Improvements In Health Indicators Research Articles

Challenges in the management of colorectal cancer in low- and middle-income countries

AimThis narrative review aims to describe colorectal cancer (CRC) management landscape in low- and middle-income countries (LMICs), presenting the most recent and relevant papers on the topic. As a secondary aim, the authors suggest new ways of improving CRC patient care in LMICs. BackgroundSeveral studies show that the incidence of colon cancer in low- and middle-income countries (LMICs) is rising. In addition to the increasing incidence, lack of early detection and impeded access to optimal multidisciplinary treatment may worsen survival outcomes. ConclusionDeveloping quality diagnostic services in the proper health context is crucial for early diagnosis and successful therapy of CRC patients, and applying a resource-sensitive approach to prioritize essential treatments based on effectiveness and cost-effectiveness is key to overcoming barriers in LMICs, with clinical research collaborations between high-income countries (HICs) and LMICs being a helpful strategy to improve health indicators and prevent the burnout of health workers.

Eucommia ulmoides male flower as a remarkable edible floral resource exerts lifespan/healthspan-promoting effects on Caenorhabditis elegans.

Natural products, especially phytochemicals, can effectively improve the health of various model organisms and ultimately prolong their lifespan. As an emerging resource of plant-based food, edible flowers have potential anti-aging effects. Here, we showed that twelve out of 30 drug-food homologous flowers' extracts significantly extended the lifespan of C. elegans, and the Eucommia ulmoides male flower was screened out by comparing centrally. The lifespan of C. elegans increased by 18.61% under the treatment of 100 μg mL-1 floral extract (EUFE). Interestingly, this effect was attenuated when EUFE was administered late or at higher concentrations. Significantly, EUFE improved health indicators that decline with aging including pharyngeal pumping, mobility, muscle morphology, and lipofuscin accumulation. EUFE also enhanced the resistance of C. elegans to oxidative/heat stress. The longevity-extending effect of EUFE was dependent on transcription factor DAF-16 and mitochondrial function. Moreover, EUFE triggered the nuclear translocation of DAF-16 and promoted downstream LGG-1 and SOD3 protein expression. In body-wall muscles, EUFE stimulated mitochondrial fission and mitophagy to mitigate age-related mitochondrial impairments. The transcriptional checkpoints of daf-16, drp-1, eat-3, lgg-1, and dct-1 further showed that EUFE regulated DAF-16 signaling and mitochondrial homeostasis. Finally, the interpretation of the EUFE components by correlation analysis, UHPLC-QE-MS, and verification experiments showed that aucubin, geniposide, and asperuloside are the main active compounds. We revealed the excellent lifespan/healthspan-promoting efficacy of EUFE and highlighted that edible flowers are worthy of further investigation as anti-aging dietary resources. Meanwhile, related mechanisms enriched the hypothesis that mitochondria might be involved in the healthspan modulation of longevity pathways.

Health leadership and rural contexts: keys to strengthening services

Health leadership in rural settings is a key element in ensuring equitable access and sustainability of health services in communities with structural constraints and scarce resources. This article analyzes the dynamics of leadership in rural areas between 2017 and 2022, employing a holistic approach to identify trends, areas of research, and international collaborations. Based on the analysis of 146 selected publications, three main lines are highlighted: adaptive leadership models, health promotion as a central strategy, and the impact of crises, such as the COVID-19 pandemic, on health management. The results show that adaptive leadership optimizes resource management and fosters community participation, strengthening trust and local commitment. Likewise, health promotion in these communities is presented as a strategic axis to address inequalities and improve health indicators. Finally, the importance of international collaboration in building knowledge and implementing sustainable solutions is highlighted. This study provides practical and theoretical inputs to strengthen public health policies in rural contexts, proposing interdisciplinary and participatory approaches as a basis for the transformation of health systems.

The Role of Transformational Leadership in Enhancing Patient Quality of Life Outcomes

Introduction: The study explored the impact of transformational leadership on patient quality of life outcomes in healthcare settings. Transformational leadership, characterized by inspiring and motivating staff, was hypothesized to influence patient care and satisfaction positively.Methods: A quantitative research design was employed, involving a sample of 200 healthcare professionals from various clinical settings. Participants completed validated questionnaires measuring their leadership styles and their patients' perceived quality of life outcomes. Data were analyzed using regression analysis to ascertain the relationship between transformational leadership and patient outcomes.Results: The findings indicated a significant positive correlation between transformational leadership practices and enhanced patient quality of life outcomes. Healthcare professionals who demonstrated transformational leadership qualities reported higher levels of patient satisfaction and improved health indicators among their patients. Specifically, components such as individualized consideration and inspirational motivation were strongly associated with better patient experiences.Conclusions: The study concluded that transformational leadership plays a crucial role in enhancing patient quality of life in healthcare settings. By fostering a supportive and motivating environment, transformational leaders can elevate patient care standards and satisfaction. These results suggest that healthcare organizations should encourage the development of transformational leadership skills among their staff to optimize patient outcomes and overall organizational performance.

Ceramides from Sea Red Rice Bran Improve Health Indicators and Increase Stress Resistance of Caenorhabditis elegans through Insulin/IGF-1 Signaling (IIS) Pathway and JNK-1.

The antiaging effects of sea red rice bran in vivo, a new saline-tolerant sea rice byproduct containing high levels of ceramides (Cers), remain unknown. This study aimed to explore the antiaging effects exerted by Cers from sea red rice bran on Caenorhabditis elegans, assess its health indicators as well as tolerance, and then reveal the mechanism of action of Cers in prolonging the mean life span through genetic studies. The results indicated that the mean life span of Cers-treated C. elegans were dose-dependent in the range of 0.10-0.50 mg/mL. Additionally, Cers improved nematode motility, reduced lipofuscin accumulation, and enhanced resistance to heat stress and antioxidant enzyme activity. Genetic studies showed that Cers treatment had altered nematode gene expression. In addition, insulin/IGF-1 and jnk-1/mitogen-activated protein kinase (MAPK) signaling pathways successfully demonstrated the longevity effects of Cers intake. In short, these results suggest that Cers enhance the resistance of C. elegans and prolong its life span.

Poor and non-poor gap in under-five child nutrition: a case from Nepal using Blinder-Oaxaca decomposition approach

IntroductionMany low-and middle-income countries (LMICs) have improved health indicators in the past decades, however, there is a differential in outcomes between socioeconomic groups. Systematic analysis of drivers of child nutrition gap between non-poor and poor groups has a policy relevance in Nepal and other countries to make progress towards universal health coverage (UHC). The objective of this paper was to estimate the mean height-for-age z scores (HAZ) gap between under-five children belonging to non-poor and poor groups, divide the gap into components (endowments, coefficients and interaction), and identify the factors that contributed most to each of the component.MethodsInformation about 6277 under-five children was extracted from the most recent nationally representative Nepal Multiple Indicator Cluster Survey (MICS) 2019. HAZ was used to assess nutritional status of children. Wealth index was used to categorize children into non-poor and poor. Mean HAZ gap between groups was decomposed using Blinder-Oaxaca technique into components: endowments (group difference in levels of predictors), coefficients (group difference in effects of predictors), and interaction (group difference due to interaction between levels and effects of predictors). Detailed decomposition was carried out to identify the factors that contributed most to each component.ResultsThere was a significant non-poor and poor gap in nutrition outcome measured in HAZ (0.447; p < 0.001) among under-five children in Nepal. The between-group mean differences in the predictors of study participants (endowments) contributed 0.210 (47%) to the gap. Similarly, the between-group differences in effects of the predictors (coefficients) contributed 0.308 (68.8%) towards the gap. The interaction contributed -0.071 (15.8%) towards minimizing the gap. The predictors/variables that contributed most towards the gap due to (i) endowments were: maternal education, province (Karnali, Sudurpaschim, Madhesh), residence (rural/urban), type of toilet facility and ethnic group (Dalit and Muslim); (ii) coefficients were: number of under-five children in family, ethnic group (Dalit and Muslim), type of toilet facility, maternal age and education.ConclusionDecomposition of the child nutrition gap revealed that narrowing the inequality between wealth groups depends not only on improving the level of the predictors (endowments) in the poor group but also on reducing differential effects of the predictors (coefficients).

EPISTEMOLOGY IN MIGRANT COMMUNITY FOR BETTER HEALTH OUTCOMES IN PRIMARY HEALTH CARE OF NORTH INDIA - A CASE STUDY

The migrant community often lacks health care access due to poor health knowledge. Epistemology deals with the nature and scope of knowledge. Epistemology links the migrant community to health system with adequate knowledge to accept the health seeking behavior in lifestyle. Objective: To assess thesalutogenic health promotion model in primary health care for the migrant population. Methods: A qualitative analysis in the migrant community was conducted in a family with an antenatal case as the index case. The epistemological salutogenic health model of General Resistance Resources (GRR) and Sense of Coherence (SOC) was applied. A health promotion model was devised in accordance to the GRR and SOC. A health system intervention was also planned to improve health indicators. Results: The family had a better approach towards heath and preparedness towards the institutional delivery of the child. The children were immunized with appropriate documentation. The success story of the family turned the migrant community to act as a social support group for positive health. There were improvements in the health indicators of the urban slum improved. Conclusion: Usingepistemology aspects and salutogenic health promotion model bridged the gaps in the health system with the migrant community. The migrant community are often ignorant towards their health but with appropriate health promotion models their health needs can be addressed.

Fiscal Decentralization and Health Outcome: Case of Pakistan

Present study is an attempt to investigate the effect of fiscal decentralization on health outcomes in Pakistan. This paper is based on time series data which covers the period from 1982 to 2019. The idea behind the present study is that fiscal decentralization plays an important role in economic development and improving health outcomes. Fiscal decentralization improves the efficiency of the public institution, which can lead to an improved health facility. To estimate the coefficients of the equation, Auto-regressive distributive lag model is used. The finding of this study shows that fiscal decentralization improves health outcomes. So, this study concludes that the federal government should share its power with the local government to improve health indicators.

Mortality Rates and Years of Life Lost Due to Cancer in Iran: Analysis of Data from the National Death Registration System, 2016

Background: Cancer incidence is a major public health concern and one of the leading causes of premature death worldwide. Therefore, this study was conducted to determine the death rate and years of life lost (YLL) due to cancer in Iran. Methods: In this study, death registration system (DRS) data in Iran was used. The Global Health Estimates (GHE-2016) cause categories and ICD-10 codes (C00-C97 and D00-D48) were assigned for deaths due to cancer. The crude, age-standardized mortality rates (ASMR) via world standard population was measured, and also YLL due to cancer were calculated using standard life expectancy. Results: The DRS recorded 53,492 deaths due to cancer (58.82% males and 41.18% females). The cancer mortality rate was 66.92 per 100,000 population (77.7 and 55.87 per 100,000 population in men and women, respectively) and ASMR was 96.4 per 100,000 population (115.7 and 77 per 100,000 population for males and females, respectively). The total YLL due to premature death was 736,564 in males, 580,254 in females, and 1,316,818 in both sexes. Death due to stomach cancer, tracheal, bronchus, and lung, leukemia, brain, and nervous system cancer, and breast cancer comprised the largest YLL category among different cancer sites. Conclusions: Accounting for more than 1,300,000 YLL attributed to cancer, it is a major public health problem in Iran. Therefore, promoting the prevention and control programs and policies are necessary to improve health indicators and since some cancers are preventable, the burden can be reduced by controlling tobacco use, dietary interventions, and promoting physical activity.

The Quality of Age Reporting in the 2014 Morocco Census

Aiming to update the economic, demographic, and social characteristics and housing conditions of the population, Morocco conducted its last General Population and Housing Census (GPHC) in 2014. Accurate data on age is a key element for decision making, and necessary to build policies and improve health indicators. The main objective of this paper is to assess the quality of age reporting in the 2014 Morocco census. We found that grouped age data was of poor quality in two regions. More attention should be paid to improving data quality in those regions in the coming census, especially among men.

Impact of expansion of primary care in child health: a population-based panel study in municipalities in the Brazilian Amazon

ObjectivesConsidering the expansion of primary care in areas of difficult access in the Brazilian territory in recent decades, the aim of this study to evaluate the effect of the Family...

The Effect of a Mobile and Wearable Device Intervention on Increased Physical Activity to Prevent Metabolic Syndrome: Observational Study.

BackgroundResearch on whether wearable devices and app-based interventions can effectively prevent metabolic syndrome (MetS) by increasing physical activity (PA) among middle-aged people living in the rural areas of South Korea remains insufficient.ObjectiveThe aim of this study was to determine whether mobile and wearable device interventions can improve health indicators, including PA, in MetS risk groups in rural South Korea.MethodsIn this clinical trial, performed from December 2019 to June 2020, participants were asked to use a wearable device (GalaxyWatch Active1) alone (standard intervention) or the wearable device and mobile app (Yonsei Health Korea) (enhanced intervention). Clinical measures and International Physical Activity Questionnaire (IPAQ) scores were evaluated initially and after 6 months. The number of steps was monitored through the website. The primary outcome was the difference in PA and clinical measures between the enhanced intervention and standard intervention groups. The secondary outcome was the decrease in MetS factors related to the change in PA.ResultsA total of 267 participants were randomly selected, 221 of whom completed the 6-month study. Among the 221 participants, 113 were allocated to the enhanced intervention group and 108 were allocated to the standard intervention group. After 6 months, the body weight and BMI for the enhanced intervention group decreased by 0.6 (SD 1.87) and 0.21 (SD 0.76), respectively (P<.001). In both groups, systolic blood pressure, diastolic blood pressure, waist circumference, and glycated hemoglobin A1c (HbA1c) decreased (P<.001). The total PA was approximately 2.8 times lower in the standard intervention group (mean 44.47, SD 224.85) than in the enhanced intervention group (mean 124.36, SD 570.0). Moreover, the enhanced intervention group achieved the recommended level of moderate to vigorous physical activity (MVPA), whereas the standard intervention group did not (188 minutes/week vs 118 minutes/week). Additionally, the number of participants in the enhanced intervention group (n=113) that reached 10,000 daily steps or more after the intervention increased from 9 (8.0%) to 26 (23.1%) (P=.002), whereas this number did not increase significantly in the standard intervention group (n=108), from 8 (7.4%) to 16 (14.8%) (P=.72). The number of participants without any MetS factors increased by 12 (11%) and 8 (7%) in the enhanced and standard intervention group, respectively.ConclusionsPA monitoring and an intervention using wearable devices were effective in preventing MetS in a rural population in Korea. Blood pressure, waist circumference, and HbA1c were improved in both intervention groups, which were effective in reducing MetS factors. However, only the participants in the enhanced intervention group continuously increased their MVPA and step counts above the recommended level to prevent MetS. Body weight and BMI were further improved, and a higher number of participants with zero MetS factors was attained from the enhanced intervention.Trial RegistrationClinical Research Information Service KCT0005783; https://cris.nih.go.kr/cris/search/detailSearch.do/16123

Estimating staffing requirements using workload indicators of staffing need at Braun District Hospital in Morobe Province, Papua New Guinea

BackgroundPapua New Guinea has seen some improvements in health indicators over the past years, but the pace of improvements is not as robust as expected. The Health Services Plan for Braun District Hospital redevelopment identified the importance of reflecting the hospital’s role in the broader health system, particularly in upgrading the services to service a bigger population. In August 2020, the hospital was upgraded from a health centre—level 3 to a district hospital level 4. The need for assessing human resources for health requirements for this level of care was thus necessary.MethodsThe National Department of Health approved the use of the workload indicators of staffing need as the best tool to support in estimating staff requirements for the newly upgraded hospital. The focus was on clinical and non-clinical staff. Using already developed workload components and activity standards by the expert working groups for level 4 facilities, we visited the facility and collected data through interviews with the Lutheran Health Services representative, hospital management and staff. The technical task force reviewed daily registers, monthly reports and the data in the electronic national health information systems. The information collected was analysed using the workload indicators of staffing need software and interpreted.ResultsThere were staffing shortages among the clinical staff like the medical officers, nursing officers, health extension officers, pharmacists, radiology staff unit and in the laboratory staff. Shortages among the non-clinical staff were recorded by the cashiers, security officers, drivers and boat skippers. The results showed that the facility lacks a medical laboratory technologist, pharmacists and a medical imaging technologist. The community health workers in this facility are utilized in all the areas where shortages are registered to multitask.ConclusionThe results from this WISN study provide evidence for basing staffing decisions on. The WISN results from Braun District Hospital show that the facility requires a total of 33 inpatient nurses against the existing 21 inpatient nurses thus giving a staff gap of − 12 and a WISN ratio of 0.67. It is thus recommended that the hospital management prioritizes recruitment of nurses or if no resources, reassign one of the outpatient nurses to alleviate the pressure among the inpatient nurses or the extra theatre nurses to offer some services in the inpatient wards. WISN results can help managers make decisions such as change of health facility status from a health centre to a district hospital.

Urbanisation, qualité des institutions et santé publique dans les pays d'Afrique subsaharienne

Cet article vise à examiner la relation entre l'urbanisation et les indicateurs de santé publique sous le prisme de la qualité des institutions dans les pays d'Afrique subsaharienne (ASS). En utilisant un panel de 41 pays couvrant la période 2002 à 2019 et la méthode des moments généralisés (GMM), les résultats montrent que l'urbanisation actuelle de l'ASS, ne s'accompagne pas d'une amélioration des indicateurs de santé. Cependant, des institutions fortes atténuent l'effet négatif de l'urbanisation sur les résultats en matière de santé publique. Ces résultats impliquent que les gouvernements des pays d'ASS doivent promouvoir des institutions fortes et inclusives afin de garantir les gains sanitaires de l'urbanisation.

Inequalities in risk behaviors for chronic noncommunicable diseases: Vigitel, 2019

This study analyzes the economic, racial, and geographic inequalities in risk behaviors for chronic non-communicable diseases of Brazilian adults. This is a cross-sectional study conducted with data from the 2019 Vigitel (Risk and Protective Factors Surveillance System for Chronic Noncomunicable Diseases Through Telephone Interview). The analyzed risk behaviors were smoking, alcohol abuse, physical inactivity, overweight, regular consumption of soft drinks or artificial juice drinks, and non-regular consumption of fruits, legumes, and vegetables. Inequalities in risk behaviors were assessed considering Brazilian's schooling level and their dwelling region, via the slope index of inequality (SII). Equiplots graphs were also built to better illustrate the inequalities. Stata svy command was used for all analyses due to the complexity of the sampling process. In total, 52,395 patients were evaluated. Significant inequalities in risk behaviors for chronic non-communicable diseases were observed: most risk behaviors were concentrated in those with low schooling. Smoking and soft drinks consumption were more observed in the Southern region of Brazil. Public policies are necessary to reduce the inequalities found, allowing for improvement in health indicators of the Brazilian population.

Progress and strength of response against noncommunicable diseases in the US-affiliated Pacific Island jurisdictions, 2010-2021.

ObjectiveTo determine the effectiveness of the response to the 2010 declared regional noncommunicable diseases (NCDs) emergency in nine US-affiliated Pacific Island jurisdictions.MethodsVital statistics and risk prevalence surveys were retrospectively reviewed using 14 standardized NCD risk, prevalence and death rate indicators to measure changes in health status over time. NCD risk and prevalence change scores were derived from subsets of these indicators, and NCD composite death rates were examined. An NCD strength-of-intervention score derived from a standardized regional monitoring tool provided measures for assessing responses aimed at curbing risk factors, prevalence and death rates. Associations between the strength-of-intervention score and changes in health status were examined.ResultsPairs of values were available for 97 of 126 individual comparisons for 14 core indicators in nine jurisdictions. The composite mean prevalence of all risk factors across the jurisdictions between baseline and follow-up (26.7% versus 24.3%, P = 0.34) and the composite mean diabetes and hypertension prevalence (28.3% versus 28.2%, P = 0.98) were unchanged, while NCD death rates increased (483.0 versus 521.9 per 100 000 per year, P < 0.01). The composite strength-of-intervention score for the region was 37.2%. Higher strength-of-intervention scores were associated with improvements in health indicators.DiscussionDespite some improvements in selected NCD indicators at the jurisdiction level, there was no significant overall change in the prevalence of risk factors, diabetes and hypertension, and death rates have continued to increase since the NCD emergency declaration. However, the adoption of public sector NCD interventions was associated with improvements in health indicators.

FORMATION AND IMPLEMENTATION OF STATE POLICY OF SOCIO-ECONOMIC DEVELOPMENT TO ENSURE SOCIAL WELFARE AND HEALTH OF CITIZENS

The article defines that the health of citizens and public well-being is a key factor in economic and social development and is of the utmost importance for every state. Giving citizens the opportunity to control their health contributes to the improvement of the quality of life, without the active participation of the people themselves, many opportunities to strengthen and protect their health and increase the level of well-being are lost. The factors underlying the well-being of society also determine strategies that take this principle into account are more effective, because fair access to education, employment, and a decent level of income contribute to maintaining health. It is substantiated that health contributes to the increase of labor productivity, the formation of more effective labor resources, as well as the reduction of costs for sickness benefits and social assistance. The most effective way to ensure the health and social well-being of the population is the coordinated work of all sectors of the state, aimed at the social determinants of health. The effectiveness of the health care system and economic productivity are interconnected in the context of optimizing the use of resources in the field of public welfare. There are both direct and indirect effects of the health sector on socio-economic development, this is important in relation to how these activities affect people's health and their work productivity. It has been proven that many segments of the population lag behind in terms of health indicators, and often, in the event of socio-economic instability, these inequalities deepen. Changes in the social characteristics of morbidity, demographics and migration can slow down progress in improving health indicators, and solving this problem requires improving governance mechanisms and public policy as a whole. The insufficient level of social cohesion and financial uncertainty further complicate activities aimed at improving the health of citizens and their social security. It has been found that a number of state authorities cannot contain costs in modern conditions, when financial constraints make it increasingly difficult to find the necessary means for health care and social protection. Before developing the reform of the health care system, it is necessary to carefully analyze the economic and social interests, which are deeply transformed, as well as the possibility of a public and civil position. The formation of management strategies allows you to get a real effect on public well-being at acceptable costs in conditions of limited resources.

Implications of the 7th NFC Award on Health Services in Pakistan

Fiscal decentralization is aimed to improve Public Services Delivery as the subnational governments get control of additional revenue and expenditures responsibilities and are in a better position to provide basic services to the local people. The 7th NFC Award is considered as a big step toward fiscal federalism wherein the criteria for horizontal and vertical distribution of resources has been changed to accommodate major demands of the federating units. This research paper has been an attempt to identify that to what extent the new fiscal arrangements under the 7th NFC Award has been successful to improve health services delivery in Pakistan. For this study data on various health indicators has been collected for the period 2001 to 2019 divided into two groups i.e., pre 7th NFC period (2001 to 2010) and post 7th NFC Award period (2011 to 2019). To identify the impact of 7th NFC Award on health services delivery in Pakistan various variables were selected including Infant Mortality, Under Five Years’ Mortality, Life Expectancy at Birth and Health Expenditures (%GDP) as dependent or endogenous variables at national level whereas for comparison at provincial level Life expectancy at birth and Under Five Years mortality were used as dependent variables. The variables were tested at the national level as well as the provincial level and interprovincial comparison was also performed. For the analysis purpose different techniques for trend analysis were applied including the Chow breakpoint test, recursive coefficient, Wald-Coefficient Restriction test, Equality of Variance test, trend estimates, Durbin Watson Test and Forecast analysis. Additionally, the Difference-in-Difference approach was also applied to compare other provinces as treatment groups i.e., Sindh, Khyber Pakhtunkhwa and Baluchistan with Punjab as a control group. The results suggest health indicators have responded positively to the additional funds’ transfer and Life expectancy at birth, Infant mortality and Under Five years’ mortality have improved at national level. Life expectancy and under five years’ mortality has generally improved in all provinces except for life expectancy in KP. While comparing the performance of other provinces with Punjab it is found that life expectancy at birth, infant mortality and Under Five years’ mortality have improved in Sindh and Khyber Pakhtunkhwa while Baluchistan did not improve health indicators in comparison to Punjab. However, to realize further benefits of the fiscal decentralization it is suggested that additional fund transfer is not a sufficient factor to bring change and should be complemented by administrative and legislative actions on part of the government. Innovations and the role of the private sector are crucial in improving public services delivery in health sector. Moreover, the capacity of the government machinery and the ability to develop plans and strategies is important to realize the benefits of the fiscal decentralization by the provinces.

Choice of Place of Delivery during COVID-19 Pandemic: Observation from a Community-Based Survey in Rural India

For the past two decades, India has made considerable improvement in health indicators and the country was on the right track toward achieving sustainable development goal-3 by 2030. However, the COVID-19 pandemic has disrupted the health-care system including the essential health services for mother and child. This study was carried out to understand the barriers for utilization of institutional delivery and its prevalence during the pandemic in rural West Bengal. A total of 318 number of women from 18 sampled villages of Canning II block of South 24 Parganas district were interviewed face to face using a semi-structured interview schedule between October and November 2020. The data were analyzed using Stata and NVivo 12 Pro software. Findings show that more than one-fourth (27.3%) of the deliveries took place at home without any assistance of medical professionals. Fear and anxiety related to COVID-19, uncertain service availability, poor service quality during the pandemic, and lack of supporting hands at households compelled women to choose home delivery instead of institutional delivery. Those delivered at institutions, many of them were released on the day of delivery itself, which resulted poor perinatal care even in the cases of institutional delivery. The findings recommend that in addition to COVID-19 related health services, essential maternal and child health services should be continued with the quality to achieve Sustainable Development Goal 3.

Determining the Components of a Health Information Social Network Based on a Delphi Study

Background and Objectives: In recent years, social networks have been considered by organizations active in the health sector. They have provided many opportunities for consulting, training, and information sharing and held promises to increase the quality and safety of health care and reduce costs. So it is necessary to study their dimensions and requirements. This study aims to identify the components of the health information social network from the perspective of experts. Methods: This research is an analytical survey using the Delphi method. The statistical population included 28 experts in the field of health information technology in Iran. The data collection tool was a questionnaire whose validity was confirmed by experts, and its reliability was 0.96 according to the Cronbach α coefficient. SPSS software version 19 was used for data analysis. Results: According to this research, the health information social network has 6 dimensions, each has several components (a total of 47 components). These dimensions include services, core users, requirements, information security, evaluation and monitoring, and technical features. Conclusion: The dimensions of this network are based on the collective opinion of experts and are a framework for creating a social network of health information. Its use helps in planning and decision making and providing high-quality health services and leads to quality improvement of health indicators.