with amoxicillin being the most commonly prescribed drug (78.53%). The number of DDD for all antibiotics increased from 17,147.13 to 77,346.67 and the average DDD/1000 inhabitants/year was 126.66 (SD: 130.28). The linear time-series regression model showed that for each one-year increase, the average log DDD/1000 inhabitants increased by 0.35 (standard error = 0.07, p < 0.001). No covariates were found to be associated with the outcome. In Minas Gerais, Brazil, a significant upward trend was observed in the number of prescriptions and the number of DDD of antibiotics prescribed by dental practitioners. No influence of factors related to public oral healthcare services on the outcome was observed, thereby emphasizing the need for further research on factors influencing medication use in dental practice.

The quality of nursing care in dying children from the nurses’ point of view in Iran: A cross-sectional study

Nowadays, the quality of nursing care is one of the most essential factors in health services and patient care. The quality of end-of-life care is of high importance, especially in vulnerable groups such as children. In the final stages of life, the needs of patients and their companions, as well as stressful conditions cause avoidance of participation in treatment, and dissatisfaction of caregivers which can reduce the quality of patient care. The present study aimed to examine the quality of nursing care in children from the point of view of nurses in hospitals related to Birjand, Iran. The present descriptive study was conducted on 350 nurses. The data collection tools used in this study were demographic questionnaire and Quality Patient Care Scale (QUALPAC). A total of 270 completed questionnaires were entered into the statistical analysis. The average quality of nursing care score in dying children was 266.17±27.79. Also, the results of the present study showed that the gender, age, marital status, and work experience of nurses have no significant effect on the quality of nursing care in dying children from the nurses' viewpoint. The quality of nursing care of dying children from the point of view of nurses was satisfactory. Nurses reported that the physical dimension of nursing care had the highest quality and the psychosocial dimension had the lowest quality. Therefore, psychological support and follow-ups for improving social support for these clients are suggested to the nursing managers and healthcare administrators.

Prevalence and Associated Factors of exclusive breast-feeding practice among Mothers with Infants Under Six Months of Age attending pediatrics OPD and EPI in Asella Referral and Teaching Hospital, East Arsi, Oromia, Ethiopia

Introduction: Exclusive breastfeeding is a highly effective and cost-efficient intervention for preventing childhood morbidities and mortalities. It can prevent approximately 13% of childhood deaths, which equates to saving at least 1.2 million children worldwide each year. However, globally, only about 35% of infants are exclusively breastfed. In developing countries, the rate is 38% for infants under six months, while in Ethiopia, approximately 52% of infants in this age group are exclusively breastfed. Objective: This study aims to assess the prevalence of exclusive breastfeeding practices and identify the associated factors among mothers of infants under six months old who are attending the pediatric outpatient department (OPD) and immunization clinics (EPI) at ARTH. Methodology: An institutional-based cross-sectional study design was employed. Data were collected using a structured questionnaire administered by six graduating Public Health students from Asella Health Science College, who received a two-day training. The collected data were coded, cleaned, and entered into Epi Info, then exported to SPSS version 26 for analysis. Descriptive statistics were used to present the respondents' characteristics through frequencies, percentages, summary measures, tables, and graphs. Bivariate and multivariate analyses were conducted to identify factors associated with exclusive breastfeeding, using odds ratios with 95% confidence intervals. A significance level was set at a p-value &lt; 0.05. Result: Around (40.4%) of mothers Out of 384 eligible mothers, all 384 agreed to participate in the study, resulting in a response rate of 100%. Approximately one-third (36.2%) of the mothers were aged between 25 and 29 years. Regarding the reasons mothers cited for not breastfeeding, 36.5% reported that they believed breast milk was insufficient, 13% mentioned that the infant was thirsty, and 8% cited a lack of time Among the various socio-demographic, health service, maternal, and infant-related factors assessed, several determinants were identified for higher chances of EBF practice. These factors include: Age of the infant: Younger infants (0-3 months) are more likely to be exclusively breastfed compared to older infants (4-5 months). Maternal occupation: Unemployed mothers are more likely to practice EBF than employed mothers. Household income: Mothers with lower monthly incomes are more likely to practice EBF. Conclusion and recommendation: The study revealed a high participation rate of 100% among the 384 eligible mothers, with a significant portion (36.2%) aged between 25 and 29 years. Despite the positive response, barriers to breastfeeding were identified, with 36.5% of mothers believing that breast milk was insufficient, 13% indicating their infants were thirsty, and 8% citing time constraints as reasons for not breastfeeding. Several socio-demographic and health-related factors significantly influence the practice of exclusive breastfeeding (EBF). Younger infants (0-3 months) are more likely to be exclusively breastfed compared to those aged 4-5 months. Additionally, unemployed mothers and those with lower household incomes demonstrate higher rates of EBF practice. Recommendations: 1. Education and Support: Implement educational programs aimed at addressing misconceptions about breast milk sufficiency and providing practical support for breastfeeding mothers, especially those returning to work. 2. Targeted Interventions: Focus on supporting employed mothers with resources and strategies to facilitate EBF, such as flexible work policies and access to breastfeeding-friendly environments. 3. Income-Based Initiatives: Develop targeted initiatives to support lower-income families in their breastfeeding efforts, ensuring access to necessary resources and information.

Factors Influencing DPT Immunization Completion among Children: Insights from Nakawa Division, Kampala, Uganda

This study investigates the factors influencing DPT (Diphtheria, Pertussis, Tetanus) immunization completion among children aged 4–23 months in Nakawa Division, Kampala, Uganda. Utilizing a descriptive cross-sectional design with both qualitative and quantitative methodologies, data were collected from 271 participants using researcher-guided questionnaires. The analysis revealed a high DPT immunization completion rate of 94%, meeting WHO targets. Significant factors associated with completion included caretaker age, religion, and attitude toward vaccine safety and acceptability, as well as health service factors like distance to the facility, ANC attendance, convenience of immunization days, and vaccine availability. However, child-related factors such as age, gender, and birth order showed no significant association. These findings underscore the importance of targeted interventions to address caregiver perceptions and improve health service delivery for sustained immunization coverage. Keywords: Diphtheria; Pertussis-Tetanus (Pertussis is commonly known as whooping cough); DPT Immunization; Completion Status; Nakawa Division, Kampala-Uganda.

Analysis of Health Service Factors on Patient Satisfaction at The Dental Clinic

Puskesmas is a technical implementation unit of the District/City Health Office that is responsible for providing first-level health services in a comprehensive, integrated and sustainable manner. The main problem as a health service institution with many competitors is the service provided whether it is in accordance with the expectations of patients/ consumers or not. The purpose of the study was to determine the factors of health services on patient satisfaction. The research design used quantitative methods conducted by analytical surveys with a cross sectional study approach. The samples in this study were 74 patients, research conducted in Simpang Kanan Health Center, Simpang Kanan District, Aceh Singkil Regency. Where the sampling technique in this study used purposive sampling techniques with inclusion criteria are able to communicate well and have ever come for treatment. Exclusion criteria are new patients seek treatment and not able to communicate well. Based on the results of statistical tests, the p-value of all variables is &lt;0.05 where there is an influence on waiting time, competence, financing system, facilities, and comfort. After a multivariate test, it is known that the facility variable is the most influential factor on patient satisfaction. It is recommended that the Simpang Kanan Health Center be able to improve discipline, competence, and public health service facilities in an effort to increase patient satisfaction.

Enhancing Contraceptive Utilization among Females of Reproductive Age: Factors, Challenges, and Strategies at Jinja Regional Referral Hospital

The research aimed to assess the factors influencing the utilization of contraceptives among females of reproductive age seeking health services at Jinja Regional Referral Hospital. Specifically, it sought to establish socio-demographic characteristics, examine health service factors affecting contraceptive utilization, and determine its prevalence. A cross-sectional and descriptive research design employing both quantitative and qualitative methodologies was utilized to ensure the gathered information was representative of the population and captured at a single point in time. The study discovered a prevalence of contraceptive use among females of 55.7%, with short-term hormonal methods being the most common at 57.1%. Key findings revealed that females aged 18 to 30 years (57.1%) were significantly more likely to use contraception (p-value = 0.036), and multiparous individuals (98.2%) were more inclined to utilize contraception compared to para-one individuals (50.6%) (p-value = 0.024). Moreover, prior counseling (73.2%) significantly promoted contraceptive usage (p-value = 0.015). In conclusion, despite the observed prevalence, contraceptive utilization remained relatively low. Recommendations include increasing the availability of contraceptive services at lower-level health care centers to enhance accessibility, educating mothers visiting health facilities about contraceptive services, and addressing contraception-related phobias through counseling to encourage uptake among females. Keywords: Contraceptives, Females, Reproductive age, Health services, Health facility.

Health literacy interventions for informal caregivers: systematic review

AimThe aim of the systematic review was to identify conceptual models and interventions designed to improve health literacy in caregivers of adults with a chronic disease/disability.MethodsMEDLINE, CINAHL, PsycINFO and Embase...

Spatial associations between chronic kidney disease and socio-economic factors in Thailand.

Chronic kidney disease (CKD) is a persistent, progressive condition characterized by gradual decline of kidney functions leading to a range of health issues. This research used recent data from the Ministry of Public Health in Thailand and applied spatial regression and local indicators of spatial association (LISA) to examine the spatial associations with night-time light, Internet access and the local number of health personnel per population. Univariate Moran's I scatter plot for CKD in Thailand's provinces revealed a significant positive spatial autocorrelation with a value of 0.393. High-High (HH) CKD clusters were found to be predominantly located in the North, with Low-Low (LL) ones in the South. The LISA analysis identified one HH and one LL with regard to Internet access, 15 HH and five LL clusters related to night-time light and eight HH and five LL clusters associated with the number of health personnel in the area. Spatial regression unveiled significant and meaningful connections between various factors and CKD in Thailand. Night-time light displayed a positive association with CKD in both the spatial error model (SEM) and the spatial lag model (SLM), with coefficients of 3.356 and 2.999, respectively. Conversely, Internet access exhibited corresponding negative CKD associations with a SEM coefficient of - 0.035 and a SLM one of -0.039. Similarly, the health staff/population ratio also demonstrated negative associations with SEM and SLM, with coefficients of -0.033 and -0.068, respectively. SEM emerged as the most suitable spatial regression model with 54.8% according to R2. Also, the Akaike information criterion (AIC) test indicated a better performance for this model, resulting in 697.148 and 698.198 for SEM and SLM, respectively. These findings emphasize the complex interconnection between factors contributing to the prevalence of CKD in Thailand and suggest that socioeconomic and health service factors are significant contributing factors. Addressing this issue will necessitate concentrated efforts to enhance access to health services, especially in urban areas experiencing rapid economic growth.

Analysis of England's incident and mental health nursing workforce data 2015-2022.

INTRODUCTION: There is a paucity of empirical data examining incidents and mental health nurses and the relationship between the two remains uncertain. Comparison of English national data for incidents and nursing workforce to examine recent trends. Descriptive analysis of two national datasets of incidents and workforce data for England between 2015 and 2022. A 46% increase in incidents was found; the leading causes are self-harm and aggressive behaviour. Despite the rise in adverse incident reporting, a 6% increase in mental health nurses was found, with more nurses in community settings than hospitals. Current services are incident reporting at greater concentrations than in previous years. Patient-related behaviour continues to be most prominently reported, rather than possible antecedent health services issues that may contribute to reporting. Whilst staffing has increased, this does not seem to have kept pace with the implied workload evident in the increase in incident reports. Greater emphasis should be placed on health service behaviour in reporting mechanisms. Self-harm and aggression should continue to be considered adverse outcomes, but causal health service factors, such as missed care, should be present in pooled reporting to help reduce the occurrence of adverse outcomes.

Women's status, empowerment, and utilization of skilled delivery services in Papua New Guinea: an empirical analysis based on structural equation modeling.

Skilled birth attendants (SBA) facilitate identifying and overcoming labor problems and saving lives. With one of the highest maternal death rates in the Asia-Pacific area, SBA utilization during childbirth among Papua New Guinea (PNG) women remains low. Women's status and empowerment are important factors in maternal and child health services and critical to maternal and child health development. This study is intended to apply structural equation modeling based on data from the Demographic and Health Survey (DHS) to evaluate the causal relationship between women's status, empowerment, and SBA utilization in PNG and the mechanisms of their influence. This study employed data from the 2016-2018 Papua New Guinea Demographic Health Survey (PNG DHS), which recruited 18,175 women aged 15-49 years. A multi-stage sample and a structured questionnaire were used to collect information on maternal health, women's empowerment, and related topics. STATA 17.0 was used to describe the data, while MPLUS 8.2 was employed for structural equation modeling and pathway analysis. The two empowerment dimensions of household decision-making (standardized path coefficient, β = 0.049, p < 0.05) and access to health services (β = 0.069, p < 0.01) were positively associated with SBA utilization, while the association between attitudes toward partner violence and SBA utilization was not statistically significant. In addition, mediation analysis revealed that education indirectly influenced SBA utilization through access to health services (β = 0.011, 95% CI: 0.002, 0.022). The findings confirmed the direct and indirect effects of women's status and empowerment on SBA utilization in PNG. Therefore, a call for further evidence-based interventions in PNG and possibly Pacific Small Island Developing States (PSIDS) is needed to improve women's educational attainment, household decision-making, and access to health services to enhance maternal and newborn health and well-being.

Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis.

Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia. Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI. Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it. The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

Trends of risk factors associated with childhood stunting and anaemia in Ghana: evidence from the Demographic Health Survey and Multiple Indicator Cluster Survey (2003-2017).

This study investigated the trend of effect estimates of the key risk factors of childhood stunting and anaemia between 2003 and 2017. A secondary analysis of the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data for the Ghanaian population between 2003 and 2017. Associations of selected socio-demographic (child age and gender; maternal age and education), economic (household wealth), environmental, dietary (minimum dietary diversity and iodine use) and health system (place of delivery and vaccination) factors were explored using the Poisson regression model. Trend analysis was explored using a fitted linear regression line on a time series plot. Ghana. Children under 5 years. The results showed a reduction in the prevalence of stunting and anaemia over the 15-year duration. These health outcomes were found to be negatively associated with a wide array of socio-demographic (child age and gender, maternal age and education, residency), economic (household wealth), dietary (iodised salt use) and health service (place of delivery and vaccination) factors; however, the most consistent statistically significant association was observed between child's age and belonging to the poor wealth quintile. In order to prevent these indicators of child malnutrition, key consideration must be given to the early developmental stages of life. Child health policies must focus on addressing the key contextual factors of child malnutrition.

Ethnography of Communication: SPEAKING Analysis on Childbirth Services in Sa'dan, North Toraja

This study aims to identify cultural communication gaps in three common childbirth speech events, namely among the Toraja ethnic community in Sa'dan, North Toraja involving childbirth attendants and different locations, namely (1) childbirth attended by a midwife in a healthcare facility, (2) childbirth attended by a to'mappakianak (traditional birth attendant) at the mother's home, and (3) childbirth with collaborative efforts between a midwife and to'mappakianak in a healthcare facility. To pursue the aim of this study, SPEAKING analysis was used. The SPEAKING analysis (Scene/Setting-Participants-Ends-Act-Key-Instruments-Norms-Genre) is a framework in communication ethnography study developed by Dell Hymes to understand and analyse the society and culture of an ethnic group through communication processes. The results indicated that both midwives and to'mappakianak culturally shared the same goal of safely attending childbirth. However, within the context of different speech community's perspectives, the experiences and cultural nuances of participants, including childbirth attendants, mothers, and families, also conveyed different meanings. These differences could be positive or negative for the involved participants. This study could provide insights for policy of maternal and child health service providers to consider cultural and communication factors in health services for Toraja ethnics in Sa'dan, North Toraja. In short, competent childbirth attendants should be culturally communicative and adhere to safe motherhood principles.