Health System-related Factors Research Articles

Assessing multilevel barriers to hydroxyurea adherence in youth with sickle cell disease using pharmacy-based refill records.

Suboptimal medication adherence is common across youth with chronic health conditions and may contribute to health disparities and adverse health outcomes, especially in underserved communities. Using pharmacy prescription records and guided by the World Health Organization Multidimensional Adherence Model, we examined patient-, treatment-, and health system-related factors that may affect hydroxyurea adherence in 72 youth with sickle cell disease (SCD), 10-18 years who had participated in the multisite "Hydroxyurea Adherence for Personal Best in SCD" (HABIT) feasibility (6 months) and efficacy (12 months) trials. Pharmacy data were collected from the year prior to study entry through the duration of each trial. We also examined hydroxyurea dose at baseline, prescribing patterns (hydroxyurea formulation and dose prescribed), quantity of hydroxyurea dispensed, and number of daily capsules/tablets prescribed. Data were analyzed using descriptive statistics. On average, youth were prescribed 1095±402mg hydroxyurea per day, requiring ingestion of 3 or more capsules for 39.4% of youth. Frequently identified potential barriers were complex medication regimens in which dose of hydroxyurea differed by day of week (47.2%); receipt of an inadequate (<30 days) supply of hydroxyurea from the pharmacy≥3 times during record collection period (29.2%); and prescription of hydroxyurea suspension suggesting problems swallowing capsules (22.2%). In this sample, most youth were exclusively prescribed 500mg capsules (62.5%), which was associated with complex medication regimens (RR 3.0, 95% CI 1.4-6.7). Potential barriers were common, occurred at all levels and are potentially modifiable with targeted interventions at the treatment- and health system-related levels.

Adherence for members taking oral oncolytic agents undergoing dose modification strategies.

e23058 Background: The use of oral oncolytic agents has transformed oncology care. Previous studies have reported that patient, treatment, and health system-related factors may influence adherence rates in patients prescribed oral oncolytic agents. The purpose of this study is to assess adherence rates in members of a large national pharmacy benefit manager taking oral oncolytic agents who experienced a modification to their dosing regimen. Methods: Adult members receiving palbociclib, abemaciclib, ribociclib, axitinib, lenvatinib, or cabozantinib between 01/01/2021 and 12/31/2022 were eligible for the study. Members who did not maintain continuous eligibility for 180 days prior to and 2 years after the first fill in the study period were excluded. Members were stratified by presence of dose modification, defined by a change in daily dose from one prescription to the next. Adherence was assessed via the proportion of days covered (PDC) which is the total days with medication coverage divided by the number of days between the index fill and exhaust of the final fill in the study period. Optimal adherence was defined as PDC ≥ 0.85. Standard statistical tests for continuous and categorical variables were utilized. Logistic regression was performed with the endpoint of optimal adherence. P values &lt; 0.05 are significant. Results: 13,641 members were included in the final analysis, with 7,093 (52%) experiencing a modification to their dosing regimen during the study period. Several significant differences in sociodemographic variables were present in this study with members experiencing a dose modification being older (mean [standard deviation (SD)]: 65.7 [11.9] vs. 64.9 [13.0] yr; p &lt; 0.001), more likely to be male (23.3% vs. 15.0%; p &lt; 0.001), more likely to reside in high socioeconomic status (SES) regions (23.7% vs. 21.5%; p = 0.005) and more likely to receive tyrosine kinase inhibitors (TKIs) (37.6% vs. 23.6%; p &lt; 0.001). Adherence was high overall with 74.6% of members achieving a PDC ≥ 0.85; however, members with dose modifications were less likely to be adherent (69.7% vs. 80.0%; p &lt; 0.001). Holding other confounders constant, having a dose modification was associated with a decreased likelihood of adherence (Odds Ratio [95% Confidence Interval]: 0.6 [0.55-0.65]; p &lt; 0.001). Conclusions: Dose modification was associated with significant decreases in adherence to oral oncolytic medications. Interventions designed to minimize dose modifications or to provide additional member support during a dose modification may optimize oral oncolytic adherence.

Health System-Related Factors that Influence Retention in Care among HIV Infected Pregnant Women in Narok County, Kenya

Purpose: The aim of the study was to establish the health system-related factors that influence retention in care among HIV infected pregnant women in Narok County, Kenya. Methodology: The study adopted a cross-sectional mixed method design. Purposive sampling method was used to sample the required sample size of 117 HIV infected pregnant women, the participants of the Focus Group Discussions (FGD) and Key Informant Interviews (KII). The study was carried out at Narok County Referral and all the sub-county hospitals in Narok County. A structured questionnaire was used to collect quantitative data. Focus group discussion and KII guides were used to collect qualitative data. Quantitative and qualitative data was analyzed using SPSS version 21 and Nvivo version 14 respectively. Chi square test and logistic regression analysis were used to determine the health system-related factors that influence retention in HIV care. Thematic content analysis was done for qualitative data. The mean age of participants was 30 years (SD=6.48). The study results generated were presented in bar graphs and tables for quantitative data. Results were presented as narrations and triangulated with qualitative data. Findings: This study established that health system-related factors (waiting time, health care workers services and ARV availability) influenced retention in care among HIV infected pregnant women. However, only ARV availability had a significant association with retention in care (P&lt;0.001, OR=0.19). The multiple logistic regression was used to predict the influence of grouped variables. Overall, the model was a significant predictor of retention in care. Health system related factors was found to increase the likelihood of being retained in care (OR=5.14), though not significant predictors of retention in care (P&lt;0.34). Unique Contribution to Theory, Practice and Policy: Health system-related factors particularly ARV drug stocks, healthcare workers staffing and timely access of services should be strengthened in order to avert stock outs, minimize waiting time and follow up patients who miss clinic appointments to increase retention among pregnant women in HIV care. Advocate for policy reforms aimed at addressing structural barriers to retention in care, including increased investment in healthcare infrastructure, workforce capacity building, and integration of HIV services within maternal and child health programs. By aligning policy initiatives with the unique needs of HIV-infected pregnant women, policymakers can foster an enabling environment for retention in care, ultimately contributing to the achievement of national and global HIV/AIDS targets.

[Translated article] Melanoma Registry of the Spanish Academy of Dermatology and Venereology (REGESMEL): Description and Data in its First Year of Operation

IntroductionThe incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. MethodsREGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. ResultsA total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. ConclusionsThe distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

Prescriptive appropriateness of dalbavancin in acute bacterial skin and skin structure infections in adults: an integrated approach between clinical profile, patient- and health system-related factors and focus on environmental impact

Prescriptive appropriateness of dalbavancin in acute bacterial skin and skin structure infections in adults: an integrated approach between clinical profile, patient- and health system-related factors and focus on environmental impact

Risk Factors for Non-Adherence to Medication for Liver Transplant Patients: An Umbrella Review.

Background/Objectives: Liver Transplantation (LT) is the second most common solid organ transplantation. Medication adherence on LT patients is key to avoiding graft failure, mortality, and important quality of life losses. The aim of this study is to identify risk-factors for non-adherence to treatment of liver transplant patients according to reliable published evidence. Methods: An umbrella review within the context of adherence to immunosuppressant medication of LT patients, was conducted. The review was performed in accordance with the principles of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Results: A total of 11 articles were finally included for the review. Non-adherence factors were identified and allocated using the WHO classification of factors for non-adherence. Each of these groups contains a subset of factors that have been shown to influence adherence to medication, directly or indirectly, according to literature findings. Conclusions: The results of the review indicate that sociodemographic factors, factors related to the patient, factors related to the treatment, condition-related and health system-related factors are good categories of predictors for both adherence and non-adherence to immunosuppressive medication in LT patients. This list of factors may help physicians in the treating and recognizing of patients with a potential risk of non-adherence and it could help in the designing of new tools to better understand non-adherence after LT and targeted interventions to promote adherence of LT patients.

Birth Plan Utilization and Associated Factors among Post Natal Women Attending Maternal Child Health Services in Moyale Sub County, Kenya

Purpose: Maternal and neonatal mortalities continue to pose big public health concern in Kenya despite several interventions. These deaths are partly attributed to three delays; delay by the mother in deciding to seek timely care, delay in arriving at the point of health service delivery and delay in receiving adequate health care once at the health facility. Birth planning is important in addressing these delays. A birth plan serves to promote positive pregnancy outcome. There is however, a paucity of data showing level of birth plan utilization and factors associated to the utilization in many areas of Kenya. This hampers efforts in promoting its utilization in reducing maternal mortality ratio. This study sought to find out extent of utilization of individual birth plan and factors that are associated with it among post-natal women attending Maternal Child Health Services in Moyale Sub County, Kenya.&#x0D; Methodology: The study was a health care facility based cross sectional study that employed multi stage sampling methods. A total of 548 post-natal women attending Maternal Child health services within Moyale Sub County were interviewed. Data was collected through a structured quantitative questionnaire and FGD guide between May 2021 and July 2021 and analyzed using binomial logistic regression in SPSS version 22. To address confounding, significant variables were put through multinomial regression analysis.&#x0D; Findings: Overall, 42.3% of interviewed women had used a birth plan. Socio-demographic factors associated with utilization of a birth plan was secondary level of education (OR=1.214(1.1-2.4), p=0.000), Diploma and above level of education (OR=5.7(0.5-62.1), p=0.042). Maternal factors influencing utilization of birth plan included previous complications (OR=2.6(1.3-3.0), p=0.039), four or more ANC visits (OR=2.4(1.28-3.69, p=0.000), trimester of first ANC (OR=1.4(1.3-3.7), p=0.000), PNC visits (OR=2.3(1.4-3.8), p=0.001). Health system related factors influencing utilization included time of more than one hour in reaching health care (OR=0.999(0.9-1.0), p=0.048), availability of staff at health facility (OR=3.6(1.9-3.9), p=0.024). Treating women with respect at health facility (OR=1.049(1.16-6.5), p=0.034) and availability of drugs/supplies at health facility (OR=3.3(2.2-4.5), p=0.000).&#x0D; Unique Contribution to Theory, Policy and Practice: The study showed that there is need to improve quality of ANC services given in health care facilities. Health care workers in health facilities offering ANC need to initiate timely IBP counselling for pregnant mothers. There is also a need for Community health volunteers under the community health strategy to offer counselling on IBP during routine household visitations. Health care providers and patient interactions also need to improve, health workers need to be trained/sensitized on good customer relations to build patient trust. Further research is also recommended to assess quality of ANC services offered in health facilities in the region. Quality of health education and counselling offered by CHV’s during home visits to pregnant mothers also needs to be examined.

Registro de Melanoma de la Academia Española de Dermatología y Venereología (REGESMEL): descripción y datos en el primer año de funcionamiento

IntroductionThe incidence of melanoma is rising in Spain. The prognostic stages of patients with melanoma are determined by various biological factors, such as tumor thickness, ulceration, or the presence of regional or distant metastases. The Spanish Academy of Dermatology and Venereology (AEDV) has encouraged the creation of a Spanish Melanoma Registry (REGESMEL) to evaluate other individual and health system-related factors that may impact the prognosis of patients with melanoma. The aim of this article is to introduce REGESMEL and provide basic descriptive data for its first year of operation. MethodsREGESMEL is a prospective, multicentre cohort of consecutive patients with invasive cutaneous melanoma that collects demographic and staging data as well as individual and healthcare-related baseline data. It also records the medical and surgical treatment received by patients. ResultsA total of 450 cases of invasive cutaneous melanoma from 19 participant centres were included, with a predominance of thin melanomas≤1mm thick (54.7%), mainly located on the posterior trunk (35.2%). Selective sentinel lymph node biopsy was performed in 40.7% of cases. Most cases of melanoma were suspected by the patient (30.4%), or his/her dermatologist (29.6%). Patients received care mainly in public health centers (85.2%), with tele-dermatology resources being used in 21.6% of the cases. ConclusionsThe distribution of the pathological and demographic variables of melanoma cases is consistent with data from former studies. REGESMEL has already recruited patients from 15 Spanish provinces and given its potential representativeness, it renders the Registry as an important tool to address a wide range of research questions.

A Systematic Review and Classification of Factors Influencing Diabetic Foot Ulcer Treatment Adherence, in Accordance With the WHO Dimensions of Adherence to Long-Term Therapies.

Effective treatment of diabetic foot ulcers (DFUs) involves a multidisciplinary treatment plan to promote wound healing and prevent complications. Given the lack of consensus data on the factors affecting patient adherence, a systematic review was performed to identify and classify factors according to the WHO Dimensions of Adherence to Long-Term Therapies. Six hundred and forty-three articles from PubMed, Embase, and Scopus were reviewed. The inclusion criteria included qualitative and quantitative studies which discussed factors affecting patient adherence to DFU treatment, had study populations that comprised patients with either prior history of or existing DFU, and had either prior history of DFU treatment or were currently receiving treatment. Factors, and associated measures of adherence, were extracted and organized according to the WHO Dimensions of Adherence to Long-Term Therapies. Seven quantitative and eight qualitative studies were included. Eleven patient-related factors, seven condition-related factors, three therapy-related factors, five socioeconomic factors, and five health system-related factors were investigated by the included studies. The largest proportion of factors studied was patient-related, such as patient insight on DFU treatment, patient motivation, and patient perception of DFU treatment. There was notable overlap in the range of discussed factors across various domains, in the socioeconomic (including social support, income, social and cultural acceptability of DFU therapy, cost) and therapy-related domains (including duration of treatment, offloading footwear, and reminder devices). Different studies found that specific factors, such as gender and patients having a low internal locus of control, had differing effects on adherence on different cohorts. Current literature presents heterogeneous findings regarding factors affecting patient adherence. It would be useful for future studies to categorize factors as such to provide more comprehensive understanding and personalized care to patients. Further research can be done to explore how significant factors can be addressed universally across different cohort populations in different cultural and socioeconomic contexts.

A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis.

The achievement of the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1 is strongly dependent on the effective utilization of skilled birth services. Despite advancements made in Skilled Birth Attendance (SBA) in Ghana, there are still instances of unassisted childbirths taking place. The aim of this study was to explore the residual barriers of SBA such as community- and health system-related factors affecting SBA in Ghana and to identify strategies for addressing them. An electronic search was done using PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 200 and 2022 on community- and health system related factors influencing SBA in Ghana. Out of the 89 articles retrieved for full screening, a total of 52 peer-reviewed articles and 1 grey article were selected for the final review. The study revealed that cultural practices (community factors), low quality of service delivery due to the inappropriate behaviors, lack of competency of skilled birth attendants (SBAs) as well as the inefficient distribution of SBAs contribute to ineffective uptake of SBA (health system factors). Also, indirect costs are associated with the utilization of skilled delivery care even with the existence of 'free' delivery care policy under the national health insurance (policy factor). For Ghana to achieve the SDGs above and improve SBA, it is essential to enhance the quality of skilled delivery care by addressing the attitude and competencies of skilled birth professionals, while plans are put in place to expand and develop the Community-based Health Planning and Services (CHPS) strategy to help address the access barriers to SBA. More so, the 'free' delivery care policy should absorb all the costs associated with skilled delivery for pregnant women as it is intended for.

Exploring factors for antibiotic over-prescription in children with acute upper respiratory tract infections in Assiut, Egypt: a qualitative study

BackgroundOver-prescription of antibiotics contributes to antibiotic resistance, which is a global health threat. Egypt has alarmingly high rates of antibiotic over-prescription for acute upper respiratory tract infections (URIs) in children. To effectively address this issue, it is important to understand the various factors that influence prescription behaviors. The Teixeira antibiotic prescription behavioral model (TAPBM) offers a comprehensive framework through which these factors can be explored. This qualitative study sought to investigate the perspectives of key stakeholders involved in pediatric healthcare in Egypt, with the primary goal of identifying the underlying determinants that contributed to this problem.MethodsThis qualitative study was conducted in Assiut City, Egypt, between January and March 2023. Purposive sampling was used to select participants, including consultant pediatricians, supervisors of pediatric training programs, and specialists in infection prevention and control. Thirteen semi-structured in-depth interviews (IDIs) were conducted, audio-recorded, and transcribed. Thematic analysis was performed using MAXQDA 2020 software.ResultsTwo main themes emerged from the analysis: intrinsic factors related to physicians, extrinsic factors related to patients, and nonphysician factors. Intrinsic factors encompass personal characteristics and attitudes. Prescribing decisions were influenced by factors such as fear of complications, limited follow-up visits, and competition. Knowledge and education also played a significant role. Moreover, diagnostic uncertainty in distinguishing between bacterial and viral infections posed a challenge. Extrinsic factors included patient and caregiver factors, such as parental expectations and demands for antibiotics, driven by the belief that they produced rapid results. Moreover, patients’ demographic factors, including socioeconomic status and living conditions, affected their prescribing behavior. Health system-related factors, such as the type of healthcare institution and the absence of formal national guidelines, were identified as influential factors. Additionally, this study highlighted the influence of the pharmaceutical industry. The potential impact of the COVID-19 pandemic on antibiotic prescriptions was addressed.ConclusionsThe study highlights the intricate interplay between intrinsic and extrinsic factors that shape antibiotic prescription decisions, underscoring the significance of addressing these factors in mitigating overprescribing.

Determinants of long acting reversible contraceptive utilisation among women of reproductive age at Balaka district hospital, Malawi

ObjectivesLimited studies have examined the factors associated with utilisation of long acting reversible contraceptive (LARC) in Malawi. The purpose of this study was to assess prevalence and determinants of LARC utilisation among women of reproductive age at Balaka district hospital, Malawi. Study designFacility based cross-sectional study was conducted from 4th July to 28th September 2022. A total of 216 women of reproductive age were selected by a systematic random sampling technique. Data collection was done through face-to-face interviews using a structured and pre-tested questionnaire. Bivariate and multivariate logistic regressions were performed to examine the association between independent variables and utilisation of LARCs. Results were presented as adjusted odds ratios (AOR) with statistical precision at p ≤ 0.05 and 95 % confidence interval (CI). ResultsThe prevalence of LARC utilisation at the study site was 26.4 %. Couple discussion (AOR = 7.169;95 % CI:1.872–27.453), partner approval (AOR = 11.157; 95 % CI:3.039–40.960), history of unplanned pregnancy (AOR = 3.099; 95 % CI: 1.114–8.622), fear of unplanned pregnancy (AOR = 3.605;95 % CI:1.286–10.107), counselling on LARCs (AOR = 3.829; 95 % CI: 1.070–13.654), number of children (AOR = 1.504; 95 % CI:1.044–2.167) and waiting time at clinic (AOR = 0.315;95 % CI: 0.174–0.571) were identified as the determinants of LARC utilisation. ConclusionThe study found low overall utilisation of LARCs. Strategies to increase LARCs utilisation should consider promoting men’s involvement in family planning (FP) activities and address health system related factors including long waiting time at clinic and strengthening counselling on LARC methods.

Factors influencing community-facility linkage forcase management ofpossible serious bacterial infections among young infants inKenya.

Despite evidence showing the feasibility and acceptability of implementing the World Health Organization's guidelines on managing possible serious bacterial infection (PSBI) in Kenya, the initial implementation revealed sub-optimal community-facility referrals and follow-up of PSBI cases. This study explores facilitators and barriers of community-facility linkages in implementing PSBI guidelines in Busia and Migori counties, Kenya. We used an exploratory qualitative study design drawing on endline evaluation data from the 'COVID-19: Mitigating Neonatal Mortality' project collected between June and July 2022. Data include case narratives with caregivers of sick young infants (0-59 days old) (18), focus group discussions with community health volunteers (CHVs) (6), and in-depth interviews with facility-based providers (18). Data were analysed using an inductive thematic analysis framework. Between August 2021 and July 2022, CHVs assessed 10 187 newborns, with 1176 (12%) identified with PSBI danger signs and referred to the nearest facility, of which 820 (70%) accepted referral. Analysis revealed several factors facilitating community-facility linkage for PSBI treatment, including CHVs' relationship with community members and facilities, availability of a CHV desk and tools, use of mobile app, training and supportive supervision. However, challenges such as health system-related factors (inadequate providers, stockout of essential commodities and supplies, and lack of transport/ambulance) and individual-related factors (caregivers' refusal to take referrals) hindered community-facility linkage. Addressing common barriers and fostering positive relationships between community health workers and facilities can enhance acceptance and access to PSBI services at the community level. Combining community health workers' efforts with a mobile digital strategy can improve the efficiency of the identification, referral and tracking of PSBI cases in the community and facilitate linkage with primary healthcare facilities.

Improving Access to Safe Water in Rural Schools of Kenya: Qualitative Multisectoral Insights.

Comprehensive strategies in water, sanitation, and appropriate hygiene behaviors can improve school enrolment and improve gender parity disparities. Lack of safe drinking water negatively impacts the social capital of people, especially school-going children in rural areas. In this study, we systematically evaluated and documented evidence on the barriers and facilitators in the access and adoption of safe water practices in rural schools in Laikipia County, Kenya. An ethnographic formative, collaborative implementation research design was used in an iterative and participatory process to evaluate community, socio-economic, and health system-related factors affecting water, hygiene, and sanitation strategies. Qualitative data was collected using key informant interviews (n=5) and focus groups (n=3) from various multisectoral participants. Directed content analysis was used to develop codes, categories, and themes from textual data. Data was organized according to the Promoting Action on Research Implementation in Health Services framework. The findings were classified and described under three key elements: context, evidence, and facilitation. Contextual elements showed an association of diarrhea outbreaks with unsafe hygiene practices compounded by water scarcity. The evidence elements were indicative of the applicability of water backpacks in strengthening handwashing, storage, and transport of water. Facilitation elements indicated evidence of gaps in synergy between the school health and public health systems, necessitating multisectoral collaboration and social capital capacity building. The national and county governments play an imperative role in ensuring access and continuous supply of safe drinking water in schools. This is fundamental in efforts towards reducing social inequalities of health among school-going children and building their social capital. Participatory, collaborative, multisectoral interventions and decision-making are crucial, leveraging on creating local ownership, in meeting the water consumption needs of children and communities in water-scarce regions.

Understanding The Reasons for High Rates of Caesarean Section Deliveries in Telangana, South India: An Explorative Study

Background: Telangana continues to top the list of the highest number of caesarean section (C-section) deliveries in the country for the financial year 2019-2020. As per NFHS-5 it is about 60.7% deliveries out of the total number of all institutionalized childbirths. This study aims to address the crucial research gap by qualitatively exploring the reasons for the high rates of unnecessary C-section rates in the state of Telangana. Methodology: A purposive sampling was done across the health care facilities and geographies in the State &amp; the districts were selected based on high, medium and low CS rates. A 360-degree stakeholder engagement approach was taken for a qualitative exploration to find out the reasons. Results: Medical, behavioural, cultural, and infrastructure including health system related factors have contributed to the rise of C-sections, particularly unnecessary elective C-sections. Limited trained personnel for doing normal deliveries in the public sector, infrastructure and safety issues for mother and child, and a preference for painless deliveries, and prior CS delivery stood out. Conclusions: As per the study's findings, it can be said that non-medical reasons account for a high percentage of C-sections in Telangana.

A comparative analysis of the profile and treatment outcomes of tuberculosis patients managed at the community and primary health care facilities in Botswana

BackgroundSuccessful treatment of Tuberculosis (TB) is necessary for mitigating and averting millions of deaths annually. This study compared the profiles and measured the association between patients, health system-related factors, and TB treatment outcomes of patients managed through the community tuberculosis care model with those managed in primary health care settings. MethodsA retrospective multicenter cross-sectional study was conducted in six districts in Botswana. Patient’s records were reviewed using a data extraction sheet, and data not captured on registers were obtained using a structured questionnaire. ResultsThree hundred and twenty-four TB patients were sampled. Most participants (84 %; n = 273) were receiving community-based DOT. Patients with moderate TB knowledge (OR 5.3,955 CI 1.01–27.7), good perception of TB care (OR 11, 95 % CI 1.29–94.0), were more likely to enroll for community DOT and achieve treatment cure. Those in businesses (OR 3.85 95 %CI 1.10–22.6), always had treatment available (OR 3.66, 95 % CI 1.12–11.4), never drank alcohol (OR 2.11, 95 %CI 1.06–4.19), used their vehicle (OR 2.11.95 %CI 0.99–4.48) were likely to enroll for community DOT. ConclusionA patient-specific education program and continuous improvement practices to increase patient TB knowledge and satisfaction should be implemented at all levels to improve treatment outcomes.

Cross-sectional analysis of factors associated with medication adherence in western Kenya

ObjectivesPoor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western...

Influence of health system factors on Fetomaternal outcomes among pregnant women presenting with antepartum hemorrhage at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu-Kenya

Background: Globally, maternal mortality is decreasing, but in developing countries, especially Sub-Saharan Africa, maternal death has remained high. Antepartum haemorrhage (APH), which is the per-vaginal bleeding after 28 weeks of gestation and before delivery complicates 2-5% of pregnancies. Although timely access to quality obstetric services, availability of trained health service providers, availability of transfusion products, theatre waiting time are major determinants of both maternal and new-born outcomes after antepartum haemorrhage, the impact of the health system and health provider related factors associated with APH on the neonatal and maternal outcomes remains to be investigated. As such, this study evaluated the influence of health system factors on maternal and neonatal outcomes among women presenting with Antepartum haemorrhage at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), Kisumu County, Kenya. Methods: The study was a prospective case-control study that recruited mothers (n=63) presenting at the maternity department with antepartum haemorrhage. The control group comprised of mothers (n=63) presenting without antepartum haemorrhage at the same maternity. The study took a period of one year. Data was coded and analysed by SPSS program version 23.0 and STATA version 14.0. Results: Abruptio placentae and placenta Previa were the major causes of APH recorded in 17 (27%) and 39 (61.9%) of APH patients, respectively. A large proportion of patients presenting with antepartum haemorrhage (APH) were younger, aged between 20-29 years (n=37, 58.7%), with an overall mean age of 26.22. Cases with APH had a lower mean parity (1.17), while controls had a higher mean parity (2.97 Caesarean section rate was high among pregnant women who had APH (n=42, 66.7%). (p=0.001). Out of these, 32 (52.4%) were done as emergency. Majority of the emergency caesarean sections were done within 30 minutes from the time the decision to deliver had been made (n=17, 54.8%). Most patients who presented with APH were referred from another facility (n=42 (66.7%) in our study. Risks of perinatal and maternal mortality were higher for patients who came from outside of JOOTRH compared to patients from JOOTRH (OR=3.16, 95%CI=1.34-5.57, P&lt; 0.0001). High risks of perinatal mortality (19.9%) and maternal mortality (3.2%) were observed among APH patients in our study hospital compared to mothers who did not experience APH (8% and 0% respectively). Majority of new-borns of patients who had APH were admitted to NBU (n=42, 66.7%) (p=0.017) and the major reason for admission to NBU was prematurity and low Apgar score. Conclusion of the study is that APH is a major cause of maternal and perinatal morbidity and mortality. This could be prevented by regular and focused antenatal care, early detection of risk factors and prompt referrals. Many facilities for caesarean sections, availability of blood banks and blood transfusion products, facilities with ICU and proper new-born units with adequate staffing can improve maternal and perinatal outcome of patients with APH

Expert Opinions about Barriers and Facilitators to Physical Activity Participation in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study.

Most adults with type 2 diabetes mellitus (T2DM) do not meet their physical activity (PA) goals despite its importance in improving their health outcomes. Our study aim was to explore the opinions of healthcare professionals regarding barriers and facilitators to PA participation in Ghanaian adults with T2DM. Using qualitative descriptive design, data were collected through semi-structured interviews with 13 healthcare professionals experienced in diabetes management in Ghana. Three main themes relating to PA barriers and facilitators were identified in a thematic analysis: health system-related factors, healthcare practitioner factors, and patient factors. Inadequate accessibility to physical therapists and therapy centres hindered the provision of PA programs. Nurses and doctors lacked sufficient knowledge and training on effective PA interventions for individuals with T2DM. Time constraints during patient consultations limited discussions on PA, while the cost associated with accessing physical therapy posed a significant challenge. Patients often disregarded PA advice from physical therapists due to their reliance on doctors, and some perceived PA as irrelevant for diabetes treatment. Despite these barriers, healthcare professionals expressed belief in PA facilitators, including integrating physical therapists and diabetes educators into diabetes care, providing structured exercise resources, improving curriculum planning to emphasise PA in health science education, and addressing knowledge gaps and misconceptions. Overall, this study highlights patient-related and healthcare system-related factors that influence PA behaviour in Ghanaian adults with T2DM. Findings from this study should inform the development of tailored PA programs for this population.

Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study.

It is critical to identify high-risk groups among children with COVID-19 from low-income and middle-income countries (LMICs) to facilitate the optimum use of health system resources. The study aims to describe the severity and mortality of different clinical phenotypes of COVID-19 in a large cohort of children admitted to tertiary care hospitals in India. Children aged 0-19 years with evidence of SARS-CoV-2 infection (real time polymerase chain reaction or rapid antigen test positive) or exposure (anti-SARS-CoV-2 antibody, or history of contact with SARS-CoV-2) were enrolled in the study, between January 2021 and March 2022 across five tertiary hospitals in India. All study participants enrolled prospectively and retrospectively were followed up for three months after discharge. COVID-19 was classified into severe (Multisystem Inflammatory Syndrome in Children (MIS-C), severe acute COVID-19, 'unclassified') or non-severe disease. The mortality rates were estimated in different phenotypes. Among 2468 eligible children enrolled, 2148 were hospitalised. Signs of illness were present in 1688 (79%) children with 1090 (65%) having severe disease. High mortality was reported in MIS-C (18.6%), severe acute COVID-19 (13.3%) and the unclassified severe COVID-19 disease (12.3%). Mortality remained high (17.5%) when modified MIS-C criteria was used. Non-severe COVID-19 disease had 14.1% mortality when associated with comorbidity. Our findings have important public health implications for low resource settings. The high mortality underscores the need for better preparedness for timely diagnosis and management of COVID-19. Children with associated comorbidity or coinfections are a vulnerable group and need special attention. MIS-C requires context specific diagnostic criteria for low resource settings. It is important to evaluate the clinical, epidemiological and health system-related risk factors associated with severe COVID-19 and mortality in children from LMICs. Department of Biotechnology, Govt of India and Department of Maternal, Child and Adolescent Health and Aging, WHO, Geneva, Switzerland.