Levels Of Health Care Delivery Research Articles

Healthcare workers' perspectives on the availability and use of mobile health technologies for disease diagnosis and treatment support in the Ashanti Region of Ghana.

Considering the usefulness of mobile health (mHealth) technologies in healthcare delivery in low- and middle-income countries, including Ghana; there is a need to explore healthcare professionals' perspectives on the availability and use of mHealth for disease screening and treatment of patients' conditions. The study's main aim is to explore healthcare professionals' perspectives regarding the availability and use of mHealth applications for disease screening and management at point-of-care in Ghana's Ashanti Region. We conducted in-depth interviews with healthcare professionals who use mHealth applications daily between July and September 2020. A purposive sampling strategy was employed to select healthcare professionals who have been using mobile health application tools to support healthcare delivery. The researchers conducted 14 in-depth interviews with healthcare professionals on the availability and use of mHealth applications to support disease diagnosis and treatment of patients' conditions. Data were transcribed, coded, arranged, and analyzed to determine categories and themes. The study results demonstrated that healthcare workers had positive perceptions towards mHealth applications. Healthcare professionals identified significant challenges concerning mHealth applications: the high cost of data; lack of education or limited awareness; poor mobile networks; unstable internet connectivity; erratic power supply; and unavailability of logistics. Healthcare professionals identified the following prerequisite strategies to strengthen the use and scale-up of mHealth applications: stable internet connectivity; creating awareness; supplying logistics; reducing the cost of data; and developing local mobile apps. The study results revealed the availability of mHealth applications at the individual level for disease screening and treatment support of patients' conditions. The study also showed several significant challenges facing mHealth applications which need to be addressed to guarantee the successful implementation and scaling-up of mHealth activities at all levels of healthcare delivery. Hence, future research should incorporate healthcare professionals' perspectives to completely understand mHealth implementation and scaling-up challenges and measures to inform policy regulations.

Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India

BackgroundMultimorbidity, the concurrent presence of two or more chronic conditions is an emerging public health challenge. Till date, most of the research have focused on the presence and interaction of selected co-morbidities in tuberculosis (TB). There exist a critical knowledge gap on the magnitude of multimorbidity among TB patients and its impact on health outcomes.MethodsWe undertook a cross-sectional study to assess the prevalence and patterns of multimorbidity among newly diagnosed TB patients in two states of India. A total of 323 patients were interviewed using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). MAQ-PC is already validated for Indian population and elicits 22 chronic conditions. We defined TB multimorbidity as the co-existence of TB with one or more chronic conditions and identified commonly occurring dyads (TB + single condition) and triads (TB + two conditions).ResultsMore than half (52%) of TB patients reported multimorbidity. Among dyads, depression, diabetes mellitus (DM), acid peptic disease (APD), hypertension, chronic alcoholism, arthritis and chronic back ache (CBA) were the most common co-occurring conditions while ‘DM + arthritis’, ‘depression + APD’, ‘depression + DM’ were the most commonly occurring triads among TB patients. Factors such as increasing age, low levels of education, alcohol abusers, drug-resistant TB and having health insurance were significantly associated with multimorbidity among TB patients.ConclusionsOur findings suggest high prevalence of multimorbidity among newly diagnosed TB patients in India. The presence of concordant and discordant conditions with TB may increase the health complexity, thus necessitating appropriate care protocols. Given, the current situation, wherein TB and non-communicable diseases (NCD) services are delivered through collaborative framework between programmes, there is a need for addressing multimorbidity at the healthcare delivery level.

Perception and utilization of partograph among midwives across selected health care facilities in Abuja metropolis, Abuja: A comparative study

Currently, countries are uniting behind a new target to accelerate the decline of maternal mortality rate (MMR) by 2030. SDG 3 encompasses this target of reducing the global MMR to less than 70 per 100 000 births, with no country having MMR more than twice global average. One of the key requirements for averting MMR is provision of care by skilled birth attendant especially midwives, using and having positive perspective to such a tool as partograph, before, during and after childbirth. Hence, the present study. Stratified sampling was used in selecting facilities. Respondents who met the inclusion criteria were drawn proportionately using simple random sampling. Data was collected using a semi-structured questionnaire. Data entry was done using statistical package for social sciences (SPSS V. 21) while hypotheses testing was done using chi-square and ANOVA at statistically significant level of 0.05. Study variables were scored. Score >3.0 was classified positive perception and <3.0 otherwise while score ≥70% was considered adequate utilization and <70% was considered otherwise. Findings showed age of respondents ranged from 39 - 59 years (38 ± 9.8). Two in every five of the respondents had 1 - 5 years of nursing job experience. Respondents had positive perception about partograph (mean 3.7(0.3)) yet inadequate (mean score 55.6%) utilization of the tool. Perception of partograph was significantly positive among respondents from primary facility (ANOVA = 12.38, p = < 0.001) compared to respondents from secondary and tertiary facilities which translated to adequate utilization (χ2 = 68.08, df = 2, p = <0.001) of partograph at that level of health care delivery. The study showed that perception and utilization of partograph in the primary health facility was more than in the secondary and tertiary facilities.

Knowledge, attitudes and practices of infection prevention and control among healthcare workers during the COVID 19 pandemic: a descriptive cross-sectional study in three Nigerian states

BackgroundEmergence of the COVID-19 pandemic created unexpected challenges for health care workers. The global and national supply chain system was disrupted, and affected infection, prevention and control (IPC) practices. This study aimed at documenting health workers knowledge, attitudes and practices (KAP) on IPC in Nigeria during the COVID-19 pandemic.MethodsThe descriptive, mixed-methods cross-sectional study was conducted in Ebonyi, Ondo and Niger states in October 2020. A structured questionnaire was administered to the health workers, complemented by semi-structured interviews that were audio recorded, transcribed and analyzed in Atlas.ti. Quantitative data were entered into REDCap and cleaned, transformed and analyzed using descriptive statistics in SPSS version 25.0 Findings from the qualitative interviews were used to explain the trends observed from quantitative study.ResultsThere were demographic differences between community and facility-based health workers in our population. A greater proportion of facility-based providers reported having IPC training compared to community-based health workers ever (p < 0.01) and during the pandemic (p < 0.05). Health care workers had moderate knowledge of general IPC, and attitudes toward and practice of IPC during COVID-19 pandemic. However, the knowledge of the relative effectiveness of prevention measures was low. The mean knowledge scores were greater among facility-based workers compared to community based healthcare workers (p = 0.001). Self-reported IPC practices increased during the pandemic compared to prior to the pandemic, with the exception of the use of N-95 masks and hand sanitizer.ConclusionThis study found moderate IPC knowledge, attitudes and practices in our study population during the pandemic as compared to pre-pandemic for the study found gaps in correct hand hygienevaried application of different IPC practices to ensure adherence to COVID-19 preventive measures. The study recommends sustained training for IPC and encourages policy makers that budget line specific to COVID-19 response across all the levels of health care delivery will enhance compliance and emergency readiness.

Development and implementation of clinical mentorship in Rwanda: successes and challenges

Rwanda has prioritized the decentralization and integration of HIV services over the past decade to ensure universal access to HIV services throughout the nation. Improving the capacity of healthcare providers to provide high-quality HIV prevention and treatment services was a crucial component of this process. In partnership with the authors, Rwanda’s national health implementation agency developed a national clinical mentorship program from 2011 to 2017 to facilitate this transition. The Rwanda Clinical Mentorship Model aims to effectively manage HIV-infected patients across all levels of healthcare delivery, implement task shifting, and adhere to national guidelines. The clinical care of HIV-positive individuals was transferred from HIV specialists to family physicians and nurses. The facility team was trained, supervised, and mentored by a multidisciplinary team. Mentorship consisted of routine site visits during which clinical case reviews, clinical supervision teaching, and data reviews were conducted to assess the facility’s performance and identify obstacles. Between 2012 and 2020, 5,774 healthcare professionals across the country received HIV testing and treatment training. This clinical mentoring has demonstrated a pragmatic, data-driven, and enduring strategy for enhancing clinical practice at all levels of care. A dedicated cadre of mentors is required to ensure the coordination and sustainability of this approach, according to one finding. The authors participated in accelerating the geographic and scope expansion of clinical mentoring in Rwanda. Developing a sustainable HIV clinical mentorship program in Rwanda requires longterm partnerships and evolving technical assistance.

Biomedical waste disposal practices among healthcare workers during COVID-19 pandemic in secondary and tertiary care facilities of Tamil Nadu

PurposeThe ongoing COVID-19 crisis has drastically changed the practice of biomedical waste (BMW) generation and management. Studies venturing into the facility level preparedness at various levels of healthcare delivery during pandemic situation is the need of the hour. Hence, we did this study to assess the BMW disposal practices amongst secondary and tertiary health facilities during COVID-19 pandemic in Tamil Nadu. Materials and methodsThis cross-sectional survey was conducted amongst doctors, nurses and allied healthcare staffs across various departments in 18 public health facilities across six districts of Tamil Nadu. Multivariable logistic regression analysis was done based on the random-intercept model to assess the determinants of BMW disposal practices. The effect size was reported as adjusted odds ratio (aOR) with 95% confidence interval (CI). ResultsIn total, 2593 BMW disposal observations were made. During nearly three-fourth of the observations (73%), the BMW was disposed of appropriately. Nurses (aOR ​= ​1.54; 95%CI: 1.06–2.23) and doctors (aOR ​= ​1.60; 95%CI: 1.05–2.45), healthcare workers in Paediatrics department (aOR ​= ​1.77; 95%CI: 1.13–2.76), healthcare workers in inpatient department (aOR ​= ​2.77; 95%CI: 1.95–3.94) and injection outpatient department (aOR ​= ​2.69; 95%CI: 1.59–4.47) had significantly better odds of having appropriate BMW disposal practices. ConclusionOur study shows that nearly during three-fourth of the observations, healthcare workers performed appropriate BMW disposal practices. However, measures should be taken to achieve 100% compliance by healthcare workers especially the target groups identified in our study by allocating appropriate resources and periodically monitor the BMW disposal practices.

Assessment of Delivery of Routine Immunization in Kashmir: A Qualitative Study

Introduction:Immunization is one of the splendid public health interventions that remarkably reduced child morbidity, mortality, and disability. Despite attaining substantial immunization coverage in Kashmir, assessment of the immunization system is quintessential for sustaining the gains and exploring the gaps. Objective: To assess the gaps in the delivery of routine immunization services in Kashmir Valley. Method: In-depth face-to-face interviews were conducted with thirty-two (32) important stakeholders, who were purposively selected as they play an active role in the planning and implementation of the Immunization Program and devise strategies at different levels of healthcare delivery. At the state level, SEPIO and SMO were interviewed at the District level, DIO/Deputy CMO was interviewed in all ten (10) districts of Kashmir Valley. From all ten Districts, two Medical-Blocks were selected from each District, and one Block Medical Officer and one Medical Officer were interviewed alternatively from each Medical-Block. Results: The thematic qualitative analysis approach was used and the analysis process generated five themes. Each of these themes included many sub-themes. 1. Factors facilitating the implementation of Routine Immunization (RI), 2. Limitations and deficits related to knowledge, attitude, monitoring, 3. Constraints encountered in the implementation of (RI) program, 4. Difficulties in the implementation of RI revealed by respondents, 5. Transformational steps to bridge gaps in the delivery of Immunization (RI) Conclusion: There were visible deficits related to knowledge, attitude, and monitoring among health professionals. Certain constraints encountered in the implementation of the program were financial constraints in the training of health care professionals and human resources constraints. The study showed the need for transformational steps to bridge gaps in the delivery of the Immunization (RI), which included regular monitoring and review meetings, teamwork and peer learning, training, and improvement in cold chain maintenance.

An Evaluation of the Reflective Constructs Influencing Community Pharmacists’ Decision-to-Procure from Pharmaceutical Suppliers: A Structural Equation Modeling Study

In low-and middle-income countries, patients’ access to affordable medicines is a perennial challenge at all levels of healthcare delivery. Community pharmacists are expected to bridge the supply and demand gap. Unlike the plethora of studies done at the hospital and government institutions level, there is a paucity of empirical evidence on the factors influencing medicine procurement decisions from supply channels at the community pharmacy level. The study aimed to investigate the influence of community pharmacists’ professional and entrepreneurial considerations on their decision-to-procure from medicine suppliers. A cross-sectional survey which adopted a self-administered questionnaire approach to obtain primary data from randomly sampled respondents (N=398) from three purposively selected states in southwestern, Nigeria. Structural equation modeling (SEM) methodology was used to test the hypothesized model at p&lt;0.05. The study revealed acceptable model fit and validity measures for measurement and structural models. Cost and profitability factors were significant predictors of decision-to-procure compared to service and product quality factors among respondents [β=0.343, p=0.001 vs. β=0.044, p=0.606]. Product selection had a positive moderating effect on cost and profitability factors [t=1.980, p=0.048] and a negative directional effect on service and product quality factors in the hypothesized model [t=-2.960, p=0.003]. Community pharmacists should balance financial considerations with a professional focus to ensure patients’ access to quality and affordable medicines. Study outcomes suggest the development and implementation of universally acceptable guidelines on medicine procurement in community pharmacy settings in low-and middle-income countries. The study validated the SEM model for evaluating priorities influencing community pharmacists’ buying decisions. To the best of the authors’ knowledge, this is the first study to use the SEM framework to explore factors informing drug procurement decisions from the community pharmacists’ perspective in low-and middle-income countries.

Stroke Recovery During the COVID-19 Pandemic: A Position Paper on Recommendations for Rehabilitation

Health care delivery shifted and adapted with the COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus 2. Stroke care was negatively affected across the care continuum and may lead to poor community living outcomes in those who survived a stroke during the ongoing pandemic. For instance, delays in seeking care, changes in length of stays, and shifts in discharge patterns were observed during the pandemic. Those seeking care were younger and had more severe neurologic effects from stroke. Increased strain was placed on caregivers and public health efforts, and community-wide lockdowns, albeit necessary to reduce the spread of COVID-19, had detrimental effects on treatment and recommendations to support community living outcomes. The American Congress of Rehabilitation Medicine Stroke Interdisciplinary Special Interest Group Health and Wellness Task Force convened to (1) discuss international experiences in stroke care and rehabilitation and (2) review recently published literature on stroke care and outcomes during the pandemic. Based on the findings in the literature, the task force proposes recommendations and interdisciplinary approaches at the (1) institutional and societal level; (2) health care delivery level; and (3) individual and interpersonal level spanning across the care continuum and into the community.

Availability and Uptake of Community-Based Rehabilitation and Inclusive Development Services for Children with Spina Bifida in Southwestern Uganda

Background: It is over a decade since services for children with Spina bifida were established in Uganda, which has increased the survival rate after Spina bifida repair through follow-ups. Such children have significant disability and other complications, which damage the central nervous system. The consequences of this are more profound in low-income countries if post-operative and long-term care interventions are not well adhered. This study explored the availability and uptake of community-based rehabilitation and inclusive development services to children with Spina bifida in Southwestern Uganda. Methods: A qualitative approach was adopted. The study considered a sample size of 110; 50 children (aged between 0 and 10 years) with Spina bifida were assessed on aspects QoL, while 50 parents and 10 professionals participated in the study. Interviews and children assessments were done at OURS and during home visits between January and April 2019. Results: Special services to children with Spina bifida were offered at one facility; OURS in the whole of Southwestern Uganda. Neuro surgeons and doctors from CURE hospital work with a team from MRRH and OURS. The findings indicated that improved health outcomes resulted from long-term rehabilitation services. These were friendly and free at OURS. Awareness about Spina bifida has been created in communities through Spina bifida associations. 82.3% of the assessed children of school-going age were not in school, some of them were had developed more health complications. Children with Spina bifida traveled long distances to access specialized services. Their peers socially excluded children. Specialized services were not offered at lower health units. Conclusion: This study concluded that such services could be extended to lower levels of healthcare delivery (at least Health Centre IV) in order to shorten the distance. The academic institutions could train more neuro surgeons and doctors and more funding should be availed through MoH.

The Final Mile: Evaluating eHealth and mHealth Utilization Among Older Adults

While health endures as a term to describe looking after oneself, looking after loved ones, and receiving care, the added component of electronic technology has emerged to affect all levels of health care delivery. Despite the prevalence of digital health and empirical evidence strongly supporting improved outcomes--the final mile--as it is sometimes called, is the sustained patient engagement with eHealth and mHealth we have yet to achieve. This research identifies a gap in the literature for understudied characteristics of digital health adoption, use affecting the aging population in the U.S., and contributes a deeper understanding of the key barriers to use of health-related technology. A mixed-methods research approach explores prevalent barriers to digital health utilization by older adults through a pre-post data collection strategy to empirically test an educational health-related intervention rooted in the Technology Acceptance Model. This validated analytic framework represents a decision ‘core’ as a user pathway for actual use. Evaluation of score data utilized a quantitative test of group means while thematic coding was employed for qualitative analysis. The results from this study are two-fold. The work strongly suggests specific barriers to adoption and use, confirming a distrust and reluctance to engage. However, additional evidence, both quantitative and qualitative illuminates substantive skills, positive perceptions, hopeful attitudes, as well as the rationale for use of available digital resources. Findings suggest future research would benefit from expanded use of the two-pronged approach to foster health-related technology engagement.

Patterns of smoking and menopause-specific quality of life: smoking duration matters more

Evidence about the association of quantity of cigarettes smoked and duration of smoking with quality of life in menopause is sparse. The purpose of this study was to examine the association between smoking patterns and menopause-specific quality of life. This cross-sectional study included 513 consecutive midlife women at two primary health care centers in Belgrade, Serbia. Collection of data was carried out from February 2014 to January 2015, using three questionnaires: socio-epidemiologic questionnaire, Menopause-specific Quality of Life questionnaire (MENQOL) and Beck’s Depression Inventory (BDI). Women reported their smoking status (smoker, former smoker, non-smoker), the length of time spent smoking and quantity of cigarettes smoked per day. There was no difference in proportions of ever smokers compared to never smokers. However, there were more women who were current nonsmokers than current smokers. A linear regression model, adjusted for residency district, relationship status, educational level, employment, drinking alcohol, having exercise, age and BDI, showed that longer duration of smoking, but not number of cigarettes smoked per day, was associated with worse Physical domain and total MENQOL score. Receiver Operating Characteristic analysis showed that menopausal symptoms as measured by total MENQOL score were significantly less bothersome for women who smoked less than 10 years and significantly more intense in women who smoked 21 to 30 years. Midlife women should be encouraged to quit smoking as soon as possible, preferably before menopause. Strategies to prevent and quit smoking should be prioritized at all levels of health care delivery for women. Supplemental data for this article is available online at

Knowledge, perception and practice of preconception care among health workers in primary healthcare settings in Ibadan, Nigeria

Background Preconception care comprises interventions that aim to identify and modify biomedical, behavioural and social risks to a woman's health or pregnancy outcome through prevention and management. Despite its importance, it is less routinely practiced in Nigeria and information on the knowledge and practice of preconception care among health workers at the community level is scanty. Hence, this study investigated healthcare workers' knowledge, perception and practice of preconception care in Ibadan, Nigeria. Methods A descriptive, cross-sectional research design, using non-probability sampling, was used to select 80 health workers across two local government areas in Ibadan to participate in this study. Four research questions with two null hypotheses were formulated to guide the study and a semi-structured questionnaire was distributed to gather data on the participants' knowledge, perceptions and practice of preconception care. The data were analysed using regression analysis, with P&lt;0.05 used to indicate significance. Results The majority of respondents had fair knowledge of preconception care (53.8%), and a generally positive perception (74.3%), but poor practice (42.2%) of preconception care. Only 15.0% practiced preconception care every day when caring for women and couples in their communities. Knowledge of preconception care was positively associated with health workers' age (P&lt;0.000), occupation (P=0.002) and years of experience (P&lt;0.000). Conclusions Healthcare workers in Ibadan need to be trained on preconception care guidelines and resources should be made available for their use at every level of healthcare delivery in Nigeria.

Report of Trend for Compliance of Infection Prevention and Control Standards in Tanzania from 2010 to 2017 in Tanzania Mainland

Introduction: The Ministry of Health of Tanzania has been implementing activities to improve infection prevention and control (IPC) practices since 2004. Activities included development of guidelines and standards, procurement of equipment and supplies, training of health workers, and supportive supervision to enhance compliance to standards. Since 2010, a team of experienced National IPC Assessors has been visiting health facilities in Tanzania Mainland to supervise and assess compliance to Standards. This paper, aimed to determine level of compliance to IPC standards using data from 2010 to 2017. Methods: National assessors carried out assessments using IPC Standards tools for Hospitals and Health Centers, through observation, simulations, records and documents review, and interviews. Data was entered in Excel Sheet and analyzed to get facility score in percentage as well as average score of all assessed facilities. Secondary data analysis from 2010 to 2017 has been done to determine compliance to the standards. Results: The baseline IPC standards compliance in all assessed facilities was 32% in 2010, improved to 53% in 2014, and dropped to 34% in 2017. Discussion: The increase in average scores between 2010 and 2014 was contributed by improved implementation of action plans, coupled with IPC advocacy and follow-ups done by partners and the Ministry. Inadequate trainings in some of the assessed facilities contributed to the decrease in compliance in 2017. Conclusion: Compliance to IPC standards in health facilities between 2010 and 2017 is below expected level, and differ by levels of health care delivery. Continued training and follow-up are recommended.

ФІНАНСОВЕ ЗАБЕЗПЕЧЕННЯ ЗАКЛАДІВ ОХОРОНИ ЗДОРОВ’Я В УМОВАХ РЕФОРМУВАННЯ

The priority is the development of health care, the main task of which is to provide quality medical services to the population and preserve their health. The main purpose of social insurance is the material support of insured persons and the possibility of receiving ФІНАНСИ, ГРОШІ І КРЕДИТ 140 Випуск IІ (82), 2021 social services through a specially created social insurance fund. The political and economic crisis and the pandemic have had a negative impact on the health sector. Given the limited financial resources, the problem is the financial support of health care facilities. All this determines the relevance of the research topic. The purpose of the article is to study the problematic issues of financial support of the health care system and to develop proposals for improving the financial mechanism for the provision of medical services. In the course of the research general scientific theoretical methods were used: system analysis - to determine the basic essences of social insurance; abstract - logical method - to generalize theoretical research and substantiate conclusions about the social insurance system. The article highlights the concepts, main characteristics of the health care industry. Expenditures of local health budgets have been studied. Expenditures of local budgets of Chernivtsi region on health care are analyzed. Factors influencing the development of health care have been identified. Proposals have been developed to improve the health care financing system. The proposed proposals for improving the health care system can be used in the practice of medical institutions. Health care reform aimed at better health care requires a set of measures to improve the financial mechanism so that funds allocated to health care ensure an adequate level of health care delivery. The above allows us to conclude that the improvement of financial support of the health care system as a component of the transformational economic system should take place in the direction of the formation of economic and social institutions inherent in market relations. appropriate conditions are created for the improvement of medical care for citizens at the level of modern European standards.

Medication Error at the Prescribing Phase

Medication errors are accidental failures in a therapeutic process that lead to and have the potential to cause or harm the patient. Medication errors can endanger patient safety, inconvenience and economic burdens. Medication errors can occur at the prescribing, recording, issuing, and administering stages. Reducing the risk of medication errors is a shared responsibility among patients, healthcare professionals, regulators and the pharmaceutical industry at all levels of healthcare delivery. This research is a quantitative research with a descriptive approach. The population taken was 912 prescriptions written by general practitioners at the PKU Muhammadiyah Cepu Hospital in March-May 2019. The sampling technique used was non-probability sampling, which was total sampling. The instrument used in this study was an observation sheet, then the collected data were processed by editing, coding, scoring, and tabulating stages which were then concluded descriptively. The results showed that the incidence of drug prescribing errors in inpatients at PKU Muhammadiyah Cepu Hospital in March 2019 found that all written prescriptions were 100% administratively incomplete. The incidence of prescription medication errors, especially the doctor's name, was 65.9%, the doctor's practice license number was 100%, the date of the prescription was 48.9%, the sign of R/70.9%, the doctor's initial 48.7% and the patient's address 97.4%. Incomplete administrative prescription writing can result in medication errors that are detrimental to health and add to the economic burden of patients.

Creating Solutions for Meeting the Challenges of Maintaining a Healthy Work Practice: Our Experience at a County Hospital

Creating Solutions for Meeting the Challenges of Maintaining a Healthy Work Practice: Our Experience at a County Hospital

Assessment of integration of emergency obstetric and newborn care in maternal and newborn care in healthcare facilities in Osun State, Nigeria.

The integration of emergency obstetric and newborn care (EmONC) into maternal and newborn care is essential for its effectiveness to avert preventable maternal and newborn deaths in healthcare facilities. This study used a theory-oriented quantitative approach to document the reported extent of EmONC integration, and its relationship with EmONC training, guidelines availability and level of healthcare facility. A descriptive cross-sectional study was conducted among five hundred and five (505) healthcare providers and facility managers across the three levels of healthcare delivery. An adapted questionnaire from NoMad instrument was used to collect data on the integration of EmONC from the study participants. Ethical approval was obtained and informed consents taken from the participants. Both descriptive (frequency, percentage, mean and median) and inferential analyses (Kruskal Wallis and Mann Whitney tests) were done with statistical significance level of p<0.05 using STATA 14. The mean age of respondents was 38.68±8.27. The results showed that the EmONC integration median score at the three levels of healthcare delivery was high (77 (IQR = 83–71)). The EmONC integration median score were 76 (IQR = 84–70), 76 (IQR = 80–68) and 78 (IQR = 84–74) in the primary, secondary and tertiary healthcare facilities respectively. Integration of EmONC was highest (83 (IQR = 87–78)) among healthcare providers who had EmONC training and also had EmONC guidelines made available to them. There were significant differences in EmONC integration at the three levels of healthcare delivery (p = 0.046), among healthcare providers who had EmONC training and those with EmONC guidelines available in their maternity units (p = 0.001). EmONC integration was reportedly high and significantly associated with EmONC training and availability of guidelines. However, the congruence of reported and actual extent of integration of EmONC at the three levels of healthcare delivery still need validation as such would account for the implementation success and maternal-neonatal outcomes.

Faktori povezani sa imunizacijom protiv sezonskog gripa među osobama sa hroničnim bolestima

Annually, at a global level, 3 to 5 million people present severe clinical forms of seasonal influenza and up to 650 000 people die of influenza-related complications. People with chronic diseases, such as cardiovascular, pulmonary, renal, hepatic, neurologic, hematologic and metabolic diseases or those reciveing immunosuppressive therapy, constitute a high-risk population group for the development of influenza-related complications, more severe clinical course and poorer health-related outcomes. Due to all of the above, people with chronic diseases are of high priority to receive the influenza vaccine. Immunization represents the key strategy to prevent influenza both in terms of effectiveness and health care costs. Based on the World Health Organization (WHO) recommendations, adequate seasonal influenza immunization coverage among people with chronic diseases is set at 75%. However, few countries achieve this threshold. Understanding predictive factors of vaccination, at different levels of health care delivery (such as individuals, service providers, health policy), is essential to secure acceptance of influenza immunization and achieve the recommended level of vaccination coverage. In this mini review, all the available evidence regarding seasonal influenza vaccination coverage is summarized, alongside factors associated with vaccine uptake in people with chronic diseases as a whole, as well as according to specific diseases such as: cardiovascular and pulmonary disorders, diabetes and cancer. Based on the reviewed empirical evidence, a wide spectrum of factors associated with immunization against influneza was found in people who have chronic diseases. Although diverse, these factors can be systematized into 4 distinctive groups: socio-demographic characteristics, individual attitudes and beliefs, health promoting behaviors and factors related to the health care system. Further efforts are needed to improve the seasonal influenza vaccination coverage. The immunization strategy needs to include the health care system and the community to support people with chronic diseases to continously accept the influenza vaccine.

Improving sepsis care in Africa: an opportunity for change?

Sepsis is common and represents a major public health burden with significant associated morbidity and mortality. However, despite substantial advances in sepsis recognition and management in well-resourced health systems, there remains a distinct lack of research into sepsis in Africa. The lack of evidence affects all levels of healthcare delivery from individual patient management to strategic planning at health-system level. This is particular pertinent as African countries experience some of the highest global burden of sepsis. The 2017 World Health Assembly resolution on sepsis and the creation of the Africa Sepsis Alliance provided an opportunity for change. However, progress so far has been frustratingly slow. The recurrent Ebola virus disease outbreaks and the COVID-19 pandemic on the African continent further reinforce the need for urgent healthcare system strengthening. We recommend that African countries develop national action plans for sepsis which should address the needs of all critically ill patients.