Healthcare Infrastructure Research Articles

Knowledge, Attitude and Practices Regarding Antimicrobial Resistance among Undergraduate Students

Background: Antimicrobial resistance (AMR) poses a significant global health threat, driven by factors such as irrational antibiotic use and limited healthcare infrastructure. Addressing knowledge gaps and promoting responsible antibiotic use among medical professionals is crucial to combat this growing problem. Objectives: This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding antibiotics and antimicrobial resistance among medical students at a medical college in North India. Methods: A cross-sectional study was conducted between October to December 2023, involving 201 medical students. Data was collected through a self-administered questionnaire covering demographic details, knowledge about antibiotics and antimicrobial resistance, attitudes toward antimicrobial resistance, and practices related to antibiotic use. Statistical analysis was performed using SPSS 20.0. Results: Participants demonstrated a mean knowledge score of 7.9±1.3, with 131 students exhibiting poor knowledge and 70 showing good knowledge regarding antibiotics and AMR. While positive attitudes towards prudent antibiotic use were prevalent, some risky behaviours such as keeping leftover antibiotics and self-medication were observed. Practices varied, with most participants completing full treatment courses but some discontinuing prematurely. Conclusion: The KAP assessment highlighted mixed findings among medical students regarding antibiotic use and AMR. While positive attitudes and practices were evident, knowledge gaps and risky behaviours persisted.

Prevalence of tuberculosis among healthcare workers in India: a systematic review and meta-analysis.

Tuberculosis (TB) poses a significant occupational hazard for healthcare workers (HCWs) in India, a country bearing a substantial portion of the global TB burden. This systematic review and meta-analysis aim to determine the prevalence of TB among HCWs in India. Analyzing ten studies up to 2024, we found a pooled prevalence of 2391.6 cases per 100,000 individuals, underscoring the critical occupational risk. Factors contributing to this high prevalence include inadequate ventilation, insufficient personal protective equipment, and frequent exposure to multidrug-resistant TB strains. Our findings emphasize the urgent need for stringent infection control measures, routine TB screening, and comprehensive educational programs. Policy recommendations include developing national TB screening guidelines and improving healthcare infrastructure. Protecting HCWs is crucial to achieving India's goal of TB elimination by 2025.

Pharmacy Compounding Regulation in the German Pharmaceutical Market. Part 2. Organisational Features (Review)

INTRODUCTION. The Russian Federation has decided to restore the system of compounding pharmacies as an element of the critical national healthcare infrastructure and pharmaceutical supply chain. To improve Russian regulatory practices, develop novel advanced approaches to pharmacy compounding and quality control, and implement these approaches, it is necessary to study relevant good compounding practices applied in healthcare systems of other countries.AIM. The study aimed to analyse the German experience in the organisation and regulation of pharmaceutical compounding to suggest recommendations for the development and implementation of Russian guidelines on good compounding and dispensing practices.DISCUSSION. This work continues a comprehensive study that delves into the current provisions of German legislation governing the system of good compounding practices. This article examines the differences between approaches to compounding by medical and pharmaceutical specialists. According to the findings, compounding by medical specialists is guided by the “free practice of medicine” principle and is subject to minimal regulatory oversight. All pharmacy organisations operate as compounding pharmacies, thereby enhancing the physical accessibility of compounded medicinal products to the population. The authors highlight the features of a process-based quality assurance system encompassing production process controls and quality control methods for compounded medicinal products. Additionally, the authors discuss the applicability of rapid test methods to compounding. In accordance with the German concept of good pharmacy practices, a compounding pharmacy may use the available validation, qualification, and verification tools in the pharmaceutical development of compounded medicinal products and may outsource its internal quality control function. Using the concept of risk ranking, compounding pharmacies may design their own sampling programmes. The article describes approaches to and requirements for organising the evaluation of compounding prescriptions. In Germany, compounding pharmacies may independently assign shelf lives to the compounded medicinal products they produce.CONCLUSIONS. Some German solutions are of considerable practical importance and are applicable to the development and implementation of Russian guidelines on good compounding and dispensing practices. In particular, pharmacy organisations may outsource the quality control of their compounded medicinal products. Additionally, pharmacies can conduct the full-scale pharmaceutical development of compounding technologies and quality control methods (including rapid test methods) using the validation, qualification, and verification tools available to drug manufacturers. Moreover, pharmacy organisations may independently assign shelf lives to the compounded medicinal products they produce. Finally, pharmacy organisations may design their individual sampling programmes.

Understanding Associations between Disasters and Sustainability, Resilience, and Poverty: An Empirical Study of the Last Two Decades

This study investigates the impact of disasters on sustainability, resilience, and poverty, using data from the “Sustainable Development Report” and the Emergency Events Database (EM-DAT) from 2000 to 2023. Regression models assessed the effects of disasters, deaths, injuries, affected individuals, and economic damage on normalized values of the dependent variables with lag periods of one, two, and three years of independent variables. The results reveal that disasters consistently negatively impact sustainability and resilience, highlighting the need for robust disaster risk reduction strategies and resilient infrastructure. Higher mortality rates significantly hindered development, emphasizing the importance of improving early warning systems, emergency preparedness, and healthcare infrastructure. While injuries and the number of affected individuals did not show significant associations, economic damage was positively associated with resilience, suggesting that financial losses might drive recovery investments. Additionally, disasters were found to exacerbate poverty levels over time with significant associations in the two and three-year lag models. This study also uncovered significant regional disparities with lower resilience, sustainability, and higher poverty levels in certain regions compared to others. Higher-income groups demonstrated better resilience and lower poverty levels. These findings underscore the necessity for targeted, region-specific strategies to enhance resilience, reduce poverty, and support sustainable development, leveraging post-disaster recovery phases for long-term improvement.

A summit on a Global Patient co-Owned Cloud (GPOC)

BackgroundDuring the last thirty years the world has benefited from the increasing adoption to cloud-based storage of personal health records. The concept of a Global Patient co-Owned Cloud (GPOC) of personal health records is presented in the GPOC Series, which contains a systematic review and meta-analysis, a global survey among 100% of the UN member states and a technical sandbox environment. GPOC contains patient co-ownership of personal health records. The global survey showed a consensus for the realisation of a GPOC.MethodsHere, we present a Delphi styled GPOC Summit. It also contains a final vote, that validates the results of the previous GPOC Survey. Hence, the Summit contains both multiple rounds of discussion and a voting.ResultsAt the GPOC Summit a unanimous consensus for patient co-ownership of the personal health records was expressed. The majority of participants underlined that GPOC may benefit global health, transfers of the personal health records globally and the dissemination of evidence-based medicine across the globe. The plausible advantages for patients, both refugees and travellers and for developing economies were underlined. GPOC, as a large substrate for global medical artificial intelligence research, was highlighted. There was unanimous positive interest for GPOC. The GPOC Summit agreed on patient co-ownership of personal health records. This collective agreement underscores the potential of GPOC to enhance global health outcomes, facilitate seamless exchange of health data, and advance medical research worldwide.ConclusionsThe summit emphasised the potential benefits of GPOC for diverse populations and economies, highlighting its potential role in improving healthcare access and infrastructure. Moving forward, coordination with relevant initiatives could enhance interoperability and standardisation in healthcare data management. In conclusion, the GPOC Summit represents one step towards realising a patient-centric, globally accessible healthcare ecosystem, with possible implications for the development and global adoption of AI-driven healthcare solutions.

Factors Affecting Maternal Mortality Rates in Nigeria: A Review of Challenges and Potential Solutions

Maternal mortality is a significant public health issue in Nigeria, accounting for approximately 23% of global maternal deaths. This review explored the main factors affecting maternal mortality rates in Nigeria and proposed potential solutions. Accurate data collection on maternal health in Nigeria, especially in rural areas, remains challenging. Aims: this paper aimed to identify the key factors contributing to maternal mortality in Nigeria and proposed solutions to address this issue. Study design: A qualitative analysis of literature review narration was employed taking into account the research methodology, instrument interpretation, and data analysis in order to avoid bias and misinterpretation of result findings. Methodology: The methodology was designed to systematically gather, analyse, and synthesise data from multiple sources, including the peer-reviewed academic literature, government reports, and NGO publications. To ensure rigor and reproducibility, in the literature search were utilised several databases and search engines beyond Google, including PubMed, Scopus, Web of Science, Google Scholar, Semantic Scholar, and Research Gate. 50 published papers and articles from credible sources were reviewed in the study, identifying the key issues such as inadequate healthcare infrastructure, socio-economic challenges, cultural and behavioural practices, as well as political factors. Results: The findings revealed that the major causes of maternal mortality in Nigeria included haemorrhage, infection, unsafe abortion, hypertensive diseases of pregnancy, and obstructed labour. There were cases of socio-economic factors such as unavailability of electricity, transportation delay, the lack of skilled medical personal and cultural factors such as traditional beliefs. Despite various interventions, progress in reducing maternal mortality has been limited. Conclusion: This paper emphasised the need for continuous investment in maternal and child health, improvements in healthcare infrastructure, education, and effective policy implementation. A holistic approach that integrates organisational structures, technical expertise, human experiences, and patient needs is essential for effectively reducing maternal mortality rates.

Enhancing Performance and Work Ethics of Low-Educated Employees

This research examines strategies to enhance the performance and work ethics of employees with limited educational backgrounds by implementing business ethics and organizational development practices, with a focus on PT Medi Modular Luar Biasa (PT MMLB), an Indonesian healthcare infrastructure company. The research addresses the challenges faced by companies in managing low-educated employees, including cognitive limitations, communication barriers, and difficulties adapting to organisational changes, which often lead to suboptimal performance and ethical lapses. Through qualitative interviews with employees and management, the study reveals significant differences in how employees with varying educational backgrounds understand and implement corporate values such as integrity, and professionalism. The research highlights the need for ethical leadership and structured organisational support to address these challenges. The findings suggest that enhancing the ethical climate and providing tailored training are crucial for improving both performance and work ethics among low-educated employees. The study proposes interventions such as clarifying role expectations, reinforcing ethical guidelines, and fostering a supportive work environment to drive continuous improvement and employee well-being. The research contributes practical recommendations for businesses facing similar challenges, emphasising the importance of ethical leadership in shaping positive employee behaviour and organisational outcomes.

Bridging the gap: enhancing TBI care in Pakistan's primary and secondary healthcare settings.

Traumatic Brain Injury (TBI) in Pakistan is predominantly caused by road traffic accidents, falls, and violence, resulting in approximately 300,000 new cases annually. Significant gaps exist in awareness, resources, and accessibility for effective TBI management, especially in primary care settings. To improve care, strategies include training healthcare providers, nationwide awareness campaigns, strengthening healthcare infrastructure, and establishing referral systems. Collaboration between government, NGOs, and international partners is crucial for enhancing TBI management.

Assessment of the Demographic Burden of Epidemics and Diseases within the African Sub-Region: A Review of Recent Epidemiological Data, Responses, and Resultant Psychosocial Risk Tendencies

Background: Over the past few decades, epidemic outbreaks and disease occurrences have become more frequent and widespread in Africa, posing challenges for poor countries in the region and impacting vulnerable populations. Limited resources, inadequate healthcare infrastructure, socioeconomic inequalities, malnutrition, mass gatherings, and lack of proper sanitation and hygiene contribute to Africa’s high burden of epidemics and infectious diseases such as cholera, measles, monkeypox, Ebola viral disease, and COVID-19. This paper reviewed epidemic outbreaks and diseases transmitted through intimate contact in Africa and their impacts on vulnerable populations. Methods: A narrative review approach was adopted to gather and analyze the relevant literature on epidemic outbreaks in African sub-regions. The review encompassed causes, transmission patterns, demographic impact, community susceptibility, preventive measures, and psychosocial risk-taking behaviors. Results: This study emphasizes the importance of addressing the causes of response lapses and the resulting human, material, and economic losses in the region. Effective preventive measures include disease surveillance, early mitigation strategies, contact tracing, personal protective measures, improved political and public health leadership, and socioeconomic equity. However, the review highlights challenges in implementing these measures effectively due to limited resources, delayed detection, and difficulties in scaling up response solutions. Conclusions: There is a need for a comprehensive approach involving health departments, infrastructure development, and addressing socioeconomic factors.

Impact of health policy changes on population health

Recent health policy changes have had a profound impact on population health, reflecting diverse approaches and outcomes across different regions. The affordable care act (ACA) in the United States expanded healthcare coverage, improving access to preventive services and chronic disease management. Despite these advancements, disparities in health outcomes persist, particularly among minority and low-income populations. In Europe, universal healthcare systems like those in Germany and the Netherlands have achieved near-universal coverage and high public satisfaction. However, socioeconomic inequalities continue to influence health outcomes, necessitating policies that address broader social determinants of health. Low- and middle-income countries (LMICs) have implemented universal health coverage (UHC) initiatives, such as Thailand's UHC scheme and Rwanda's community-based health insurance. These reforms have led to significant improvements in maternal and child health, reduced out-of-pocket expenditures, and increased healthcare utilization among the poor. However, disparities between urban and rural populations remain a challenge, underscoring the need for comprehensive strategies that strengthen healthcare systems and infrastructure. Future directions for health policy improvement include addressing health disparities, integrating technology, and promoting preventive care. Community-based interventions and cultural competency training for healthcare providers can reduce disparities and enhance patient satisfaction. The integration of telemedicine, electronic health records, and health information exchanges can improve care coordination and access to services, although equitable access to digital health tools is essential. Emphasizing preventive care through increased funding, incentivizing providers, and raising public awareness can significantly reduce the burden of chronic diseases. Engaging patients in their healthcare decisions and promoting shared decision-making fosters a collaborative and effective healthcare environment. Policymakers must adopt comprehensive and adaptable strategies to address persistent disparities, integrate technology, and promote preventive care, ultimately leading to more equitable and effective health outcomes for diverse populations.

Challenges in Malaria Control and Prevention in East Africa

Malaria remains a critical public health issue in East Africa, where high transmission rates persist despite extensive control and prevention efforts. This review article explores the multifaceted challenges that hinder effective malaria control and prevention in the region, including the emergence of drug-resistant Plasmodium parasites, insecticide-resistant mosquito vectors, inadequate healthcare infrastructure, socio-economic barriers, and environmental factors. The review methodology involved analyzing recent studies, reports, and data from international health organizations. Drug resistance and vector control are significant issues, with resistance to both anti-malarial drugs and insecticides compromising treatment efficacy and prevention efforts. Additionally, socio-economic factors such as poverty and lack of education, coupled with climate variability and environmental changes, further complicate malaria control. Addressing these challenges requires a coordinated approach that integrates continuous monitoring, healthcare system strengthening, community engagement, and international collaboration. By tackling these issues, East Africa can improve its malaria control efforts and ultimately enhance the health outcomes of its populations. Keywords: Malaria Control, Drug Resistance, Insecticide Resistance, Healthcare Infrastructure, Socio-Economic Barriers.

An Efficient Image Encryption Scheme for Medical Image Security

In the contemporary landscape of digital healthcare, the confidentiality and integrity of medical images have become paramount concerns, necessitating the development of robust security measures. This research endeavors to address these concerns by proposing an innovative image encryption scheme tailored specifically for enhancing medical image security. The proposed scheme integrates a sophisticated blend of symmetric and asymmetric encryption techniques, complemented by a novel key management system, to fortify the protection of medical image data against unauthorized access and malicious tampering. The proposed DNA-based encryption algorithm leverages the unique properties of DNA encoding to securely scramble image data, providing an added layer of protection. By utilizing DNA sequences in the encryption and decryption processes, the scheme achieves a high level of data confusion and diffusion, significantly enhancing security. The efficacy of the proposed encryption scheme is validated through comprehensive experimental evaluations, which demonstrate its proficiency in ensuring data security while maintaining computational efficiency. The scheme's compatibility with existing medical imaging systems is also examined, affirming its seamless integration into contemporary healthcare infrastructures. This research contributes to the advancement of medical image security by proposing an efficient encryption scheme that strikes a balance between stringent security requirements and practical implementation considerations. The primary contributions include the development of a DNA-based encryption algorithm and a novel key management system, both of which significantly enhance the security of medical images. This research contributes to the advancement of medical image security by proposing an efficient encryption scheme that strikes a balance between stringent security requirements and practical implementation considerations. By safeguarding the confidentiality and integrity of medical images, the proposed scheme empowers healthcare providers to uphold patient privacy and trust in the digital age. Experimental results show that this approach ensures robust encryption without compromising image quality, making it suitable for sensitive medical imaging applications.

Thrombolysis for Ischemic Stroke Despite Recent Ingestion of Direct Oral Anticoagulants - A Growing Dilemma Also in India.

The administration of intravenous thrombolysis (IVT) for patients with acute ischemic stroke who have recently ingested direct oral anticoagulants (DOACs) presents a clinical challenge due to the perceived increased risk of intracranial hemorrhage (ICH). Traditional guidelines from the US and European authorities advise against IVT within 48 h of last DOAC ingestion, unless specific coagulation tests indicate safety. However, emerging observational studies suggest that IVT might be safe in selected patients. A US stroke registry study and a global multicenter cohort study both reported no significant increase in symptomatic ICH among patients on DOACs compared to those not on anticoagulants. A systematic review of all published observational studies further supported these findings, showing comparable bleeding rates and functional outcomes in DOAC-treated patients. Reversal agents like idarucizumab for dabigatran have demonstrated potential in facilitating safer IVT administration, though logistical and cost-related barriers limit their widespread use. The variability in global guidelines reflects differing approaches to risk assessment and resource availability, highlighting the need for individualized treatment decisions. In India, the increasing prevalence of atrial fibrillation and stroke as well as prescription of DOACs necessitate adapted guidelines that consider local health-care infrastructure. Despite the promising observational data, the lack of randomized controlled trials underscores the need for further research to establish robust evidence for IVT use in this context. Collaborative international efforts and inclusion of diverse patient populations in future studies will be crucial to refine treatment protocols and improve outcomes for stroke patients on DOACs.

Identifying Work-Related Injuries Among Healthcare Workers in Makkah Hospitals, Saudi Arabia: A Cross-Sectional Study in 2024.

Background Work-related injuries (WRIs) are a major occupational health issue among healthcare workers (HCWs) worldwide. HCWs face numerous daily hazards including needlestick injuries, chemical exposures, ergonomic strains, and psychological stressors crucial for their health and healthcare system functionality.In Makkah, Saudi Arabia, healthcare infrastructure advances raise concerns about work-related injuries among HCWs. This study in Makkah hospitals aims to identify, understand, and manage WRIs for improved occupational health guidelines and strategies. Methods This descriptive cross-sectional study on HCWs was conducted at Makkah hospitals using an electronic questionnaire that investigated the demographics, work-related injuries, and occupational hazards. The data collected from the retrieved questionnaires were analyzed using the IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Results Among 379 enrolled HCWs, 172 (49.3%) were physicians and 89 (19.8%) were nurses; 304 (80.2%) of the total participants knew about occupational safety. The total incidence of WRIs was 67.8%. WRIs were significantly associated with age (P˂0.001), gender (P=0.02), educational level (P˂0.001), profession (P˂0.001), working hours (P˂0.001), and shift time (P˂0.001). Conclusion WRIs were highly prevalent among HCWs with varying rates based on the type of injury and the frequency of injury. WRIs were associated with various factors including age, gender, education, profession, working house, and shift time of the participants.

Challenges and Opportunities in Accessing Surgery for Glioblastoma in Low-Middle Income Countries: A Narrative Review.

Glioblastoma: a highly aggressive brain tumor, presents substantial challenges in treatment and management, with surgical intervention playing a pivotal role in improving patient outcomes. Disparities in access to brain tumor surgery arise from a multitude of factors, including socioeconomic status, geographical location, and healthcare resource allocation. Low- and middle-income countries (LMICs) often face significant barriers to accessing surgical services, such as shortages of specialized neurosurgical expertise, limited healthcare infrastructure, and financial constraints. Consequently, glioblastoma patients in LMICs experience delays in diagnosis, suboptimal treatment, and poorer clinical outcomes compared to patients in high-income countries (HICs). The clinical impact of these disparities is profound. Patients in LMICs are more likely to be diagnosed at advanced disease stages, receive less effective treatment, and have lower survival rates than their counterparts in HICs. Additionally, disparities in access to surgical care exacerbate economic and societal burdens, emphasizing the urgent need for targeted interventions and health policy reforms to address healthcare inequities. This review highlights the importance of addressing global disparities in access to brain tumor surgery for glioblastoma through collaborative efforts, policy advocacy, and resource allocation, aiming to improve outcomes and promote equity in surgical care delivery for all glioblastoma patients worldwide.

Perceptions of patients and healthcare providers regarding barriers and enablers of HIV anti-retroviral therapy among women at a regional hospital in Ghana: implications for national HIV/AIDS control

BackgroundThe Acquired Immune Deficiency Syndrome (AIDS) pandemic has created a lot of devastation over the last four decades and continues to be a public health threat. Anti-retroviral treatment (ART), a group of medications that people who have been diagnosed with the Human Immunodeficiency Virus (HIV) infection take, has been shown to be efficacious and has significantly improved the fight against the disease. In Ghana, women carry a higher prevalence and incidence of HIV. The study’s objectives were to understand the experiences of women living with HIV/AIDS on ART and determine the barriers and enablers for ART uptake from the perspective of both the females living with HIV and their healthcare providers in the Upper East Regional Hospital of Ghana.MethodsThis was a qualitative study that used interviews to acquire data from women living with HIV on the perceived barriers and enablers for ART. The Upper East Regional Hospital in Ghana was the study site. We used a phenomenological approach to explore the lived experiences, perceptions, and meanings associated with ART among women. We collected data until we reached thematic saturation, interviewing a total of sixteen women living with HIV. We conducted a focus group discussion with nine healthcare workers providing care at the ART clinic. Data were analysed using thematic analysis.ResultsWomen living with HIV and their healthcare providers viewed an environment that provided encouragement and support from healthcare workers and patients’ relatives, the ability to conceal HIV status, peer counselling, and the perceived benefits of therapy as enablers of ART uptake and medication adherence. The following were barriers to ART uptake and adherence: ill health, forgetfulness, long distances to ART clinics, cultural and spiritual beliefs, and fear of stigma.ConclusionsEnablers of ART uptake should be expanded upon and encouraged so that women living with HIV/AIDS can access drugs in a timely and stress-free manner. On the other hand, the barriers identified can be addressed through education, the expansion of healthcare infrastructure, and the economic empowerment of women.

Epidemiological features and temporal trends of the co-infection between HIV and tuberculosis, 1990–2021: findings from the Global Burden of Disease Study 2021

BackgroundThe co-infection of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and tuberculosis (TB) poses a significant clinical challenge and is a major global public health issue. This study aims to elucidate the disease burden of HIV-TB co-infection in global, regions and countries, providing critical information for policy decisions to curb the HIV-TB epidemic.MethodsThe ecological time-series study used data from the Global Burden of Disease (GBD) Study 2021. The data encompass the numbers of incidence, prevalence, mortality, and disability-adjusted life year (DALY), as well as age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and DALY rate for HIV-infected drug-susceptible tuberculosis (HIV-DS-TB), HIV-infected multidrug-resistant tuberculosis (HIV-MDR-TB), and HIV-infected extensively drug-resistant tuberculosis (HIV-XDR-TB) from 1990 to 2021. from 1990 to 2021. The estimated annual percentage change (EAPC) of rates, with 95% confidence intervals (CIs), was calculated.ResultsIn 2021, the global ASIR for HIV-DS-TB was 11.59 per 100,000 population (95% UI: 0.37–13.05 per 100,000 population), 0.55 per 100,000 population (95% UI: 0.38–0.81 per 100,000 population), for HIV-MDR-TB, and 0.02 per 100,000 population (95% UI: 0.01–0.03 per 100,000 population) for HIV-XDR-TB. The EAPC for the ASIR of HIV-MDR-TB and HIV-XDR-TB from 1990 to 2021 were 4.71 (95% CI: 1.92–7.59) and 13.63 (95% CI: 9.44–18.01), respectively. The global ASMR for HIV-DS-TB was 2.22 per 100,000 population (95% UI: 1.73–2.74 per 100,000 population), 0.21 per 100,000 population (95% UI: 0.09–0.39 per 100,000 population) for HIV-MDR-TB, and 0.01 per 100,000 population (95% UI: 0.00–0.03 per 100,000 population) for HIV-XDR-TB in 2021. The EAPC for the ASMR of HIV-MDR-TB and HIV-XDR-TB from 1990 to 2021 were 4.78 (95% CI: 1.32–8.32) and 10.00 (95% CI: 6.09–14.05), respectively.ConclusionsThe findings indicate that enhancing diagnostic and treatment strategies, strengthening healthcare infrastructure, increasing access to quality medical care, and improving public health education are essential to combat HIV-TB co-infection.Graphical

Under-Five Mortality and Associated Risk Factors in Children Hospitalized at David Bernardino Pediatric Hospital (DBPH), Angola: A Hierarchical Approach.

Reducing under-five mortality is a crucial indicator of overall development in a country. However, in Angola, understanding the factors contributing to hospital deaths in this vulnerable demographic remains incomplete despite improvements in healthcare infrastructure and public health policies. With one of the highest under-five mortality rates in sub-Saharan Africa, Angola faces significant challenges such as malaria, malnutrition, pneumonia, neonatal conditions, and intestinal infectious diseases, which are the leading causes of death among children. This study aimed to identify factors associated with hospital deaths among children aged 28 days to five years admitted to DBPH in Luanda between May 2022 and June 2023. Using a hospital-based case-control design, the study included 1020 children, among whom 340 experienced hospital deaths. Distal and intermediate determinants emerged as primary predictors of hospital mortality, showing significant associations with: mother without schooling (OR [95%CI] 4.3 [1.2-15.7], p < 0.027); frequent alcohol consumption during pregnancy (OR [95%CI] 3.8 [2.5-5.9], p < 0.001); hospital stay ≤24 h (OR [95%CI] 13.8 [6.2-30.8], p < 0.001); poor nutritional status (OR [95%CI] 2.1 [1.4-3.2], p < 0.001); short interbirth interval (OR [95%CI] 1.7 [1.1-2.5], p < 0.014); maternal age ≤19 years (OR [95%CI] 5.6 [3.0-10.8], p < 0.001); and maternal age ≥35 years (OR [95%CI] 2.1 [1.2-3.7], p < 0.006). These findings highlight the preventable nature of most under-five hospital deaths and underscore the urgent need to address social inequities and improve the quality of primary healthcare services to effectively reduce child mortality in Angola.

The emergence of a tailored multidimensional model for evaluating efficiency in teaching hospitals: main challenges and proposition of a theoretical framework

Background: Teaching hospitals serve as training grounds for students and residents across various specialties, while also providing more complex healthcare services that contribute to research production and advancements in health technologies. Considering all their functions, the efficiency evaluation of these institutions warrants special attention in the literature. This study aims to review the existing literature, identify the main challenges faced by previous studies, and establish new guidelines to address flaws in models assessing teaching hospitals' efficiency. Methods: An integrative review was conducted across five major databases: Springer Link, Scopus, ScienceDirect, Web of Science, and Inderscience. The search yielded 384 records, and after removing duplicates and following PRISMA guidelines, 28 studies were deemed eligible for inclusion. Results: The review reveals a scarcity of evaluation models specifically tailored to teaching hospitals. Data envelopment analysis is the most frequently used method in this field but exhibits several weaknesses. Key challenges identified include the lack of literature on the positive relationship between increased inputs and quality, proving the reliability of DEA, addressing its limitations in handling numerous input and output variables, improving communication with hospital managers, refining the categorization of healthcare professionals, and enhancing the understanding of productivity differences between medical residents and senior physicians. Conclusions: We propose a theoretical framework to guide future studies on the efficiency assessment of teaching hospitals, emphasizing the need for a multidimensional approach. This model should incorporate economic-financial, quality, and educational dimensions, alongside commonly applied dimensions such as healthcare, staff, and physical and technological infrastructure. Moreover, the challenges pointed out based on the integrative review suggest a rich agenda for upcoming studies, encourage the development of management tools to assess efficiency in teaching hospitals and contribute to formulating an agenda to orient public policies related to efficient resource management in teaching hospitals and educational and health systems.

Global Insights on Prehospital Stroke Care: A Comprehensive Review of Challenges and Solutions in Low- and Middle-Income Countries.

Stroke is a leading cause of disability and mortality worldwide, and it disproportionately affects low- and middle-income countries (LMICs), which account for 88% of stroke fatalities. Prehospital stroke care delays are a crucial obstacle to successful treatment in these settings, especially given the limited therapeutic window for thrombolytic treatments, which may greatly improve recovery chances when initiated early after stroke onset. These delays are caused by a lack of public understanding of stroke symptoms, sociodemographic and cultural variables, and insufficient healthcare infrastructure. This review discusses these issues in detail, emphasizing the disparities in stroke awareness and reaction times between locations and socioeconomic classes. Innovative options for reducing these delays include the deployment of mobile stroke units and community-based educational campaigns. This review also discusses how technology improvements and personalized educational initiatives might improve stroke awareness and response in LMICs. The primary goal is to give a thorough assessment of the challenges and potential remedies that might serve as the foundation for policy reforms and healthcare improvements in LMICs, eventually improving stroke care and lowering disease-related mortality and disability.