Primary Units Research Articles

Unreliable service system with strategic customers: effect of abandonments and repair time

AbstractIn this study, we analyze the reneging behavior of strategic customers in a Markovian queueing system with a single server which is subject to breakdowns. In the event of a breakdown, the server is replaced with a secondary backup unit which serves at a diminished service speed. The restoration of the primary unit is possible only when the system is empty and through a repair process. Reneging is possible and the customers may decide to abandon the system at any time. To focus on the effect of reneging, we also consider the case where reneging is prohibited and the customers decide exclusively, whether to join or balk. We also consider the case where the repair duration is instantaneous. For these models, we derive the equilibrium strategies for the customers and evaluate the performance of the system under both scenarios. Moreover, we discuss the effects of the server repairing procedure and present numerical experiments that reveal key differences in the customer strategic behavior. We identify cases where reneging is beneficial in terms of social welfare, as well as cases where prohibiting reneging ensures greater welfare.

Clinically-based PhDs by publication: a South African experience

ABSTRACT Reports on PhDs by publication in the biomedical fields are present in the literature, yet similar studies in the clinical sciences are absent. This investigation provides much-needed insights into this area of doctoral knowledge production, using the discipline as the primary unit of analysis, by detailing the scope and publication outcomes of 20 clinically-based PhDs by publication from the School of Clinical Medicine, University of KwaZulu-Natal, South Africa. Bibliometric data were extracted from each thesis, analysed descriptively and results contrasted with the literature. Findings showed that the thesis characteristics studied, such as number of publications, authorship and timelines, varied from those quoted in the literature. Furthermore, there was great diversity across the sampled theses. This suggests that our PhD graduates have crafted their theses into unique, individualised outputs while complying with institutional requirements.

Thickness monitoring of threshing mixture on the oscillating plate of corn grain harvester

Cleaning is a critical operation in the corn grain harvesting process, and the operation is seriously affected by the uneven distribution of the threshing mixture on the oscillating plate. To monitor the thickness of the threshing mixture on the oscillating plate of the corn grain harvester, in this study, we adopted the lever principle to design a corn threshing mixture thickness monitoring device based on the piezoresistive effect and theoretically analyzed the lever impact mechanics. The factors affecting the force on the sensor of the monitoring device are the vibration frequency of the oscillating plate, the thickness of the threshing mixture, and grain moisture content, which were obtained through theoretical analysis. The operational performance of the corn threshing mixture thickness monitoring device was assessed through a set of single-factor experiments, revealing the influence laws of three factors on the impact voltage: vibration frequency, thickness of the threshing mixture, and grain moisture content. A back-propagation (BP)11Back-propagation (BP) neural network prediction model was established using an orthogonal experiment with impact voltage, vibration frequency, and grain moisture content as input layers and the thickness of the corn threshing mixture as the output layer. An STM32 microcontroller was used as the primary control unit to build a thickness monitoring data acquisition and processing system that could process and operate the impact voltage collected by the pressure sensor and the vibration frequency signal collected by a Hall sensor. The data were wirelessly transmitted to a PC to predict the thickness of the threshing mixture by using the trained BP neural network. The experimental results of monitoring the variation in corn threshing mixture thickness demonstrated that the device could effectively monitor changes in thickness. The monitoring accuracy of the monitoring device was found to be over 90%, and the system can be used for monitoring the threshing mixture thickness on the oscillating plate of the corn grain harvester.

Analysis Of Knowledge, Perceptions And Practices On The Prevention Of Bullying By Teachers In Primary And Junior High School Education Units

Analysis Of Knowledge, Perceptions And Practices On The Prevention Of Bullying By Teachers In Primary And Junior High School Education Units

Integration of family planning into the primary health care in Ethiopia: results from national assessment

BackgroundFamily planning (FP) is part of Ethiopia’s essential health service package. However, integrating FP into other health care services is a relatively new concept. Integrated service can minimize missed opportunities and allow health workers to provide FP services and Reproductive, Maternal, Newborn, Child, Adolescent, and Nutrition (RMNCAH-N) services simultaneously. Thus, the objective of this study was to assess the levels of FP integration into maternal and child health (MCH) services at primary health care service delivery units in Ethiopia.MethodsThis was a facility-based cross-sectional study conducted from July to October 2022. We conducted a nationally representative survey of primary health care (PHC) facilities selected from seven regions and two-city administrations in Ethiopia to assess the current level of FP integration across four service delivery units (antenatal care unit, postnatal care unit, post-abortion care unit, and immunization unit) of the facilities. We collected data from selected health facilities through interview with health facility managers, healthcare providers in the selected service units, clients seeking health services, and extraction of data from facility records. We employed descriptive analysis, and categorized the degree of FP integration according to the FP information and services provided in the selected service delivery units.ResultsThis national FP integration survey included 122 health facilities (39 primary hospitals, 42 health centers, and 41 health posts) from seven regions and two city administrations. The study found a huge discrepancy regarding FP counselling given at ANC, PNC, PAC, and immunization service delivery units as reported by health care providers and clients. The proportion of PNC and immunization clients who received FP counselling was higher at health post compared to hospitals and health centers. Moreover, the proportion of PAC clients who received FP information was higher in primary hospitals compared to health centers.ConclusionData from facility records and provider interviews showed significant FP integration within ANC, PNC, and immunization units of PHC facilities. However, client exit interviews indicated low FP counselling integration. Facility records revealed few PNC and PAC clients received contraceptives in the past year. The study found high FP counselling and provision of at least one short- or long-acting contraceptive at PNC and PAC units. No facility offered contraceptives at immunization units, indicating missed FP integration opportunities.

Evaluation of diabetes care services, data quality, and availability of resources in Ethiopia: Difference-in-differences analysis of the NORAD-WHO NCDs’ midterm project evaluation

BackgroundThe Ethiopian government, supported by NORAD, the WHO, and other partners, is decentralizing diabetes care to primary health units via a task-shifting approach. Despite substantial investment, there is still a lack of up-to-date information on diabetes screening, diagnosis, treatment, and medication availability in the country.ObjectiveThis study assessed the effects of the NORAD-WHO intervention on diabetes care services, data quality, and the availability of infrastructure and medical supplies in Ethiopia.MethodsA quasiexperimental study was conducted across 31 NORAD-WHO project facilities and 62 control facilities in six regions of Ethiopia and Addis Ababa. We used descriptive statistics to assess diabetes screening, diagnosis, treatment services, medication availability, and data quality over 54 months from January 2019 to June 2023. Additionally, we performed a difference-in-differences (DID) regression analysis comparing data from two periods: before the intervention (January to December 2019) and after the intervention (July 2022 to June 2023).ResultsThis study revealed a notable increase in diabetes services, with over 82% of facilities offering screening, early diagnosis, and treatment. Written treatment guidelines are present in three quarters of the facilities. The proportion of trained staff increased from 58% in 2019 to 100% in 2023 across all the evaluated facilities. Intervention facilities had significantly more functional glucometers than did control facilities, averaging four (95% CI: 3.4, 4.6) per month in 2023 compared with 2.5 (95% CI: 2.1, 2.9) in 2019. However, hemoglobin A1C testing remains uncommon. Despite improvements in diabetes service data, issues with missing records, overreporting, and timeliness persist, with an average reporting rate of 99.2% and on-time reporting rate of 51.5%. The NORAD-WHO intervention notably increased the average number of fasting blood sugar tests by 17 per month (95% CI: 12.2–21.8, p = 0.014).ConclusionsThis midterm evaluation revealed a significant increase in the availability of fasting blood sugar tests in the intervention facilities. Additionally, the availability of medical equipment, laboratory services, and medications has improved over the years. Intervention facilities, with more trained healthcare professionals and better resources, outperform control facilities in screening, diagnosing, treating, and managing high blood sugar levels. Notably, intervention facilities screened more clients for diabetes and showed that patients receiving follow-up care achieved better glycemic control than did those at control facilities. While there has been progress in diabetes service data availability, addressing issues such as missing data, overreporting, and reporting timeliness is essential for further improving the quality of diabetes services.Clinical trial numberNot applicable.

Student-led educational outreach visits as a strategy to advance pharmacy education: A qualitative analysis of students' perspectives of a Brazilian study

Background: Pharmacy education in Brazil has recently transformed to better prepare students for public health services, requiring mandatory experiential learning. Essential medicines lists (EML) are vital for improving access to medications, though their distribution is limited. As part of a community outreach initiative, pharmacy students carried out Educational Outreach Visits (EOV) to healthcare professionals and engaged with users of primary healthcare units to promote the EML. This paper discusses the students' perceptions of leading these EOV in a municipality in southeastern Brazil. Methods: Eight students involved in EOV participated in a focus group discussion. The session was recorded and transcribed, followed by content analysis. Three thematic categories were established: 1) importance for the training of the future pharmacist, 2) relevance of the initiative, and 3) challenges of the experience. Results: The students expressed that their involvement in EOV allowed them to gain insights into the reality of the healthcare system and contributed to improving their understanding of pharmaceutical services. Additionally, the initiative was viewed as a method to advance access to medicines in the public health system. Regarding the challenges, the students were apprehensive about not answering some questions and interacting with physicians. Conclusion: In the view of undergraduate pharmacy students, EOV is relevant to training pharmacists to work in Sistema Único de Saúde (SUS) and improving access to medicines in the public system. The lack of confidence to deliver EOV, particularly in communicating with physicians, should be considered when preparing students to participate in similar initiatives.

Spatial Expansion Characteristics and Nonlinear Relationships of Driving Factors in Urban Agglomerations: A Case Study of the Yangtze River Delta Urban Agglomeration in China

Urban agglomerations are increasingly becoming the primary regional units in global competition, characterized by the rapid expansion of impervious surface areas, which negatively impacts both society and the environment. This study quantifies the spatiotemporal expansion of these surfaces in the Yangtze River Delta urban agglomeration and explores its driving factors using a Geographically Weighted Random Forest model. The results demonstrate a transition from “point expansion” to “infill development”, while also revealing a gradual southward shift in the developmental focus of the Yangtze River Delta urban agglomeration. Although expansion intensity has decreased, spatial clustering has intensified. Based on the expansion patterns of impervious surface areas, we propose a novel regional classification method, dividing the Yangtze River Delta urban agglomeration into three zones: “A-Development Decline Zone”, “B-Development Core Zone”, and “C-Development Ascendance Zone”. Socio-economic factors are the primary drivers of this expansion, followed by science and education, and then the ecological environment, while physical geography factors have the least impact. The study reveals differentiated regional development characteristics and further refines the sub-regions within the urban agglomeration, providing a new perspective for future regional coordinated development policies.

A Comprehensive Review of Advanced Treatment Technologies for the Enhanced Reuse of Produced Water

Produced water (PW) is considered to be the largest source of industrial wastewater associated with oil and gas extraction operations for industrial production. It is a mixture of organic and inorganic compounds that has high complexity in terms of various characteristics. Globally, the volume of PW is increasing along with the expansion of gas and oil fields, leading to major impacts on the environment. Existing treatment technologies involve partially treating the PW through removing the suspended solids, heavy metals, without removing organic components and re-injecting the water underground using water disposal injection wells. The treatment process consists of a primary treatment unit to remove the particles, followed a secondary biological or chemical processing treatment, while the final treatment stage involves the use of a tertiary treatment unit to improve the water quality and remove the remainder of the undesired components. Moreover, while PW is considered one of the available options to be utilized as a water source, no alternate advanced treatment options on a commercial scale are available at present due to the limitations of existing PW treatment technologies, associated with their maintainability, sustainability, cost, and level of quality improvement. As such, research focused on finding an optimal treatment approach to improve the overall process continues to be conducted, with the aim of reusing the water instead of injecting it underground. This literature review discusses the latest advanced technologies for PW treatment aimed at reusing the full stream capacity of PW and eliminating the need for wastewater disposal via injection. It is concluded that researchers should focus on hybrid treatment technologies in order to remove the pollutants from PW, effectively allowing for its reuse.

Surveillance of SARS-CoV-2 in Healthcare Workers Before and After COVID-19 Vaccination: A Cohort Study in a Primary Care Unit of Brazil.

Healthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection. Viral surveillance for early detection of COVID-19 is a critical strategy to understand this population's infection dynamics and prevent transmission. The study examines SARS-CoV-2 infection and reinfection among HCWs vaccinated against COVID-19 working at a primary healthcare unit serving a disenfranchised community in Brazil. The study was conducted in Cidade Estrutural, Federal District, Brazil, between February and October 2021. Participants were interviewed and provided samples. A prospective open cohort study was used to analyze the frequency of SARS-CoV-2 infection and reinfection, and the vaccine-induced seroconversion. Nasopharyngeal swab specimen was collected from workers presenting with flu-like symptoms and subjected to RT-qPCR. Peripheral blood samples were also collected every 30 ± 2 days for eight months, starting from the day participants received their first dose of COVID-19 vaccine, and submitted to serological testing (IgM and IgG chemiluminescence). The frequencies of infection and reinfection (RT-qPCR positive results 90 days after the infection) were calculated along with their respective confidence intervals (95% CI). Of the 128 workers, 61 (47.65%; CI: 39.19-56.25) reported probable SARS-CoV-2 infection before vaccination and 50 (39.06%; CI: 31.04-47.71) had SARS-CoV-2 infection after vaccination, confirmed by molecular test. Reinfection was identified in seven workers (7/50, 14%; CI: 6.95-26.18) based on the 90-day interval between results. The serological data from the 128 workers during the cohort indicated that 68 (53.12%; CI: 44.5-61.5) had IgG antibodies and 46 had IgM antibodies (35.93%; CI: 28.14-44.54) against SARS-CoV-2. SARS-CoV-2 infection was common in 56% of the community health workers (CHWs), 50% of registered nurses, and licensed vocational nurses (33%). Following the COVID-19 vaccination, the percentage of infections among HCWs decreased from 47.83% to 4.35%. These results demonstrate that (i) approximately 40% of the workers were infected with SARS-CoV-2 in 2021 and (ii) reinfections confirmed by RT-qPCR occurred in 14% of the HCWs after vaccination. The results provide valuable insights into the circulation of SARS-CoV-2 among HCWs in a primary care unit serving a minoritized community.

Overweight is the main behavioral risk factor associated with colorectal cancer mortality in the Brazilian population: an ecological analysis

Colorectal cancer in Brazil is among the main public health concern. The burden of disease can be related to unhealthy lifestyle behavior and inequality in access to health services. The aim of this study was to identify the main factors associated with colorectal cancer mortality in Brazil. This is an ecological study that had the Brazilian Federal Units as the primary units of analysis. Colorectal cancer mortality data (ICD C18-C21) were obtained from Brazilian national mortality system to the year 2020. Prevalence of overweight, food consumption (fiber, whole grains and red meat), physical inactivity, smoke, alcohol consumption, the median of household income, years of study, rates of cancer treatment units and oncologist by Brazilian Federal Units were considered as factor associated to the colorectal cancer mortality. Quasipoisson Generalized Linear Models were used to associate CRC mortality and variables related to dietary intake, risk behavior, and access to health services. In 2020, there were 21,501 deaths by colorectal cancer (51% among women). Prevalence of overweight (men: IRR 1.03; CI: 1.01–1.04; women IRR 1.05; CI 1.02–1.08) and the density of oncologist (men: IRR 1.02; CI: 1.01–1.03; women IRR 1.02; CI 1.01–1.03) were the main factors associated with colorectal cancer mortality. Sociodemographic and food consumption characteristics were not statistically associated with CRC. Prevalence of overweight was the strongest factor associated with mortality from colorectal cancer in Brazil in 2020. Therefore, current public policies to reduce overweight and obesity should be prioritized and strengthened in Brazil.

An innovative design and development of up-flow compact constructed wetland for sewage treatment

The growing demand for sustainable sewage treatment requires technologies that overcome the limitations of energy-intensive and chemical-dependent systems. This study presents an innovative solution addressing both environmental and operational challenges with the design and development of an Up-flow Compact Constructed Wetland (UCCW) based Sewage Treatment Plant (STP). This system integrates preliminary, primary, secondary, and tertiary treatment units into a single setup. The performance of UCCW based STP was evaluated over 720 days under different Hydraulic Retention Times (HRTs), considering seasonal variations in both rectangular and circular configurations. The system achieved significant pollutant removal as Total Suspended Solids (96%), Chemical Oxygen Demand (86%), Biochemical Oxygen Demand (90%), Total Nitrogen (70%), Total Phosphorus (65%), and Fecal Coliforms (99%) at a 36-h HRT. These parameters meet discharge standards, except FC, which requires disinfection for safe reuse and recycling. Further, Response Surface Methodology (RSM) and Monte Carle Simulation of UCCW based STP confirmed optimal and reliable performance at a 36-h HRT. Compared to conventional treatment technologies, the UCCW based STP demonstrated higher efficiency, a smaller footprint (1m2/KLD), better operational flexibility, cost-effectiveness, and minimal operation & maintenance to make it sustainable for decentralised treatment.

PENGUATAN KAPASITAS ASESOR BAN-PDM MELALUI PELATIHAN LURING DALAM IMPELEMENTASI INSTRUMEN AKREDITASI TERBARU

The 2024 BAN-PDM Assessor Training was held to strengthen the capacity of assessors in implementing the latest Accreditation Instrument for Primary and Secondary Education Units. This training focused on enhancing assessors' understanding and skills in the accreditation process, including data collection techniques and the use of the accreditation information system, SISPENA. The training method involved a combination of theoretical and practical approaches, including lectures, accreditation process simulations, and hands-on practice with SISPENA. The activities began with theoretical introduction, followed by data collection simulations, document analysis, and SISPENA usage practice. The training was conducted in person over three days, divided into several sessions focusing on direct interaction, group discussions, and practical exercises. The results showed a significant improvement in assessors' understanding and skills in using the accreditation instrument and SISPENA. Participants successfully applied data collection techniques and operated the system effectively, gaining practical skills to conduct field accreditation. The training successfully prepared assessors to face accreditation challenges in Maluku Province more efficiently and effectively.

Evaluating the current methodological practices and issues in existing literature in pooling complex surveys: a systematic review

BackgroundPooling data from complex survey designs is increasingly used in the health and medical sciences. However, current methodological practices are not well documented in the literature while performing the pooling strategy. We aimed to review related pooling studies and evaluate the quality of pooling within the framework of specific methodological guidelines, particularly when combining complex surveys such as Demographic & Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS).MethodsWe performed a systematic literature search focusing on studies utilizing the pooling method with DHS and MICS survey data. These studies were selected from those published between 2010 and 2021 and were retrieved from electronic databases (PubMed and Scopus) in accordance with pre-defined inclusion criteria. Then, we extracted 355 studies for the final review and evaluated the reporting quality of the pooling strategy while considering some methodological issues.ResultsThe majority of studies (81.4%) reported using a pooled (one-stage) approach, while 11.8% used a separate (two-stage) approach, and 6.8% used both approaches. Approximately 63.3% of studies did not clearly describe their pooling strategy. Only 3.4% of the studies mentioned the variable harmonization process, while 66.9% addressed dealing with heterogeneity between surveys. All studies that used the separate (two-stage) approach conducted a meta-analytic procedure, while 38.1% of studies using the pooled approach employed a multilevel model. More than half of the studies (55.6%) mentioned the use of clustered standard errors. The Delta method, Bootstrap, and Taylor linearization were each applied in 11.1% of the studies for variance estimation. Survey weights, primary sampling unit (PSU) or cluster, and strata were used together in 30.5% of the studies. Survey weights were employed by 69.8%, PSU or cluster by 43.8%, and the strata variable by 31.7%. Sensitivity analysis was conducted in 16% of the studies.ConclusionsOur study revealed that fundamental methodological issues associated with pooling complex survey databases, such as the selection of pooling procedures, data harmonization, accounting for cycle effects, quality control checks, addressing heterogeneity, selecting model effects, utilizing survey design variables, and dealing with missing values, etc., were inadequately reported in the included studies. We recommend authors, readers, reviewers, and editors examine pooling studies more attentively and utilize the customized checklist developed by our study to assess the quality of future pooling studies.

Evaluation of the Sustainability Status of Arabica Coffee-based Eco-farming on Sembalun’s Drylands, East Lombok Regency

Aims: This study aims to evaluate the application of eco-farming practices to support the sustainability of Arabica coffee farming in the drylands of Sembalun, East Lombok Regency. Specifically, it aims to: (1) assess the effectiveness of eco-farming in creating a sustainable agricultural system, (2) evaluate the sustainability status of Arabica coffee farming in Sembalun, and (3) identify solutions that enhance the sustainability of Arabica coffee farming and the well-being of local farmers. Study Design: The study follows a mixed-methods design, integrating both qualitative and quantitative approaches. Place and Duration of Study: The research was conducted in the Arabica coffee farming areas of Sembalun, East Lombok Regency, over a period of two months Methodology: Arabica coffee farmers in Sembalun were selected as the primary unit of analysis. Data collection involved direct interviews, field observations, and documentation of farming practices. The gathered data were analyzed using Multiaspect Sustainability Analysis (MSA) with Exsimpro software to assess the sustainability across five dimensions: ecology, economy, sociocultural aspects, institutional factors, and technology. Results: The findings reveal varying levels of sustainability across the evaluated dimensions. The sustainability status of Arabica coffee farming in Sembalun is considered good, with an average score of 64.58, indicating that current farming practices meet sustainability standards. Sustainability solutions for Arabica coffee farming in Sembalun involve a holistic approach, including agroforestry, farmer empowerment through training and cooperatives, product diversification, and support from government and private sectors to balance economic and environmental goals. Conclusion: The study provides a comprehensive evaluation of the sustainability status of Arabica coffee farming in Sembalun, highlighting the role of eco-farming practices in improving ecological balance, economic viability, social welfare, institutional support, and technological advancement in farming. The findings suggest several actionable recommendations for policy enhancements to support long-term sustainability and improve farmer well-being in this region.

Lady health workers smoking cessation initiative in rural Pakistan

BackgroundIn Pakistan, tobacco smoking and indoor smoke from cooking fires pose significant health risks. Lady Health Workers (LHWs) play a crucial role in improving healthcare access, particularly in rural areas. This study aimed to explore the practicality of training LHWs to deliver health education aimed at reducing household exposure to tobacco smoke and indoor biomass smoke, while also documenting baseline exposure levels and assessing the immediate impact on household awareness and intentions to reduce exposure.The ProgramOver 170 LHWs were trained and equipped with health education resources to raise awareness about the risks of tobacco and biomass smoke exposure. The training was designed to be integrated into their routine duties.ResultsOver 24 weeks, the program was delivered to 25,760 households in Gujranwala district. Approximately half of these households had at least one person who smoked, with 90% smoking indoors. Many (85%) households used indoor cooking fires. Only 24% of household head-women were aware of the health risks associated with indoor smoke exposure. Awareness of less harmful alternatives to smoking was low. Most households had someone who wanted to stop smoking and 51 women and 146 men agreed to try a tobacco harm reduction (THR) product. Primary health units’ staff appreciated the project, especially the training provided. They believed the program could be sustainable, and LHWs expressed interest in continuing it.ConclusionThe study demonstrated the practicality of training LHWs to deliver health education on reducing tobacco and biomass smoke exposure in rural settings. The program effectively raised awareness and showed potential for sustainable integration into existing healthcare structures, highlighting the value of community-centric approaches in low-resource settings.

Feasibility and challenges in sustaining a community based surveillance system in post-Ebola Sierra Leone

BackgroundIn outbreak-prone settings, community-based surveillance (CBS) systems can alert health authorities to respond in a timely manner where suspected cases of disease are being reported. After the 2014–2016 Ebola outbreak, the WHO and other stakeholders supported the establishment of CBS in Sierra Leone, for which community health workers (CHW) were trained to collect and report symptoms data of 11 priority health conditions in their communities. Our study objective was to assess feasibility and challenges to sustain CBS in a low resource setting as part of a World Bank evaluation of Sierra Leone’s Ministry of Health and Sanitation’s (MoHS) CBS and electronic Integrated Disease Surveillance & Response (eIDSR) systems.MethodsIn 2019 we conducted a mixed methods assessment consisting of a household incidence survey, health facility survey, household case verification survey, a costing analysis, and in-depth interviews and focus group discussions with key stakeholders of the CBS system in eight chiefdoms of 4 purposefully selected districts in Sierra Leone. The study period for primary data collection was February through April 2019. We also conducted secondary data analysis of surveillance data in DHIS2 of all 32 chiefdoms.ResultsIn districts where CBS was ‘fully functional’, the number and type of CBS alerts corresponded to the number and type of diseases reported through facility based eIDSR system in the same period. However under-reporting of diarrhea and measles suspects from the community still appeared to occur, and reporting deteriorated when primary health care staff including CHWs reported the stoppage of stipends. The annual budget impact for CBS was estimated at 4.4 million USD in 2018. The majority of costs were made at community level (73%) compared to regional (0.3%), primary health unit (21%), district (4%) and national (2%) level. The most important costs drivers were training of CHWs (59% of total costs) and salaries (including stipends of the CHWs) of human resources (15%). Barriers included sustainable financing of human resources, internet connectivity, as well as limited trainings and supportive supervision, and unsupported transportation costs for CHWs and peer supervisors (PS). CHWs and community members reported that communities are more willing to share information about health issues compared to the pre-CBS implementation period.ConclusionsThe similarity between CBS and IDSR reports support the possibility that CBS increases the sensitivity of disease surveillance to the level of the community, which would enable local authorities to take early prevention measures when and where impact will be the greatest. Qualitative interviews suggest that CBS has improved the interface between the community and primary level of the health system. However if the barriers to sustainability are left unaddressed, opportunities for CBS to prevent disease outbreaks will go unrealized.

Digital transformation: The geopolitical-organizational nexus

This special issue aimed to attract articles situating digital transformation in the geopolitical-organizational nexus. Unlike innovation and change panaceas (or fads) like business process reengineering (BPR) which became popular in the 1990s, digital transformation is a multi-level concept. Extending beyond the redesign of organizational and business processes, the analytical boundaries of digital transformation include ecosystems, organizational networks, business and operational processes, organizational identities, governance structures, and quality/cost dynamics. However, the extant literature on digital transformation continues to use the organization as the primary unit of analysis. Definitions of digital transformation vary widely, with some not dissimilar to the BPR era. The papers included in this special issue provide analytical and empirical examples on the pervasive effects from contemporary digital technology for society, organizations, and citizens. Future work which isolates the digital technology artefact would benefit from further refinement of the digital transformation concept. A starting point is to revisit the digital technology evolution over past decades which reveal the inflection points of technological change, specifically for mainframes, PCs, and the Internet. Such analysis will increase our understanding and contextualization of past panaceas like BPR for generating new insights on how digital technologies are front and center in debates on digital transformation.

Dermatologic Manifestations in Patients with Metabolic Syndrome in Brazil

Metabolic syndrome (MS), a cluster of cardiovascular risk factors associated with increased mortality, exhibits systemic manifestations in various organs, including the skin. This study aimed to investigate the prevalence of dermatological manifestations in patients with MS attending primary healthcare units staffed by Family Health residents in Gurupi, Tocantins, Brazil. This descriptive, cross-sectional epidemiological study enrolled 93 men and women aged between the ages 25 and 60 y across four Basic Health Units and used a questionnaire administered during medical consultations. In total, 69.89% of samples exhibited dermatological manifestations. Morbid obesity was the leading factor linked to MS and skin alterations, with 100% of these patients presenting with some form of dermatosis, the most identified cutaneous manifestations by prevalence were erythematous lesions, papules and plaques, vesicles and blisters, scaling, and changes in pigmentation.

Spatiotemporal patterns and factors contributing to neonatal mortality in Ethiopia: Data from EDHS 2000 to 2019.

Although Ethiopia has substantial improvements in various health indicators such as maternal and child mortality, the burden of neonatal mortality remains high. Between 2016 and 2019, neonatal mortality increased from 29 deaths per 1,000 live births to 33 deaths per 1,000 live births. This study aimed to explore the spatial patterns and factors contributing to neonatal mortality in Ethiopia. Data from the Ethiopian Demographic and Health Surveys (EDHS) for the years 2000, 2005, 2011, 2016, and 2019 were analyzed. The EDHS sampling design uses a two-stage cluster sampling technique, considering census enumeration areas as primary sampling units and households as secondary sampling units. We used the Spatial Scan analysis in SaTScan and Getis-Ord Gi* statistic in Geographic Information System (GIS), to analyse the spatiotemporal patterns of neonatal mortality. Maternal, newborn and health service-related factors contributing to neonatal mortality were also analyzed using a multilevel logistic regression model. Adjusted Odds Rios (AOR) with corresponding 95% CI were presented as a measure of association and a P-value of 0.05 was used to declare statistical significance. During the initial three consecutive surveys, there was a consistent pattern of hot spot clusters in the Amhara and Benshangul Gumuz regions, along with certain parts of the Oromia region. However, in later surveys, these clusters shifted to the eastern parts of the country, notably including the Somali region. Early initiation of breast feeding was associated with reduced chances of neonatal death (Adjusted Odds Ratio [AOR]) = 0.27; 95% Confidence Interval [CI]: 0.23, 0.32). Neonates born at home (AOR = 1.46; 95% CI: 1.16, 1.82) and male babies had a higher likelihood of mortality during the neonatal period compared to their counterparts (AOR = 1.36; 95% CI: 1.24, 1.51). The odds of neonatal mortality increased with the number of children a mother had ever given birth to (AOR = 1.36; 95% CI: 1.24, 1.51). In contrast, longer birth intervals were associated with a reduced risk of neonatal mortality (AOR = 0.76; 95% CI: 0.68, 0.83). The central southern, central-western, north-western, and northern parts of Ethiopia had most of the neonatal death clusters in the first three rounds of DHS while eastern Ethiopia had the highest neonatal mortality clusters in the latest two surveys. Our results underscore the importance for policymakers and health administrators to reassess intervention approaches and reallocate resources to regions identified as hot spots for neonatal mortality. Enhancing the initiation of breastfeeding within the first hour of birth would improve newborn survival rates. Special attention and care need to be given to babies born of smaller sizes.