Practices In Health Facilities Research Articles

Essential newborn care practices in health facilities of Nepal: Evidence from Nepal Health Facility Survey 2015 and 2021.

Availability of newborn care practices in health facilities (HFs) plays an important role in improving the survival and well-being of newborns. In this paper, we aimed to assess practice of carrying out different newborn care practices among HFs between 2015 and 2021, and associated factors in Nepal. We analyzed data of 621 and 786 HFs offering delivery and newborn care services from Nepal Health Facility Surveys 2015 and 2021, respectively. We summarized categorical variables with a weighted percent and 95% confidence interval (CI). We estimated weighted unadjusted absolute difference in percentage of different newborn care practices between 2015 and 2021, and its 95% CI using binomial regression model. We applied univariable and multivariable logistic regression analysis to determine the factors associated with the availability of all seven newborn care practices. The percentage of HFs carrying out all seven newborn care practices was 50.5% (95% CI: 44.6, 56.3) in 2015 and 83.7% (95% CI: 79.8, 87.0) in 2021 with an overall difference of 33.3 percent points (95% CI: 26.4, 40.1). The proportion of HFs reporting all seven newborn care practices increased significantly between 2015 and 2021 in each all three ecological regions and in provinces except Madhesh and Gandaki. In 2021, private hospitals had lower odds of carrying out all seven newborn care practices compared to federal/provincial hospitals (AOR = 0.26, 95% CI: 0.11, 0.63). Similarly, in 2021, the odds of HFs carrying out all seven newborn care practices was 2.87 (95% CI: 1.06, 8.31) times higher in Sudurpashchim compared to Koshi province. In 2021, HFs carrying out seven newborn care practices did not differ significantly based on ecological belts, quality assurance activities, external supervision, delivery service-related training, and frequency of HF meetings. In conclusion, there has been significant improvement in proportion of facilities carrying out seven essential newborn care practices between 2015 and 2021. Type of facility and provinces were associated with the HFs carrying out seven newborn care practices in Nepal.

Healthcare Waste Management Practices and Its Associated Factors Among Healthcare Workers in Health Facilities in Ethiopia: A Systematic Review and Meta-analysis

Introduction: Waste Management Practices have garnered growing interest in hospitals, research facilities, and laboratories over the past few years. However, there seems to be noticeable absence of a comprehensive understanding regarding research on waste management practices in health facilities among healthcare workers. Objective: This study aimed to determine the prevalence and factors associated with healthcare waste management practices among healthcare workers in Ethiopia. Methods: The search was performed by using the Web of Science (WoS) database, PubMed, and the Cochrane Library. To assess the presence of publication bias, by using funnel plots, contour-enhanced funnel plots, trim and fill analysis, and Begg and Egger regression test. A significance level of P ⩽ .05 was used to indicate potential publication bias. Heterogeneity between studies was assessed using the I2 statistics. Results: From retrieved original studies, 15 studies were included in the meta-analysis with a total of n = 5260 healthcare workers. The pooled prevalence of waste management practices in Ethiopia was 52.86% (95% CI = 51.57, 54.15), with significant heterogeneity observed between studies ( I2 = 97.0%; P ⩽ .001). Sub-group analysis based on regional distribution in Ethiopia revealed that the highest prevalence of waste management practices was observed in Southern Nation and Nationalities and People’s Region with 61.9% (95% CI = 52.953, 64.449). Conclusions: This systematic review and meta-analysis revealed that the pooled prevalence of waste management practices among healthcare workers in Ethiopia was notably low. Training and the presence of guidelines were significantly associated with waste management practices. The healthcare facilities have improved access to and availability of policies related to waste management and the Ministry of Health promotes their use through various means, including training for healthcare professionals.

A clustered randomized control trial to assess feasibility, acceptability, and impact of implementing the birth companion intervention package in Ethiopia, Kenya, and Nigeria: study protocol

BackgroundA birth companion is a simple and low-cost intervention that can improve both maternal and newborn health outcomes. The evidence that birth companionship improves labor outcomes and experiences of care has been available for many years. Global and national policies exist in support of birth companions. Many countries including Ethiopia, Kenya, and Nigeria have not yet incorporated birth companions into routine practice in health facilities. This paper presents the protocol for a trial that aims to assess if a package of interventions that addresses known barriers can increase the coverage of birth companions.MethodsThis two parallel arm cluster randomized controlled trial will evaluate the impact of a targeted intervention package on scale-up of birth companionship at public sector health facilities in Ethiopia (five study sites encompassing 12 facilities), Kenya (two sites encompassing 12 facilities in Murang’a and 12 facilities in Machakos counties), and Nigeria (two sites encompassing 12 facilities in Kano and 12 facilities in Nasarawa states). Baseline and endline assessments at each site will include 744 women who have recently given birth in the quantitative component. We will interview a maximum of 16 birth companions, 48 health care providers, and eight unit managers quarterly for the qualitative component in each country.DiscussionAmple evidence supports the contribution of birth companions to positive health outcomes for mothers and newborns. However, limited data are available on effective strategies to improve birth companion coverage and inform scale-up efforts. This trial tests a birth companion intervention package in diverse clinical settings and cultures to identify possible barriers and considerations to increasing uptake of birth companions. Findings from this study may provide valuable evidence for scaling up birth companionship in similar settings.Trial registrationTrial is registered with ClinicalTrials.gov with identifier: NCT05565196, first posted 04/10/ 2022.

Improving Health Staff Performance Using Standardized Performance Management Systems in Bunyangabu District Health Facilities in Western Uganda

Introduction: The performance management concept is not new but has undergone a relatively slow development in the Ugandan health sector and lacks documented proof of practice. Performance management is a continuous process of identifying, measuring and developing the performance of individuals and aligning performance with the strategic goals of the organization. Aim of the study: The study aimed to improve the performance of health workers through established performance management practices in health facilities of Bunyangabu district in order to inform and benchmark interventions. Methodology: A before and after study design was employed to conduct this study. Both qualitative and quantitative research methods were used to collect data from selected health facilities in Bunyangabu district, interventions which included, training, support supervision and mentor-ship were used. Pre and post intervention data was collected and analyzed using excel, stata, and epi info computer software . Findings: The baseline analysis showed that up to 25% of the health managers were not aware of the recommended performance management practices, 45% able to set performance targets, 20% had job descriptions, 30%had conducted appraisals and only 15% knew about the rewards and sanctions. 85% could not state the vision or mission of the organizations.The interventions applied during the study including training in performance management improved the level of awareness among participants from 75% to 95% in six months, knowledge on target setting from 15-80%, knowledge on Job description from 20-62%, knowledge in performance appraisal from 30-70%, and knowledge in rewards and sanctions from 15 – 70%. The raise in knowledge was associated with an improvement in key health service delivery indicators; staff attendance 62-88%, eMTCT retention on ART 79-88%, PNC at 6weeks 26-53%, HTS linkage 89-97%, and ART coverage 92.5 – 99.7%.The study of associations indicated that the performance management was associated with health facility performance as follows performance planning (r=.757; P = 0.001), performance monitoring (r=.692) ; P=0.001), and functional rewards and sanctions committees (r=.66843); P=0.000). Conclusion: The study concludes that there is a knowledge gap among health facility managers about performance management.The study also concludes that inclusion of performance management in routine support supervision is associated with improved quality of health services and Continuous monitoring and mentor-ships influence performance among health workers. Keywords: health staff, individual performance management, standardized staff performance management systems, accredited facilities, performance planning, performance monitoring, performance appraisal, rewards and sanctions DOI: 10.7176/PPAR/13-3-04 Publication date: April 30 th 2023

Maternal Knowledge of Kangaroo Care: Level of Practice in Health Facilities in Calabar Metropolis

This study is aimed to assess the level of knowledge and identify the level of practice of Kangaroo care among mothers with preterm and low birth weight babies in health facilities in Calabar Metropolis. The study was a quantitative, descriptive survey design study. Four objectives and four corresponding research questions guided the study. A self-designed questionnaire was used to collect information and the Statistical Package for Social Sciences (SPSS), Version 24 was used to analyse the data. Demographic data revealed that 30.5% of the respondents were between 18 – 30years, 53.4% were between 31 – 40years, 10% were between 41 – 50years while 6.1% were between 50years and above, 16% had no formal education, 10.8% had primary school education, 20% had secondary school education while 53.2% had tertiary education. The result of the study revealed that 72.5% of the total respondents has little or no knowledge of Kangaroo mother care while only 27.5% has knowledge of Kangaroo mother care, 24.1% of the respondents had practiced Kangaroo mother care while 75.9% had not practiced Kangaroo mother care, lack of assistance from husband and family member in home chores is part of the factors that limited the practice of Kangaroo mother care among women with preterm and low birth weight babies in health facilities and that assistance from husband and family member in home chores enabled them practice Kangaroo mother care. The study concludes that the level of knowledge and practice is low among women in health facilities in Calabar Metropolis. Therefore, the study recommends that training and education about Kangaroo Mother Care practice should be carried out on a regular basis.

Solid waste management in hospitals: A comparative assessment in some selected hospitals in Obuasi Municipality of Ghana

The types of waste generated in hospitals as well as the management practices adopted by the hospitals for the disposal and treatment of the waste have become an issue of great concern to both local authorities and the public. This research aimed at assessing solid waste disposal and management practices of some selected hospitals in the Obuasi Municipality of Ghana. Three hospitals in Obuasi were selected for the study. The names of the hospitals are represented with the letters A, B and C. The objectives of the study were to know the types of waste generated in the hospitals, quantify the waste generated during the study period and compare the solid waste management practices adopted by the hospitals with the Health Care Waste Management guidelines (HCWM) of the Ministry of Health (MoH), Ghana. Relevant data and information were obtained for four weeks in the selected hospitals concurrently. Results from the study showed that hospitals generate plastics, papers, putrescible waste and hazardous waste. In terms of waste quantities, a total of 2,260.95 kg of waste were generated in the three hospitals during the study period. Plastic waste was 495 kg (21.89%), papers were 398.7 kg (17.63%) and putrescible wastes were 788.15 kg (34.86%) and 579.1 kg (25.61%) of the waste was hazardous waste.The waste management practices adopted by the hospitals were below standard. Although some proper waste collection was carried out, no waste sorting, processing or treatment was done. Two of the hospitals had contracted Zoomlion Ghana Limited to dispose their waste at the landfill site whiles the other hospital disposes of the solid waste in an open pit and burn the waste as well. Observation made during the study was that most of the waste management staff had low educational backgrounds and therefore have a low understanding of proper waste management practices as well as low remunerations. Comparisons made between the hospitals in terms of their waste management pratices and the MoH guidelines on Health Care Waste Management (HCWM) show that the hospitals do not adhere to the guidelines and standards. The study recommend that regulatory authorities enforce strict adherence to standards and effective monitoring of waste management practices in health facilities to safeguard public health and environmental safety. • More putrescible waste were generated in the hospitals (788.15 kg) (34.86%) than hazardous waste (579.1 kg) (25.61%). • The waste management practices adopted by the hospitals were below standard; no waste treatment, sorting or processing was of waste was done. • Most of the waste management staff had low educational backgrounds and hence lower understanding of proper waste management practices. • The hospitals do not adhere to the Health care waste management guidelines, and standards.

Matrix analyses of pharmaceutical products for the years 2017 to 2019 among public health facilities in Hadiya zone, Ethiopia: a cross-sectional descriptive study

BackgroundTo date, global healthcare spending becomes a primary concern, and pharmaceutical costs are the main drivers. The issue is more pressing in developing countries like Ethiopia. However, there is a scantiness of comprehensive data on inventory control practices in health facilities. This study, therefore, aimed to assess the criticality, financial value, and consumption patterns of pharmaceuticals using inventory matrix analyses and explore the related challenges.MethodsA cross-sectional study supplemented with qualitative assessments was carried out from December 2020 to January 2021 in public health facilities. Three hospitals and 14 health centers were proportionally selected using a simple random sampling technique. Self-administered questionnaires and review of logistics documents and databases like Dagu-Facility were used to obtain the quantitative data. The data were analyzed using excel spreadsheets and SPSS version 23. We gathered the qualitative data through face-to-face in-depth interviews.ResultsThe facilities spent 66,312,277.0 Ethiopian birrs to procure 518 pharmaceuticals between 2017 and 2019. Of the total products, 68 (13.1%) belonged to class A and 353 (68.1%) belonged to class C. Among 427 items identified by VEN analysis, 202 (47.3%) were vitals, and 201 (47.1%) were essential products making the highest proportions. Cross-tabulations of ABC and VEN showed that 230 (53.9%) items formed category I, representing 84.3% of total expenditures. Sterile surgical gloves #7.5, amoxicillin capsules, examination gloves, and 40% dextrose injection were among the top-ten high-value closing inventories, accounting for 21% of class X items. The fast-moving items were the most prevalent in all years, accounting for more than 45%, and shared the maximum expenditure, up to 90%. Scarcity of infrastructure and skilled human resources, shortage of pharmaceuticals and problems with suppliers, and management issues were the major challenges in the health facilities.ConclusionMost of the items identified by ABC-VEN and FSN-XYZ were Category one, i.e., mainly vital costly products and a few fast-moving items with high closing inventory values, respectively, suggesting close supervision. However, several issues became impediments. Hence, facilities should alleviate the bottlenecks and monitor the stock status to prevent theft and stock out.

Evaluation of the quality of maternal death review cycles in Burkina Faso.

To assess the quality of the maternal death review (MDR) cycle in selected health facilities in Burkina Faso in accordance with national standards. A multiple case study using a qualitative approach performed in five health districts and two regional hospital centers in Burkina Faso. The facilities were chosen by contrasted purposive sampling based on hospital maternal mortality rate and urban or rural location. Structured and semistructured interviews were conducted and data analyzed thematically, horizontally, and vertically. Of the seven facilities included, six performed MDR. The MDR cycle was incomplete in five facilities because the implementation of recommendations had not been assessed. All cases of maternal death lacked vital information. Case analysis was not conducted in accordance with the national standards in most of the facilities. The action plans for implementing recommendations were not commonly used. The MDR process and its various stages did not meet quality standards. Identifying the determinants leading to lack of adherence to MDR standards will contribute to optimal choice of interventions and improving good practices in health facilities.

Building Health System Resilience in Africa During the COVID-19 Pandemic

Many essential health services have been paused because of the COVID-19 pandemic. To ensure that adequate health delivery is not impeded during the COVID-19 pandemic, this study aimed to describe the strategies for building health system resilience in Africa during the COVID-19 pandemic. The integration of COVID-19 care into routine healthcare delivery across African countries should be prioritized. Investment in human and material resources for the health sector should be prioritized by policymakers. Adequate community engagement should be prioritized across all communities in Africa. Investment in leadership development training across all health sectors would promote initiative-driven decision making and promote infection control practices in health facilities.

Clinical Learning in Medical and Health Professions Education amid COVID-19 Pandemic: A Literature Review of Various Methods and Innovations

BACKGROUND: COVID-19 has caused disruption to medical education and health care systems around the world. The highly contagious nature of the virus makes it difficult for educational institutions to continue their studies as usual, thus affecting the medical and health professions education which is based on face-to-face lectures, practicum, skills laboratories, and clinical practice in health facilities. AIM: This paper discovers clinical learning initiatives across the globe and highlights the contribution toward educational processes. METHODOLOGY: This study utilized an integrated literature review method. A systematic search for articles published was performed in Springer, ScienceDirect, PubMed, and EBSCOHost. Primary search monetary terms were e-learning (all synonyms) and health sciences education (all synonyms), including COVID-19. Articles published within the period of COVID-19 pandemic included in this study. For the synthesis, the 20 included studies selected were coded. In this study, data were synthesized through narrative synthesis using thematic analysis (TA). To identify the recurrent themes author followed six steps when synthesizing data using TA, for example, familiarizing with the data, developing initial (sub) codes, searching for (sub) themes, reviewing (sub) themes, compiling ideas or issues, and producing final data in line with the study aims and objectives. RESULTS: Out of records identified, a total of citations was screened, of which 20 were found to be of relevance to this study most were quantitative (14.70%) in design. Studies were published in 2020 since the beginning of COVID-19 pandemic. The geographical range of papers covered mostly the moderate-income regions. On conducting TA of the included studies, it was possible to obtain two broad descriptive themes/categories: enablers or drivers of, and barriers or challenges to, under which important themes have emerged. CONCLUSION: Study suggests that developing e-learning in effective clinical learning is needed, not only limited to moving the learning process but also needing to follow the instructional design, so that learning outcomes can be achieved by students. In addition, a learning process that promotes self-directed-learning is needed so that students have flexibility, use relevant learning styles and are able to integrate knowledge, skills and attitudes as a meaningful learning process.

Access to water, sanitation and hygiene services in health facilities in sub-Saharan Africa 2013\u20132018: Results of health facility surveys and implications for COVID-19 transmission

BackgroundThe COVID-19 pandemic has highlighted important needs in water, sanitation and hygiene (WASH) services and standard practices for infection prevention and control in sub-Saharan Africa. We assessed the availability of WASH and standard precautions for infection prevention in health facilities across 18 countries in sub-Saharan Africa, as well as inequalities by location (rural/urban) and managing authority (public/private). Data from health facility surveys conducted between 2013 and 2018 in 18 sub-Saharan African countries were used to estimate the access to an improved water source within 500 m, an improved toilet, soap and running water or alcohol-based hand rub, and standard precautions for infection prevention at health facilities. Rural-urban differences and public-private differences in access to services were calculated. We also compared population level access to health facility access to services.ResultOverall, 16,456 health facilities from 18 countries were included. Across countries, an estimated 88 % had an improved water source, 94 % had an improved toilet, 74 % had soap and running water or alcohol-based hand rub, and 17 % had standard precautions for infection prevention available. There was wide variability in access to water, sanitation and hygiene services between rural and urban health facilities and between public and private facilities, with consistently lower access in both rural and public facilities. In both rural and urban areas, access to water, sanitation and hygiene services was ubiquitously better at health facilities than households.ConclusionsAvailability of WASH services in health facilities in sub-Saharan Africa has improved but remains below the global target of 80 % in many countries. Ensuring adequate access to WASH services and enforcing adherence to safety and hygiene practices in health facilities will be essential to minimize the risk of COVID-19 transmission.

Quality of Integrated Management of Newborn and Childhood Illness Services at Health Centers in Jimma, Southwest Ethiopia.

BackgroundThe Integrated Management of Newborn and Childhood Illness (IMNCI) strategy includes both preventive and curative interventions to improve practices in health facilities, the health system and at home. The quality of these interventions has been very rarely subjected to scientific inquiry in Ethiopia. This study assessed quality of IMNCI services in health centers of Jimma, South West Ethiopia, 2014.MethodsA facility based cross-sectional study was conducted from March 2–15, 2014 in the health centers of Jimma among 411 care takers exit interview and total of 60 consultation sessions were observed using checklist and participants enrolled through convenient sampling technique. Descriptive statistics were used and factor analysis was employed to create measurement scales for satisfaction of caretakers. Factor scores were used in linear regression analyses to determine presence of statistically significant association between explanatory variables and the outcome variable at P value <0.05.ResultsThe response rate for the exit interview was 411 (97.4%). The mean score of overall caretakers satisfaction was 63.4. Specifically 23.4%, 33.6%, and 19.2% of the respondents were dissatisfied with waiting time, amount of explanation they received about the problem or treatment, and availability of medicines, respectively. Availability of prescribed medications (95% CI: 0.577 to 0.047), receiving first dose of medication at health facility (95% CI: 0.087, 0.552), receiving laboratory services (95% CI:0.455,0.056) were among factors that significantly associated with the caretakers’ satisfaction score.Conclusion and RecommendationsPerceived mean of caretakers’ satisfaction at the health centers of Jimma town was low as compared to national standards and long waiting time while providing services. Availability of prescribed medications, receiving first dose of medication and receiving laboratory services were factors associated with patients’ satisfaction. Respective health centers need to ensure availability of medications and supplies and professionals need to pay special attention on medical services like laboratory services, medication and decrease waiting time while providing health services.

Efficiency, quality, and management practices in health facilities providing outpatient HIV services in Kenya, Nigeria, Rwanda, South Africa and Zambia

Efficiency, quality, and management practices in health facilities providing outpatient HIV services in Kenya, Nigeria, Rwanda, South Africa and Zambia

Efficiency, quality, and management practices in health facilities providing outpatient HIV services in Kenya, Nigeria, Rwanda, South Africa and Zambia.

Few studies have assessed the efficiency and quality of HIV services in low-resource settings or considered the factors that determine both performance dimensions. To provide insights on the performance of outpatient HIV prevention units, we used benchmarking methods to identify best-practices in terms of technical efficiency and process quality and uncover management practices with the potential to improve efficiency and quality. We used data collected in 338 facilities in Kenya, Nigeria, Rwanda, South Africa, and Zambia. Data envelopment analysis (DEA) was used to estimate technical efficiency. Process quality was estimated using data from medical vignettes. We mapped the relationship between efficiency and quality scores and studied the managerial determinants of best performance in terms of both efficiency and quality. We also explored the relationship between management factors and efficiency and quality independently. We found levels of both technical efficiency and process quality to be low, though there was substantial variation across countries. One third of facilities were mapped in the best-performing group with above-median efficiency and above-median quality. Several management practices were associated with best performance in terms of both efficiency and quality. When considering efficiency and quality independently, the patterns of associations between management practices and the two performance dimensions were not necessarily the same. One management characteristic was associated with best performance in terms of efficiency and quality and also positively associated with efficiency and quality independently: number of supervision visits to HIV units.

Profile of Antimicrobial Use in the Pediatric Population of a University Hospital Centre, 2015/16 to 2018/19

Antimicrobial stewardship is a standard practice in health facilities to reduce both the misuse of antimicrobials and the risk of resistance. To determine the profile of antimicrobial use in the pediatric population of a university hospital centre from 2015/16 to 2018/19. In this retrospective, descriptive, cross-sectional study, the pharmacy information system was used to determine the number of days of therapy (DOTs) and the defined daily dose (DDD) per 1000 patient-days (PDs) for each antimicrobial and for specified care units in each year of the study period. For each measure, the ratio of 2018/19 to 2015/16 values was also calculated (and expressed as a proportion); where the value of this proportion was ≤ 0.8 or ≥ 1.2 (indicating a substantial change over the study period), an explanatory rating was assigned by consensus. Over the study period, 94 antimicrobial agents were available at the study hospital: 70 antibiotics (including antiparasitics and antituberculosis drugs), 14 antivirals, and 10 antifungals. The total number of DOTs per 1000 PDs declined from 904 in 2015/16 to 867 in 2018/19. The 5 most commonly used antimicrobials over the years, expressed as minimum/maximum DOTs per 1000 PDs, were piperacillin-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicillin (51/69), vancomycin (53/68), and cefotaxime (55/58). In the same period, the care units with the most antimicrobial use (expressed as minimum/maximum DOTs per 1000 PDs) were hematology-oncology (2529/2723), pediatrics (1006/1408), and pediatric intensive care (1328/1717). This study showed generally stable consumption of antimicrobials from 2015/16 to 2018/19 in a Canadian mother-and-child university hospital centre. Although consumption was also stable within drug groups (antibiotics, antivirals, and antifungals), there were important changes over time for some individual drugs. Several factors may explain these variations, including disruptions in supply, changes in practice, and changes in the prevalence of infections. Surveillance of antimicrobial use is an essential component of an antimicrobial stewardship program.

Healthy choices in New South Wales health facilities for staff and visitors: a policy evaluation

Abstract Issue Obesity and its determinants are risk factors for most leading causes of chronic diseases. In New South Wales (NSW), Australia, 1 in 2 adults and more than 1 in 5 children are above a healthy weight. As a key symbolic part of a suite of health eating policies, the NSW Ministry of Health implemented a Healthy Food and Drink in NSW Health facilities for Staff and Visitors Framework (Framework) across 18 Local Health Districts (LHDs). Many countries are grappling to understand the effectiveness of obesity prevention policies. Description 2: This policy evaluation synthesised evaluation study findings and internal records to assess the effectiveness of the Framework in achieving implementation targets: a) the removal of sugar-sweetened drinks (SSDs) from sale (Dec 2017), b) implementation of 12 food-based practices (Dec 2018). Results The overall implementation package was appropriate for the large, geographically dispersed, decentralised health system (160 health facilities; 927 food outlets;76 retailers) and variable retail arrangements. The Ministry provided LHDs with overall direction, phasing, and monitoring; the LHDs had local leadership, governance, cross-functional support and autonomy to implement in a way to suit them. Accountability and pace of implementation was driven most notably by monitoring and reporting using an electronic tool (PHIMS-N), and a 'network of practice' that was pivotal to problem solving. SSDs were removed from 96% (n = 606) of applicable food outlets; overall average achievement of all practices was high at 82% (22.4 SD). Nine in 10 (92%) consumers support the Framework, and retailers are accepting of its targets. Lessons: This was the right policy at the right time, with well-orchestrated implementation. Annual monitoring and reporting enabled by PHIMS-N is unique in this type of policy implementation and essential for tracking progress, informing decision making, and ensuring accountability. Key messages Implementation of the Framework has resulted in the removal of SSDs from sale, increased availability of healthier foods and decreased unhealthy foods as measured by 12 food-based practices. The Framework is feasible and effective in influencing retail practices in health facilities, has high consumer support for its goals, and overall acceptability and adoption amongst retailers.

Formative research to scale up a handwashing with soap and water treatment intervention for household members of diarrhea patients in health facilities in Dhaka, Bangladesh (CHoBI7 program)

BackgroundDuring the time a diarrhea patient presents at a health facility, the household members of the patient are at higher risk of developing diarrheal diseases (> 100 times for cholera) than the general population. The Cholera-Hospital-based-Intervention-for-7-Days (CHoBI7) is a health facility-initiated water treatment and handwashing with soap intervention designed to reduce transmission of diarrheal diseases between patients and their household members. The present research aimed to (1) develop a scalable approach to integrate the CHoBI7 intervention program into services provided at government and private health facilities in Bangladesh; and (2) tailor the intervention program for the household members of all diarrhea patients, irrespective of the etiology of disease.MethodsWe conducted 8 months of formative research, including 60 semi-structured interviews, 2 group discussions, and a pilot study. Thirty-two interviews were conducted with diarrhea patients and their family caregivers, government stakeholders, and health care providers both to explore existing WASH and diarrhea patient care practices in health facilities and to identify considerations for scaling the CHoBI7 program. Fifty-two diarrhea patient households participated in a pilot study of a modified version of the CHoBI7 intervention program for tailoring. Twenty-eight interviews and 2 group discussions were conducted with pilot households to explore experiences with and recommendations for intervention delivery.ResultsThe intervention program was modified based on formative research findings. Pilot study participants recognized the benefits of the CHoBI7 intervention program and made suggestions to improve the acceptability and feasibility of the intervention. Modifications included 1) providing additional pictorial modules, cues to action, enabling technologies, and supplies for safe drinking water and handwashing with soap behaviors in the health facility; 2) switching out technology prone to breaks and leaks as well as sourcing plastic technologies from a high-quality, local manufacturer; and 3) including instructions discouraging the non-use or misuse of technologies and supplies. Considerations for scalability include the local availability and marketing of enabling technologies and supplies, staff for program delivery in health facilities, and potential integration into existing government or health promotion programs.ConclusionsFormative research identified important considerations for the content, delivery, and scalability of the CHoBI7 health facility-initiated WASH intervention program.

A Cross-Sectional Study on Oyo State Health Care Worker’s Knowledge, Attitude and Practice regarding Corona Virus Disease 2019 (COVID-19)

Background: Health workers are at the front line of the COVID-19 outbreak response and as such are exposed to hazards that put them at risk of infection. Poor knowledge among HCWs and inadequate infection control practices may lead to the increased risk of COVID-19 nosocomial transmission. This study assessed the knowledge, attitude and practice of Oyo state health care workers on COVID-19 as part of emergency preparedness. Methods: A hospital based cross-sectional survey was conducted in selected health facilities in Oyo State, Nigeria. A total of 350 HCWs were assessed for the knowledge, attitudes and practices on COVID-19 using a semi-structured questionnaire. Multivariate analysis was conducted to identify predictors of good knowledge at 95% confidence interval with Epi-info software. Results: The level of good knowledge on COVID-19 was 78.6% and positive attitude was 64% among the respondents. Majority of respondents practice safe measures in the prevention of COVID-19 including washing of hands (95.3%), routine cleaning (82.7%) and high-level disinfection (83.9%). However, use of personal protective equipment (PPE) was low (56.8%). Predictors of good knowledge on COVID-19 were being a female HCW [Adjusted Odd’s Ratio (AOR) = 6.5 95% CI 1.0 - 17.2], ≥10 years length in service [AOR = 5.2 95% CI 2.7 - 18.9] and being a secondary or tertiary facility [AOR = 3.6 95%CI 1.7 - 32.2]. Conclusions: Overall knowledge and attitude were satisfactory however the practices of HCWs on the use of personal protective equipment were not satisfactory. Effective infection control measures including regular skill-based training and/or orientation for all categories of HCWs can improve infection control practices in health facilities.

Study protocol: Impact of quality improvement interventions on perinatal outcomes in health facilities\u2014a systematic review

BackgroundAbout 5.8 million maternal deaths, neonatal deaths and stillbirths occur every year with 99% of them taking place in low- and middle-income countries. Two thirds of them could be prevented through cost-effective interventions during pregnancy, intrapartum and postpartum periods. Despite the availability of standards and guidelines for the care of mother and newborn, challenges remain in translating these standards into practice in health facilities. Although several quality improvement (QI) interventions have been systematically reviewed by the Cochrane Effective Practice and Organization of Care (EPOC) group, evidence lack on QI interventions for improving perinatal outcomes in health facilities. This systematic review will identify QI interventions implemented for maternal and neonatal care in health facilities and their impact on perinatal outcomes.Methods/designThis review will look at studies of mothers, newborn and both who received inpatient care at health facilities. QI interventions targeted at health system level (macro), at healthcare organization (meso) and at health workers practice (micro) will be reviewed. Mortality of mothers and newborn and relevant health worker practices will be assessed. The MEDLINE, Embase, World Health Organization Global Health Library, Cochrane Library and trial registries electronic databases will be searched for relevant studies from the year 2000 onwards. Data will be extracted from the identified relevant literature using Epi review software. Risk of bias will be assessed in the studies using the Cochrane risk of bias tool for randomized and observational studies. Standard data synthesis and analysis will be used for the review, and the data will be analysed using EPPI Reviewer 4.DiscussionThis review will inform the global agenda for evidence-based health care by (1) providing a basis for operational guidelines for implementing clinical standards of perinatal care, (2) identify research priorities for generating evidence for QI interventions and (3) QI intervention options with lessons learnt for implementation based on the level of needed resources.Systematic review registrationPROSPERO registration number CRD42018106075

Multidrug-resistant tuberculosis outbreak associated with poor treatment adherence and delayed treatment: Arua District, Uganda, 2013\u20132017

BackgroundIn August 2017, the Uganda Ministry of Health was notified of increased cases of multidrug-resistant tuberculosis (MDR-TB) in Arua District, Uganda during 2017. We investigated to identify the scope of the increase and risk factors for infection, evaluate health facilities’ capacity to manage MDR-TB, and recommend evidence-based control measures.MethodsWe defined an MDR-TB case-patient as a TB patient attending Arua Regional Referral Hospital (ARRH) during 2013–2017 with a sputum sample yielding Mycobacterium tuberculosis resistant to at least rifampicin and isoniazid, confirmed by an approved drug susceptibility test. We reviewed clinical records from ARRH and compared the number of MDR-TB cases during January–August 2017 with the same months in 2013–2016. To identify risk factors specific for MDR-TB among cases with secondary infection, we conducted a case-control study using persons with drug-susceptible TB matched by sub-county of residence as controls. We observed infection prevention and control practices in health facilities and community, and assessed health facilities’ capacity to manage TB.ResultsWe identified 33 patients with MDR-TB, of whom 30 were secondary TB infection cases. The number of cases during January–August 2017 was 10, compared with 3–4 cases in January–August from 2013 to 2016 (p = 0.02). Men were more affected than women (6.5 vs 1.6/100,000, p < 0.01), as were cases ≥18 years old compared to those < 18 years (8.7 vs 0.21/100,000, p < 0.01). In the case-control study, poor adherence to first-line anti-TB treatment (aOR = 9.2, 95% CI: 2.3–37) and initiating treatment > 15 months from symptom onset (aOR = 11, 95% CI: 1.5–87) were associated with MDR-TB. All ten facilities assessed reported stockouts of TB commodities. All 15 ambulatory MDR-TB patients we observed were not wearing masks given to them to minimize community infection. The MDR-TB ward at ARRH capacity was 4 patients but there were 11 patients.ConclusionThe number of cases during January–August in 2017 was significantly higher than during the same months in 2013–2016. Poor adherence to TB drugs and delayed treatment initiation were associated with MDR-TB infection. We recommended strengthening directly-observed treatment strategy, increasing access to treatment services, and increasing the number of beds in the MDR-TB ward at ARRH.