Facility Level Research Articles

Assessing the Efficacy of Various Differentiated Service Delivery (DSD) Models in Chosen Healthcare Centers within Masaiti District.

Purpose: This study delves into the assessment of Differentiated Service Delivery (DSD) models within the healthcare framework of Masaiti District, focusing on their effectiveness, components, and implementation challenges. Methodology: Using a mixed method approach with explanatory embedded design, the study objectives encompass a multi-faceted exploration. These include an analysis of the specific components integrated into each DSD model adopted in Masaiti, an investigation into the interplay between facility level and individual stage participation in differentiated care, and an identification of the implementation difficulties faced in public health facilities. Findings: The study reveals a statistically significant connection (p < 0.05) between facility stage participation and individual stage engagement in differentiated care, with a Cramer's V coefficient of 0.131 indicating a small effect size. This suggests a feasible relationship between the degree of individual participation in differentiated care and the facility's capacity to encourage and facilitate such participation. Unique contribution to theory, practice, and policy (recommendations):This research provides valuable insights for healthcare policymakers, practitioners, and stakeholders involved in the design, implementation, and improvement of DSD models. It highlights the distinctive features and methodologies of each DSD model in Masaiti District, the influence of healthcare facility hierarchies on DSD model effectiveness, and the challenges encountered during implementation. By addressing these aspects, the study offers recommendations to enhance the efficacy and sustainability of DSD initiatives within the Masaiti healthcare context.

The proportion and determinants of appropriate health seeking behavior for febrile illness among caregivers of children under-five years in Butula sub-county, Busia county, Kenya

Background Almost 10 million children under the age of five in Kenya, die due to fever-related diseases. In Busia, a county in Kenya, malaria accounts for 13% of all child fatalities under the age of five, a number higher than any other county. This study aimed to determine (a) proportion of appropriate health-seeking behavior and (b) determinants of health-seeking behaviors (HSBs) among their caregivers in Butula Sub-County, Busia County, as reported by the caregivers. Methods This cross-sectional mixed-method study included 271 caregivers, 11 community health volunteers, and health facility workers in Butula Sub-County. Systematic random sampling for participants and purposive sampling for key informants were used. A questionnaire collected the data that was analysed using frequency and percentages and logistic regression. Results 70.1% of caregivers reported seeking care for a child's fever within 24 hours. Individual factors that caregivers reported to influence appropriate health-seeking HSB were unemployment (adjusted odds ratio (aOR) = 0.49, 95% CI: 0.217 – 0.593, p = 0.018), self-medication preference (aOR = 0.14, 95% CI: 0.054 – 0.363, p < 0.001), had atleast two children (aOR = 0.63, 95% CI: 0.425 – 0.937, p = 0.042), and confidence in identifying fever (aOR = 7.0, 95% CI: 2.200 – 22.439, p = 0.001). Health-system factors reported to influence HSBs were facility too far (aOR = 0.86, 95% CI: 0.526 – 0.914, p = 0.027), getting health education (aOR = 1.8, 95% CI: 1.201-4.122, p=0.015), and facility level (aOR = 4.4, 95% CI: 2.015 – 9.750, p < 0.001). Qualitative findings found health system factors related to HSB as stockouts, facility distance, and staff workload. Conclusions Policy and practice efforts should focus on significant individual and health system determinants for HSBs among caregivers of children under five with febrile illness.

Evaluation of the sentinel yellow fever surveillance system in Uganda, 2017–2022: strengths and weaknesses

BackgroundUganda has a sentinel surveillance system in seven high-risk sites to monitor yellow fever (YF) patterns and detect outbreaks. We evaluated the performance of this system from 2017 to 2022.MethodsWe evaluated selected attributes, including timeliness (lags between different critical time points), external completeness (proportion of expected sentinel sites reporting ≥ 1 suspect case in the system annually), and internal completeness (proportion of reports with the minimum required data elements filled), using secondary data in the YF surveillance database from January 2017–July 2022. We conducted key informant interviews with stakeholders at health facility and national level to assess usefulness, flexibility, simplicity, and acceptability of the surveillance system.ResultsIn total, 3,073 suspected and 15 confirmed YF cases were reported. The median time lag from sample collection to laboratory shipment was 37 days (IQR:21–54). External completeness was 76%; internal completeness was 65%. Stakeholders felt that the surveillance system was simple and acceptable, but were uncertain about flexibility. Most (71%) YF cases in previous outbreaks were detected through the sentinel surveillance system; data were used to inform interventions such as intensified YF vaccination.ConclusionThe YF sentinel surveillance system was useful in detecting outbreaks and informing public health action. Delays in case confirmation and incomplete data compromised its overall effectiveness and efficiency.

Development of a Nuclear Safety and Security Integration Assessment Tool for Research Reactors and Associated Facilities.

Nuclear safety and security are essential elements of radiation protection. Integration of nuclear safety and security provides a means to identify conflict and synergy points. Research has not been performed to enable integrated practices at the facility level. A tool was developed through research to help staff and regulators assess the level of integration practiced within a research reactor. This tool aims to improve the identification of synergistic and conflict points. Eight criteria of nuclear safety and security integration were used to create the integration assessment tool: access control, transportation, emergency response, proper disposal of materials, testing and maintenance, defense in depth, training and education, and culture. The tool's final score can range from 0.0375 to 1, with a score of 1 indicating complete integration. The tool was used by research reactor staff to assess practiced integrative techniques. The testing and maintenance criterion scored the highest level of integration (0.84). Training and education and culture scored the lowest levels of integration (0.50). The areas with the highest scores identified points of actively practiced integration. In contrast, those areas with lower scores indicated a lack of integrative practices. The total integration score was 0.69. This tool determined that the facility practiced an adequate level of integration. By analyzing integration levels with this tool, a measurable standard of integrative practices can be employed to achieve improved radiation protection.

A qualitative exploration of how a community engagement approach influences community and health worker perceptions related to family planning service delivery in Togo.

There is a growing body of evidence that asserts community engagement approaches can improve the quality of reproductive health services. Family planning (FP) programs in Togo are implementing such approaches, which aim to mobilize both health workers and communities to improve FP service quality and FP uptake. However, there is not enough known about the enabling factors and challenges associated with implementation, or the extent to which the programs improve outcomes leading to contraceptive uptake. We qualitatively explored how a community engagement approach influenced health worker and community perceptions related to FP service delivery in and around the city of Lomé, Togo, within the context of the broader integration of social and behavior change and service delivery. We conducted 18 in-depth interviews with health workers and 9 focus group discussions with community members. We found the approach, which included community dialogues, site walkthrough visits and the development of community action plans, worked synergistically together to support collaborative action between communities and health workers to increase mutual understanding of their collective needs related to FP services. Community members cited improved reception at the health facilities by health workers and indicated that the site walkthrough visits created a greater sense of empathy towards the providers and the challenges faced in their work environment. Health workers acknowledged a greater understanding of barriers at the community level following community dialogues, particularly among community members that are not routinely encountered at the health facility for reproductive health services such as men and youth. We found limited implementation of health facility improvements included in community action plans because they were dependent on commitment from community leadership and the need to mobilize additional support or financial resources. Community engagement approaches are a promising mechanism to support collaboration and enhance mutual understanding between health workers and communities to achieve improved FP service quality. Future programs should consider incorporating additional mechanisms to monitor community action plans and provide support to address structural challenges at the facility level particularly those that require financial resources.

Spatial Differentiation Characteristics, Driving Mechanisms, and Governance Strategies of Rural Poverty in Eastern Tibet

Rural areas in Tibet, with its complex terrain, fragile ecology, and poor facilities, are subject to a combination of social–ecological system elements, facing the typical risks of recurrent, marginal, and potential poverty. At present, the spatial differentiation and driving mechanism of rural spatial poverty risk in Tibet are not clear, which adversely affects the formulation of differentiated and precise governance strategies. Thus, based on the social–ecological system perspective, 967 poor rural villages in eastern Tibet were taken as an example, using intelligent techniques such as random forest, geographic detector, and multi-scale geographically weighted regression to identify the spatial differentiation characteristics and the driving mechanism of poverty. The results indicated that (1) the high poverty incidence of rural areas in eastern Tibet showed a scattered block distribution, of which approximately 37% of the villages presented a spatial distribution characterised by a high degree of clustering of the high poverty incidence. (2) Topography and the level of public facilities were key factors influencing the poverty levels of rural areas in eastern Tibet, in which the coupling explanatory power between the construction land slope index (CLSI) and several poverty-causing factors was high. (3) Geological disaster, land surface temperature, CLSI, traffic accessibility, livestock resources, cropland per capita, and tourism resources differentially drove the poverty incidence of rural areas in eastern Tibet, forming spatial partitions dominated by the risks of potential, marginal, and recurrent poverty. For different partitions, differentiated governance strategies of upgrading ecological environments, optimising geographical locations, and revitalising social resources were proposed to provide references for solving the problem of relative poverty in the new period.

Two Novel Antibiotic Use Metrics for Facilities and Individual Prescribers in Post-Acute and Long-Term Care Settings

Background: Measuring and reporting antibiotic use are essential to antimicrobial stewardship activities. The most common metric to assess facility-level use is days of antibiotic therapy per 1000 days of care (DOT/1000 DOC). This metric may be difficult to calculate, not be readily comparable, or not provide actionable data to individual prescribers, particularly those that work in post-acute and long-term care (PALTC) settings. Here we use data from a centralized dispensing pharmacy to develop antibiotic use metrics suitable for offering individualized feedback to prescribers working in PALTC settings. Methods: We obtained medication dispensing data and resident census data for 13 PALTC settings within the same network. After omitting non-pharmacologic items and limiting the data to medications dispensed from 1/2020 – 12/2022, we determined the following metrics by month: days of antibiotic therapy (DOT), number of medications prescribed, number of antibiotic courses prescribed (antibiotic starts), and the number of individual residents issued a prescription for any medication (unique residents). These metrics were assessed for each facility (2020 – 2022) and for prescribers responsible for > 1% of prescriptions within that facility (2022 only). Prescriber-level unique residents was the number of residents issued a prescription by the given provider. We obtained facility-level census data to calculate antibiotic DOT/1000 resident days of care (DOC) as a standard to which we compared novel metrics. Results: During the 3-year study period, 1718 prescribers at 13 PALTC settings wrote for 672256 medications, including 31087 antibiotic courses. At the facility level, the correlation between monthly antibiotic starts (courses)/unique residents and antibiotic DOT/1000 DOC was 0.83 (p < 0 .0001). The correlation between monthly antibiotic DOT/unique residents and antibiotic DOT/1000 DOC was 0.98 (p < 0 .0001). Trends in monthly values of both novel metrics and DOT/1000 DOC were consistent across the examined period (Figure 1). For individual prescribers, both novel metrics permit assessment and comparison of antibiotic prescription rates over time (Figure 2). Conclusions: Pharmacy dispensing data can be used to determine antibiotic DOT/unique residents and antibiotic starts/unique residents at the facility level and for individual providers. The novel metric antibiotic DOT/unique residents demonstrated strong correlation with antibiotic DOT/1000 DOC at the facility level. In addition to supporting tracking and reporting of antibiotic use among PALTC settings, these new metrics permit visualization of the antibiotic prescribing rates of individuals prescribers, as well as peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC.

Changes in Antibiotic Use and Disruptions to Antimicrobial Resistance Detection in South Africa and Uganda, 2019 – 2020

Background: The COVID-19 pandemic disrupted routine health services worldwide, including systems to detect antimicrobial resistance (AR). AR is a mounting global health threat with some studies showing the highest mortality rate from AR infection is in Sub-Saharan Africa (SSA). Antibiotic use is a major contributor to AR. We sought to characterize COVID-19-related changes to antibiotic use and AR detection capacity in two countries in SSA from 2019 to 2020. Methods: Health facilities (HF) in South Africa and Uganda were surveyed as part of a larger study assessing disruptions to essential health services in SSA in the context of COVID-19. Modified stratified random sampling of HF by facility level was conducted in regions with high COVID-19 cumulative prevalence. Hospital pharmacists were surveyed to identify perceived changes in antibiotic use. Among facilities with the capacity to detect AR, surveys were conducted with AR laboratory managers to identify perceived changes in staff, equipment, training, and supplies. Descriptive data analysis was conducted using frequencies and proportions. Results: A total of 39 HFs in South Africa and 45 HFs in Uganda responded to the antibiotic use survey. Increases in total antibiotic use from 2019 to 2020 were reported by 82% (23/28) of HF in South Africa and 68% (27/40) in Uganda. Increased use of antibiotics for multi-drug resistant bacteria (per World Health Organization Reserve classification) was reported by 36% (9/25) and 38% (8/21) of HFs in South Africa and Uganda, respectively. 19 HFs in South Africa and 12 HFs in Uganda responded to the AR detection capacity survey. HFs in both countries reported decreases in laboratory staff responsible for AR (33% [13/40] in South Africa and 31% [11/35] in Uganda). Decreased availability of reagents and consumables for bacteriology and antimicrobial susceptibility testing was reported by 50% (8/16) and 33% (4/12) of HFs, and decreased availability of specimen collection supplies for bacterial cultures was reported by 41% (7/17) and 42% (5/12) of HFs in South Africa and Uganda, respectively. Diversion of laboratory supplies was reported in both countries (32% [6/19] in South Africa and 25% [3/12] of HF in Uganda). Conclusions: HFs in South Africa and Uganda reported increases in antibiotic prescribing, a risk factor for increased AR, concurrently with disruptions in AR detection capacity during the early phases of the COVID-19 pandemic. These findings emphasize the importance of investing in bacteriology and AR testing in SSA and maintaining support during infectious disease pandemics.

Harnessing the power of infection prevention and public health data systems to support health care in Washington State during the COVID-19 pandemic

State health departments' (SHD) role in infection prevention and control (IPC) includes robust educational and consultative services for various health care settings. During the COVID-19 pandemic, Washington-SHD (W-SHD) IPC staff conducted remote and on-site Infection Control Assessment and Response (ICAR) consultations for long-term care (LTC) and non-LTC health care facilities. ICAR consultations were classified as "reactive" in response to a COVID-19 outbreak or "proactive" to help facilities improve IPC protocols. Facility addresses were geocoded to census tracks, classifying urban or rural areas. Facility types and characteristics were analyzed, assessing theimpacts of repeat visits. All descriptive statistics, Pearson's χ2 tests, and odds ratios were calculated. Between March 2020 and December 2022, W-SHD conducted 3,093 ICARs at 1,703 health care facilities in 94.9% (37/39) of Washington counties. Of the total visits, most were in LTC (90.5%) and 48.9% were reactive. Facilities with initial on-site ICARs had 1.5 times the odds of having a repeat visit than facilities with initial remote visit (95%CI: 1.21, 1.87). Maintaining strong connections with health care facilities can help bolster infection prevention practices and minimize loss of information at the facility level. Evidence-based findings on the sustainability of the W-SHD's ICAR services during the COVID-19 pandemic illustrated the value of public health IPC programs.

Assessing the quality of Hand Hygiene data produced by Alberta Health Services using a time-in-motion study

Background: Alberta Health Services (AHS) measures hand hygiene compliance through direct observations performed by trained site-based reviewers (SBRs) and facilitated by the Infection Prevention and Control (IPC) program. Within AHS there are >100 acute care facilities, ranging in bed size from four beds to more than 1,000, with catchment populations ranging from one million. A time-in-motion study using trained AHS IPC staff was proposed to validate the completeness and accuracy of data being collected by the SBRs. Methods: The AHS IPC staff performed direct observations at pre-selected facilities across all five zones and four different unit types (emergency, medical, surgical, and intensive care) for four 30-minute periods during weekdays between June and September 2023. An iPad app was used to capture results from all four moments of hand hygiene. The reviewer indicated the day and time of the review and captured as many representative hand hygiene moments and healthcare providers as possible. The distributions of the four moments of hand hygiene, healthcare provider group and overall compliance were compared at the unit type and facility level (tertiary, large urban, regional, pediatric, and small sites) between this time-in-motion study and SBR data collected June-September 2023. Results: The study collected 175 reviews and 4,683 observations from 14 facilities and 48 units. Between June and September 2023, SBRs collected 2,625 reviews and 61,506 observations from these same facility and unit types. Across all facility and unit types, the distribution of the four moments was similar between the study and SBRs. Similar proportions of healthcare providers were also observed. However, the overall hand hygiene compliance collected in the study was approximately 10% lower across all unit types as compared to that collected by the SBRs (study: 63%-84%; SBRs: 75%-92%). Conclusions: In public health surveillance, completeness and accuracy are two characteristics of high-quality data. A time-in-motion study identified that the hand hygiene observations collected by SBRs were complete, as the range of healthcare providers observed, and the distribution of their moments, mirrored that collected in the study. However, the SBRs reported higher compliance than the study participants and the true hand hygiene compliance is likely lower than what is currently being reported. Since this difference was seen consistently across all unit and facility types, trending data over time should still identify areas in need of improvement and may help to suggest causes of the over-reporting.

Four Years And More Than 200,000 Deaths Later: Lessons Learned From The COVID-19 Pandemic In US Nursing Homes.

Nursing home residents and staff were disproportionately affected by the COVID-19 pandemic, drawing attention to long-standing challenges of poor infection control, understaffing, and substandard quality of care in many facilities. Evolving practices and policies during the pandemic often focused on these challenges, with little effect. Despite the emergence of best practices to mitigate transmission of the virus, even the highest-quality facilities experienced outbreaks, indicating a larger systemic problem, rather than a quality problem at the facility level. Here we present a narrative review and discussion of the evolution of policies and practices and their effectiveness, drawing on evidence from the United States that was published during 2020-23. The lessons learned from this experience point to the need for more fundamental and nuanced changes to avoid similar outcomes from a future pandemic: greater integration of long-term care into public health planning, and ultimately a shift in the physical structure of nursing homes. More incremental measures such as vaccination mandates, higher staffing, and balancing infection control with resident quality of life will avoid some adverse outcomes, but without more systemic change, nursing home residents and staff will remain at substantial risk for repetition of the poor outcomes from the COVID-19 pandemic.

Hospital-Level Variability in the Adoption of Image-Guided Focal Therapy for Localized Prostate and Kidney Cancer

BackgroundFocal therapy, a minimally invasive procedure, offers targeted treatment for kidney and prostate cancer using image guidance. However, the current institutional landscape of its adoption in localized prostate and kidney cancer remains less understood. This analysis compares its usage between the 2 cancers to discern health system determinants affecting the adoption of these treatments. MethodsThe study used data from adult patients with localized prostate and kidney cancer from the National Cancer Database. We calculated adjusted probabilities of focal therapy usage per facility via multivariable mixed-effects logistic regression model with hospital-level random effects. We analyzed interhospital variability through ranked caterpillar plots and Spearman correlation coefficient. ResultsAmong 1,559,334 prostate and 425,753 kidney cancer patients, 1.6% and 6.3% received focal therapy, respectively. The interhospital variation ranged from 0.13% to 32.17% for prostate cancer and 1.16% to 30.48% for kidney cancer. The hospital-level odds of focal therapy for prostate and kidney cancer were weakly correlated (Spearman's ρ = 0.21; P < .001). ConclusionsOur analysis revealed a substantial hospital-level discrepancy in the utilization of focal therapy. Despite this, there was a limited correlation between the use of focal therapy for these two types of cancer within the same hospital. Our findings emphasize the presence of multifaceted factors influencing the adoption of focal therapy, both at facility and healthcare system levels.

Unit costs and cost-effectiveness of a device to improve TB treatment adherence in China.

Adherence to TB drugs is crucial for improving treatment outcomes. Digital adherence technologies can improve adherence; however, there is a lack of evidence on cost-effectiveness. This study aimed to explore the cost-effectiveness of medication event reminder monitors (MERM) in China compared with the standard of care, using results from a pragmatic, cluster-randomised superiority trial of an electronic MERM in China. We collected primary unit cost data from the societal perspective, both at and above the health facility level. We estimated the incremental cost-effectiveness of MERM using a Markov model with a 20-year time horizon; a 3% discount rate was applied to costs and outcomes. We explored uncertainty through a series of sensitivity and scenario analyses. The incremental cost of MERM was $27.22 per patient. Probabilistic sensitivity analysis showed significant uncertainty about the intervention's cost-effectiveness. Changing assumptions around key parameters substantially affected our estimated incremental cost-effectiveness ratio. Although the incremental cost of the MERM box was low, current evidence does not indicate that the intervention would be cost-effective. However, the intervention's cost-effectiveness could improve if implemented as part of a broader strategy, including enhanced patient management.

Exploring the role of international rankings in the development of institutional public relations strategies

The study uncovered that educational institutions cannot exclusively rely on their international ranking achievements to maintain their legitimacy. Universities must prioritize strategic communication to enhance their competitive position in the global education market. The study employed a mixed-methods approach, encompassing in-depth interviews and focus group discussions with a cohort of 37 first-year students attending a private institution. The study revealed that students' decision-making process in selecting a private university was intricate and involved multiple aspects. In addition to rankings, students also considered variables such as parental influence, networking possibilities, and the level of facilities and support services provided by the university. Consequently, colleges should prioritize not only their rankings but also other marketing tactics to recruit students. Although university rankings like QS and Times Higher Education significantly influence the perception of institutions in terms of quality and prestige, it is advisable to adopt a more balanced approach. Access to information via digital platforms, such as websites and social media, has played a critical role in demonstrating the program's and university's reliability. Public relations initiatives, however, have focused on highlighting the excellence of education and the societal obligations of universities in the fiercely competitive higher education sector.

Readiness Level of Bottled Drinking Water Production Facilities in Meeting Good Processed Food Production Requirements in the Aceh and Bogor Regions

Readiness Level of Bottled Drinking Water Production Facilities in Meeting Good Processed Food Production Requirements in the Aceh and Bogor Regions

A novel multi-objective robust possibilistic flexible programming to design a sustainable apparel closed-loop supply chain network

Designing a sustainable Closed-Loop Supply Chain (CLSC) network is imperative for the apparel industry, given its escalating adverse effects on economic, environmental, and social dimensions. In this study, a novel tri-objective location-allocation optimization model is specifically developed for designing a sustainable apparel CLSC, incorporating the industry's unique facilities. The aim of the model is to simultaneously minimize the costs and negative environmental impacts while maximizing social benefits under demands and returns uncertainty. A notable research contribution lies in addressing the unique challenges of treating different types of returns, including commercial, End Of Use (EOU) and End Of Life (EOL) returns due to their uncertain quality and quantity. Additionally, the model optimizes the environmental performance levels of production facilities, a novel aspect in the apparel CLSC research. Moreover, the flexibility of constraints related to the demand fulfilment is considered. To cope with such flexibility and uncertainties, a new hybrid robust possibilistic flexible programming model is developed, by extending the previous methodologies. A core innovation of this solution approach lies in the pioneering utilization of hexagonal fuzzy numbers for uncertain epistemic parameters, making a significant advancement in the field of CLSC. Comparative analysis with the similar studies demonstrates the superiority of the proposed model, incorporating hexagonal fuzzy numbers over the method using triangular fuzzy numbers. Furthermore, AUGMECON method using lexicographic optimization is applied to handle the multi-objective model. The application of the proposed model is shown focusing on Southwestern Ontario in Canada. The results reveal that commercial and EOU returns have a more detrimental impact on economic, environmental, and social sustainability aspects compared to EOL returns.

Satisfaction Evaluation and Sustainability Optimization of Urban Medical Facilities Based on Residents’ Activity Data in Nanjing, China

Research on public service facility evaluation has mainly focused on spatial accessibility and facility quality from a supply perspective, but has rarely focused on the evaluation of service facilities from a usage perspective. Researchers can observe the service quality, frequency of use, functional connotation, satisfaction level, and other aspects of facilities from the user’s perspective, effectively compensating for the disadvantage of insufficient precision in traditional macro statistical data. This study proposes a new method for evaluating medical facility usage and service quality based on residents’ activity data. We established an evaluation index system from the perspective of residents’ activity by measuring intensity, frequency, and service satisfaction through network grading data and online comments context. Then, we evaluated the supply and demand relationship of medical facilities, identifying the influencing factors of medical satisfaction. We have also proposed specific strategies for sustainable optimization of medical services. The results show that (1) the service attitude (0.024, 0.002**), service efficiency (0.133, 0.001*), and service quality (0.017, 0.001**) of medical institutions are the core factors that affect medical satisfaction, followed by the convenience of residents in accessing medical resources, showing a significant positive correlation (p &lt; 0.01, Total R2 = 0.9061); and (2) the medical service level in Nanjing City is generally balanced, although spatial heterogeneity exists in the Qixia and Jiangning boroughs.

Evaluating a clinical mentorship intervention on maternal and neonatal complications in primary health facilities in Blantyre district, Malawi: A longitudinal analysis of the Global Action in Nursing program

BackgroundWhile Malawi has made great strides increasing the number of facility-based births, maternal and neonatal mortality remains high. An intervention started in 2019 provided short-course training followed by year-long longitudinal bedside mentorship for nurse midwives at seven health facilities in Blantyre district. The intervention was initiated following invitation from the district to improve outcomes for patients during childbirth. This study examined the impact of the intervention on the reporting of obstetric and neonatal complications and related care. MethodsPatient level data were collected from the District Health Information System 2 database from intervention and non-intervention facilities. Bivariate analysis explored the impact of longitudinal bedside mentorship on select District Health Information System 2 variables at six-month intervals. Outcomes were then analyzed using nonlinear quantile mixed models to better account for the impact of time and clustering at the facility level. ResultsSignificant changes were found in the reporting of obstetric and neonatal complications over time at intervention facilities compared to non-intervention facilities. Intervention facilities showed statistically significant increases in the reporting of prolonged labor, pre/eclampsia, fetal distress, retained placenta, and premature labor. There was also a statistically significant decrease in the reporting of no complications in the multivariate model (95%CI: −0.8 to −0.2). In both the bivariate and multivariate models, the reporting of ‘None’ significantly decreased (0.8 % median), while the reporting of prematurity (0.2 % median) and asphyxia (0.3 % median) both significantly increased. The missingness of data at intervention facilities decreased to almost zero compared to non-intervention facilities. DiscussionThe increase in reported maternal and neonatal complications suggests improved early identification of complications at the facility level. The improved accuracy of patient data from intervention facilities shows the impact mentorship has on data quality which is crucial for the allocation of resources. By highlighting the apparent dose–response relationship of longitudinal bedside mentorship, this study will inform the broader use of mentorship in training programs. Future research is needed to explore the impact of longitudinal mentorship on quality of care.

Relationship between medication safety‐related processes and medication use in residential aged care facilities

AbstractObjectiveTo explore the association between the implementation of medication safety‐related processes measured with the Medication Safety Self‐Assessment for Long‐Term Care (MSSA‐LTC) tool and medication use in residential aged care facilities (RACFs).MethodsA descriptive cross‐sectional study was conducted in Australian RACFs. Data on facility characteristics, aggregated medication use at the facility level for selected medications commonly associated with a high risk of harm and the MSSA‐LTC were completed by clinical pharmacists providing clinical pharmacy services. The Spearman's correlation test was used to evaluate the association between the MSSA‐LTC score and medication use. A scatter plot between the MSSA‐LTC score and medication use data was generated, and a linear trend line was plotted using the least squares method.ResultsData were collected from 31 RACFs servicing 2986 residents. Most medication safety‐related processes were implemented in Australian RACFs. A higher facility MSSA‐LTC score was associated with a lower proportion of residents with polypharmacy (r = −.48, p = .01) and one or more benzodiazepines (r = −.41, p = .03). In addition, a negative linear trend was observed between the MSSA‐LTC score and the average number of medications per resident, the proportion of residents with one or more anticonvulsants and the proportion of residents using one or more opioid analgesics.ConclusionsThis study indicates that implementing medication safety‐related processes may improve medication use in RACFs.

Childhood Cancer Awareness Program in Bungoma County, Kenya.

Awareness could play a key role in reducing underdiagnosis and accelerating referral of childhood cancer in low- and middle-income countries and ultimately improve outcomes. This study describes the implementation of a childhood cancer awareness program in Bungoma County in Kenya, containing five components: (1) baseline data collection of primary healthcare facilities; (2) live training session for healthcare providers (HCP); (3) early warning signs posters; (4) online SMS course for HCP; and (5) radio campaign. This study was conducted between January and June 2023. All 144 primary healthcare facilities (level 2 and 3 health facilities) within Bungoma County were visited by the field team. All 125 level 2 (87%) and 19 level 3 (13%) facilities participated in the study. National Health Insurance Fund (NHIF) failed to cover services in 37 (26%) facilities. HCP were more often reported absent at level 3 (89%) than level 2 (64%) facilities (P = 0.034). The 144 live training sessions were attended by over 2000 HCP. Distribution of 144 early warning signs posters resulted in 50 phone calls about suspected childhood cancer cases. Sixteen children were later confirmed with childhood cancer and treated. Online SMS learning was completed by 890 HCP. Knowledge mean scores improved between pre-test (7.1) and post-test (8.1; P < 0.001). Finally, 540 radio messages about childhood cancer and a live question-and-answer session were broadcasted. This study described the implementation of a childhood cancer awareness program in Kenya involving both HCP and the general public. The program improved HCP's knowledge and increased the number of referrals for children with cancer.