Inadequate Health Care Research Articles

Exploring the lived experiences of deep vein thrombosis patients in Lahore, Pakistan: a qualitative phenomenological study on healthcare challenges, resilience and social support

ObjectiveThis study aimed to explore and describe the lived psychological and emotional experiences of sufferers of deep vein thrombosis (DVT) and to narrate the effect of those experiences on their...

HUMAN EXPLOITATION IN ARAVIND ADIGA’S NOVEL THE WHITE TIGER

Aravind Adiga’s The White Tiger explores the stark social disparities between the wealthy and impoverished in India, illustrating how systemic poverty perpetuates marginalization. The protagonist, Balram Halwai, narrates his journey from a lower-caste background to becoming a self-made, successful individual in India. Balram's story is not just one of personal ambition but also of navigating a rigidly stratified society. This study addresses two primary issues: the exploitation Balram endures due to his socioeconomic status; and his strategic actions are to attain freedom from the oppressive forces in his life. Using a library research method, the study integrates secondary sources, including books and articles, to deepen the analysis of the novel. Employing a psychological approach, this study examines the psychological complexities of Balram’s character, supported by theories on character development, data credibility, theoretical triangulation, and reliability. Balram is depicted as an astute yet morally ambiguous character, exhibiting selfishness, cunning, irresponsibility, dishonesty, and a lack of remorse. The analysis reveals how his behaviors and attitudes—such as detachment from others and deviant tendencies—are shaped by his environment. India’s entrenched caste system underpins various social issues in the novel, including poverty, unemployment, corruption in education, inadequate healthcare, exploitation, discrimination, and the persistence of hierarchical master-servant relationships. These factors collectively influence Balram’s psychological development, and shape him into a figure both reflective and critical of the society he navigates.

A case study on development of a spiral oral health curriculum for medical students.

Inadequate oral healthcare remains a critical public health issue in children and adults in the US affecting adverse social, psychological, economic, and health outcomes. Medical clinicians have a clear role in addressing oral health issues and improving outcomes. Oral health guidelines for health profession schools were developed by the Association of American Medical Colleges (AAMC) oral health core competencies, and the newer Center for Integration of Primary Care and Oral Health's (CIPCOH) Entrustable Professional Activities (EPAs). However, the majority of health professional school deans and residency directors in the US report they are not satisfied with the oral health knowledge and skills of their learners at graduation. To address this issue, faculty at the University of Massachusetts Chan Medical School (UMCMS) have worked for the past decade to develop and implement a true spiral curriculum building on lessons of knowledge, skills, and attitudes throughout the 4-year student experience. The current UMCMS curriculum involves most courses at the medical school, has community-based and interprofessional components, and is taught using multimedia. Most of the curriculum is mandatory with selective opportunities for those in specialty tracks or who are seeking more hands-on training. Our study evaluated the UMCMS curriculum using the AAMC and CIPCOH EPA guidelines. Findings show that all students receive training in 42 of 48 AAMC oral health competencies and seven of seven CIPCOH oral health EPAs with the opportunity to explore oral health further through elective courses. Assessments of students show they perform well and evaluation of the oral health curricula by students are positive. Although our oral health curriculum is robust, the next steps include expanding the evaluation of students to ensure they universally meet competencies. We expect that this case study can serve as a map for creating a generalizable, spiral curriculum for other medical schools.

Homicides by offenders with psychotic illness in Italy and Turkiye: A comparison of offender and crime-scene profiles

ObjectiveThe primary aim of this study was to conduct a comparative analysis of homicide cases and their perpetrators with psychotic illnesses in Italy and Turkiye, identifying the extent to which country-specific factors influence offender profiles and crime-scene characteristics. MethodThis cross-national chart review study recruited individuals with psychotic illnesses from forensic psychiatric centers in Italy and Turkiye who were referred for criminal responsibility assessments. Data were collected on the offenders' background characteristics, psychiatric history, victim profiles, and crime-scene details. ResultsCompared to the Italian sample, a higher prevalence of hospitalizations, contact with mental health services, and past offending history prior to the index homicide in the Turkish sample highlight inadequate community mental health care and monitoring systems, as well as insufficient supervision by the criminal justice system in Turkiye. Turkish offenders were less likely to exhibit organized crime scenes and post-crime behavior, with fewer stressors preceding the offense, suggesting a greater role of positive psychotic symptoms in their homicidal acts. ConclusionDespite certain similarities, the differences between the two samples highlight the impact of sociocultural, healthcare, and legal systems on offender profiles and crime-scene characteristics. These findings emphasize the need for tailored mental health services, forensic psychiatric assessments and legal supervision that take into account country-specific factors.

From legislation to actual health service: evaluation of health provisions in the disability law of Ghana by adolescents with mobility and visual impairments and their families

BackgroundDespite Ghana’s Persons with Disability Act, 2006 (Act 715) making provisions for access to healthcare services for adolescents with disabilities and their families, a corpus of literature has reported that persons with disabilities continue to face challenges in accessing healthcare services. However, the voices of adolescents with disabilities and their families are very scarce in such discourse. This study explored the experiences of adolescents with disabilities and their families in accessing healthcare services as per the provisions described in Ghana’s Act 715.MethodsThis study involved 45 participants, including 25 adolescents with disabilities and 20 family members from a municipality in Ghana. Employing a qualitative descriptive design, semi-structured interviews were conducted which was then analyzed thematically and interpreted using Critical Disability Theory.ResultsThe study identified two major categories of barriers to healthcare access: environmental (socio-economic difficulties, poor built environment, unavailability of rehabilitation services) and systemic (cultural beliefs, poor support at healthcare facilities and inadequate healthcare legislative provisions for families of children with disabilities). Despite legal provisions for free healthcare, participants faced significant financial barriers, with specialist services often not covered by the National Health Insurance Scheme.ConclusionsThe study calls for policy adjustments to fully cover specialist care under Ghana’s National Health Insurance Scheme, establishment of local-level health assessment and resource centers, educational campaigns to change cultural perceptions, and training of healthcare workers to promote quality access to healthcare.

Causes of Coronary Angioplasty Denial in Patients Diagnosed with Significant Coronary Artery Disease in East Afghanistan

Coronary Artery Disease (CAD) is a leading cause of mortality worldwide, with coronary angioplasty being a crucial intervention for patients with significant disease. This study aimed to identify and analyze the causes of coronary angioplasty denial in patients with significant coronary artery disease in Afghanistan, focusing on demographic, socioeconomic, and clinical factors. A case-control study was conducted with a sample size of 213 patients diagnosed with significant CAD at tertiary care center in Afghanistan. The case group consisted of 106 patients who were denied angioplasty, and the control group included 107 patients who underwent the procedure. Data were collected on demographic characteristics, comorbidities, education, residence, functional status, income, and the reasons for angioplasty denial. Descriptive statistics and comparative analyses were performed to assess the factors associated with denial. The primary reasons for angioplasty denial were financial constraints (45.3%, p < 0.001), limited hospital facilities (15.1%, p = 0.045), patient refusal (23.6%, p < 0.001), and physician preference for conservative management (12.3%, p = 0.091). Denial rates were higher among patients who were older, had multiple comorbidities, were from rural areas, and had lower education and income levels. Illiteracy and cultural beliefs contributed significantly to patient refusal, while inadequate healthcare infrastructure disproportionately affected rural populations. Financial and infrastructural barriers are the leading causes of coronary angioplasty denial in Afghanistan, exacerbating disparities in healthcare access, particularly among low-income and rural patients. Addressing these issues through policy reforms, improved healthcare infrastructure, and targeted public health education is essential to reducing CAD-related morbidity and mortality in the country.

Characteristics of Diseases in Developing Countries

In the urgent realm of global health, it is imperative to acknowledge and promptly address the distinct characteristics of diseases that afflict developing countries. These nations face a unique set of challenges that contribute to the burden of illness and significantly impact the quality of life for their populations. By promptly exploring the key features of diseases in developing countries, we can better understand the complex interplay between socioeconomic factors and health outcomes [1]. One of the primary characteristics of diseases in developing countries is their disproportionate impact on vulnerable populations. Socio-economic disparities, limited access to healthcare, inadequate sanitation infrastructure, and poor nutrition contribute to the heightened susceptibility of marginalized communities to preventable infectious diseases such as hydatid cysts, malaria, tuberculosis, and diarrheal illnesses. The lack of resources and infrastructure further exacerbates the spread of these diseases, creating a cycle of sickness and poverty [2,3]. Furthermore, the prevalence of neglected tropical diseases (NTDs) is a defining feature of the disease landscape in developing countries. These illnesses, which include dengue fever, Chagas disease, and schistosomiasis, predominantly affect populations in low-resource settings and often go unnoticed on the global health agenda. The burden of NTDs is compounded by limited funding for research and treatment, leaving affected communities without adequate support and interventions [4]. In addition to infectious diseases, non-communicable diseases (NCDs) are on the rise in developing countries, posing a dual burden of illness alongside contagious diseases. Factors such as urbanization, lifestyle changes, and an aging population contribute to the increasing prevalence of conditions like cardiovascular diseases, diabetes, and cancer. The inadequate healthcare infrastructure in many developing countries further hinders NCDs' prevention, diagnosis, and management, leading to poorer health outcomes for those affected [5]. Addressing the characteristics of diseases in developing countries requires a multi-faceted approach that encompasses strengthening the healthcare system, investing in public health infrastructure, and, most importantly, providing equitable access to essential medicines. By ensuring fair access to these medicines, we can work towards achieving health equity and reducing the burden of disease in developing countries.

Risk factors associated with multidrug-resistant Klebsiella pneumoniae infections: a multicenter observational study in Lebanese hospitals

BackgroundKlebsiella pneumoniae is a significant global public health burden, especially in low-income countries and regions with fragile healthcare infrastructures, due to its ability to cause severe infections, increase mortality rates, and its rising antimicrobial resistance. This study aimed to estimate the proportion of multidrug-resistant (MDR) K. pneumoniae infections and identify associated risk factors.MethodsData were retrospectively collected from three academic hospitals in Beirut, Lebanon, between January 2021 and September 2023 using a standardized form. Binary logistic regression was used to determine risk factors associated with MDR, extended-spectrum beta-lactamase (ESBL)-producing, and carbapenem-resistant K. pneumoniae (CRKP) infections.ResultsOut of 2,655 K. pneumoniae cases, 410 met the inclusion criteria. The primary infection sources were the urinary tract (58.3%) and the respiratory tract (12.4%). Among the isolates, 61% were MDR K. pneumoniae, with 7.3% being extensively drug-resistant, and 0.5% pandrug-resistant. Additionally, 36.8% were ESBL-producing, while 6.3% were CRKP. Predictors significantly associated with MDR K. pneumoniae infections included male sex (adjusted odds ratio [AOR] = 3.46, 95% CI = 1.01–11.86, P = 0.04), recent antibiotics use (AOR = 4.52, 95% CI = 1.65–12.36, P = 0.003), and recent cancer chemotherapy (AOR = 3.43, 95% CI = 1.25–9.42, P = 0.01). ESBL-producing infections were associated with age ≥ 65 years, higher Charlson Comorbidity Index (CCI), and recent antibiotic use. CRKP infections were linked to male sex, prior antibiotic use, and longer hospital stays prior to infection (all P < 0.05).ConclusionsMDR K. pneumoniae infections are steadily rising in Lebanon, along with an increase in ESBL-producing and CRKP cases. The main risk factors for MDR K. pneumoniae infections were male sex, recent antibiotic use, and cancer chemotherapy. ESBL-producing infections were associated with advanced age, higher CCI, and recent antibiotic use, while CRKP infections were linked to male sex, prior antibiotic use, and prolonged hospital stays. This situation is further exacerbated by inadequate healthcare infrastructure and suboptimal national surveillance. Strengthening local surveillance and implementing effective antibiotic stewardship programs are critical to managing this growing threat..

Impact of Knowledge, Attitudes, And Perceptions Regarding the Covid-19 Vaccine Among Students at A Tertiary Institution in Kenya

COVID-19 vaccination was authorized as a preventive measure due to its proven effectiveness in reducing infection, severity, and mortality rates. mRNA-based vaccines, such as the Pfizer-BioNTech and Moderna vaccines, work by utilizing a small piece of the virus's genetic material called messenger RNA (mRNA). Viral vector-based vaccines, such as the Oxford-AstraZeneca and Johnson &amp; Johnson vaccines, use a harmless virus to deliver a modified version of the SARS-CoV-2 virus's genetic material into cells. As of June 2021, COVID-19 vaccines approved to be safe and effective by the WHO included: AstraZeneca (oxford vaccine), Johnson and Johnson, Pfizer (BioNTech), Moderna, Sinopharm, and Sinovac. Both mRNA-based and viral vector-based vaccines have shown high efficacy in preventing COVID-19 and reducing the severity of the disease. We assessed how knowledge, attitudes, and perceptions of COVID-19 vaccines influenced uptake by students at a tertiary institution in Kenya. This was a descriptive cross-sectional study conducted in Kabarak University-Main Campus. The sampling procedure employed was the convenience sampling method. The data was collected via a self-administered questionnaire on 385 students and analyzed using SPSS. Vaccination was not entirely successful (at threshold) in Kenya due to insufficient public education (benefits or side effects); inadequate health care professionals; myths &amp; misconceptions (including the risk of infertility), opinions &amp; beliefs (clinical trials short time to detect long term side effects like malignancies); resistance (fear for death or infection, fear of expired vaccines administration); mistrust on government (forced, threats by leaders, a charade to donations, benefits government, research on Kenyans) &amp; mistrust on the sources of vaccines (China, Russia), reluctance, procrastination, negligence &amp; ignorance (not embraced, negative attitude to westernization, the pandemic is over!); infection even after being vaccinated and the dosage forms available injection, fear for syringes, oral preferred. The study results revealed that 15.1% strongly agreed that a vaccine is important to end the COVID-19 pandemic; 33.5% agreed that a vaccine is important to end the COVID-19 pandemic; 33.2% were undecided that a vaccine is important to end the COVID-19 pandemic. The study findings showed that 53.0% had been vaccinated as compared to 47.0% who had not been vaccinated. That is medical students (pharmacy and medicine) had higher rates of vaccine uptake compared to Engineering students.

Unveiling the Burden of Nephrolithiasis in Low- and Lower-Middle Income Countries: A Review on Its Presentation, Risk Factors, Treatment Practices, and Future Directions

Background: Nephrolithiasis, or kidney stone disease, presents a significant global health burden, with global incidence rates and treatment practices varying widely. This study aims to discuss the epidemiology, risk factors, treatment modalities, and challenges for nephrolithiasis in the lower half of the World Bank rankings; that is, in low- and lower-middle-income countries. Methods: A comprehensive literature review was conducted using PubMed for each country on the list, focusing on studies published from January 2000 onwards and reporting data on prevalence, risk factors, treatment practices, and economic implications. Results: Nephrolithiasis represents a significant burden for healthcare systems, with noteworthy geographical variability in prevalence possibly dependent on socioeconomic status and gender. Risk factors include dietary habits, climate, pollution, and infectious diseases. Treatment practices in some regions still rely on open surgery due to limited access to advanced endourological techniques, while other regions demonstrate high proactivity in research. The burden is exacerbated by inadequate healthcare infrastructure and training. Conclusions: Addressing nephrolithiasis in challenging economic circumstances requires targeted interventions, including improved access to modern treatment methods, enhanced training for healthcare professionals, and better socioeconomic and environmental conditions. Future research should focus on region-specific strategies and the development of sustainable healthcare solutions.

Global view of haematolymphoid tumor classifications and their application in low- and middle-income countries.

The accurate diagnosis of haematolymphoid malignancies is crucial for effective cancer care, but major obstacles to diagnosis exist in low- and middle-income countries (LMICs). This article explores the global applicability of current haematolymphoid classification systems, which are predominantly derived from data generated in high-income countries (HICs). Although disproportionately burdened with poor cancer outcomes, LMICs are generally faced with limited diagnostic resources, suboptimal access to therapeutics, and inadequate healthcare infrastructure. The article highlights the challenges faced by LMICs, including inconsistent access to high-quality pathology services, limited availability of advanced diagnostic techniques, and a lack of population-based cancer registry data. It also discusses the progress made in narrowing the gap between LMICs and HICs, such as the introduction of resource-adapted classifications, improved guidance on essential diagnostic tools, and strengthening of in-country professional pathology networks. Innovative diagnostic approaches, including gene expression profiling and machine learning, represent potential solutions for improving the diagnostic accuracy in LMICs, but addressable gaps remain. Recommendations are suggested for sustainable investments in diagnostic infrastructure, capacity-building, and population-based cancer registries to enhance the global applicability of haematolymphoid classification systems and improve outcomes for patients in LMICs.

Community policing practice in the Nigerian police: Implications of employee burnout

The Nigerian police force's implementation of community policing has coincided with increased criminal activities, exacerbated by factors like high youth unemployment, inadequate healthcare, malnutrition, poverty, banditry, and intercommunal conflicts. Against this backdrop, this aimed at assessing how burnout affects the implementation of community policing within the Nigerian police force. It specifically aimed to explore how three dimensions of burnout—emotional exhaustion, personal accomplishment, and depersonalization—influence officers' adherence to and practice of community policing principles. By examining these factors, the study sought to provide a comprehensive understanding of how the psychological well-being of police officers impacts their ability to effectively engage in community-oriented policing strategies. Participants were 369 police personnel, which consisted of 266 males and 94 females, with a mean age of 36.6 years. The study adopted the cross-sectional research design. The Maslach Burnout Inventory (MBI), and the Community Policing Inventory were used as measures of burnout and community policing respectively. Three hypotheses were tested with the multiple linear regression. Results revealed that emotional exhaustion did not significantly predict the practice of community policing (β = -.087, t = -1.332, p = .184), accounting for 8.7% variability in the practice of community policing. Personal accomplishment did not significantly predict the practice of community policing (β = .113, t = 1.951, p = .052), accounting for 11.3% variability in the practice of community policing. Depersonalization significantly negatively predicts the practice of community policing (β = -.275, t = -4.425, p &lt;.001), accounting for 27.5% variability in the practice of community policing. It was recommended that future studies investigate the mediating and moderating variables that can provide a deeper understanding of the intricate relationship between burnout and community policing in the Nigerian setting.

Providing Cataract Surgeries at a Rural Primary Health Centre through Non-governmental Organisation Collaboration: An 8-year Experience

Abstract The National Programme for Control of Blindness and Visual Impairment aims to reduce blindness and visual impairment in India. Despite these efforts, rural areas still have high numbers of cataract patients due to inadequate healthcare services. Leveraging non-governmental organisation (NGO) networks to provide rural eye care camps has been proposed to address these challenges. This article shares an 8-year collaboration with an NGO in rural Haryana, delivering cataract surgeries. Initially, surgeries were conducted in temporary locations; however, due to complications, they were shifted to hospitals, increasing travel difficulties. In 2016, collaboration with ICARE Eye Hospital began, involving screening camps and transporting patients for surgery. This reduced patient expenses and referral burdens, performing 1690 surgeries with high satisfaction. Authors recommend similar collaborations to achieve the national blindness reduction goal.

Silent Diabetes: Key Risk Factors Among the Low-Income Population of Langkawi Island, Kedah, Malaysia (2022-2023).

Diabetes mellitus (DM) poses a growing global health challenge, contributing to significant morbidity, mortality, and economic burden. In Malaysia, the prevalence of diabetes is increasing, especially among low-income populations with limited access to healthcare. Many cases remain undiagnosed, increasing the risk of severe complications and further straining healthcare resources. Island populations, such as those in Langkawi, are particularly vulnerable due to geographical isolation, socioeconomic constraints, and inadequate healthcare services. To determine the prevalence of undiagnosed DM and identify the associated risk factors among the low-income population on Langkawi Island, Kedah, Malaysia. We conducted a cross-sectional study from January 2022 to December 2023, involving 1,070 participants aged 40 years and above, all eligible under the low-income scheme. Data on sociodemographic characteristics, body mass index (BMI), lifestyle, and medical history were collected through a structured proforma from four local health clinics. Logistic regression analysis was used to identify significant predictors of undiagnosed DM. The model's predictive accuracy was assessed using the area under the receiver operating characteristic (ROC) curve. The prevalence of undiagnosed DM among the low-income population on Langkawi Island was 6.7%. Multiple logistic regression found three important predictors: having a higher BMI (overweight: adjusted odds ratio (AOR): 2.72; 95% confidence interval (CI): 1.40-5.30; p = 0.003; obese: AOR: 2.43; 95% CI: 1.19-5.00; p = 0.015); living on a smaller island (AOR: 1.71; 95% CI: 1.03-2.85; p = 0.039); and having a medical history (AOR: 0.21; 95% CI: 0.12-0.36; p < 0.001). The model demonstrated good predictive accuracy with an area under the ROC curve of 0.758 and correctly classified 93.3% of cases. This study reveals a significant burden of undiagnosed DM within Langkawi's low-income population, especially among individuals with higher BMI and those residing in geographically isolated areas. The findings highlight the urgent need for enhanced, context-specific screening programsand early detection efforts tailored to this vulnerable population. Effective public health strategies should prioritize regular health check-ups, obesity management, and improved access to healthcare services in isolated communities to reduce the prevalence and complications associated with undiagnosed diabetes.

Impact of energy consumption on life expectancy in lower-middle-income West African countries

Life expectancy is a key determinant of a nation&amp;rsquo;s health and well-being. However, West African countries face several challenges in improving life expectancy, such as inadequate healthcare infrastructure, corruption, poor sanitation, and environmental quality due to environmental degradation. In addition, energy accessibility is an important determinant of health outcomes and environmental quality. The United Nations&amp;rsquo; Sustainable Development Goals 7, 12, 13, 14, and 15 are directly linked with energy access; achieving these goals will lead to an improvement in energy access. Therefore, in this study, using data obtained from the World Bank and the Central Bank of Nigeria Statistical Bulletin, we investigated the impact of energy consumption and corruption on life expectancy in lower-middle-income West African countries from 1990 to 2021. The results of the cross-sectional auto-regressive distributed lag technique showed that renewable energy has a positive and significant impact on life expectancy in lower-middle-income West African countries in both the short and long run. However, non-renewable energy was found to have a significant and negative impact on life expectancy in the long run and a negative but non-significant impact in the short run. Corruption had a debilitating effect on life expectancy in both the short and long run. We recommend that policymakers should make a conscious and deliberate push toward transitioning to renewable energy through public&amp;ndash;private partnerships to provide affordable and clean energy while tackling corruption.

The rising tide of tuberculosis in Pakistan: Factors, impact, and multi-faceted approaches for prevention and control.

Tuberculosis (TB) remains a major public health concern in Pakistan, which is ranked fifth among high-burden TB nations worldwide. The growing frequency of drug-resistant TB strains, particularly multidrug-resistant TB (MDR-TB), creates new obstacles. Socioeconomic factors, a lack of awareness, and inadequate healthcare infrastructure all contribute to the spread of the disease. This study investigates the mechanisms contributing to the growth in tuberculosis cases in Pakistan, the implications for public health, and multifaceted approaches to prevention and control. A comprehensive literature study was undertaken, including an analysis of peer-reviewed articles, World Health Organization (WHO) data, and government sources, to identify factors driving tuberculosis prevalence, control issues, and disease-fighting tactics.Result: Several factors like Poverty, overcrowding, malnutrition, stigma, and restricted access to healthcare services are all factors contributing to an increase in tuberculosis incidence in Pakistan. The prevalence of MDR-TB, along with a lack of an integrated healthcare response, complicates efforts to contain the disease's spread. Tuberculosis has a profound social, mental, and financial impact on individuals and communities. Public health efforts, such as the National Tuberculosis Control Program (NTP) and international partnerships, have been created to eradicate tuberculosis, although considerable hurdles persist. This study investigates the mechanisms contributing to the growth in tuberculosis cases in Pakistan, the implications for public health, and multifaceted approaches to prevention and control.

Advancing Immunization in Africa: Overcoming Challenges to Achieve the 2030 Global Immunization Targets.

African immunization programs are crucial in reducing the prevalence of infectious diseases and improving public health outcomes. This review provides an overview of the current status of immunization efforts in Africa, highlights key challenges, and offers recommendations to help the continent achieve the 2030 Global Immunization Goals. While progress has been made, significant challenges remain. For instance, the WHO African Region reports full immunization coverage at 56.5%, partial coverage at 35.1%, and zero immunization coverage at 8.4%. Between 2019 and 2021, approximately 67 million children in Africa did not receive routine vaccinations, with West and Central Africa particularly affected. DTP1 coverage remained stable at 80%, but DTP3 coverage saw a slight drop to 72% between 2021 and 2022. As of 2022, MCV1 coverage reached 69%, reflecting ongoing efforts against measles. Key barriers to vaccination include limited parental education, religious beliefs, inadequate healthcare systems, and vaccine hesitancy. Addressing these barriers requires community-driven approaches like door-to-door campaigns and mobile clinics. To reach the 2030 immunization targets, health systems must be strengthened, vaccine supply chains optimized, and financial resources-both domestic and international-expanded. The Immunization Agenda 2030 (IA2030) emphasizes data-driven decision-making, nation-ownership, and tailored strategies to overcome obstacles and raise immunization coverage among several demographic groups. Achieving these 2030 goals in Africa requires collaborative efforts to ensure equitable access to vaccines, address sociocultural challenges, and strengthen health system infrastructure.

Kinder und Jugendliche mit Post-COVID-Syndrom: eine qualitative Studie zu Erfahrungen und Zufriedenheit mit der Versorgung in einem Modellprojekt in Bayern (Post-COVID Kids Bavaria)

BackgroundAgainst the background of inadequate healthcare provision for children and adolescents with post-COVID-19 syndrome (PCS), a model project was initiated in Bavaria (PoCoKiBa: Post-COVID Kids Bavaria), offering specialized diagnostics and care. The aim of this study was to explore and describe the experiences and satisfaction of children and adolescents with PCS, as well as their parents, with the healthcare provided in the model project. MethodsFrom October to December 2022, seven focus group discussions were conducted via video conference or in person with a total of 32 participants (19 children/adolescents, twelve mothers, one father). These represented 28 children and adolescents affected by PCS (aged 7 to 17 years). The focus group discussions were recorded, transcribed and analysed using qualitative content analysis. ResultsStudy participants talked about their experiences with the care they received within and beyond the model project, continuity of care, communication between doctors and patients, patient information, and the accompanying study. At the sites of the model project, patients found physicians who spent more time with their patients and took them seriously. Following diagnosis, some patients have benefited from recommendations for therapeutic services or everyday behaviours, while others complained about a lack of treatment suggestions or support for dealing with PCS in their everyday life. DiscussionThe experiences of study participants with the medical care of their PCS symptoms within or beyond the model project mirror the well-known challenges of healthcare provision. There is considerable room for improvement in the care of children and adolescents with PCS, particularly in the organization of the complex diagnostic process, which involves several organ systems, and in the provision of targeted information to patients and families affected. ConclusionThe supply of healthcare services, as established and offered in the PoCoKiBa model project, is crucial for families with a child affected by PCS, since it can offer expertise in diagnosis and treatment that is currently not available in routine health care.

The Opioid Crisis, Preventing and Managing Substance Abuse in India: A Systematic Review.

The opioid crisis has emerged as a significant public health concern globally, with India facing unique challenges in preventing and managing substance abuse. This systematic review aims to analyze the current state of the opioid crisis in India, evaluate existing prevention and management strategies, and propose evidence-based recommendations for addressing this complex issue. A comprehensive literature search was conducted across multiple databases, resulting in the inclusion of 30 studies meeting the predefined criteria. The review highlights the multifaceted nature of the opioid crisis in India, influenced by factors such as socioeconomic conditions, cultural norms, and healthcare accessibility. Key findings include the need for comprehensive prevention programs, improved access to evidence-based treatments, and integration of harm reduction strategies. The review also emphasizes the importance of addressing co-occurring mental health disorders and the potential of community-based interventions in managing substance abuse. Challenges identified include stigma, limited access to treatment, inadequate healthcare infrastructure, regulatory barriers, and lack of comprehensive policies. Recommendations for future directions include developing culturally appropriate prevention programs, assessing the long-term effectiveness of treatment modalities, exploring innovative approaches to reduce stigma, and investigating the role of technology in improving access to care. By implementing a multifaceted approach that considers the unique sociocultural context of India (including factors such as family structures, religious beliefs, economic disparities, and regional variations in drug use patterns), there is potential to significantly reduce the burden of opioid abuse and improve outcomes for affected individuals and communities.

"Private Hospitals Generally Offer Better Treatment and Facilities": Out-of-Pocket Expenditure on Healthcare and the Preference for Private Healthcare Providers in South India.

Out-of-pocket expenditure (OOPE) directly reflects households' financial burden for healthcare. Despite efforts to enhance accessibility and affordability through government initiatives and insurance schemes, OOPE remains problematic, especially in rural areas with inadequate public healthcare infrastructure. This study examines factors influencing OOPE in Karnataka's Dakshina Kannada, Udupi, and Shimoga districts, investigating socioeconomic characteristics, healthcare infrastructure, and accessibility to inform policies for equitable healthcare access and reduced household financial strain. Using purposive sampling, 61 semi-structured interviews were conducted in rural and urban South Karnataka, recorded in Kannada after obtaining consent, and thematically analyzed. Results revealed mixed perceptions of healthcare quality, cost, and accessibility between government and private hospitals. Government facilities were lauded for improved infrastructure and affordability, while private hospitals were preferred for quality and personalized care despite higher costs. Health insurance significantly impacted OOPE reduction. Participants emphasized the need for increased awareness of government insurance programs and improved quality in public hospitals. The study concludes that private hospitals are favored for superior care despite expenses, while government hospitals are valued for affordability. Expanding insurance coverage and improving public awareness are crucial for enhancing healthcare accessibility and affordability.