Area Health Service Research Articles

Practice of Family Planning Methods by the Eligible Couple in the Rajshahi City Corporation Area

This study investigates family planning practices among eligible couples in the urban setting of Rajshahi City Corporation, Bangladesh. The research aims to determine the prevalence and demographic factors associated with family planning, as well as the types and sources of family planning methods, decision-making processes, and challenges faced. Data was collected through a cross-sectional study, with 300 eligible couples participating. The findings reveal a commendable prevalence of family planning practices (88.0%) in the area, reflecting accessible and effective reproductive health services. Notably, a significant association was found between the sex of respondents and family planning practices (χ²= 25.549, p<0.001), with a higher percentage of females (88.2%) actively practicing family planning. Female partners played a central role in decision-making, and small family sizes with shorter age gaps between children were observed. Challenges related to side effects (87.2%) and method-related problems highlighted the need for targeted interventions. Enhancing awareness and education programs, strengthening counseling services, and promoting male involvement. Collaboration with NGOs and healthcare providers is suggested to improve family planning services in urban settings, contributing to healthier demographics in Rajshahi City Corporation. These significant statistics underscore the importance of tailored strategies to enhance family planning practices in urban areas.

Probability of Inappropriate Complementary Feeding Practices on Children Aged 6-23 Months in Indonesia: Results of Indonesian Demographic Health Survey in 2017

Background: One of the causes of the double burden of nutrition problems in Indonesia is the early feeding of complementary feeding. The practice of providing complementary feeding in several countries, including Indonesia, has not reached the target and it is not yet known the magnitude of the probability of complementary feeding not following the recommendations in Indonesia based on national survey data. 
 Objective. To identify the risk factors for the failure of Infant and Young Child Feeding (IYCF) practice in urban and rural NTT.
 Objectives: This study aims to determine the Probability of inappropriate complementary feeding practices in Children aged 6-23 Months in Indonesia and the factors that influence it. 
 Methods: The research design uses cross-sectional studies. The data is sourced from the 2017 Indonesian Health Demographic Survey (IDHS) results. The sample was selected from women of childbearing age in IDHS 2017, namely women of childbearing age aged 15-49 years who had children aged 6-23 months who met the inclusion and exclusion criteria of 4,985 children. The data were analysed using multivariate logistic regression. 
 Results: The practice of giving complementary feeding according to recommendations in children aged 6-23 months in Indonesia is only 55.53%. Socio-economic status is very poor (p= 0.000; OR=1.785; 95% CI 1.44-2.213), rural residence (p= 0.000; OR=1.168; 95% CI 1.025-1.33), lower education (p= 0.002; OR=1.398; 95% CI 1.149-1.702), and grande multipara parity (p= 0.001; OR=1.57; 95% CI 1.238-1.992) is significantly associated with the practice of giving complementary feeding not by the recommendations.
 Conclusions: The probability of the practice of giving complementary feeding is not by the recommendation of 86% due to the socio-economic status of very poor families living in rural areas, low maternal education levels, and mothers with grande-multipara parity. It is necessary to improve the socio-economics of the family through the empowerment of mothers and families, increase access to health services in rural areas, improve maternal education through various programs, and intensify family planning programs to limit the number of children in the family.

Spatial analysis of primary healthcare accessibility patterns in Migori County, Kenya

The inequitable and insufficient evidence-based allocation of health resources has exacerbated the health disparities in developing nations. Indicators of inadequate accessibility and misuse of health resources include urban-centered health facility site selection and overlapping health service areas. This research employed Service area analysis and the Maximum Covering Location Problem (MCLP) to assess spatial accessibility while considering the operational schedules of basic healthcare providers. Utilizing the motorbike model, the spatial accessibility to basic healthcare facilities amounted to 84%. However, certain facilities did not operate during weekends or around the clock. During the weekends, accessibility decreased to 60%, and for 24-hour accessibility, it dropped to 49%. Consequently, it is evident that the operating hours of healthcare facilities have a significant effect on spatial accessibility. This study proposed the upgrade of strategically positioned healthcare facilities to enhance spatial access and bolster the referral network for the local population.

Measures to Narrow the Gap of Basic Medical and Health Services for Urban and Rural Residents

Health is the foundation of economic and social development, and people's health and longevity is an important symbol of national prosperity and national strength. Since the reform and opening up, our country has made remarkable achievements in the reform and development of health field. A sound medical and health service system is the basis for reducing the occurrence of diseases and ensuring residents' equal access to medical and health services. With the implementation of the "Healthy China 2030" Plan and a series of policies, promoting a healthy lifestyle and improving the level of basic medical and health services have become the fundamental direction of current medical and health development. Under the guidance of this development direction, in view of the inherent problems of basic medical and health services in rural areas of Hebei Province, it is necessary to fully investigate and understand the actual needs of residents in rural areas, increase the supply body of basic medical and health service resources, and solve the problem of insufficient total amount and uneven distribution of basic medical and health resources. Make up for the weak basic medical and health service foundation in rural areas of Hebei Province, strive to build a people-oriented basic medical and health service system that is balanced between urban and rural areas, and consciously transfer human, material and financial resources in urban areas to rural areas, so as to lay a solid foundation for protecting the health level of rural residents.

Evaluating maternal health capacity building in rural and underserved areas: a research protocol.

The US is currently experiencing a maternal health crisis. Maternal morbidity and mortality in the US are higher than in other developed nations and continue to rise. Infant mortality, likewise, is higher in the US than in other developed nations. Limited availability of maternal health services, particularly in rural areas, contributes to this crisis. Maternal health outcomes are poorer, and maternal care workforce shortages are more severe in rural areas of the US. In rural areas where obstetric specialists are rare, many patients rely on family medicine physicians for maternity care. However, the number of family medicine physicians who provide maternal care services is decreasing, aggravating shortages. Calls have been made to build maternal care capacity in rural areas. The role family medicine will play in addressing the maternal health crisis is not clear. Maternal care shortages are complex issues resulting from multiple factors; likewise, efforts to build maternal health capacity are challenging and require multifaceted approaches. With funding from the Health Resources and Services Administration (HRSA), the University of Utah seeks to address the shortage of quality maternity care in rural and underserved areas of Utah by strengthening partnerships, enhancing maternal care training of family medicine residents and obstetrics fellows, and improving the transition from training to rural practice for residents and fellows. This protocol describes the evaluation of the HRSA-funded project. The evaluation includes three components. Component 1 consists of qualitative interviews with a diverse group of maternal health providers, administrators, educators and academics, patients, and others. Interviews will be analyzed using qualitative content analysis. Component 2 is a survey of family medicine residents and obstetrics fellows, which aims to increase understanding of the factors and circumstances influencing intention to practice in rural or underserved areas and to provide maternal health services. Component 3 involves surveying fellowship alumni and tracking graduates to assess effectiveness of training programs in producing physicians who provide maternal health services in rural and underserved areas. Surveys will be analyzed with descriptive statistics including means, frequencies, and cross-tabulations. If sample size and participation provide sufficient power, statistical tests will be included in analyses. Evaluation results will help to fill an important gap in research literature concerning outcomes of projects and initiatives designed to build maternal care capacity in rural areas of the US. In addition, results will provide valuable information regarding effective practices for building capacity, which can be adopted elsewhere to address maternal care shortages. Finally, results will help to define the role of family medicine in addressing the maternal health crisis. Amid maternal care shortages, fewer and fewer family medicine physicians are providing maternal care in their practice. Evaluation results will clarify the role of training and preparation of family medicine residents in addressing workforce shortages. This evaluation will provide important contributions, but additional research is needed, including research protocols and studies of project outcomes, to understand how best to resolve the maternal care crisis in the US.

Abstract B118: Racial and ethnic minorities remain underrepresented in cancer clinical trials despite local cancer incidence

Abstract Introduction: Over the last two decades, racial and ethnic minorities have been underrepresented in cancer clinical trials. Some have suggested that location is a barrier to inclusion in cancer clinical trials. The aim of this project is to assess how diversity of cancer clinical trials reflect their surrounding communities. Methods: Cancer clinical trials for the top five most deadly cancers including lung, breast, prostate, colon and pancreatic were selected from ClinicalTrials.gov. Trials were excluded if they were conducted outside the US or in multiple NIH-designated health service areas (HSA). Location-specific enrollment fractions were determined by comparing the proportion of trial participants to the local cancer incidence. National Cancer Institute (NCI) and Centers for Disease Control and Prevention (CDC) state cancer profiles (statecancerprofiles.cancer.gov) were used to determine HSA-specific data of cancer incidence by race and ethnicity. Results: 904 cancer clinical trials were identified from 2008-2022, including lung (n=157), breast (n= 330), prostate (n=219), colon (n=111) and pancreas (n=87). Overall, reporting of race and ethnicity was poor with only 53.6% of total trials reporting race and 35.9% reporting ethnicity. Compared to the local cancer incidence surrounding trial centers, White patients were overrepresented (p<0.0001), whereas Black (p<0.0001), Asian/Pacific Islander (p<0.0001), American Indian/Alaskan (p<0.0001) and Hispanic (p=0.004) were underrepresented. Furthermore, Black patients were underrepresented across breast (p=0.009), prostate (p<0.0001), lung (p<0.0001), colon (p=0.027) and pancreas (p<0.0001) cancer clinical trials when compared to the local cancer incidence. Conclusion: Racial and ethnic minority patients remain underrepresented in cancer clinical trials when compared to local cancer incidence. These findings reaffirm that location is not the only barrier to cancer clinical trial participation. Further efforts are needed to reduce healthcare disparities and improve patient care. Citation Format: Kelly M. Herremans, Andrea N. Riner, Vignesh Vudatha, Devon C. Freudenberger, Jose G. Trevino. Racial and ethnic minorities remain underrepresented in cancer clinical trials despite local cancer incidence [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B118.

OUT-OF-POCKET EXPENDITURE ON OUT-PATIENT CARE IN EAG STATES: AN ANALYSIS BASED ON NSSO 75TH ROUND DATA

Regardless of their socio-economic status, everyone has the human right to receive healthcare. Since the Indian government spends so little on health care, healthcare spending has been a major source of concern. However, most of the literature in India on determinants of health spending has focused on hospitalization, and there are relatively fewer separate studies on health-seeking behaviour and expenditure in outpatient departments. The purpose of this study was to determine the patterns of health-care-seeking behaviour and the pattern of expenditure incurred by households during outpatient care in Empowered Action Group (EAG) States. The present study used secondary data from the latest 75th round of National Sample Survey (NSS) conducted from July 2017 to July 2018 on the key indicators of social consumption in India: Health. The finding suggest that the seeking behaviour of ailing persons as outpatients, across EAG states only limited population access to public sources of healthcare (36.8% in rural and 27.3% in urban). Rajasthan (46.7%), Madhya Pradesh (41.5%), Bihar (32.9% rural), and Uttar Pradesh (31.3%) have the highest percentage of outpatient who expressed dissatisfaction with the standard of public health services in rural areas. Among EAG states of urban areas, Uttar Pradesh (42.6%) have the highest percentage of not satisfied with the quality of care by government sources. Among EAG states, Significant inter-state variation was observed, with Rajasthan (Rs. 886) reporting the highest expenditure for outpatient treatment and Chhattisgarh (Rs. 350) reporting the lowest in rural areas. However, Uttar Pradesh (Rs. 1194) reported the highest and Odisha (Rs. 508) reported the lowest expenditure incurred on outpatient care by ailing persons in urban areas. The amount that each state spends on healthcare varies greatly, which causes inter-state differences in the cost of outpatient treatment in EAG states. As a result, the government needs to control the cost of medications and diagnostic tests and ensure that plans for outpatient care include coverage. KEYWORDS: Outpatient care, out-of-pockect expenditure, EAG states,

Abstract 12575: Diagnoses Associated With Telemedicine Use in Cardiology Clinics During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic led to widespread adoption of telemedicine, which has persisted in healthcare delivery. We aimed to characterize telemedicine use in ambulatory cardiology clinics over 2 years following onset of the COVID-19 pandemic. Question: What diagnoses are associated with telemedicine use in cardiology appointments? Methods: In this retrospective cohort study, demographic and encounter data of all cardiology clinic and telemedicine visits in the University of California Los Angeles (UCLA) Health System from 3/16/2020 to 6/27/2022 were obtained. Encounters were included if they were conducted by physicians, complete with ICD-10 codes, and not missing demographic data. Mixed effects logistic regression was used to model the association of diagnosis class (based on ICD-10 codes) with whether encounter was scheduled as telemedicine, adjusting for age, sex, race, ethnicity, social vulnerability index, date, and zip code. Results: The analysis included 72,878 patients (49.8% women, age 61.5 ± 17.2 years, 57.2% white, 12.5% Hispanic, 82.6% with zip code in a UCLA Health service area) over 248,373 encounters. Each patient had a median of 2 encounters (range 1-82). Of all encounters, 27,894 (11.2%) were scheduled as telemedicine. Telemedicine was more likely used in management of chronic conditions, especially metabolic disorders (adjusted OR [aOR] 2.26, 95% CI 2.10-2.44) and cardiomyopathies (aOR 2.10, 95% CI 1.93-2.28), than for evaluation of undifferentiated signs/symptoms. Telemedicine was less likely used for general exam/screening (aOR 0.52, 95% CI 0.46-0.58) and heart transplant (aOR 0.51, 95% CI 0.50-0.64; Table ). Conclusion: In this study, the most established use case for telemedicine in cardiology was care of chronic cardiac diagnoses among non-transplant patients. Ongoing maintenance of chronic cardiovascular conditions through telemedicine may be a sustainable healthcare delivery model post COVID-19 pandemic.

Q fever infection is a preventable risk associated with pet food manufacturing.

This paper highlights the occupational risk of Q fever from exposure to raw animal products in the context of multiple notified Q fever cases from 2020 to 2023 linked to four pet food manufacturing facilities in South-East Queensland, Australia. The Queensland Government Notifiable Conditions System was used to identify Q fever cases linked to pet food manufacturing in the Metro North and Gold Coast Hospital and Health Service areas of Brisbane, Australia. Data on each case from routine public health follow-up were collected and descriptively analysed. Between 2020 and 2023, 12 confirmed Q fever infections (17% of total cases) were linked to four pet food manufacturing facilities. Eleven cases reported direct or environmental exposure to raw meat and animal products. None were previously vaccinated for Q fever. These cases demonstrate the increased risk of Q fever infection as part of the pet food manufacturing process, highlighting an underappreciated preventable occupational risk, which can be mitigated with the use of pre-screening and vaccination of workers. All occupations should conduct workplace-based risk assessments to identify risks such as Q fever to prevent adverse negative health outcomes.

Fewer Communities Left Behind: Peritoneal Dialysis (PD) Initiation Patterns by Health Service Area in an Era of Expansion

Fewer Communities Left Behind: Peritoneal Dialysis (PD) Initiation Patterns by Health Service Area in an Era of Expansion

Identifying the sources and impacts of caregiver fatigue and burnout among mental health caregivers: A qualitative approach

Introduction: To identify work-related issues to assist mental health caregivers in identifying sources and effects of caregiver burnout; to establish a dialogue between the participants and identified sources of stress in the workplace to address identified problems; and to make recommendations to local area health services to prevent and manage stressors in a mental health caregiver practice. The proposed study will help the sector by pinpointing the causes of caregiver burnout and burnout in the mental health caregiving profession and offering solutions to those causes. Method: 20 experienced registered caregivers working as mental health caregivers were recruited using the snowball method, and convenience sampling was used to target study participants interested in finding reasons for caregiver burnout and burnout at work. Semi-structured interviews were used to collect data, in which questions about relative impact are used to help clients focus on factors outside themselves to solve problems. Results: Emotional stress and burnout are the overarching themes of studies conducted on the effects of burnout on mental health caregivers in various settings: job insecurity and labor casualization; problems with management and systems; challenges with the nature of work; inadequate resources and services; problems with other health care; aggressive and criminal consumers; and belittling consumers and caregivers. Conclusion: The physical and emotional constraints of work all contribute to mental health caregivers’ experiences of caregiver burnout. Employees’ ability to deal with and respond to pressure in the workplace has been shown to be negatively affected by stress.

The effect of non-medical cannabis retailer proximity on use of mental health services for psychotic disorders in Ontario, Canada.

Cannabis is associated with the onset and persistence of psychotic disorders. Evidence suggests that accessibility of substances is associated with an increased risk of use-related harms. We sought to examine the effect of residing in proximity to non-medical cannabis retailers on the prevalence of health service use for psychosis. We conducted a cross-sectional study using linked health administrative data, and used geospatial analyses to determine whether people in Ontario, Canada (aged 14-60 years) resided within walking (1.6 km) or driving (5.0 km) distance of non-medical cannabis retailers (open as of February-2020). We identified outpatient visits, emergency department (ED) visits, and hospitalizations for psychotic disorders between 01-April-2019 and 17-March-2020. We used zero-inflated Poisson regression models and gamma generalized linear models to estimate the association between cannabis retailer proximity and indicators of health service use. Non-medical cannabis retailers were differentially located in areas with high levels of marginalization and pre-existing health service use for psychosis. People residing within walking or driving distance of a cannabis retailer had a higher rate of psychosis-related outpatient visits, ED visits, and hospitalizations, compared to people living outside these areas. This effect was stronger among those with no prior service use for psychosis. Proximity to a non-medical cannabis retailer was associated with higher health service use for psychosis, even after adjustment for prior health service use. These findings suggest that opening of non-medical cannabis retailers could worsen the burden of psychosis on mental health services in areas with high-risk populations.

Knowledge, confidence, and practices of clinical associates in the management of mental illness.

Additional human resources are needed to provide mental health services in underserved areas in South Africa (SA). Clinical associates, the mid-level medical worker cadre in SA, could potentially be used to deliver these services. The study explored the self-reported knowledge, confidence, and current practices of clinical associates related to mental health assessment and management. South Africa. A cross-sectional study was conducted. The link to the electronic questionnaire was distributed to clinical associates via databases and social media. Data were analysed with Stata v17. Of the 209 participants, 205 (98.1%) indicated they had training on management of patients with mental illness during their undergraduate degree and 192 (91.9%) had a mental health rotation. Few (10.7%) had any additional mental health training. Most participants rated their knowledge of priority mental disorders as 'good' or 'excellent'. Only 43.2% of the participants felt quite or very confident to perform a mental health examination. Participants who felt quite or very confident to manage patients presenting with suicide risk, aggression, and confusion were 44.9%, 46.9% and 53.1%, respectively. Factors associated with a confidence score of 75% and higher were male gendered, working in Gauteng or Northern Cape provinces, and in a rural area. The majority of participants were already involved in mental health assessment and management in their current work. Clinical associates have a contribution to make in mental health service provision, but this may need to be supplemented by additional practical training. Potential gaps in training have been identified.

My Health My Language bridging the gap in public healthcare messaging

Abstract Issue Like many other European countries there has been a sharp increase in the number of migrants in Ireland recently. 13.9% of migrants in Ireland have poor or no English (Census 2016) and are not reached with mainstream public health messaging. Prior to the COVID-19 pandemic, most intercultural health resources were written rather than audio-visual. A clear need to reach out to these communities was identified. Project In 2021 the Health Service Executive (HSE) National Social Inclusion Office (NSIO) initiated a project with Translate Ireland (TI) to address the gap in intercultural health resources. Through consultation, priority health protection and health service areas were identified for inclusion in a suite of videos in main migrant languages. NSIO consulted with mychild.ie, National Immunisation Office, Irish College of GPs, Public Health, HSE Communications and the Sexual Health/Crisis Pregnancy Programme to ensure the scripts were aligned with HSE policy. TI identified health professionals living and working in Ireland, that were part of the migrant communities, to deliver key messages in the videos. TI worked with the presenters in wording the scripts to ensure cultural appropriateness. Results 11 primary care/maternal care videos were produced in 17 languages (187 videos), for healthcare professionals and people seeking health information. A dedicated webpage was created to ensure the videos were easily accessible and the project was named My Health My Language. The project was formally launched in June 2022 by the Minster of Health. We engaged with migrant communities, NGOs and government departments to share the multi-media video messages. By June 2023 there are 14,055 views of the videos. Lessons As smartphones are widely used by underserved groups, video messaging is very effective, for those with limited English or where English is not their first language. Short URLs on social media are very effective in providing access to videos. Key messages • My Health My Language is a health equity initiative, addressing health information needs of people who have limited English or where English is not their first language. • Culturally appropriate healthcare videos by peer healthcare professionals speaking in their own language have had significant reach, with over 14,000 views since launching in April 2022.

Time's ticking! Effects of deadline on the utilization of health services: Evidence from a cluster-randomized controlled trial

The low utilization of health services in rural areas is an essential factor affecting the health level of rural residents. Based on insights from behavioral economics, this study evaluates the average treatment effect of imposing a deadline on vision-care vouchers (i.e., the voucher-deadline intervention) on the utilization of health services. Using the vision health as a case study, a non-masked cluster-randomized controlled trial was conducted in 13 rural schools of a county in Shaanxi Province of China during 2018–2019. Among 1270 baseline sample students with myopia, 610 students from 6 schools were randomly assigned to receive vouchers with no deadline (i.e., the Control group), and 660 students from 7 schools to receive vouchers with a 30-day deadline (i.e., the Deadline group). The results showed that the voucher-deadline intervention significantly improved the vision-center visiting rate by 13.2 percentage points within 30 days and shortened the interval between visits (i.e., increased timeliness) by 18.7 days. In comparison, the vision-center visiting rate and the interval between visits among the control group were 16.7% and 30.5 days, respectively. However, considering a longer time frame (6 months), we found that intervention only shifted students' utilization to before the voucher expires without improving overall utilization rate. The loss aversion and time pressure induced by the voucher deadline are possible explanations for the treatment effects. This study suggests insights from behavioral economics can enhance the design of public health programs to improve the utilization and the cost-effectiveness of health-service programs. Trial registrationisrctn.org Identifier ISRCTN03252665.

Conducting a Comprehensive Assessment of the Public Health Workforce: Lessons Learned and Opportunities for the Future.

Indiana was one of the earliest states to conduct a comprehensive public health workforce assessment in preparation for the use of federal funds for infrastructure strengthening. Experiences from this assessment provide insights that may be useful to other public health agencies and partners. This brief summarizes key lessons and highlights opportunities for improved workforce assessments. For example, the lack of standardized job titles within local health departments (LHDs) can be mitigated by collecting the top 3 job tasks employees engage in daily and reassigning standardized titles based on nationally collected workforce data. This facilitates comparisons across LHD employees nationally. In addition, many employees felt their job tasks did not align well with the Foundational Public Health Services (FPHS) areas and capabilities, which contributed to the likely overestimation of effort. Further consideration of how to better align and/or integrate FPHS assessment within current practice is needed in addition to improved ways of assessing efforts toward FPHS.

Subcutaneous mycoses: Endemic but neglected among the Neglected Tropical Diseases in Ethiopia.

Subcutaneous (deep) mycoses are a chronic infectious disease of the skin and underlying structures endemic in tropical countries. The disease has serious medical and socioeconomic consequences for patients, communities and health services in endemic areas. The inclusion of mycetoma and other subcutaneous mycoses in the list of Neglected Tropical Diseases by WHO highlights the need to assess the burden of these diseases and establish control programs where necessary. In Ethiopia no strategies can be devised because of a lack of epidemiologic information. To address this evidence gap, we performed a national rapid assessment of the geographic distribution of subcutaneous mycoses. We conducted a rapid retrospective assessment using hospital records to identify all suspected and confirmed cases of subcutaneous mycoses in 13 referral hospitals across the country between 2015 and 2022. In each hospital the logbooks were reviewed for diagnoses of subcutaneous mycosess, as diagnosed per routine practice. Descriptive analysis was done. From 13 hospitals we extracted 143 cases of subcutaneous mycoses, registered from July 2018 to September 2022. 118 (82.5%) patients were diagnosed as mycetoma, 21 (14.7%) as chromoblastomycosis and the remaining 4 (2.8%) as sporotrichosis. The mean age of patients was 35.8 years (SD = 14.5). 101 (70.6%) patients were male and 96 (67.1%) patients were farmers. 64 (44.8%) cases were from the Tigray regional state. 56 (65.9%) patients had information on diagnostic microscopic evaluation: for mycetoma histopathologic evaluation and fine needle aspiration cytology had a higher positivity rate while for chromoblastomycosis potassium hydroxide (KOH) staining had a better yield. The main clinical presentations were nodules, sinuses and infiltrative plaques on the skin. Radiologic findings of bone involvement was present in some. Mycetoma and other subcutaneous mycoses are endemic in Ethiopia, with cases reported from almost all regions with the highest cases numbers reported from the northern part of the country. A routine program and systems should be developed to identify and document the burden of subcutaneous fungal infections in the country. Diagnosis and treatment guidelines should be developed.

Traditional Birth Attendant in the Maternal and Child Health Space in Nigeria: Ancient Practices and Modern Recommendations

Background: Arguments on the usefulness of Traditional Birth Attendants (TBAs) in maternal and child health care and the reduction of maternal and child morbidity and mortality indices or not, persist. This paper sought to explore the ancient practices of TBAs and to strike a balance to portray modern recommendations that would contribute to improved maternal and child health status. Methods: The method used was review of relevant literatures from open-access journals and google scholar data base, as well as research reports on variables of the subject in developing countries. Results: Findings revealed that the overlapping root of TBAs’ practice burden include poor social amenities, inadequate health facilities and services in rural areas where over 70% of the population reside. While evidencebased report showed that even when 93% of rural women registered for Ante-Natal Care, 49% were delivered at home by TBAs and 73% has sought help from them for retained placenta with bleeding. Also, 41% of women of child bearing age indicated that maternal and child infection is a risk associated with the patronage of TBAs, whereas 32.8% indicated that bleeding during and after delivery were equally risks associated with TBA-provided maternal health services. Such circumstances of service were associated with harmful practices with attendant health and medical complications to recipient mother and child. However, helpful ancient practices of TBAs include; home visiting to promote well-being of mother and child (9.84%), sitz bath (17.20%), encouraging breastfeeding up to 2years (18.90%) etc. The modern recommendations, x-rayed the remedial actions on the harmful practices and associated negative consequences to improving maternal and child health indices in Nigeria. Conclusion: For reasonable and sustainable reduction in the burden associated with the practices of TBAs in maternal and child health care in Nigeria, contextual focused training and continuous mentoring is a necessity.

Kesetaraan Gender dalam Pengambilan Keputusan Pemanfaatan Pelayanan Kesehatan di Daerah Urban dan Rural, Indonesia

Utilization of health services by pregnant and postpartum women can save women from the incidence of maternal death and severe complications during pregnancy and postpartum. Several factors that directly contribute to the utilization of health services are decision making and sources of information obtained by pregnant and postpartum women regarding the utilization of health services. This study aims to analyze gender equality in decision making on the use of health services in urban and rural areas of Indonesia. This study used a mixed-method approach from primary data and a literature review. The target in this article was pregnant women and postpartum mothers who were spread out in several health centers in Surabaya City and Bojonegoro Regency with a total of 175 respondents who were calculated using the proportion estimation formula. Data analysis used univariate and bivariate analysis. The results showed that the wife in terms of the number of frequencies dominated in making decisions on the use of health services (92.5%). In addition, when the decision maker is the husband, all postpartum mothers (100%) will take advantage of health services. Related to the source of information that many respondents chose in providing information related to pregnancy health for the use of health services, it was health workers (86.3%) compared to other media. The wife's decision is a determinant in making decisions about the use of health services. On the other hand, husband’s support as a decision maker can also influence his wife to take advantage of health services.

Changes in Children and Youth's Mental Health Presentations during COVID-19: A Study of Primary Care Practices in Northern Ontario, Canada.

Recent research suggests that children and youth are at increased risk of anxiety and depression due to the indirect effects of the COVID-19 pandemic. In Canada, children and youths may face additional hurdles in accessing mental health services in rural areas due to socioeconomic disadvantages and healthcare provider shortages worsened by the pandemic. Our study aimed to assess changes in primary healthcare utilization related to depression and anxiety among children and youth aged 10-25 years in Northern Ontario, Canada. We analyzed de-identified electronic medical record data to assess primary healthcare visits and prescriptions for depression and anxiety among children and youth aged 10-25 years. We used provider billing data and reasons for visits and antidepressant/antianxiety prescriptions compared with 21 months pre-pandemic (1 June 2018 to 28 February 2020) and 21 months during the pandemic (1 April 2020 to 31 December 2021). Our interrupted time series analysis showed an average increase in visits by 2.52 per 10,000 person-months and in prescriptions by 6.69 per 10,000 person-months across all ages and sexes. Females aged 10 to 14 years were found to have the greatest relative change in visits across all age-sex groups. The greatest relative increases in antianxiety and antidepression prescriptions occurred among females and males aged 10 to 14 years, respectively. These findings indicate that there were increased anxiety and depression presentations in primary healthcare among children and youths living in northern and rural settings during the COVID-19 pandemic. The increased primary healthcare presentations of anxiety and depression by children and youths suggest that additional mental health resources should be allocated to northern rural primary healthcare to support the increased demand. Adequate mental health professionals, accessible services, and clinical recommendations tailored to northern rural populations and care settings are crucial.